Knowledge @lert for Infection Control – April 2014
Increased EMRSA-15 health-care worker colonization demonstrated in retrospective review of EMRSA hospital outbreaks
Background: Health care worker (HCW) colonization with methicillin resistant Staphylococcus aureus (MRSA) is a documented cause of hospital outbreaks and contributes to ongoing transmission. At Royal Perth Hospital (RPH) it had been anecdotally noted that the increasing prevalence of EMRSA-15 appeared to be associated with increased HCW colonization compared with Aus2/3-EMRSA. Hence we compared HCW colonization rates during outbreaks of EMRSA-15 and Aus2/3-EMRSA at a single institution. Methods: We performed a retrospective review of EMRSA-15 and Aus2/3-EMRSA outbreaks from 2000–2009 at RPH, a quaternary hospital in Western Australia. Outbreak files were reviewed and relevant data extracted. Results: Ten EMRSA-15 outbreaks were compared with seven Aus2/3 outbreaks. The number of patients colonized was similar between EMRSA-15 and Aus2/3-EMRSA outbreaks (median 7 [range 3–20] and 11 [5–26], respectively; P = 0.07) but the number of HCWs colonized was significantly higher in EMRSA-15 outbreaks compared to Aus2/3-EMRSA outbreaks (median 4 [range 0–15] and 2 [1-3], respectively; P = 0.013). The percentage of HCWs colonized was also higher in EMRSA-15 outbreaks versus Aus2/3-EMRSA outbreaks (median 3.4% [range 0–5.5%] and 0.81% [0.56–2.2%], respectively; P = 0.013). Conclusions: This study demonstrates a higher level of HCW colonization during EMRSA-15 outbreaks compared with Aus2/3-EMRSA outbreaks. This finding suggests that MRSA vary in their ability to colonize HCWs and contribute to outbreaks. MRSA type should be determined during outbreaks and future research should investigate the mechanisms by which EMRSA-15 contributes to increased HCW colonization.
Changing epidemiology of infections due to extended spectrum beta-lactamase producing bacteria
Background: Community-associated infections caused by extended-spectrum beta-lactamase (ESBL) producing bacteria are a growing concern. Methods: Retrospective cohort study of clinical infections due to ESBL-producing bacteria requiring admission from 2006-2011 at a tertiary care academic medical center in Providence, RI. Results: A total of 321 infections due to ESBL-producing bacteria occurred during the study period. Fifty-eight cases (18%) were community-acquired, 170 (53%) were healthcare-associated, and 93 (29%) were hospital-acquired. The incidence of ESBL infections per 10,000 discharges increased during the study period for both healthcare-associated infections, 1.9 per year (95% CI 1-2.8), and for community-acquired infections, 0.85 per year (95%CI 0.3-1.4) but the rate remained unchanged for hospital-acquired infections. For ESBL-producing E. coli isolates, resistance to both ciprofloxacin and trimethoprim-sulfamethoxazole was 95% and 65%, respectively but 94% of isolates were susceptible to nitrofurantoin. Conclusions: Community-acquired and healthcare-associated infections due to ESBL-producing bacteria are increasing in our community, particularly urinary tract infections due to ESBL-producing E. coli. Most isolates are resistant to oral antibiotics commonly used to treat urinary tract infections. Thus, our findings have important implications for outpatient management of such infections
Infection control interventions in small rural hospitals with limited resources: results of a cluster-randomized feasibility trial
Background: There are few reports on the feasibility of conducting successful infection control (IC) interventions in rural community hospitals. Methods: Ten small rural community hospitals in Idaho and Utah were recruited to participate in a cluster-randomized trial of multidimensional IC interventions to determine their feasibility in the setting of limited resources. Five hospitals were randomized to develop individualized campaigns to promote HH, isolation compliance, and outbreak control. Five hospitals were randomized to continue with current IC practices. Regular blinded observations of hand hygiene (HH) compliance were conducted in all hospitals as the primary outcome measure. Additionally, periodic prevalence studies of patient colonization with resistant pathogens were performed. The 5-months intervention time period was compared to a 4-months baseline period, using a multi-level logistic regression model. Results: The intervention hospitals implemented a variety of strategies. The estimated average absolute change in “complete HH compliance” in intervention hospitals was 20.1% (range, 7.8% to 35.5%) compared to -3.1% (range -6.3% to 5.9%) in control hospitals (p = 0.001). There was an estimated average absolute change in “any HH compliance” of 28.4% (range 17.8% to 38.2%) in intervention hospitals compared to 0.7% (range -16.7 to 20.7%) in control hospitals (p = 0.010). Active surveillance culturing demonstrated an overall prevalence of MRSA carriage of 9.7%. Conclusions: A replicable intervention significantly improved hand hygiene as a primary outcome measure despite barriers of geographic distance and lack of experience with study protocols. Active surveillance culturing identified unsuspected reservoirs of MRSA colonization and further promoted IC activity.
$35 a day from Controversies in Hospital Infection Prevention A new paper in the American Journal of Infection Control takes a look at the cost of contact precautions. The investigators determined that on average 48 gowns and pairs of gloves are used daily for each isolated patient, and donning and removing the personal protective equipment consumed 43 minutes of time per isolated patient per day. This resulted in a cost of $35 per isolated patient day. In the ICU setting the cost was higher at $42.
2 minutes per day (or, Still beating that dead horse, contact precautions edition) from Controversies in Hospital Infection Prevention “Further research is needed, both to better define the patient population for whom the benefits of contact isolation outweigh the risks and to develop strategies to ameliorate those risks for those who must be placed into isolation.”
Using public health scenarios to predict the utility of a national syndromic surveillance programme during the 2012 London Olympic and Paralympic Games R. A. MORBEY, A. J. ELLIOT, A. CHARLETT, S. IBBOTSON, N. Q. VERLANDER, S. LEACH, I. HALL, I. BARRASS, M. CATCHPOLE, B. McCLOSKEY, B. SAID, A. WALSH, R. PEBODY, G. E. SMITH, Epidemiology & Infection, Volume 142 Issue 05, pp 984-993
Predictors of influenza in the adult population during seasonal and A(H1N1)pdm09 pandemic influenza periods G. GEFENAITE, M. TACKEN, J. KOLTHOF, B. MULDER, J. C. KOREVAAR, I. STIRBU-WAGNER, J. BOS, R. P. STOLK, E. HAK, Epidemiology & Infection, Volume 142 Issue 05, pp 950-954
Surveillance of human influenza A(H3N2) virus from 1999 to 2009 in southern Italy A. DE DONNO, A. IDOLO, M. QUATTROCCHI, A. ZIZZA, G. GABUTTI, A. ROMANO, P. GRIMA, I. DONATELLI, M. GUIDO, Epidemiology & Infection, Volume 142 Issue 05, pp 933-939
ICT News Desk: Treating Bloodstream Infections Growing drug resistance, a high prevalence of Staph bacteria and ineffective antibiotics prescribed to 1 in 3 patients are among the challenges facing community hospitals in treating patients with serious bloodstream infections, according to researchers at Duke Medicine.
Are community environmental surfaces near hospitals reservoirs for gram-negative nosocomial pathogens? Background: Hospital visitors and staff visit neighboring businesses, creating the potential for contamination of surfaces with hospital flora.
Working relationships of infection prevention and control programs and environmental services and associations with antibiotic-resistant organisms in Canadian acute care hospitals Background: Environmental contamination in hospitals with antibiotic-resistant organisms (AROs) is associated with patient contraction of AROs. This study examined the working relationship of Infection Prevention and Control (IPAC) and Environmental Services and the impact of that relationship on ARO rates.