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Hygiene requirements for cleaning and disinfection of surfaces: recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc13. [PMID: 38655122 PMCID: PMC11035912 DOI: 10.3205/dgkh000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
This recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) addresses not only hospitals, but also outpatient health care facilities and compiles current evidence. The following criteria are the basis for the indications for cleaning and disinfection: Infectious bioburden and tenacity of potential pathogens on surfaces and their transmission routes, influence of disinfecting surface cleaning on the rate of nosocomial infections, interruption of cross infections due to multidrug-resistant organisms, and outbreak control by disinfecting cleaning within bundles. The criteria for the selection of disinfectants are determined by the requirements for effectiveness, the efficacy spectrum, the compatibility for humans and the environment, as well as the risk potential for the development of tolerance and resistance. Detailed instructions on the organization and implementation of cleaning and disinfection measures, including structural and equipment requirements, serve as the basis for their implementation. Since the agents for surface disinfection and disinfecting surface cleaning have been classified as biocides in Europe since 2013, the regulatory consequences are explained. As possible addition to surface disinfection, probiotic cleaning, is pointed out. In an informative appendix (only in German), the pathogen characteristics for their acquisition of surfaces, such as tenacity, infectious dose and biofilm formation, and the toxicological and ecotoxicological characteristics of microbicidal agents as the basis for their selection are explained, and methods for the evaluation of the resulting quality of cleaning or disinfecting surface cleaning are presented.
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Schleusener J, Lohan SB, Busch L, Zamudio Díaz DF, Opitz N, Sicher C, Lichtenthäler T, Danker K, Dommerich S, Filler T, Meinke MC, Zwicker P. Irradiation of human oral mucosa by 233 nm far UV-C LEDs for the safe inactivation of nosocomial pathogens. Sci Rep 2023; 13:22391. [PMID: 38104221 PMCID: PMC10725486 DOI: 10.1038/s41598-023-49745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
The inactivation of multi resistant pathogens is an important clinical need. One approach is UV-C irradiation, which was previously not possible in vivo due to cytotoxicity. Recently, far UV-C irradiation at λ < 240 nm was successfully used on skin with negligible damage. A potential application site is the nasal vestibule, where MRSA accumulates and cannot be treated using antiseptics. We irradiated 3D mucosa models and excised human mucosa with 222 and 233 nm far UV-C in comparison to 254 nm and broadband UV-B. Eradication efficiency was evaluated by counting colony forming units; irritation potential was evaluated by hen's egg-chorioallantoic membrane assay and trans epithelial electrical resistance; cell viability was assessed by MTT. DNA damage and cell protective mechanisms were evaluated immunohistopathologically. On mucosa models, MRSA reduced by ≈ 5 log10 for 60 mJ/cm2 irradiation at 233 nm. A slightly increased cell viability was observed after 24 h. Lower doses showed lower irritation potential than the positive controls or commercial mouthwash, while 80 mJ/cm2 had strong irritation potential. DNA damage occurred only superficially and decreased after 24 h. On excised human mucosa, < 10% of keratinocytes were affected after 150 mJ/cm2 222 nm or 60 mJ/cm2 233 nm.
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Affiliation(s)
- Johannes Schleusener
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Silke B Lohan
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Loris Busch
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Pharmaceutics and Biopharmaceutics, Philipps-Universität Marburg, Robert‑Koch‑Str. 4, 35032, Marburg, Germany
| | - Daniela F Zamudio Díaz
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Technische Universität Berlin, Institute of Food Technology and Food Chemistry, Gustav-Meyer-Allee 25, 13355, Berlin, Germany
| | - Nevin Opitz
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand‑Sauerbruch‑Str., 17475, Greifswald, Germany
| | - Claudia Sicher
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand‑Sauerbruch‑Str., 17475, Greifswald, Germany
| | - Tom Lichtenthäler
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand‑Sauerbruch‑Str., 17475, Greifswald, Germany
| | - Kerstin Danker
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Steffen Dommerich
- Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Filler
- Ferdinand-Braun-Institut (FBH), Gustav‑Kirchhoff‑Str. 4, 12489, Berlin, Germany
| | - Martina C Meinke
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Paula Zwicker
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand‑Sauerbruch‑Str., 17475, Greifswald, Germany
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Wiese C, Wiesmüller GA. [Basic Knowledge of Hygiene in Voluntary Disaster Control Using - German Red Cross in the Rhein-Erft District as an Example]. DAS GESUNDHEITSWESEN 2023; 85:1238-1244. [PMID: 37253370 PMCID: PMC10883010 DOI: 10.1055/a-2035-9504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Full-time workers in the rescue service are often exposed to a risk of infection. The volunteers of the German disaster control (Katastrophenschutz; KatS) are exposed to a similar risk of infection when they are deployed. The aim of this study was to investigate the hygiene status of the two operational units of the German Red Cross (Deutsches Rotes Kreuz; DRK) in the Rhein-Erft District (Rhein-Erft-Kreis; REK). The 66 volunteers of the two operational units (Einsatzeinheiten; EE) "NRW BM 05" and "NRW BM 02" were assessed by means of a written questionnaire. The results showed that they had good general knowledge of hygiene.There were, however, deficits in the knowledge of specific diseases and some multi-resistant pathogens. In general, perceived risk varied greatly, and was often above 5 on a scale from 1-10, where "1" stands for no perceived risk and "10" for high perceived risk. Thus, there is a certain "concern" about getting an infection in action. Appropriate training courses are needed to optimize this situation in the future.
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Affiliation(s)
- Christoph Wiese
- Bildungszentrum, Deutsches Rotes Kreuz Kreisverband Rhein-Erft e.V., Bergheim, Germany
- Geschäftsführung, ZfMK - Zentrum für Umwelt, Hygiene und Mykologie, Köln, Germany
- Institut für Arbeits-, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Gerhard A Wiesmüller
- Geschäftsführung, ZfMK - Zentrum für Umwelt, Hygiene und Mykologie, Köln, Germany
- Institut für Arbeits-, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
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Schaumburg F. Risk-Adapted Screening for Methicillin-Resistant Staphylococcus aureus. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:445-446. [PMID: 37594462 PMCID: PMC10481943 DOI: 10.3238/arztebl.m2023.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster (UKM), Münster, Germany
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Wiese-Posselt M, Saydan S, Schwab F, Behnke M, Kola A, Siegfried Kramer T, Gastmeier P, Maechler F. Screening for Methicillin-Resistant Staphylococcus aureus. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:447-453. [PMID: 37199029 PMCID: PMC10481939 DOI: 10.3238/arztebl.m2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/23/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) has become less common in Germany in recent years. In this paper, we report data from the MRSA module of the Hospital Infection Surveillance System (Krankenhaus-Infektionen- Surveillance-System, KISS) for the years 2006-2021. We also describe the association of MRSA rates with the frequency of patient screening for MRSA and discuss the findings. METHODS Participation in the MRSA KISS module is voluntary. Once a year, the participating hospitals submit structural data, information on cases in which MRSA was detected (both colonizations and infections; both detected on admission and nosocomially acquired), and the number of nasal swabs taken for the detection of MRSA to the German National Reference Center for the Surveillance of Nosocomial Infections. Statistical analyses were performed with R software. RESULTS The number of hospitals participating in the MRSA module rose from 110 in 2006 to 525 in 2021. From 2006 onward, the overall MRSA prevalence in German hospitals increased, reaching a maximum of 1.04 cases per 100 patients in 2012. The prevalence on admission fell by 44% from 0.96 in 2016 to 0.54 in 2021. The incidence density of nosocomial MRSA fell by an average of 12% per year, from 0.27 per 1000 patient-days in 2006 to 0.06 in 2021, while MRSA screening frequency increased sevenfold by 2021. The nosocomial incidence density was stable, independently of the screening frequency. CONCLUSION MRSA rates in German hospitals fell markedly from 2006 to 2021, reflecting a general trend. The incidence density was no higher in hospitals with a low or moderate screening frequency than in those with a high one. Thus, a targeted, riskadapted MRSA screening strategy on hospital admission can be recommended.
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Affiliation(s)
- Miriam Wiese-Posselt
- Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Selin Saydan
- Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German National Reference Center for the Surveillance of Nosocomial Infections at the Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German National Reference Center for the Surveillance of Nosocomial Infections at the Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Axel Kola
- Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Siegfried Kramer
- Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Petra Gastmeier
- German National Reference Center for the Surveillance of Nosocomial Infections at the Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friederike Maechler
- German National Reference Center for the Surveillance of Nosocomial Infections at the Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Mehdorn M, Kolbe-Busch S, Lippmann N, Moulla Y, Scheuermann U, Jansen-Winkeln B, Chaberny IF, Gockel I, Kassahun WT. Rectal colonization is predictive for surgical site infections with multidrug-resistant bacteria in abdominal surgery. Langenbecks Arch Surg 2023; 408:230. [PMID: 37301803 PMCID: PMC10257639 DOI: 10.1007/s00423-023-02961-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Superficial surgical site infections (SSI) are a common complication after abdominal surgery. Additionally, multidrug-resistant organisms (MDRO) have shown an increasing spread in recent years with a growing importance for health care. As there is varying evidence on the importance of MDRO in different surgical fields and countries as causative agents of SSI, we report our findings of MDRO-caused SSI. METHODS We assembled an institutional wound register spanning the years 2015-2018 including all patients with abdominal surgery and SSI only, including demographics, procedure-related data, microbiological data from screenings, and body fluid samples. The cohort was examined for the frequency of different MDRO in screenings, body fluids, and wound swabs and assessed for risk factors for MDRO-positive SSI. RESULTS A total of 138 out of 494 patients in the register were positive for MDRO, and of those, 61 had an MDRO isolated from their wound, mainly multidrug-resistant Enterobacterales (58.1%) followed by vancomycin-resistant Enterococcus spp. (19.7%). As 73.2% of all MDRO-carrying patients had positive rectal swabs, rectal colonization could be identified as the main risk factor for an SSI caused by a MDRO with an odds ratio (OR) of 4.407 (95% CI 1.782-10.896, p = 0.001). Secondly, a postoperative ICU stay was also associated with an MDRO-positive SSI (OR 3.73; 95% CI 1.397-9.982; p = 0.009). CONCLUSION The rectal colonization status with MDRO should be taken into account in abdominal surgery regarding SSI prevention strategies. Trial registration Retrospectively registered in the German register for clinical trials (DRKS) 19th December 2019, registration number DRKS00019058.
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Affiliation(s)
- Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, University Hospital of Leipzig, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Uwe Scheuermann
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
- Department of General, Visceral and Oncological Surgery, Klinikum St. Georg, Leipzig, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Woubet Tefera Kassahun
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Gaube S, Däumling S, Biebl I, Rath A, Caplunik-Pratsch A, Schneider-Brachert W. Patients with multi-drug-resistant organisms feel inadequately informed about their status: adverse effects of contact isolation. J Hosp Infect 2023; 133:89-94. [PMID: 36481686 DOI: 10.1016/j.jhin.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contact isolation of patients with multi-drug-resistant organisms (MDROs) is an essential element of infection prevention strategies in hospitals worldwide. However, this practice may be associated with adverse side effects on patients' health and well-being. AIM This study was the first to assess mental health and well-being variables among isolated patients compared with non-isolated control patients in a German cohort. METHODS We conducted a matched case-control study among N = 267 patients admitted to a tertiary care teaching hospital in Germany. Their levels of anxiety, depression, loneliness, and dissatisfaction with their hospital experience were assessed using a questionnaire. Additionally, among isolated patients, it was evaluated how well they felt informed about their MDRO status. FINDINGS In our cohort, patients under contact isolation were significantly more dissatisfied than non-isolated control patients but did not show higher levels of anxiety, depression, and loneliness. A large proportion of patients felt insufficiently informed about their MDRO status. This lack of information was the strongest predictor of dissatisfaction among isolated patients. CONCLUSION These findings underline the importance of adequate patient communication. It is essential for patients' well-being to receive timely, relevant, and understandable information about the background and consequences of their infection or colonisation with MDROs.
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Affiliation(s)
- S Gaube
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; LMU Center for Leadership and People Management, LMU Munich, Munich, Germany.
| | - S Däumling
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - I Biebl
- LMU Center for Leadership and People Management, LMU Munich, Munich, Germany; Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - A Rath
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A Caplunik-Pratsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - W Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Comparison of the certified Copan eSwab system with commercially available cotton swabs for the detection of multidrug-resistant bacteria in rectal swabs. Am J Infect Control 2022; 50:1145-1149. [PMID: 35158014 DOI: 10.1016/j.ajic.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Rectal swabs are well-implemented screening tools for multidrug-resistant bacteria (MDRB). Since certified swabs such as the Copan eSwab system experienced a delivery bottleneck during the COVID-19 pandemic, commercially available alternatives such as commonly used double-tipped cotton swabs had to be investigated, especially considering their similarity to professional cotton swabs for microbiological purposes. METHODS Diagnostic properties of commercial cotton swabs (comparable to Q-tips) and Copan eSwabs were qualitatively compared in a prospective single-center study using microbiological standard cultures and PCR methods for the detection of multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci (VRE). RESULTS A total of 196 swab pairs were collected from 164 participants. MDRB were detected in 36 of 164 cases (22%). There were neither false-negative nor false-positive results using commercial cotton swabs. In 8 of 196 samples (4.1%) MDRB species were detected only by using cotton swabs, including vancomycin-resistant Enterococcus faecium, OXA-48 producing Escherichia coli, ESBL-producing Klebsiella pneumoniae and ESBL-producing Escherichia coli. DISCUSSION Commercial cotton swabs turned out to be a reliable alternative to Copan eSwabs. For practical use as a screening tool, relevant storage- and manufacturer-related contamination must be ruled out beforehand. CONCLUSIONS Commonly available double-tipped cotton swabs can be used for rectal MDRB screening in the event of supply shortages of certified swabs. Further studies should clarify their suitability as a sampling system for nasopharyngeal MRSA carriage or even for the molecular biological detection of SARS-CoV-2.
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Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1074-1115. [PMID: 36173419 PMCID: PMC9521013 DOI: 10.1007/s00103-022-03576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Füller MA, Kampmeier S, Wübbolding AM, Grönefeld J, Kremer A, Groll AH. Prospective surveillance of colonization and disease by methicillin-resistant Staphylococcus aureus (MRSA) at a European pediatric cancer center. Support Care Cancer 2022; 30:7231-7239. [PMID: 35589879 PMCID: PMC9385780 DOI: 10.1007/s00520-022-07140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/10/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Children and adolescents undergoing treatment for cancer or allogeneic hematopoietic cell transplantation are at increased risk for methicillin-resistant Staphylococcus aureus (MRSA). We therefore examined the occurrence and outcome of MRSA colonization and infection in patients of a large European pediatric cancer center. METHODS In a prospective observational cohort study conducted between 2007 and 2018, nasopharyngeal swabs for culture of MRSA were obtained from all admitted patients. The primary endpoint of the study was the colonization rate over time. Secondary endpoints included genetic relatedness of isolates, time burden of isolation measures, and results of decolonization efforts. RESULTS During the study period, MRSA screening identified 34 colonized patients (median age: 10 years; range: 0-21) without trends over time. MRSA colonization was associated with the presence of classical risk factors. There was no molecular evidence of patient-to-patient transmission. A standard MRSA eradication regimen led to a lasting eradication of the organism in 26 of 34 patients. MRSA infection occurred in two patients with no associated fatalities. CONCLUSION Prospective monitoring revealed low rates of MRSA colonization and infection at our center. These low rates and the absence of patient-to-patient transmission support the effectiveness of the management bundle of MRSA identification, isolation, and decolonization.
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Affiliation(s)
- Miriam A Füller
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | | | - Anna M Wübbolding
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Judith Grönefeld
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Almut Kremer
- Medical Controlling, University Hospital Münster, Münster, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany.
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Schlatterer K, Maxeiner HG, Zouboulis CC, Daeschlein G. Methicillin-resistenter Staphylococcus aureus (MRSA) – eine zentrale Hygiene-Herausforderung in der Dermatologie. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1703-1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDer Methicillin-resistente Staphylococcus aureus ist ein im täglichen Alltag insbesondere für den Bereich der Dermatologie relevanter multiresistenter gram-positiver bakterieller Erreger. Chronische Wunden und atopische Dermatitis sowie der Typ II-Diabetes mellitus spielen hier als Risikofaktoren eine wichtige Rolle. Dieser Übersichtsartikel fokussiert sich neben Ausführungen zu Bedeutung und klinischem Vorkommen auf eine zusammenfassende Darstellung der Hygieneaspekte bei der Behandlung von MRSA-besiedelten oder -infizierten Patienten. Ziel einer solchen Behandlung mit etablierten Hygienekonzepten ist es, eine mögliche Verbreitung des multiresistenten Erregers von einem Patienten auf andere Personen zu verhindern. Werden diese Hygiene-Maßnahmen umgesetzt und gleichzeitig bei einer Infektion eine evidenzbasierte, nach dem Antibiotic-Stewardship ausgerichtete antibiotische Therapie initiiert, sind dies zwei wesentliche Bausteine, um auch weiterhin, wie in den letzten Jahren schon in Nord- und Mitteleuropa beobachtet, rückläufige MRSA-Prävalenzen zu erzielen.
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Affiliation(s)
- Kathrin Schlatterer
- Institut für Laboratoriumsmedizin, Sankt Gertrauden Krankenhaus, Berlin
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | | | - Christos C. Zouboulis
- Hochschulkliniklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | - Georg Daeschlein
- Hochschulkliniklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
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Kolberg L, Buschbeck J, Wagner A, Jonat S, Wolf G, Peters J, Behrends U, Steinhauser M, Huebner J, von Both U. Evaluating current practice and knowledge about antibiotic stewardship principles in paediatric tertiary hospitals to identify target areas for future teaching activities. Infection 2022; 50:1273-1279. [PMID: 35366158 PMCID: PMC9522681 DOI: 10.1007/s15010-022-01807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Antibiotic exposure among hospitalized children is very high. With inappropriate antimicrobial use resulting in increased rates of antimicrobial resistance, the implementation of antibiotic stewardship programs is critically needed. This survey study aimed to identify current practice and knowledge about antibiotic stewardship and infection control among paediatricians in tertiary care paediatric hospitals in and around Munich, Germany. METHODS A prospective cross-sectional study based on an anonymous questionnaire, structured into different sub-sections regarding antibiotic use, antimicrobial resistance, antibiotic stewardship and infection control, was conducted between 1st of May and 30th of June 2016 in five paediatric hospitals. RESULTS In total, 111 paediatricians across all grades were eligible for participation. The overall proportion of correct answers for all sub-sections of the survey ranged from 54.1% correct answers in the antibiotic handling and bacterial resistance section to 72.9% correct answers in the hospital hygiene/infection control section. In general, knowledge across all categories was similar for junior doctors, middle-grade doctors or consultants. Advocating empiric use of narrow-spectrum instead of broad-spectrum antibiotics was considered to be the most difficult measure to implement in daily practice (36.9%). De-escalation from broad-spectrum empirical therapy to targeted treatment was considered the easiest measure to achieve (43.2%). CONCLUSION Our results demonstrate that principles of antimicrobial stewardship and aspects of hospital hygiene/infection control are not satisfactorily known among hospital-based paediatricians in and around Munich. We identified four important target areas for future educational interventions that should play a more prominent role in both pre- and postgraduate medical training.
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Affiliation(s)
- Laura Kolberg
- Department of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig-Maximilians University, Lindwurmstr. 4, 80337, Munich, Germany.
| | - Judith Buschbeck
- Department of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig-Maximilians University, Lindwurmstr. 4, 80337, Munich, Germany
| | - Annabelle Wagner
- Department of Paediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Susanne Jonat
- Department of Paediatrics, Clinic Starnberg, Starnberg, Germany
| | - Gerhard Wolf
- Department of Paediatrics, Children's Hospital Traunstein, Ludwig-Maximilians University, Munich, Germany
| | - Jochen Peters
- Department of Paediatrics, Dritter Orden Clinic, Munich, Germany
| | - Uta Behrends
- Department of Paediatrics, School of Medicine, Schwabing Municipal Hospital, Technical University of Munich, Munich, Germany.,German Center for Infection Research (DZIF) Partner Site Munich, Munich, Germany
| | - Maximilian Steinhauser
- Department of Paediatrics, School of Medicine, Schwabing Municipal Hospital, Technical University of Munich, Munich, Germany
| | - Johannes Huebner
- Department of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig-Maximilians University, Lindwurmstr. 4, 80337, Munich, Germany.,German Center for Infection Research (DZIF) Partner Site Munich, Munich, Germany
| | - Ulrich von Both
- Department of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig-Maximilians University, Lindwurmstr. 4, 80337, Munich, Germany.,German Center for Infection Research (DZIF) Partner Site Munich, Munich, Germany
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13
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Boeing C, Correa-Martinez CL, Schuler F, Mellmann A, Karch A, Kampmeier S. Development and Validation of a Tool for the Prediction of Vancomycin-Resistant Enterococci Colonization Persistence-the PREVENT Score. Microbiol Spectr 2021; 9:e0035621. [PMID: 34523992 PMCID: PMC8557884 DOI: 10.1128/spectrum.00356-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Vancomycin-resistant enterococci (VRE) are nosocomial pathogens with increasing prevalence worldwide. Extensive hygiene measures have been established to prevent infection transmission in hospitals. Here, we developed a predictive score system (the predictive vancomycin-resistant enterococci [PREVENT] score) to identify the clearance or persistence in patients with a history of VRE carrier status at readmission. Over a cumulative 3-year period, patients with a positive VRE carrier status were included. The study population was recruited in two successive time periods and separated into training data for predictive score development and validation data for evaluation of the predictive power. The risk factors for persistent VRE colonization were analyzed in a univariable analysis before development of a logistic regression model based on the potential risk factors. The score points were determined proportionally to the beta coefficients of the logistic regression model. The data from 448 (79%) patients were used as the training data, and those from 119 (21%) as the validation data. Multivariable analysis revealed the following variables as independent risk factors: age of ≥60 years, hemato-oncological disease, cumulative antibiotic treatment for >4 weeks, and a VRE infection. The resulting logistic regression model exhibited an acceptable area under the curve (AUC) of 0.81 (95% confidence interval [CI], 0.72 to 0.91). The predictive score system had a sensitivity of 82% (95% CI, 65 to 93%) and a specificity of 77% (95% CI, 66 to 85%). The developed predictive score system is a useful tool to assess the VRE carrier status of patients with a history of VRE colonization. On the basis of this risk assessment, more focused and cost-effective infection control measures can be implemented. IMPORTANCE Given the increasing relevance of VRE as nosocomial pathogens worldwide, infection prevention and control measures, including patient isolation and contact precautions, are indispensable to avoid their spread in the hospital setting. In this study, we developed and validated the PREVENT score, a tool for rapid risk assessment of VRE persistence in patients with a history of previous VRE colonization. The score is designed to be easily performed, employing clinical information available in a regular admission setting and immediately providing information to inform the decision of whether to adopt patient isolation and contact precautions during the hospital stay. After validation, the score was shown to accurately identify patients with persistent VRE colonization upon admission, representing a suitable option as (i) a complementary method yielding preliminary results significantly more quickly than culture-based VRE detection techniques and (ii) an alternative strategy for VRE detection in settings in which microbiological VRE screening is not routinely performed due to limited resources.
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Affiliation(s)
- Christian Boeing
- Institute of Hygiene, University Hospital Münster, Münster, Germany
| | | | - Franziska Schuler
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | | | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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14
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Glaab J, Lobo-Ploch N, Cho HK, Filler T, Gundlach H, Guttmann M, Hagedorn S, Lohan SB, Mehnke F, Schleusener J, Sicher C, Sulmoni L, Wernicke T, Wittenbecher L, Woggon U, Zwicker P, Kramer A, Meinke MC, Kneissl M, Weyers M, Winterwerber U, Einfeldt S. Skin tolerant inactivation of multiresistant pathogens using far-UVC LEDs. Sci Rep 2021; 11:14647. [PMID: 34282225 PMCID: PMC8290050 DOI: 10.1038/s41598-021-94070-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022] Open
Abstract
Multiresistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) cause serious postoperative infections. A skin tolerant far-UVC (< 240 nm) irradiation system for their inactivation is presented here. It uses UVC LEDs in combination with a spectral filter and provides a peak wavelength of 233 nm, with a full width at half maximum of 12 nm, and an irradiance of 44 µW/cm2. MRSA bacteria in different concentrations on blood agar plates were inactivated with irradiation doses in the range of 15-40 mJ/cm2. Porcine skin irradiated with a dose of 40 mJ/cm2 at 233 nm showed only 3.7% CPD and 2.3% 6-4PP DNA damage. Corresponding irradiation at 254 nm caused 15-30 times higher damage. Thus, the skin damage caused by the disinfectant doses is so small that it can be expected to be compensated by the skin's natural repair mechanisms. LED-based far-UVC lamps could therefore soon be used in everyday clinical practice to eradicate multiresistant pathogens directly on humans.
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Affiliation(s)
- Johannes Glaab
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany
| | - Neysha Lobo-Ploch
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany
| | - Hyun Kyong Cho
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany
| | - Thomas Filler
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany
| | - Heiko Gundlach
- Institut für Optik und Atomare Physik, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Martin Guttmann
- Institut für Festkörperphysik, Technische Universität Berlin, Hardenbergstr. 36, 10623, Berlin, Germany
| | - Sylvia Hagedorn
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany
| | - Silke B Lohan
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Frank Mehnke
- Institut für Festkörperphysik, Technische Universität Berlin, Hardenbergstr. 36, 10623, Berlin, Germany
- Georgia Institute of Technology, Atlanta, GA, USA
| | - Johannes Schleusener
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Claudia Sicher
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Luca Sulmoni
- Institut für Festkörperphysik, Technische Universität Berlin, Hardenbergstr. 36, 10623, Berlin, Germany
| | - Tim Wernicke
- Institut für Festkörperphysik, Technische Universität Berlin, Hardenbergstr. 36, 10623, Berlin, Germany
| | - Lucas Wittenbecher
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany
| | - Ulrike Woggon
- Institut für Optik und Atomare Physik, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Paula Zwicker
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Axel Kramer
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Martina C Meinke
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Kneissl
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany
- Institut für Festkörperphysik, Technische Universität Berlin, Hardenbergstr. 36, 10623, Berlin, Germany
| | - Markus Weyers
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany
| | - Ulrike Winterwerber
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany
| | - Sven Einfeldt
- Ferdinand-Braun-Institut gGmbH, Leibniz-Institut für Höchstfrequenztechnik, Gustav-Kirchhoff-Str. 4, 12489, Berlin, Germany.
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15
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Prang P, Schuld C, Rupp R, Hensel C, Weidner N. Influence of patient isolation due to colonization with multidrug-resistant organisms on functional recovery after spinal cord injury. PLoS One 2021; 16:e0249295. [PMID: 33770131 PMCID: PMC7997009 DOI: 10.1371/journal.pone.0249295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
STUDY DESIGN Chart reviews were combined with neurological and functional outcome data obtained from the prospective European Multicenter Study on Spinal Cord Injury (EMSCI, www.emsci.org). OBJECTIVES To determine if strict physical isolation of multidrug-resistant organisms (MDRO)-positive patients negatively affects neurological recovery and functional outcome in the first year after acute spinal cord injury (SCI). SETTING SCI Center Heidelberg University Hospital. METHODS Individuals with acute (< 6 weeks) traumatic or ischemic SCI were included. During primary comprehensive care, isolated MDRO-positive patients (n = 13) were compared with a MDRO-negative control group (n = 13) matched for functional (Spinal Cord Independence Measure-SCIM) and neurological impairment (motor scores based on the International Standards for Neurological Classification of Spinal Cord Injury-ISNCSCI) at an early stage up to 40 days after SCI. SCIM scores and motor scores were obtained at 12 weeks (intermediate stage) and 24 or 48 weeks (late stage) after SCI. RESULTS Isolated MDRO-positive (median duration of hospitalization: 175 days, 39% of inpatient stay under isolation measures) and non-isolated MDRO-negative (median duration of hospitalization: 161 days) patients showed functional and neurological improvements, which were not statistically different between groups at the intermediate and late stage. CONCLUSION Prolonged isolation due to MDRO colonization for over a third of the inpatient comprehensive care period does not appear to impair neurological recovery and functional outcome within the first year after SCI.
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Affiliation(s)
- Peter Prang
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Ruediger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Cornelia Hensel
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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16
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Gunnink LB, Arouri DJ, Jolink FE, Lokate M, de Jonge K, Kampmeier S, Kreis C, Raschke M, Kleinjan M, ter Maaten JC, Friedrich AW, Bathoorn E, Glasner C. Compliance to Screening Protocols for Multidrug-Resistant Microorganisms at the Emergency Departments of Two Academic Hospitals in the Dutch-German Cross-Border Region. Trop Med Infect Dis 2021; 6:tropicalmed6010015. [PMID: 33530494 PMCID: PMC7838951 DOI: 10.3390/tropicalmed6010015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Infections caused by multidrug-resistant organisms (MDROs) are associated with prolonged hospitalization and higher risk of mortality. Patients arriving in the hospital via the emergency department (ED) are screened for the presence of MDROs in compliance with the screening protocols in order to apply the correct isolation measures. In the Dutch–German border region, local hospitals apply their own screening protocols which are based upon national screening protocols. The contents of the national and local MDRO screening protocols were compared on vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and carbapenemase-producing and carbapenem-resistant Enterobacteriaceae (CPE/CRE). The practicality of the screening protocols was evaluated by performing an audit. As a result, the content of the MDRO screening protocols differed regarding risk factors for MDRO carriage, swab site, personal protective equipment, and isolation measures. The observations and questionnaires showed that the practicality was sufficient; however, the responsibility was not designated clearly and education regarding the screening protocols was deemed inappropriate. The differences between the MDRO screening protocols complicate patient care in the Dutch–German border region. Arrangements have to be made about the responsibility of the MDRO screening, and improvements are necessary concerning education regarding the MDRO screening protocols.
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Affiliation(s)
- Lisa B. Gunnink
- Department of Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (L.B.G.); (D.J.A.); (F.E.J.J.); (M.L.); (K.d.J.); (A.W.F.); (E.B.)
| | - Donia J. Arouri
- Department of Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (L.B.G.); (D.J.A.); (F.E.J.J.); (M.L.); (K.d.J.); (A.W.F.); (E.B.)
| | - Floris E.J. Jolink
- Department of Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (L.B.G.); (D.J.A.); (F.E.J.J.); (M.L.); (K.d.J.); (A.W.F.); (E.B.)
| | - Mariëtte Lokate
- Department of Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (L.B.G.); (D.J.A.); (F.E.J.J.); (M.L.); (K.d.J.); (A.W.F.); (E.B.)
| | - Klaas de Jonge
- Department of Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (L.B.G.); (D.J.A.); (F.E.J.J.); (M.L.); (K.d.J.); (A.W.F.); (E.B.)
| | - Stefanie Kampmeier
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany;
| | - Carolin Kreis
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany; (C.K.); (M.R.)
| | - Michael Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany; (C.K.); (M.R.)
| | - Mirjam Kleinjan
- Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Jan C. ter Maaten
- Department of Internal Medicine, Emergency Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Alex W. Friedrich
- Department of Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (L.B.G.); (D.J.A.); (F.E.J.J.); (M.L.); (K.d.J.); (A.W.F.); (E.B.)
| | - Erik Bathoorn
- Department of Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (L.B.G.); (D.J.A.); (F.E.J.J.); (M.L.); (K.d.J.); (A.W.F.); (E.B.)
| | - Corinna Glasner
- Department of Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (L.B.G.); (D.J.A.); (F.E.J.J.); (M.L.); (K.d.J.); (A.W.F.); (E.B.)
- Correspondence: ; Tel.: +31-(0)-50-36-13480
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17
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Raschpichler G, Raupach-Rosin H, Akmatov MK, Castell S, Rübsamen N, Feier B, Szkopek S, Bautsch W, Mikolajczyk R, Karch A. Development and external validation of a clinical prediction model for MRSA carriage at hospital admission in Southeast Lower Saxony, Germany. Sci Rep 2020; 10:17998. [PMID: 33093607 PMCID: PMC7582828 DOI: 10.1038/s41598-020-75094-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/07/2020] [Indexed: 11/09/2022] Open
Abstract
In countries with low endemic Methicillin-resistant Staphylococcus aureus (MRSA) prevalence, identification of risk groups at hospital admission is considered more cost-effective than universal MRSA screening. Predictive statistical models support the selection of suitable stratification factors for effective screening programs. Currently, there are no universal guidelines in Germany for MRSA screening. Instead, a list of criteria is available from the Commission for Hospital Hygiene and Infection Prevention (KRINKO) based on which local strategies should be adopted. We developed and externally validated a model for individual prediction of MRSA carriage at hospital admission in the region of Southeast Lower Saxony based on two prospective studies with universal screening in Braunschweig (n = 2065) and Wolfsburg (n = 461). Logistic regression was used for model development. The final model (simplified to an unweighted score) included history of MRSA carriage, care dependency and cancer treatment. In the external validation dataset, the score showed a sensitivity of 78.4% (95% CI: 64.7-88.7%), and a specificity of 70.3% (95% CI: 65.0-75.2%). Of all admitted patients, 25.4% had to be screened if the score was applied. A model based on KRINKO criteria showed similar sensitivity but lower specificity, leading to a considerably higher proportion of patients to be screened (49.5%).
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Affiliation(s)
- Gabriele Raschpichler
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Heike Raupach-Rosin
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
- Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Nicole Rübsamen
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Birgit Feier
- Central Laboratory, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Sebastian Szkopek
- Institute for Microbiology, Immunology and Hospital Hygiene, Städtisches Klinikum Braunschweig gGmbH, Brunswick, Germany
| | - Wilfried Bautsch
- Institute for Microbiology, Immunology and Hospital Hygiene, Städtisches Klinikum Braunschweig gGmbH, Brunswick, Germany
| | - Rafael Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
- Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Hanover Medical School, Hanover, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany.
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
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18
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Enninger A, Schmidt P, Hasan C, Wager J, Zernikow B. Multidrug-Resistant Organisms in Palliative Care: A Systematic Review. J Palliat Med 2020; 24:122-132. [PMID: 33085565 DOI: 10.1089/jpm.2019.0654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Multidrug-resistant organisms (MDROs) are an important health care issue. Patients in Western societies often present an increased morbidity of chronic conditions accompanied by poor immune status and the use of devices. In particular, patients in palliative care (PC) are at greater risk of MDRO colonization, due to accompanying special devices and being hospitalized. Objective: To gain an overview of the literature regarding MDROs in PC. Design: Systematic review Data sources: On the 19th of October 2019 the databases " PubMed" and " CINAHL" were used to identify studies reporting on MDROs in PC; the search was updated on 16th of May 2020. Results: Seventeen out of 486 articles were included. Six represent qualitative data, 10 quantitative data, and one a mixed methods approach. Prevalence data range from 4.0% to 18%. MDRO colonization has a negative impact on patients and families. It leads to uncertainties and higher workload by staff members. Strategies for the management of MDROs in the field of PC are predominantly available for methicillin-resistant Staphylococcus aureus. Not even half of institutions utilize existing protocols. Recommendations for dealing with MDROs indicate required staff and time resources as well as information, communication, and specific knowledge. Conclusion: There is a great need for studies examining the prevalence of all MDROs in the PC setting. Additionally, not only patients but also a public enlightenment on MDROs should be provided to decrease knowledge gaps and therefore reduce transmission on MDROs.
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Affiliation(s)
- Anna Enninger
- Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Pia Schmidt
- Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.,Pediatric Palliative Care Center and German Pediatric Pain Center, Children's and Adolescents' Hospital, Datteln, Witten/Herdecke University, Datteln, Germany
| | - Carola Hasan
- Pediatric Palliative Care Center and German Pediatric Pain Center, Children's and Adolescents' Hospital, Datteln, Witten/Herdecke University, Datteln, Germany
| | - Julia Wager
- Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.,Pediatric Palliative Care Center and German Pediatric Pain Center, Children's and Adolescents' Hospital, Datteln, Witten/Herdecke University, Datteln, Germany
| | - Boris Zernikow
- Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.,Pediatric Palliative Care Center and German Pediatric Pain Center, Children's and Adolescents' Hospital, Datteln, Witten/Herdecke University, Datteln, Germany
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19
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Girndt M. [Hygiene in nephrology]. DER NEPHROLOGE 2020; 15:321-331. [PMID: 32837573 PMCID: PMC7364289 DOI: 10.1007/s11560-020-00447-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with chronic kidney diseases are particularly at risk of infections and must therefore be protected against the risks of infection in dialysis treatment. Viral hepatitis no longer plays a very prominent role in dialysis facilities because nosocomial transmission can be reliably avoided. Nowadays, patients colonized with multidrug-resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria or vancomycin-resistant enterococci, are more common. Bloodstream infections, which particularly occur in dialysis via central venous catheters, are potentially very dangerous for patients. Regular surveillance and targeted interventions in the event of excessive infection numbers are necessary. The hygienic handling of dialysis fluids has now become established through decades of experience and is ensured through the use of quality management systems. The coronavirus crisis poses special challenges for dialysis centers.
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Affiliation(s)
- M. Girndt
- Klinik für Innere Medizin II, Nephrologie, Rheumatologie, Endokrinologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle/Saale, Deutschland
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Heudorf U, Berres M, Hofmann S, Steul K. Management of patients with multidrug-resistant organisms in rehabilitation facilities. Results of a survey in the Rhine-Main region, Germany, 2019. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc15. [PMID: 32685359 PMCID: PMC7336045 DOI: 10.3205/dgkh000350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction: Multidrug-resistant organisms (MDRO) are a problem in medical facilities, including rehabilitation facilities in Germany. The national recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) for prevention of and dealing with patients affected by MDRO are obligatory in rehabilitation facilities. A survey on the management of patients with MDRO in rehabilitation facilities in the Rhine-Main area is presented below. Materials and methods: The questions from a recently published survey in 45 rehabilitation facilities in 26 European countries (Doherty et al., 2019) were largely adopted unchanged: the type, size, and organization of the facility, availability of guidelines on MDRO, screening and (estimated) prevalence of MDRO, as well as special hygiene measures or restrictions for patients with MDRO. Results: 22 of the 43 institutions contacted participated (58%). All facilities had specific recommendations on how to deal with MDRO and more than 95% had adequate hygiene staff. The facilities encompassed 4,369 beds, with 3,909 (89%) of them in single-bed rooms, and only a few offered 3-bed rooms. About 20% of patients in general rehabilitation and 100% in early neurological rehabilitation are screened on admission. Six (27%) facilities refused to accept patients with MDRO. 40% of the facilities treated these patients in their own room and/or in a separate area. 27% of the facilities prohibited eating in the dining room and participating in hydrotherapy. Only 6 (27%) of the rehabilitation centers indicated that patients with MDRO are allowed to participate in full rehabilitation programs. Discussion: In accordance with the results of Doherty et al. (2019), there were many restrictions for rehabilitation patients with MDRO, indicating considerable need for improvement. Necessary hygiene recommendations to avoid the transmission of MDRO must not lead to rejection of inpatient rehabilitation or to less intensive rehabilitation.
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Affiliation(s)
- Ursel Heudorf
- MDRO Network Rhine-Main, Frankfurt/Main, Germany,*To whom correspondence should be addressed: Ursel Heudorf, MDRO Network Rhine-Main, Breite Gasse 28, 60313 Frankfurt/Main, Germany, Phone: +49 69 21248884, E-mail:
| | - Marlene Berres
- MDRO Network Rhine-Main, Frankfurt/Main, Germany,Public Health Authority Frankfurt am Main, Frankfurt/Main, Germany
| | - Sabine Hofmann
- MEDIAN Clinic Hessen GmbH & Co. KG, Bad Nauheim, Germany
| | - Katrin Steul
- MDRO Network Rhine-Main, Frankfurt/Main, Germany,Public Health Authority Frankfurt am Main, Frankfurt/Main, Germany
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Höring S, Lemmen S. [Management of patients with multidrug-resistant bacteria after hospital discharge]. MMW Fortschr Med 2020; 162:56-60. [PMID: 32248468 DOI: 10.1007/s15006-020-0343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Steffen Höring
- Zentralbereich für Krankenhaushygiene und Infektiologie (ZfKI), Zentrum für Infektiologie (DGI), Universitätsklinikum Aachen, Pauwelsstr. 30, D-52074, Aachen, Deutschland.
| | - Sebastian Lemmen
- Leiter des Zentralbereichs für Krankenhaushygiene und Infektiologie (ZfKI), Zentrum für Infektiologie (DGI), Universitätsklinikum Aachen, Deutschland
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Schmidt P, Hartenstein-Pinter A, Wager J, Hasan C, Zernikow B. Addressing multidrug resistant pathogens in pediatric palliative care patients-the nurses point of view: A qualitative study. Palliat Med 2020; 34:349-357. [PMID: 31659938 PMCID: PMC7074707 DOI: 10.1177/0269216319883981] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multidrug resistant pathogens are a large-scale healthcare issue. In particular, children with life-limiting conditions have a significantly increased risk of multidrug resistant pathogen colonization. Official hygiene requirements recommend children, who are colonized with multidrug resistant pathogens, to be isolated. In the context of pediatric palliative care, such isolation adversely affects the aim of social participation. To overcome this challenge of conflicting interests on a pediatric palliative care inpatient unit, a hygiene concept for patients colonized with multidrug resistant pathogens, called PALLINI, was implemented. AIM The aim of this study was to identify the nurses' attitudes and opinions toward PALLINI. METHODS Nurses (N = 14) from the pediatric palliative care unit were queried in guideline-oriented interviews. Interviews were analyzed qualitatively by means of content analysis. RESULTS The following four categories were identified: (1) safety, (2) effort, (3) quality of care, and (4) participation. All categories demonstrated ambivalence by nursing staff regarding PALLINI. Ambivalence arose from guaranteeing infection control versus noncompliance by the families, additional workload for patients with multidrug resistant pathogens versus lack of resources, impaired relationship with the parents versus enabling better care for the child, as well as enabling some limited contact versus the larger goal of genuine social participation. Despite this, nurses reported the importance of arranging everyday-life for the patients so that they experience as much social participation as possible. CONCLUSION The implementation of a new hygiene concept is challenging. Despite positive reception of PALLINI from the nurses, ambivalence remained. Addressing these ambivalences may be critical to best implement the new hygiene concept.
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Affiliation(s)
- Pia Schmidt
- Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Almut Hartenstein-Pinter
- Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Julia Wager
- Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Carola Hasan
- Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Boris Zernikow
- Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Bauer A, Grünewald M, Eberhardt H, Schulz R, Martus P, Brüggenjürgen B, Joos S, Sturm H. Ambulatory screening and decontamination to prevent Staphylococcus aureus complications in patients undergoing elective surgery (STAUfrei): study protocol for a controlled intervention study. BMC Infect Dis 2020; 20:95. [PMID: 32005137 PMCID: PMC6995168 DOI: 10.1186/s12879-020-4804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) are the most common health care associated infections in German acute hospitals and can result in prolonged hospital stays, increased use of antibiotics and utilisation of care. Staphylococcus aureus bacteria (methicillin-resistant S Aureus (MRSA) and methicillin-susceptible S Aureus (MSSA)) are amongst the most prominent causes of SSI. While up to 90% of documented S Aureus colonization is already detectable prior to hospital admission, the majority of hygiene measures in Germany is focused on the hospital setting. It is hypothesized that early detection and decontamination of S Aureus colonization in primary care can prevent health care associated infections and reduce the number of S Aureus isolates in the hospital setting. METHODS This study is a controlled interventional study (N = 13,260) with a pre-post comparison. The intersectoral intervention (over 2 years) will encompass the following elements: ambulatory detection and decontamination of MRSA and MSSA prior to elective surgery combined with a structured follow-up care. Patients from the control group will be screened in the hospital setting, in accordance with the standard operating procedure (SOP) in routine care. The primary endpoint is the reduction of MRSA and MSSA colonization upon hospital admission. Secondary endpoints are complication rate (SSI), length of stay, recolonization of patients (3 and 6 months after release), patient and provider satisfaction, patient compliance and cost development. DISCUSSION In case of positive results, the chance of a widespread uptake and implementation in routine care are considered high. The active involvement of primary care providers in the implementation of screening and decontamination as well as follow-up care is a unique feature of this study. The positive resonance of primary care providers during the recruitment phase highlights the relevance of the topic to the participating actors. These efforts are coupled with patient education and specifically trained medical staff, promising a sustained impact. The STAUfrei care pathway can homogenize current practices in routine care and provide a template for further intersectoral cooperation. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00016615. Registered on April 1st, 2019.
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Affiliation(s)
- Antonia Bauer
- Institute of General Practice and Interprofessional Care, Faculty of Medicine of the Eberhard Karls University Tübingen, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany.
| | | | | | | | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Tübingen, Germany
| | | | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, Faculty of Medicine of the Eberhard Karls University Tübingen, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
| | - Heidrun Sturm
- Institute of General Practice and Interprofessional Care, Faculty of Medicine of the Eberhard Karls University Tübingen, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
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Correa-Martinez CL, Stollenwerk VB, Kossow A, Schaumburg F, Mellmann A, Kampmeier S. Risk Factors for Long-Term Vancomycin-Resistant Enterococci Persistence-A Prospective Longitudinal Study. Microorganisms 2019; 7:E400. [PMID: 31561632 PMCID: PMC6843193 DOI: 10.3390/microorganisms7100400] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 01/05/2023] Open
Abstract
Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens that require effective infection control measures, representing a challenge for healthcare systems. This study aimed at identifying risk factors associated with prolonged VRE carriage and determining the rate of clearance that allows the discontinuation of contact precautions. During a 2-year study, screening was performed in patients with a history of VRE or at risk of becoming colonized. After bacterial identification and antibiotic susceptibility testing, glycopeptide resistance was confirmed by PCR. Isolates were compared via whole genome sequence-based typing. Risk factors were recorded, and follow-up screening was performed upon readmission, defining patients as long-term carriers if still colonized ≥10 weeks after first detection. Of 1059 patients positive for VRE, carriage status was assessed upon readmission in 463 patients. VRE was cleared in 56.4% of the cases. Risk factors associated with long-term persistence were hospital stays (frequency, length), hemato-oncological disease, systemic treatment with steroids, and use of antibiotics. No specific genotypic clustering was observed in patients with VRE clearance or persistence. VRE clearance is possibly underestimated. The identification of risk factors favoring long-term carriage may contribute to a targeted implementation of infection control measures upon readmission of patients with history of VRE.
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Affiliation(s)
- Carlos L Correa-Martinez
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany.
| | - Verena B Stollenwerk
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany.
| | - Annelene Kossow
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany.
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Domagkstraße 10, 48149 Münster, Germany.
| | - Alexander Mellmann
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany.
| | - Stefanie Kampmeier
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany.
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Neubeiser A, Bonsignore M, Tafelski S, Alefelder C, Schwegmann K, Rüden H, Geffers C, Nachtigall I. Mortality attributable to hospital acquired infections with multidrug-resistant bacteria in a large group of German hospitals. J Infect Public Health 2019; 13:204-210. [PMID: 31420314 DOI: 10.1016/j.jiph.2019.07.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/08/2019] [Accepted: 07/27/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND According to extrapolations, around 35,000 patients in Germany develop hospital acquired infections (HAI) with a multidrug-resistant organism (MDRO) every year, and about 1500 of them die. Previous estimations were based on laboratory data and prevalence studies. Aim of this study was to establish the incidences of hospital acquired MDRO infections and the resulting deaths by expert review. METHODS Data on patients suffering from a hospital acquired MDRO infection were collected from 32 hospitals from all care levels. Records of patients with MDRO infection who died in the year 2016 underwent an onsite review by two experts to determine the impact of the infection, if any, on the cause of death. RESULTS A total of 714,108 in-patients were treated in 32 hospitals participating in the study. Of these patients, 1136 suffered a hospital acquired MDRO infection (1.59 per 1000 patients). 215 patients with an MDRO infection died [0.301 per 1000, (95% CI 0,261-0,341)], but only in 78 cases this was estimated as the cause of death [0.109 per 1000 patients (95% CI 0.085-0.133)]. CONCLUSION By putting the above rates in relation to the total number of in-patients in Germany, it can be rated that around 31,052 patients per year suffer a hospital acquired MDRO infection, and 2132 patients die from it. These results from our reviewer investigation confirm earlier extrapolations.
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Affiliation(s)
- Alicia Neubeiser
- Department for Hygiene, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Marzia Bonsignore
- Zentrum für Hygiene, Evangelische Kliniken Gelsenkirchen GmbH, Munckelstr. 27, 45879 Gelsenkirchen, Germany
| | - Sascha Tafelski
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, Germany
| | - Christof Alefelder
- Department for Hygiene, Helios Kliniken West, Universitätsklinik Wuppertal, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Karin Schwegmann
- Centrale Department for Hygiene, Helios Kliniken, Senator-Braun-Allee 33, 31135 Hildesheim, Germany
| | - Henning Rüden
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Hygiene und Umweltmedizin, Germany
| | - Christine Geffers
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Hygiene und Umweltmedizin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Irit Nachtigall
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, Germany; Department for Hygiene, Helios Kliniken Ost and Bad Saarow, Pieskower Str. 33, 15526 Bad Saarow, Germany.
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Keizer J, Braakman-Jansen LMA, Kampmeier S, Köck R, Al Naiemi N, Te Riet-Warning R, Beerlage-De Jong N, Becker K, Van Gemert-Pijnen JEWC. Cross-border comparison of antimicrobial resistance (AMR) and AMR prevention measures: the healthcare workers' perspective. Antimicrob Resist Infect Control 2019; 8:123. [PMID: 31367344 PMCID: PMC6647090 DOI: 10.1186/s13756-019-0577-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background Cross-border healthcare may promote the spread of multidrug-resistant microorganisms (MDRO) and is challenging due to heterogeneous antimicrobial resistance (AMR) prevention measures (APM). The aim of this article is to compare healthcare workers (HCW) from Germany (DE) and The Netherlands (NL) on how they perceive and experience AMR and APM, which is important for safe patient exchange and effective cross-border APM cooperation. Methods A survey was conducted amongst HCW (n = 574) in hospitals in DE (n = 305) and NL (n = 269), using an online self-administered survey between June 2017 and July 2018. Mann-Whitney U tests were used to analyse differences between answers of German and Dutch physicians (n = 177) and German and Dutch nurses (n = 397) on 5-point Likert Items and Scales. Results Similarities between DE and NL were a high awareness about the AMR problem and the perception that the possibility to cope with AMR is limited (30% respondents perceive their contribution to limit AMR as insufficient). Especially Dutch nurses scored significantly lower than German nurses on their contribution to limit AMR (means 2.6 vs. 3.1, p ≤ 0.001). German HCW were more optimistic about their potential role in coping with AMR (p ≤ 0.001), and scored higher on feeling sufficiently equipped to perform APM (p ≤ 0.003), although the mean scores did not differ much between German and Dutch respondents. Conclusions Although both German and Dutch HCW are aware of the AMR problem, they should be more empowered to contribute to limiting AMR through APM (i.e. screening diagnostics, infection diagnosis, treatment and infection control) in their daily working routines. The observed differences reflect differences in local, national and cross-border structures, and differences in needs of HCW, that need to be considered for safe patient exchange and effective cross-border APM.
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Affiliation(s)
- J. Keizer
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, P.O. Box 217, 7500AE Enschede, The Netherlands
| | - L. M. A. Braakman-Jansen
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, P.O. Box 217, 7500AE Enschede, The Netherlands
| | - S. Kampmeier
- Institute of Hygiene, University Hospital Münster, Münster, Germany
| | - R. Köck
- Institute of Hygiene, University Hospital Münster, Münster, Germany
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
- Institute of Hospital Hygiene Oldenburg, Oldenburg, Germany
| | - N. Al Naiemi
- Department of Infection Prevention, Hospital Group Twente, Almelo/Hengelo, Netherlands
- LabMicTA, Hengelo, Netherlands
| | - R. Te Riet-Warning
- Department of Infection Prevention, Hospital Group Twente, Almelo/Hengelo, Netherlands
| | - N. Beerlage-De Jong
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, P.O. Box 217, 7500AE Enschede, The Netherlands
| | - K. Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - J. E. W. C. Van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, P.O. Box 217, 7500AE Enschede, The Netherlands
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Weßels C, Strommenger B, Klare I, Bender J, Messler S, Mattner F, Krakau M, Werner G, Layer F. Emergence and control of linezolid-resistant Staphylococcus epidermidis in an ICU of a German hospital. J Antimicrob Chemother 2019; 73:1185-1193. [PMID: 29438544 DOI: 10.1093/jac/dky010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate an outbreak of linezolid-resistant Staphylococcus epidermidis (LRSE) in an interdisciplinary ICU, linezolid consumption and infection control measures taken. Methods Routine surveillance of nosocomial infections revealed colonization and infection with LRSE affecting 14 patients during a 15 month period. LRSE isolates were analysed with respect to their clonal relatedness, antimicrobial susceptibility, the presence of cfr and/or mutations in the 23S rRNA, rplC, rplD and rplV genes. cfr plasmids were characterized by Illumina sequencing. Medical records were reviewed and antibiotic consumption was determined. Results Molecular typing identified the presence of three different LRSE clusters: PFGE type I/ST168 (n = 5), PFGE type II/ST5 (n = 10) and PFGE type III/ST2 (n = 1). Ten strains harboured the cfr gene; we also detected mutations in the respective ribosomal protein genes. WGS revealed an almost identical 39 kb cfr plasmid obtained from strains of different genetic background (ST2, ST5, ST168) that shows high similarity to the recently published LRSE plasmid p12-02300. Due to an increase in the number of patients treated for infections with MRSA, a significant increase in linezolid usage was noted from January to July 2014 (from 5.55 to 20.41 DDDs/100 patient-days). Conclusions Here, we report the molecular epidemiology of LRSE in an ICU. Our results suggest the selection of resistant mutants under linezolid treatment as well as the spread of cfr-carrying plasmids. The reduction of linezolid usage and the strengthening of contact precautions proved to be effective infection control measures.
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Affiliation(s)
- Christina Weßels
- Institute of Hospital Hygiene, City of Cologne Hospitals, Cologne, Germany
| | - Birgit Strommenger
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Ingo Klare
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Jennifer Bender
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Sabine Messler
- Labor im Sommershof, Praxis für Laboratoriumsmedizin Dr. med. Christiane Boogen, Cologne, Germany
| | - Frauke Mattner
- Institute of Hospital Hygiene, City of Cologne Hospitals, Cologne, Germany
| | - Michael Krakau
- Department of Internal Medicine, City of Cologne Hospitals, Cologne, Germany
| | - Guido Werner
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Franziska Layer
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
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Peters C, Dulon M, Nienhaus A, Schablon A. Occupational Infection Risk with Multidrug-Resistant Organisms in Health Personnel-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111983. [PMID: 31167449 PMCID: PMC6604006 DOI: 10.3390/ijerph16111983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 12/19/2022]
Abstract
The increase in multi-drug-resistant organisms (MDROs) in the last years has become a public health problem. MDROs are partially responsible for numerous nosocomial infections, extended hospital stays, high costs, and high mortality. In addition to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), Gram-negative bacteria are also a key area of focus. The knowledge of MDROs among the medical staff in the occupational context is limited, with the exception of MRSA. Therefore, a systematic review was carried out to determine the occupational risk for employees posed by MDROs. The search included studies from the year 2000 onwards among personnel who had contact with MDROs. A total of 22 primarily cross-sectional studies in hospital or geriatric care settings were found, with large differences regarding number of participants, examination method, inclusion of a control group, and study quality. The most frequently examined pathogens were extended-spectrum ß-lactamase (ESBL)-producing bacteria with a prevalence of 2.6-48.5%, VRE (0-9.6%), and MRSA (0.9-14.5%). There are only few qualitatively good studies available on MDROs' risk infection for employees in the health service. Any comparison of the results was limited by data heterogeneity. More research is required to describe the occupational risk of infection with MDROs.
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Affiliation(s)
- Claudia Peters
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany.
| | - Madeleine Dulon
- Department of Occupational Medicine, Public health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, 22089 Hamburg, Germany.
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany.
- Department of Occupational Medicine, Public health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, 22089 Hamburg, Germany.
| | - Anja Schablon
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany.
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MRSA Point Prevalence among Health Care Workers in German Rehabilitation Centers: A Multi-Center, Cross-Sectional Study in a Non-Outbreak Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091660. [PMID: 31086069 PMCID: PMC6539477 DOI: 10.3390/ijerph16091660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 11/21/2022]
Abstract
People working in health care services have an increased risk of being infected with methicillin-resistant Staphylococcus aureus (MRSA), though little is known about the prevalence in rehabilitation centers. This cross-sectional study investigated the MRSA prevalence in employees from different rehabilitation centers and aimed to identify risk factors for MRSA transmission. We invited all staff (i.e., with and without patient contact from 22 participating rehabilitation centers; n = 2499) to participate. Study participation included a questionnaire on personal characteristics, lifestyle, personal and occupational risk factors for MRSA and nasal swabs taken by the study team. In total, 1005 persons participated in the study (response: 40.2%). Only four participants carried MRSA (0.40 (95% CI 0.00–1.00) per 100). MRSA carriage did not seem to be occupationally related, as it was found in different occupations with and without direct contact with MRSA patients, as well as in different clinics with different indications and patient clientele. We could not find a clear association between MRSA carriage and potential risk factors due to the low number of cases found. Genotyping revealed the spa types t032 (Barnim epidemic strain) and t1223. Our results suggest a low point prevalence of nasal MRSA colonization in a non-outbreak setting in employees from rehabilitation centers.
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Hellmich L, Fabri M. [25-year-old male with erythematous, encrusted, painful nodules in the beard area : Preparation for the specialist examination: part 49]. Hautarzt 2019; 70:85-88. [PMID: 30976859 DOI: 10.1007/s00105-019-4367-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Luisa Hellmich
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Mario Fabri
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Jurke A, Daniels-Haardt I, Silvis W, Berends MS, Glasner C, Becker K, Köck R, Friedrich AW. Changing epidemiology of meticillin-resistant Staphylococcus aureus in 42 hospitals in the Dutch-German border region, 2012 to 2016: results of the search-and-follow-policy. Euro Surveill 2019; 24:1800244. [PMID: 30994105 PMCID: PMC6470371 DOI: 10.2807/1560-7917.es.2019.24.15.1800244] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 03/03/2019] [Indexed: 11/20/2022] Open
Abstract
IntroductionMeticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections.AimWe describe MRSA colonisation/infection and bacteraemia rate trends in Dutch-German border region hospitals (NL-DE-BRH) in 2012-16.MethodsAll 42 NL-DE BRH (8 NL-BRH, 34 DE-BRH) within the cross-border network EurSafety Health-net provided surveillance data (on average ca 620,000 annual hospital admissions, of these 68.0% in Germany). Guidelines defining risk for MRSA colonisation/infection were reviewed. MRSA-related parameters and healthcare utilisation indicators were derived. Medians over the study period were compared between NL- and DE-BRH.ResultsMeasures for MRSA cases were similar in both countries, however defining patients at risk for MRSA differed. The rate of nasopharyngeal MRSA screening swabs was 14 times higher in DE-BRH than in NL-BRH (42.3 vs 3.0/100 inpatients; p < 0.0001). The MRSA incidence was over seven times higher in DE-BRH than in NL-BRH (1.04 vs 0.14/100 inpatients; p < 0.0001). The nosocomial MRSA incidence-density was higher in DE-BRH than in NL-BRH (0.09 vs 0.03/1,000 patient days; p = 0.0002) and decreased significantly in DE-BRH (p = 0.0184) during the study. The rate of MRSA isolates from blood per 100,000 patient days was almost six times higher in DE-BRH than in NL-BRH (1.55 vs 0.26; p = 0.0041). The patients had longer hospital stays in DE-BRH than in NL-BRH (6.8 vs 4.9; p < 0.0001). DE-BRH catchment area inhabitants appeared to be more frequently hospitalised than their Dutch counterparts.ConclusionsOngoing IPC efforts allowed MRSA reduction in DE-BRH. Besides IPC, other local factors, including healthcare systems, could influence MRSA epidemiology.
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Affiliation(s)
- Annette Jurke
- North Rhine-Westphalian Centre for Health, Section Infectious Disease Epidemiology, Bochum, Germany
| | - Inka Daniels-Haardt
- North Rhine-Westphalian Centre for Health, Department Health Promotion, Health Protection, Bochum, Germany
| | - Welmoed Silvis
- Laboratory for Medical Microbiology and Public Health (LabMicTA), Hengelo, Netherlands
| | - Matthijs S Berends
- Certe Medical Diagnostics and Advice, Groningen, Netherlands
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, Netherlands
| | - Corinna Glasner
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, Netherlands
| | - Karsten Becker
- University Hospital Münster, University of Münster, Institute of Medical Microbiology, Münster, Germany
| | - Robin Köck
- University Hospital Münster, University of Münster, Institute of Medical Microbiology, Münster, Germany
- University Hospital Münster, University of Münster, Institute for Hygiene, Münster, Germany
- Institute of Hygiene, DRK Kliniken Berlin, Berlin, Germany
| | - Alex W Friedrich
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, Netherlands
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Schubert M, Kämpf D, Jatzwauk L, Kynast F, Stein A, Strasser R, Dulon M, Nienhaus A, Seidler A. Prevalence and predictors of MRSA carriage among employees in a non-outbreak setting: a cross-sectional study in an acute care hospital. J Occup Med Toxicol 2019; 14:7. [PMID: 30923557 PMCID: PMC6419512 DOI: 10.1186/s12995-019-0226-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/26/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Health care workers have an increased risk of being infected with Methicillin-resistant Staphylococcus aureus (MRSA), though little information is available about how prevalent (dormant) MRSA colonization is among health care workers. The aim of this study was to estimate the prevalence and predictors of MRSA carriage in a non-outbreak setting in a university hospital in Germany. METHODS The entire staff of a university hospital heart center for cardiologic maximum medical care and cardiac surgery were invited to participate in a cross-sectional study (N = 575). The sampled population included health care workers as well as employees with no close patient contact.A questionnaire concerning personal and occupational risk factors as well as lifestyle and demographic factors was applied and nasal swabs were taken. In total 180 persons (31.3%) participated in the study. RESULTS The majority of study participants had close contact to patients at work (n = 149, 82.8%). Thereof, about one-third had contact to MRSA-patients (n = 53, 35.6%), and most reported wearing protective clothing (n = 44, 83.0%). None of the administrative staff tested positive for MRSA and only one in 149 persons (0.7%, CI 0.00-0.02) with close patient contact carried MRSA (strain CC1-MRSA-IV). This person had close contact to patients with MRSA, less than 1 year of work experience, and had been treated with antibiotics within the last 12 months. CONCLUSION The results of our study suggest low point prevalence rates of MRSA colonization in health care workers in a non-outbreak setting.
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Affiliation(s)
- Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Daniel Kämpf
- Institute and Policlinic of Occupational and Social Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lutz Jatzwauk
- Department of Hospital Infection Control, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Franziska Kynast
- Institute and Policlinic of Occupational and Social Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Annette Stein
- Heart Center, University Hospital of the Technical University Dresden, Dresden, Germany
| | - Ruth Strasser
- Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Madeleine Dulon
- Department of Occupational Medicine, Public Health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany
| | - Albert Nienhaus
- Department of Occupational Medicine, Public Health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Krämer J, Triantafyllias K, Kohnen W, Leber M, Dederichs-Masius U, Zucker A, Körber J, Schwarting A. Patients with Rheumatic Diseases do not have an Increased Risk of MRSA Carrier Status. Rheumatol Ther 2018; 5:371-381. [PMID: 29860570 PMCID: PMC6251847 DOI: 10.1007/s40744-018-0116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) both in rheumatologic and non-rheumatologic rehabilitation centers. In addition, we sought to evaluate the practice value of existing screening recommendations of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO). METHODS The analysis was performed in four rehabilitation clinics (rheumatology, psychosomatic medicine, oncology, and cardiology) with at least 200 patients per clinic tested for MRSA. RESULTS Nine (1.1%) of the 842 patients were colonized with MRSA. Only five of them should have been tested according to the commission's recommendations. The prevalence was 0.5% (n = 207) in rheumatologic, 0.9% (n = 224) in psychosomatic, 1.4% (n = 209) in oncologic and 1.5% (n = 202) in cardiologic patients. We found a greater exposure to risk factors in cardiologic and oncologic patients. Among patients with carrier status, a higher percentage was exposed to three potential risk factors not applied by the commission. CONCLUSIONS The prevalence of MRSA in our cohort correlates with data from previous studies. The low percentage among rheumatologic patients suggests that they are not more likely to reveal MRSA carrier status than other patient groups and that long-term immunosuppression does not necessarily represent a risk factor for MRSA colonization. Since only five out of nine patients with carrier status would have been detected following the recommendations of the KRINKO, further studies on potential risk factors are warranted.
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Affiliation(s)
- Judith Krämer
- University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | - Wolfgang Kohnen
- University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | | | | | | | - Andreas Schwarting
- University Medical Center, Johannes Gutenberg University, Mainz, Germany.
- ACURA Rheumatology Center, Bad Kreuznach, Germany.
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Hutzschenreuter L, Flessa S, Dittmann K, Hübner NO. Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis. Antimicrob Resist Infect Control 2018; 7:147. [PMID: 30519461 PMCID: PMC6267031 DOI: 10.1186/s13756-018-0442-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/21/2018] [Indexed: 11/21/2022] Open
Abstract
Background Nosocomial infections are among the most common complications in hospitals. A major part is caused by multidrug-resistant organisms (MDRO). MRSA is still the most prominent and frequent MDRO. The early detection of carriers of multidrug-resistant bacteria is an effective measure to reduce nosocomial infections caused by MDRO. For patients who are planning to go to the hospital, an outpatient screening for MDRO and pre-hospital decolonization is recommended. However, the effectiveness of such pre-admission MDRO management in preparation for a planned hospital stay has not yet been sufficiently scientifically examined from an economic perspective. Methods A decision tree will be used to develop scenarios for MDRO screening and treatment in the context of the outpatient and inpatient sectors using MRSA-positive patients as an example. Subsequently, the expected costs for the respective strategy are presented. Results The decision tree analysis shows that the expected costs of outpatient MRSA management are €8.24 and that of inpatient MRSA management are €672.51. Conclusion The forward displacement of the MRSA screening to the ambulatory sector and any subsequent outpatient decolonization for patients with a planned hospitalization is the most cost-effective strategy and should become a standard benefit. Excluding opportunity costs, the expected costs of inpatient MRSA management are €54.94.
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Affiliation(s)
- Luise Hutzschenreuter
- Institute of Health Care Management, University of Greifswald, Friedrich-Loeffler-Str. 70, 17489 Greifswald, Germany
| | - Steffen Flessa
- Institute of Health Care Management, University of Greifswald, Friedrich-Loeffler-Str. 70, 17489 Greifswald, Germany
| | - Kathleen Dittmann
- Institute of Hygiene and Environmental Health, University Medicine of Greifswald, Walther-Rathenau-Straße 49a, 17489 Greifswald, Germany
| | - Nils-Olaf Hübner
- Institute of Hygiene and Environmental Health, University Medicine of Greifswald, Walther-Rathenau-Straße 49a, 17489 Greifswald, Germany
- IMD Laboratory Greifswald MVZ GmbH, Vitus-Bering-Straße 27a, 17493 Greifswald, Germany
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Deinhardt-Emmer S, Sachse S, Geraci J, Fischer C, Kwetkat A, Dawczynski K, Tuchscherr L, Löffler B. Virulence patterns of Staphylococcus aureus strains from nasopharyngeal colonization. J Hosp Infect 2018; 100:309-315. [DOI: 10.1016/j.jhin.2017.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023]
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Rate and impact of multidrug-resistant organisms in patients with aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2018; 160:2049-2054. [PMID: 30046875 DOI: 10.1007/s00701-018-3637-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Multidrug-resistant organisms (MDRO) are an increasing problem in critical care medicine. This study describes for the first time the rate and impact of MDRO in patients suffering from aneurysmal subarachnoid hemorrhage (SAH). METHODS Anonymized data of SAH patients admitted to our institution from November 2010 to August 2017 were retrospectively reviewed. Patients with microbiological tests positive for MDRO were identified. Screening of MDRO was in consensus with national recommendations. RESULTS 449 SAH patients were reviewed with 18 patients (prevalence: four MDRO-positive patients per 100 SAH patients) having positive tests for MDRO during their hospital stay. The prevalence upon admission was 1.3 MDRO-positive patients per 100 patients. The acquisition rate was 1.1 MDRO-positive patients per 1000 hospital days. Patients positive for an MDRO had a significantly extended length of stay in intensive care (mean ± SD 26.7 ± 13.0 versus 18.4 ± 11.7 days, p = 0.004) and in hospital (mean ± SD 33.9 ± 12.4 versus 24.4 ± 12.6 days, p = 0.002). MDRO detection was associated with a significant prolonged duration of mechanical ventilation (median (IQR) 254.0 (14.9-632.8) versus 37.5 (3.3-277.0) hours, p = 0.02). There was no statistically significant effect on the Glasgow Outcome Scale (GOS) at discharge and at follow-up after 164.4 ± 113.0 days. CONCLUSIONS MDRO positivity is present in 4% of aneurysmal SAH patients. It seems to be associated with a prolonged length of stay and prolonged duration of mechanical ventilation. The importance of infection control standards in neurointensive care units is emphasized.
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Papastergiou P, Tsiouli E. Healthcare-associated transmission of Panton-Valentine leucocidin positive methicillin-resistant Staphylococcus aureus: the value of screening asymptomatic healthcare workers. BMC Infect Dis 2018; 18:484. [PMID: 30261854 PMCID: PMC6161321 DOI: 10.1186/s12879-018-3404-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/21/2018] [Indexed: 12/03/2022] Open
Abstract
Background Three patients hospitalised in the coronary care unit of a general district hospital (England, UK) were tested positive for Panton-Valentine leucocidin methicillin-resistant Staphylococcus aureus colonisation during their routine weekly screening for methicillin-resistant Staphylococcus aureus (MRSA). The isolates were indistinguishable and all three patients have previously had negative screening tests. The outbreak investigation team considered exploring the possibility of PVL-MRSA transmission from members of staff to the patients and potentially between members of staff. Method As part of the investigations, healthcare workers on coronary care unit and intensive care unit were screened for MRSA carriage. Results Among 134 screened healthcare workers, five staff members (3.7%) were MRSA colonised. Among these isolates, four were Panton-Valentine leukocidin positive. However, only two healthcare workers had an indistinguishable isolate with the isolate identified among the colonised patients. Decolonisation treatment was offered to all colonised patients and healthcare workers. Conclusion In low MRSA prevalence settings, healthcare workers may be a reservoir of MRSA and an important potential source of transmission to patients. Screening and decolonisation of colonised healthcare workers may provide a valuable strategy in managing linked hospital acquisitions and reduce the risk of occupationally acquired complications. MRSA mass screen of healthcare workers should be considered in transmission with a strain that has a potentially increased virulence, such as Panton-Valentine leucocidin methicillin-resistant Staphylococcus aureus.
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Affiliation(s)
- Panagiotis Papastergiou
- Microbiology Department, NRP Innovation Centre, Norwich Research Park, Norfolk and Norwich University Hospital, Colney, Norwich, NR4 7GJ, UK. .,Infection Prevention Control/ Microbiology Department, The Queen Elizabeth Hospital King's Lynn, Gayton Road, King's Lynn, PE30 4ET, UK.
| | - Eleni Tsiouli
- Microbiology Department, NRP Innovation Centre, Norwich Research Park, Norfolk and Norwich University Hospital, Colney, Norwich, NR4 7GJ, UK.,Infection Prevention Control/ Microbiology Department, The Queen Elizabeth Hospital King's Lynn, Gayton Road, King's Lynn, PE30 4ET, UK
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Bickenbach J, Schöneis D, Marx G, Marx N, Lemmen S, Dreher M. Impact of multidrug-resistant bacteria on outcome in patients with prolonged weaning. BMC Pulm Med 2018; 18:141. [PMID: 30126392 PMCID: PMC6102812 DOI: 10.1186/s12890-018-0708-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 08/09/2018] [Indexed: 12/05/2022] Open
Abstract
Background Pneumonia and septic pneumonic shock are the most common indications for long-term mechanical ventilation and prolonged weaning, independent of any comorbidities. Multidrug resistant (MDR) bacteria are emerging as a cause of pneumonia or occur as a consequence of antimicrobial therapy. The influence of MDR bacteria on outcomes in patients with prolonged weaning is unknown. Methods Patients treated in a specialized weaning unit of a university hospital between April 2013 and April 2016 were analyzed. Demographic data, clinical characteristics, length of stay (LOS) in the intensive care unit (ICU) and weaning unit, ventilator-free days and mortality rates were determined in prolonged weaning patients with versus without MDR bacteria (methicillin-resistant Staphylococcus aureus bacteria, [MRSA]; extended spectrum beta lactamase [ESBL]- and Gyrase-producing gram negative bacteria resistant to three of four antibiotic groups [3 MRGN]; panresistant Pseudomonas aeruginosa and other carbapenemase-producing gram-negative bacteria resistant to all four antibiotic groups [4 MRGN]). Weaning failure was defined as death or discharge with invasive ventilation. Results Of 666 patients treated in the weaning unit, 430 fulfilled the inclusion criteria and were included in the analysis. A total of 107 patients had isolates of MDR bacteria suspected as causative pathogens identified during the treatment process. Patients with MDR bacteria had higher SAPS II values at ICU admission and a significantly longer ICU LOS. Four MRGN P. aeruginosa and Acinetobacter baumanii were the most common MDR bacteria identified. Patients with versus without MDR bacteria had significantly higher arterial carbon dioxide levels at the time of weaning admission and a significantly lower rate of successful weaning (23% vs 31%, p < 0.05). Mortality rate on the weaning unit was 12.4% with no difference between the two patient groups. There were no significant differences between patient groups in secondary infections and ventilator-free days. Conclusions In patients with pneumonia or septic pneumonic shock undergoing prolonged weaning, infection with MDR bacteria may influence the weaning success rate but does not appear to impact on patient survival.
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Affiliation(s)
- Johannes Bickenbach
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, D-52074, Aachen, Germany.
| | - Daniel Schöneis
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, D-52074, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, D-52074, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sebastian Lemmen
- Department of Infection Control and Infectious Diseases, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Dreher
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Peters C, Kleinmüller O, Nienhaus A, Schablon A. Prevalence and risk factors of MRSA colonisations: a cross-sectional study among personnel in outpatient care settings in Hamburg, Germany. BMJ Open 2018; 8:e021204. [PMID: 30012786 PMCID: PMC6082463 DOI: 10.1136/bmjopen-2017-021204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Healthcare workers frequently come into contact with infected individuals and are at a greater risk of infection than the general population due to their occupation. Multidrug-resistant organisms (MDROs) also pose a significant challenge for personnel and medical facilities. Currently, little is known about the occupational risk of methicillin-resistant Staphylococcus aureus (MRSA) in outpatient care settings. Therefore, a cross-sectional study was conducted in Hamburg to investigate MRSA colonisation among outpatient nursing staff. METHODS MRSA screening with nasal swabs was carried out, the known risk factors for colonisation were determined and information on infection control was inquired. Where tests were positive, a control swab was taken; if this confirmed a positive result, decolonisation was offered. A molecular biological examination of the MRSA samples was performed. The occupational MRSA exposure and risk factors were compared with the situation for personnel in inpatient geriatric care. RESULTS A total of 39 outpatient services participated in the study and 579 employees were tested. The MRSA prevalence was 1.2% in all and 1.7% in nursing staff. Most of the employees that tested positive had close or known contact with MRSA patients. Health personnel frequently reported personal protective measures and their application. Compared with inpatient care staff, outpatient staff were older and had worked in their profession for a longer time. CONCLUSION This study marks the first time that data has been made available on the occupational MRSA risk of outpatient care personnel in Hamburg. The MRSA prevalence is low and provides a good basis for describing the MRSA risk of occupational exposure by health personnel in outpatient care.
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Affiliation(s)
- Claudia Peters
- Institute for Health Services Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf Kleinmüller
- Institute for Health Services Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Albert Nienhaus
- Institute for Health Services Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Occupational Medicine, Public Health and Hazardous Substances, Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany
| | - Anja Schablon
- Institute for Health Services Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Dohle C, Korr G, Friedrichs M, Kullmann V, Tung ML, Kaase M, Rüssmann H, Sissolak D, Werber D, Becker L, Fuchs S, Pfeifer Y, Semmler T, Widders G, Eckmanns T, Werner G, Zill E, Haller S. Effektives Management eines Ausbruchs mit multiresistenten Klebsiella pneumoniae in der Neurorehabilitation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:543-552. [DOI: 10.1007/s00103-018-2728-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Perspectives on multidrug-resistant organisms at the end of life. Z Gerontol Geriatr 2018; 52:264-271. [DOI: 10.1007/s00391-018-1378-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 01/16/2018] [Accepted: 02/15/2018] [Indexed: 11/26/2022]
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Findings from an outbreak of carbapenem-resistant Klebsiella pneumoniae emphasize the role of antibiotic treatment for cross transmission. Infection 2017; 46:103-112. [PMID: 29177610 DOI: 10.1007/s15010-017-1103-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE In January 2015, we noticed by rectal swab analyses that seven of 23 patients at an early rehabilitation ward had been colonized with carbapenem-resistant Klebsiella pneumoniae (CKP). Here, we describe risk factors for CKP acquisition. METHODS In the present study, the outbreak is described and risk factors for CKP acquisition are examined, e.g., antibiotic treatment. Microbiological analyses including corresponding results were examined to study when colonization with CKP occurred and whether patients had suffered from diarrhea. To examine whether spread of bacteria was clonal, multi-locus sequence typing as well as Xbal macrorestriction and pulsed-field gel electrophoresis was performed. The presence of carbapenmase was examined by PCR analysis. Through univariate analysis of risk factors in the small study sample, the role of antibiotic consumption, isolation procedures, patient's age, gender, and Barthel index on colonization was elucidated. RESULTS Clonal spread of the novel sequence type (ST)2255 was identified. Additionally, one patient was colonized with Escherichia coli and Serratia marcescens, both resistant to carbapenems, while a further patient carried another carbapenem-resistant E. coli strain. In all isolates, carbapenemase gene bla OXA-48 was found to be located on a conjugative plasmid (60 kb), suggesting in vivo transmission from CKP to E. coli and S. marcescens. Univariate tests indicated that antibiotic treatment was the only risk factor showing a significant association with being colonized by CKP. In addition, the likelihood of diarrhea appeared to be higher in this group. Antibiotic treatment was associated with CKP colonization, whereas patients´ age, gender, Barthel index at admission, and residence with a CKP-colonized roommate were not. Diarrhea also seemed to support to distribution of CKP. CONCLUSIONS In this small outbreak, antibiotic treatment seemed to be the predominant risk factor for monoclonal transmission of bla OXA-48 positive CKP.
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Pichler G, Pux C, Babeluk R, Hermann B, Stoiser E, De Campo A, Grisold A, Zollner-Schwetz I, Krause R, Schippinger W. MRSA prevalence rates detected in a tertiary care hospital in Austria and successful treatment of MRSA positive patients applying a decontamination regime with octenidine. Eur J Clin Microbiol Infect Dis 2017; 37:21-27. [PMID: 28849282 DOI: 10.1007/s10096-017-3095-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/14/2017] [Indexed: 12/31/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) decontamination regimens predominantly use chlorhexidine bathing in combination with mupirocin nasal ointment. However, resistances in Staphylococcus aureus strains are increasingly common and there is a need of alternative, safe and feasible protocols. This interventional cohort study performed at the Albert Schweitzer Hospital in Graz, Austria, aimed to (1) determine MRSA prevalence at different body sites and (2) assess the efficacy of the decontamination using octenidine-based leave-on products added to existing robust infection control measures. All inpatients of this tertiary care hospital being treated in geriatric medical wards (GWs) and apallic care units (ACUs) were screened for MRSA and decontamination rates were determined after one, two or three decontamination cycles, respectively. At baseline, MRSA was detected in 25 of the 126 patients screened (19.8%). We found MRSA in 13/126 (10.3%) swabs from nasal vestibules, in 12/126 (9.5%) skin swabs, in 11/51 (21.6%) swabs from PEG-stomata or suprapubic catheters and in 8/13 (61.5%) tracheostomata swabs. A maximum of three 5-day decontamination cycles reduced the number of MRSA positive patients by 68.0%. Excluding non-compliant and deceased patients, decontamination reduced MRSA carriage by 93.3% (n = 15). No adverse events related to the applied decontamination regimen occurred. Exclusive screening of the nose might underreport MRSA prevalence rates. In this study, decontamination with octenidine-based leave-on products was safe and effective in a critical patient population.
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Affiliation(s)
- G Pichler
- Department of Neurology, Albert Schweitzer Hospital, 8020, Graz, Styria, Austria.
| | - C Pux
- Department of Neurology, Albert Schweitzer Hospital, 8020, Graz, Styria, Austria
| | - R Babeluk
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - B Hermann
- Department of Medical Geriatrics, Albert Schweitzer Hospital, Graz, Styria, Austria
| | - E Stoiser
- Department of Medical Geriatrics, Albert Schweitzer Hospital, Graz, Styria, Austria
| | - A De Campo
- Department of Internal Medicine, Albert Schweitzer Hospital, Graz, Styria, Austria
| | - A Grisold
- Department of Microbiology and Environmental Medicine, Institute of Hygiene, Medical University of Graz, Graz, Styria, Austria
| | - I Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Styria, Austria
| | - R Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Styria, Austria
| | - W Schippinger
- Department of Internal Medicine, Albert Schweitzer Hospital, Graz, Styria, Austria
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Vahlensieck W, Rudolph R, Knopf HJ, Dahl U, Fabry W. [Management of multiresistant bacteria in urology]. Urologe A 2017; 56:764-772. [PMID: 28493114 DOI: 10.1007/s00120-017-0393-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Contamination and infection with extensive drug resistant (XDR) bacteria are increasing in urology with the exception of methicillin resistant Staphylococcus aureus (MRSA) (stabilization). They often lead to logistic and therapeutical problems. Only 30-50% of XDR cases are of exogenous origin. To slow this trend, screening, hygiene programs, isolation, decontamination, targeted therapy of symptomatic infections, education programs, and success controls should be applied. Furthermore, all regulatory and legal instructions should be followed. Local hygiene networks help to find apt measures for XDR control. It is important to balance hygiene measures against hygiene hysteria. To prepare urological instruments, a local instrument preparation plan that takes into consideration all legal instructions should be followed. The efforts in health system general prophylactic measures should be supported. Only with consistent implementation in all areas of daily life (health care, local environment, animal husbandry, and soil contaminated within the framework of animal husbandry) can a substantial reduction of XDR bacteria be achieved in the long term.
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Affiliation(s)
- W Vahlensieck
- Kurpark-Klinik, Kurstr. 41-45, 61231, Bad Nauheim, Deutschland.
| | - R Rudolph
- Urologische Gemeinschaftspraxis, Kirchheim, Deutschland
| | - H-J Knopf
- St. Ansgar Krankenhaus, Höxter, Deutschland
| | - U Dahl
- , Frankfurt am Main, Deutschland
| | - W Fabry
- Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
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Biehl LM, Bertz H, Bogner J, Dobermann UH, Kessel J, Krämer C, Lemmen S, von Lilienfeld-Toal M, Peter S, Pletz MW, Rohde H, Schmiedel S, Schubert S, Ullmann AJ, Fätkenheuer G, Vehreschild MJGT. Screening and contact precautions - A survey on infection control measures for multidrug-resistant bacteria in German university hospitals. Antimicrob Resist Infect Control 2017; 6:37. [PMID: 28413631 PMCID: PMC5390437 DOI: 10.1186/s13756-017-0191-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/17/2017] [Indexed: 12/17/2022] Open
Abstract
To assess the scope of infection control measures for multidrug-resistant bacteria in high-risk settings, a survey among university hospitals was conducted. Fourteen professionals from 8 sites participated. Reported policies varied largely with respect to the types of wards conducting screening, sample types used for screening and implementation of contact precautions. This variability among sites highlights the need for an evidence-based consensus of current infection control policies.
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Affiliation(s)
- Lena M. Biehl
- Department I of Internal Medicine, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
- German Centre for Infection Research (DZIF), site Bonn-Cologne, Cologne, Germany
| | - Hartmut Bertz
- Department of Haematology/Oncology and Stem Cell Transplantation, University Medical Centre, Freiburg, Germany
| | - Johannes Bogner
- Department of Infectious Disease, Med IV, University Hospital of Munich, Munich, Germany
| | - Ute-Helke Dobermann
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Johanna Kessel
- Infectious Diseases, Medical Clinic II, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Carolin Krämer
- Department of Haematology, Oncology, Haemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
| | - Sebastian Lemmen
- Division of Infection Control and Infectious Diseases, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
| | - Marie von Lilienfeld-Toal
- Department of Internal Medicine II, Haematology and Medical Oncology, Jena University Hospital, Jena, Germany
| | - Silke Peter
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
| | - Mathias W. Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Schmiedel
- 1st Department of Medicine, University Medical Centre Hamburg–Eppendorf, Hamburg, Germany
| | - Sören Schubert
- Max-von-Pettenkofer Institute, Ludwig-Maximilians-University, Munich, Germany
| | - Andrew J. Ullmann
- Department of Internal Medicine II, Division of Infectious Diseases, University Hospital Würzburg, Würzburg, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
- German Centre for Infection Research (DZIF), site Bonn-Cologne, Cologne, Germany
| | - Maria J. G. T. Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
- German Centre for Infection Research (DZIF), site Bonn-Cologne, Cologne, Germany
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Günther F, Blessing B, Tacconelli E, Mutters NT. MRSA decolonization failure-are biofilms the missing link? Antimicrob Resist Infect Control 2017; 6:32. [PMID: 28360994 PMCID: PMC5371339 DOI: 10.1186/s13756-017-0192-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/21/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Device-associated infections due to biofilm-producing methicillin-resistant Staphylococcus aureus (MRSA) have been recently associated with the failure of antibiotic treatment and decolonization measures. The goal of our study was to evaluate the extent to which the formation of biofilms influenced the efficacy of topical decolonization agents or disinfectants such as mupirocin (MUP), octenidine (OCT), chlorhexidine (CHG), polyhexanide (POL), and chloroxylenol (CLO). METHODS Bacterial killing in biofilms by the disinfectants and MUP was determined as the reduction [%] in metabolic activity determined by a biofilm viability assay that uses kinetic analysis of metabolic activity. The test substances were diluted in water with standardized hardness (WSH) at 25 °C at the standard concentration as well as half the standard concentration to demonstrate the dilution effects in a practical setting. The tested concentrations were: CHG 1%, 2%; OCT 0.1%, 0.05%; PH 0.04%, 0.02%; and CLO 0.12%, 0.24%. A test organism suspension, 1 mL containing ~1 × 109 bacterial cells/mL, and 1 mL of sterile WSH were mixed and incubated for six different exposure times (15 s, 1, 3, 5, 10 and 20 min) after the test substance was added. Additionally, the bactericidal effects of all substances were tested on planktonic bacteria and measured as the log10 reduction. RESULTS The disinfectants OCT and CHG showed good efficacy in inhibiting MRSA in biofilms with reduction rates of 94 ± 1% and 91 ± 1%, respectively. POL, on the other hand, had a maximum efficacy of only 81 ± 7%. Compared to the tested disinfectants, MUP showed a significantly lower efficacy with <20% inhibition (p < .05). Bactericidal effects were the greatest for CHG (log10 reduction of 9.0), followed by OCT (7.7), POL (5.1), and CLO (6.8). MUP, however, showed a very low bactericidal effect of only 2.1. Even when the exposure time was increased to 24 h, 2% MUP did not show sufficient bactericidal effect. CONCLUSIONS Our data provide evidence that OCT and CHG are effective components for disinfection of MRSA-biofilms. On the other hand, exposure to MUP at the standard concentrations in topical preparations did not effectively inhibit MRSA-biofilms and also did not show adequate bactericidal effects. Combining an MUP-based decolonization regimen with a disinfectant such as OCT or CHG could decrease decolonization failure.
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Affiliation(s)
- Frank Günther
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69126 Heidelberg, Germany
| | - Brigitte Blessing
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69126 Heidelberg, Germany
| | - Evelina Tacconelli
- Division of Infectious Diseases - Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
| | - Nico T. Mutters
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69126 Heidelberg, Germany
- Division of Infectious Diseases - Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
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Becker J, Diel R. Screening for Methicillin-resistant Staphylococcus aureus in a residence home for elderly in Germany. J Occup Med Toxicol 2017; 12:3. [PMID: 28174596 PMCID: PMC5291946 DOI: 10.1186/s12995-017-0149-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 01/26/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Since many hospitals report high MRSA colonization rates among elderly patients, and because it has been shown that S. aureus colonization increases with advancing age, there are concerns about the introduction of MRSA into nursing homes by MRSA positive patients discharged from hospital. So far, admission screening and subsequent longitudinal screening in residence homes or screening at time of hospital discharge is not established on a regular base. On the other hand, MRSA is acquired frequently during hospital stay. Therefore, the MRSA status of residents remains unclear at the time of re-admission to the residence home. This study was conducted to evaluate the rate of nasal MRSA carriage among residents and nursing staffs of 2 nursing homes for the elderly, the potential acquisition of MRSA during a hospital stay and the feasibility to perform direct screening tests in nursing homes for elderly. METHODS In a study period of 5 months, possibility of active PCR-based screening for MRSA has been tested within 2 residence homes for the elderly, with the obligation to avoid inconvenience to the daily working time and working schedule. Residents and staff members were included in the study and positive test results were confirmed with MRSA culture. RESULTS Feasibility of active on site screening in a residence home for the elderly using a rapid PCR method has been confirmed. 154 of 156 residents participated on baseline testing for all current and new admitted residents. In 9 participating residents with former unknown status, nasal carriage with MRSA was confirmed (5.8%). Among 32 documented and eligible movements between the nursing home and the hospital, MRSA could be confirmed after return to the residence home in 2 cases (6.3%). MRSA could also be detected in 1 of 14 participating nursing staff (7.1%). CONCLUSION Prevalence of MRSA was in a range that has been observed for nursing homes in Germany in previous studies. Residents can acquire MRSA during a hospital stay so that further spread after re-admission into the nursing home cannot be excluded. This study shows that easy to perform direct screening tests in outpatient facilities for nursing of the elderly are promising tools as part of potential new strategies for transmission and infection control in such facilities. Additional studies are needed to investigate if screening followed by interventional hygiene measures can reduce MRSA transmission and infection in such facilities.
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Affiliation(s)
- Jürgen Becker
- Cepheid GmbH, Unterlindau 29, 60323 Frankfurt, Germany
| | - Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany
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MRSA Prevalence and Risk Factors among Health Personnel and Residents in Nursing Homes in Hamburg, Germany - A Cross-Sectional Study. PLoS One 2017; 12:e0169425. [PMID: 28068356 PMCID: PMC5222188 DOI: 10.1371/journal.pone.0169425] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction The increase of multidrug-resistant organisms in hospitals causes problems in nursing homes. Staff in geriatric nursing homes are at greater risk of MRSA colonisation. The aim of the study was to describe the occupational exposure to MRSA among health personnel in geriatric nursing. Methods A point prevalence survey was conducted among health personnel and residents of geriatric nursing homes within the greater Hamburg district. Nasal swabs and, where relevant, wound swabs were collected for the screening survey. Risk factors for MRSA colonisation were identified by means of a questionnaire and using the files held on the residents. Where tests on nursing staff were positive, a control swab was taken; when the results were confirmed positive, decolonisation was performed. The responsible general practitioners were notified of positive MRSA findings among residents. A molecular biological examination of the MRSA samples was performed. Results A total of 19 institutions participated in the study. Nasal swabs were taken from 759 nursing staff and 422 residents. Prevalence of MRSA was 1.6% among staff and 5.5% among residents. MRSA colonisation among health personnel indicated a correlation with male gender (OR 4.5, 95% CI 1.4–14.1). Among the residents, chronic skin diseases (OR 3.2, 95% CI 1.0–10.3) and indwelling devices (OR 3.2, 95% CI 1.2–8.1) were identified as risk factors. No link between MRSA in residents and in health personnel could be established. Conclusion The number of MRSA colonisations among nursing staff and residents of geriatric nursing homes in Hamburg was rather low at 1.6% and 5.5% respectively and equates to the results of other surveys in non-outbreak scenarios.
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Fussen R, Lemmen S. [Multidrug resistant bacteria in the intensive care unit : Reasonable measures for prevention]. Med Klin Intensivmed Notfmed 2016; 111:743-754. [PMID: 27766376 DOI: 10.1007/s00063-016-0223-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 11/24/2022]
Abstract
Multidrug resistant (MDR) bacteria present an increasing threat for intensive care patients. Whereas colonization of intensive care patients with methicillin-resistant staphylococcus aureus (MRSA) in German ICUs has remained at a constant level in recent years and therapeutic options have improved, colonization and infections with MDR gram-negative bacteria and vancomycin-resistant enterococci are increasing year by year. Only a few or even no therapeutic options remain for the treatment of these bacteria. If recommendations and guidelines for the prevention of transmission of MDR bacteria do exist they often are of moderate evidence due to lack of randomized controlled trials. The single most important measure to avoid transmission and infection with sensible and MDR bacteria is still hand disinfection. Screening and barrier precautions must be adapted and implemented to pathogen and local conditions. In addition to those specific measures universal decolonization with antiseptics have been demonstrated to be effective at least in intensive care patients.
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Affiliation(s)
- R Fussen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - S Lemmen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
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