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An outbreak of hepatitis C virus attributed to the use of multi-dose vials at a colonoscopy clinic, Waterloo Region, Ontario. ACTA ACUST UNITED AC 2021; 47:224-231. [PMID: 34035670 DOI: 10.14745/ccdr.v47i04a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Hepatitis C virus (HCV) transmission has been epidemiologically linked to healthcare settings, particularly out-of-hospital settings such as endoscopy clinics and hemodialysis clinics. These have been largely attributed to lapses in infection prevention and control practices (IPAC). Objective To describe the public health response to an outbreak of HCV that was detected among patients of a colonoscopy clinic in Ontario, and to highlight the risks of using multi-dose vials and the need for improved IPAC practices in out-of-hospital settings. Methods Screening for HCV was conducted on patients and staff who attended or worked at the clinic within the same timeframe as the index case's procedure. Blood samples from positive cases underwent viral sequencing. Inspections of the clinic assessed IPAC practices, and a chart review was done to identify plausible mechanisms for transmission. Outcome A total of 38% of patients who underwent procedures at the clinic on the same day as the index case tested positive for HCV. Genetic sequencing showed a high degree of similarity in the HCV genetic sequence among the samples positive for HCV. Chart review and clinic inspection identified use of multi-dose vials of anesthesia medication across multiple patients as the plausible mechanism for transmission. Conclusion Healthcare workers, especially those in out-of-hospital procedural/surgical premises, should be vigilant in following IPAC best practices, including those related to the use of multi-dose vials, to prevent the transmission of bloodborne infections in healthcare settings.
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Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012-2014. Infect Control Hosp Epidemiol 2021; 42:1458-1463. [PMID: 33641684 DOI: 10.1017/ice.2021.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE To stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in association with myocardial perfusion imaging (MPI) at a cardiology clinic. DESIGN Outbreak investigation and quasispecies analysis of HCV hypervariable region 1 genome. SETTING Outpatient cardiology clinic. PATIENTS Patients undergoing MPI. METHODS Case patients met definitions for HBV or HCV infection. Cases were identified through surveillance registry cross-matching against clinic records and serological screening. Observations of clinic practices were performed. RESULTS During 2012-2014, 7 cases of HCV and 4 cases of HBV occurred in 4 distinct clusters among patients at a cardiology clinic. Among 3 case patients with HCV infection who had MPI on June 25, 2014, 2 had 98.48% genetic identity of HCV RNA. Among 4 case patients with HCV infection who had MPI on March 13, 2014, 3 had 96.96%-99.24% molecular identity of HCV RNA. Also, 2 clusters of 2 patients each with HBV infection had MPI on March 7, 2012, and December 4, 2014. Clinic staff reused saline vials for >1 patient. No infection control breaches were identified at the compounding pharmacy that supplied the clinic. Patients seen in clinic through March 27, 2015, were encouraged to seek testing for HBV, HCV, and human immunodeficiency virus. The clinic switched to all single-dose medications and single-use intravenous flushes on March 27, 2015, and no further cases were identified. CONCLUSIONS This prolonged healthcare-associated outbreak of HBV and HCV was most likely related to breaches in injection safety. Providers should follow injection safety guidelines in all practice settings.
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Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol 2018; 40:1-17. [DOI: 10.1017/ice.2018.303] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Coyle JR, Goerge E, Kacynski K, Rodgers R, Raines P, Vail LS, Lowhim S. Hepatitis C Virus Infections Associated with Unsafe Injection Practices at a Pain Management Clinic, Michigan, 2014-2015. PAIN MEDICINE 2018; 18:322-329. [PMID: 28204717 DOI: 10.1093/pm/pnw157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background In 2015, the Michigan Department of Health and Human Services (MDHHS) was notified of an acute case of hepatitis C virus (HCV). The patient had no traditional HCV risk factors. The only known subcutaneous exposure was health care received at a pain management clinic. Design A field investigation was undertaken to determine the likely route of HCV acquisition and assess potential risk to other patients. Setting and Patients The investigation involved a free-standing outpatient pain management clinic and its patients with a subcutaneous exposure. Methods Investigators utilized the Centers for Disease Control and Prevention’s (CDC) viral hepatitis health care-associated infection investigation protocol to guide field investigation, assess risk to patients, perform patient notification, and test patients for blood-borne pathogens. Results The index case was found to be the final patient seen in the clinic’s operating room for the week. Examining the MDHHS viral hepatitis registry revealed another acute HCV patient seen immediately before the index case. The second acute case was preceded by a patient chronically infected with HCV. Due to the possibility of patient-to-patient HCV transmission, 122 patients were recommended to be tested for blood-borne pathogens. Ninety-two patients presented for testing. No additional transmission events were discovered. Conclusion Health care-associated transmission of HCV likely occurred at an outpatient pain management clinic; possibly the result of multiple patient use of single-dose vials. Because no other cases were discovered this may represent an isolated incident as opposed to a systematic breakdown in infection control standards. This circumstance highlights the need for continued vigilance and adherence to CDC’s Minimum Expectations for Safe Care in Outpatient Settings.
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Affiliation(s)
- Joseph R Coyle
- Michigan Department of Health and Human Services, Communicable Disease Division, Bureau of Disease Control and Prevention, Lansing, Michigan, USA
| | - Emily Goerge
- Michigan Department of Health and Human Services, Communicable Disease Division, Bureau of Disease Control and Prevention, Lansing, Michigan, USA
| | | | - Ruby Rodgers
- Ingham County Health Department, Lansing, Michigan, USA
| | | | - Linda S Vail
- Ingham County Health Department, Lansing, Michigan, USA
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Tai E, Guy GP, Dunbar A, Richardson LC. Cost of Cancer-Related Neutropenia or Fever Hospitalizations, United States, 2012. J Oncol Pract 2017; 13:e552-e561. [PMID: 28437150 DOI: 10.1200/jop.2016.019588] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Neutropenia and subsequent infections are life-threatening treatment-related toxicities of chemotherapy. Among patients with cancer, hospitalizations related to neutropenic complications result in substantial medical costs, morbidity, and mortality. Previous estimates for the cost of cancer-related neutropenia hospitalizations are based on older and limited data. This study provides nationally representative estimates of the cost of cancer-related neutropenia hospitalizations. METHODS We examined data from the 2012 National Inpatient Sample and Kids' Inpatient Database. Hospitalizations for cancer-related neutropenia were defined as those with a primary or secondary diagnosis of cancer and a diagnosis of neutropenia or a fever of unknown origin. We examined characteristics of cancer-related neutropenia hospitalizations among children (age < 18 years) and adults (age ≥ 18 years). Adjusted predicted margins were used to estimate length of stay and cost per stay. RESULTS There were 91,560 and 16,859 cancer-related neutropenia hospitalizations among adults and children, respectively. Total cost of cancer-related neutropenia hospitalizations was $2.3 billion for adults and $439 million for children. Cancer-related neutropenia hospitalizations accounted for 5.2% of all cancer-related hospitalizations and 8.3% of all cancer-related hospitalization costs. For adults, the mean length of stay for cancer-related neutropenia hospitalizations was 9.6 days, with a mean hospital cost of $24,770 per stay. For children, the mean length of stay for cancer-related neutropenia hospitalizations was 8.5 days, with a mean hospital cost of $26,000 per stay. CONCLUSION We found the costs of cancer-related neutropenia hospitalizations to be substantially high. Efforts to prevent and minimize neutropenia-related complications among patients with cancer may decrease hospitalizations and associated costs.
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Affiliation(s)
- Eric Tai
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Gery P Guy
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Angela Dunbar
- Centers for Disease Control and Prevention, Atlanta, GA
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Yablon BR, Dantes R, Tsai V, Lim R, Moulton-Meissner H, Arduino M, Jensen B, Patel MT, Vernon MO, Grant-Greene Y, Christiansen D, Conover C, Kallen A, Guh AY. Outbreak of Pantoea agglomerans Bloodstream Infections at an Oncology Clinic-Illinois, 2012-2013. Infect Control Hosp Epidemiol 2017; 38:314-319. [PMID: 27919308 PMCID: PMC6489440 DOI: 10.1017/ice.2016.265] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections. DESIGN Epidemiologic investigation of the outbreak. SETTING Oncology clinic (clinic A). METHODS Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012-May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility's water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis. RESULTS Twelve cases were identified; median (range) age was 65 (41-78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates. CONCLUSIONS Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed. Infect Control Hosp Epidemiol 2017;38:314-319.
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Affiliation(s)
- Brian R. Yablon
- Centers for Disease Control and Prevention (CDC), Epidemic Intelligence Service Program, Atlanta, Georgia
| | - Raymund Dantes
- Centers for Disease Control and Prevention (CDC), Epidemic Intelligence Service Program, Atlanta, Georgia
- CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
| | - Victoria Tsai
- Illinois Department of Public Health, Chicago, Illinois
- Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Altanta, Georgia
| | - Rachel Lim
- West Suburban Medical Center, Oak Park, Illinois
| | | | - Matthew Arduino
- CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
| | - Bette Jensen
- CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
| | | | | | - Yoran Grant-Greene
- Centers for Disease Control and Prevention (CDC), Epidemic Intelligence Service Program, Atlanta, Georgia
- Illinois Department of Public Health, Chicago, Illinois
| | | | - Craig Conover
- Illinois Department of Public Health, Chicago, Illinois
| | | | - Alice Y. Guh
- CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
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van den Heever A, Scribante J, Perrie H, Lowman W. Microbial contamination and labelling of self-prepared, multi-dose phenylephrine solutions used at a teaching hospital. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2016. [DOI: 10.1080/22201181.2016.1251062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Thompson D, Bowdey L, Brett M, Cheek J. Using medical student observers of infection prevention, hand hygiene, and injection safety in outpatient settings: A cross-sectional survey. Am J Infect Control 2016; 44:374-80. [PMID: 26804308 DOI: 10.1016/j.ajic.2015.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Health care-associated infection outbreaks have occurred in outpatient settings due to lapses in infection prevention. However, little is known about the overall infection prevention status in outpatient environments. METHODS A cross-sectional design was employed to assess infection prevention policies and practices at 15 outpatient sites across New Mexico in 2014 during a medical student outpatient rotation. A standardized infection prevention checklist was completed via staff interview; observations of injection safety practices and hand hygiene behavior were conducted. Aggregate data were analyzed using Excel (Microsoft, Redmond, WA) and Stata (version 12.1, Stata Corp, College Station, TX) statistical software. RESULTS Medical practice staff interviews reported a mean of 92.8% (median, 96.7%; range, 75.0%-98.9%) presence of recommended policies and practices. One hundred sixty-three injection safety observations were performed that revealed medication vial rubber septums were disinfected with alcohol 78.4% (95% confidence interval [CI], 71.1%-84.7%) of the time before piercing. Three hundred thirty hand hygiene observations revealed 33.9% (95% CI, 28.8%-39.1%) use of alcohol-based handrub, 29.1% (95% CI, 24.2%-34.0%) use of soap and water, and 37.0% (95% CI, 31.8%-42.4%) use of no hand hygiene. DISCUSSION AND CONCLUSION These findings support the need for ongoing infection prevention quality improvement initiatives in outpatient settings and underscore the importance of assessing both self-report and observed behavior of infection prevention compliance.
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Garrett JH. A Review of the CDC Recommendations for Prevention of HAIs in Outpatient Settings. AORN J 2016; 101:519-25; quiz 526-8. [PMID: 25946178 DOI: 10.1016/j.aorn.2015.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/11/2015] [Accepted: 02/18/2015] [Indexed: 11/29/2022]
Abstract
According to the Centers for Disease Control and Prevention (CDC), most health care-associated infections (HAIs) are caused by contamination from the hands of health care providers or patients, contamination from the environment, and contamination from the patient's own skin. To mitigate common sources of infection transmission, frontline health care providers must be compliant with basic infection-prevention interventions, including hand hygiene, environmental cleaning and disinfection, safe injection practices, and designation of a trained health care professional to be responsible for the infection prevention and control program. Integration of CDC recommendations should incorporate a bundled approach to these interventions and should be part of a comprehensive approach to infection prevention and control. Effective infection-prevention practices in outpatient settings are critical for reducing the risk of infection transmission, improving patient safety and patient outcomes, and reducing costs associated with health care delivery.
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Iqbal K, Klevens RM, Kainer MA, Baumgartner J, Gerard K, Poissant T, Sweet K, Vonderwahl C, Knickerbocker T, Khudyakov Y, Xia GL, Roberts H, Teshale E. Epidemiology of Acute Hepatitis B in the United States From Population-Based Surveillance, 2006-2011. Clin Infect Dis 2015; 61:584-92. [PMID: 25904365 DOI: 10.1093/cid/civ332] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 04/15/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND An estimated 20 000 new hepatitis B virus (HBV) infections occur each year in the United States. We describe the results of enhanced surveillance for acute hepatitis B at 7 federally funded sites over a 6-year period. METHODS Health departments in Colorado, Connecticut, Minnesota, Oregon, Tennessee, 34 counties in New York state, and New York City were supported to conduct enhanced, population-based surveillance for acute HBV from 2006 through 2011. Demographic and risk factor data were collected on symptomatic cases using a standardized form. Serum samples from a subset of cases were also obtained for molecular analysis. RESULTS In the 6-year period, 2220 acute hepatitis B cases were reported from the 7 sites. For all sites combined, the incidence rate of HBV infection declined by 19%, but in Tennessee incidence increased by 90%, mainly among persons of white race/ethnicity and those aged 40-49 years. Of all reported cases, 66.1% were male, 57.1% were white, 58.4% were aged 30-49 years, and 60.1% were born in the United States. The most common risk factor identified was any drug use, notably in Tennessee; healthcare exposure was also frequently reported. The most common genotype for all reported cases was HBV genotype A (82%). CONCLUSIONS Despite an overall decline in HBV infection, attributable to successful vaccination programs, a rise in incident HBV infection related to drug use is an increasing concern in some localities.
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Affiliation(s)
- Kashif Iqbal
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R Monina Klevens
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | - Yury Khudyakov
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Guo-Liang Xia
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry Roberts
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eyasu Teshale
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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See I, Nguyen DB, Chatterjee S, Shwe T, Scott M, Ibrahim S, Moulton-Meissner H, McNulty S, Noble-Wang J, Price C, Schramm K, Bixler D, Guh AY. Outbreak of Tsukamurella species bloodstream infection among patients at an oncology clinic, West Virginia, 2011-2012. Infect Control Hosp Epidemiol 2015; 35:300-6. [PMID: 24521597 DOI: 10.1086/675282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility. DESIGN Epidemiologic investigation of the outbreak with a case-control study. METHODS A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed. RESULTS Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September-October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy. CONCLUSION Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.
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Affiliation(s)
- Isaac See
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kliner M, Dardamissis E, Abraham KA, Sen R, Lal P, Pandya B, Mutton KJ, Wong C. Identification, investigation and management of patient-to-patient hepatitis B transmission within an inpatient renal ward in North West England. Clin Kidney J 2015; 8:102-6. [PMID: 25713718 PMCID: PMC4310432 DOI: 10.1093/ckj/sfu130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Transmission of hepatitis B virus (HBV) is rare within healthcare settings in developed countries. The aim of the article is to outline the process of identification and management of transmission of acute hepatitis B in a renal inpatient ward. METHODS The case was identified through routine reporting to public health specialists, and epidemiological, virological and environmental assessment was undertaken to investigate the source of infection. An audit of HBV vaccination in patients with chronic kidney disease was undertaken. RESULTS Investigations identified inpatient admission to a renal ward as the only risk factor and confirmed a source patient with clear epidemiological, virological and environmental links to the case. Multiple failures in infection control leading to a contaminated environment and blood glucose testing equipment, failure to isolate a non-compliant, high-risk patient and incomplete vaccination for patients with chronic kidney disease may have contributed to the transmission. CONCLUSIONS Patient-to-patient transmission of hepatitis B was shown to have occurred in a renal ward in the UK, due to multiple failures in infection control. A number of policy changes led to improvements in infection control, including reducing multi-function use of wards, developing policies for non-compliant patients, improving cleaning policies and implementing competency assessment for glucometer use and decontamination. HBV vaccination of renal patients may prevent patient-to-patient transmission of HBV. Consistent national guidance should be available, and clear pathways should be in place between primary and secondary care to ensure appropriate hepatitis B vaccination and follow-up testing.
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Affiliation(s)
- Merav Kliner
- Cheshire and Mersey Health Protection Team, Public Health England, Liverpool, UK
| | - Evdokia Dardamissis
- Cheshire and Mersey Health Protection Team, Public Health England, Liverpool, UK
| | - K. Abraham Abraham
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
| | - Rachel Sen
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
| | - Pankaj Lal
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
| | - Bhavna Pandya
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
| | | | - Christopher Wong
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
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Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center. Am J Infect Control 2014; 42:731-4. [PMID: 24969124 DOI: 10.1016/j.ajic.2014.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Four patients were hospitalized July 2011 with Pseudomonas aeruginosa bloodstream infection (BSI), 2 of whom also had Klebsiella pneumoniae BSI. All 4 patients had an indwelling port and received infusion services at the same outpatient oncology center. METHODS Cases were defined by blood or port cultures positive for K pneumoniae or P aeruginosa among patients receiving infusion services at the oncology clinic during July 5-20, 2011. Pulsed-field gel electrophoresis (PFGE) was performed on available isolates. Interviews with staff and onsite investigations identified lapses of infection control practices. Owing to concerns over long-standing deficits, living patients who had been seen at the clinic between January 2008 and July 2011 were notified for viral blood-borne pathogen (BBP) testing; genetic relatedness was determined by molecular testing. RESULTS Fourteen cases (17%) were identified among 84 active clinic patients, 12 of which involved symptoms of a BSI. One other patient had a respiratory culture positive for P aeruginosa but died before blood cultures were obtained. Available isolates were indistinguishable by PFGE. Multiple injection safety lapses were identified, including overt syringe reuse among patients and reuse of syringes to access shared medications. Available BBP results did not demonstrate iatrogenic viral infection in 331 of 623 notified patients (53%). CONCLUSIONS Improper preparation and handling of injectable medications likely caused the outbreak. Increased infection control oversight of oncology clinics is critical to prevent similar outbreaks.
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Klevens RM, Liu S, Roberts H, Jiles RB, Holmberg SD. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health 2014; 104:482-7. [PMID: 24432918 PMCID: PMC3953761 DOI: 10.2105/ajph.2013.301601] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2013] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Because only a fraction of patients with acute viral hepatitis A, B, and C are reported through national surveillance to the Centers for Disease Control and Prevention, we estimated the true numbers. METHODS We applied a simple probabilistic model to estimate the fraction of patients with acute hepatitis A, hepatitis B, and hepatitis C who would have been symptomatic, would have sought health care tests, and would have been reported to health officials in 2011. RESULTS For hepatitis A, the frequencies of symptoms (85%), care seeking (88%), and reporting (69%) yielded an estimate of 2730 infections (2.0 infections per reported case). For hepatitis B, the frequencies of symptoms (39%), care seeking (88%), and reporting (45%) indicated 18 730 infections (6.5 infections per reported case). For hepatitis C, the frequency of symptoms among injection drug users (13%) and those infected otherwise (48%), proportion seeking care (88%), and percentage reported (53%) indicated 17 100 infections (12.3 infections per reported case). CONCLUSIONS These adjustment factors will allow state and local health authorities to estimate acute hepatitis infections locally and plan prevention activities accordingly.
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Affiliation(s)
- R Monina Klevens
- At the time of the study, all authors were with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STDs and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Leonard L, Timmins F. Remembering the importance of preventing blood-borne infections in the critical care setting. Nurs Crit Care 2013; 18:4-7. [PMID: 23289551 DOI: 10.1111/nicc.12008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Lenora Leonard
- Infection Prevention & Control Nurse Specialist, UPMC Beacon Hospital Dublin, Dublin, Ireland
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Perz JF, Grytdal S, Beck S, Fireteanu AM, Poissant T, Rizzo E, Bornschlegel K, Thomas A, Balter S, Miller J, Klevens RM, Finelli L. Case-control study of hepatitis B and hepatitis C in older adults: Do healthcare exposures contribute to burden of new infections? Hepatology 2013; 57:917-24. [PMID: 22383058 DOI: 10.1002/hep.25688] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 02/20/2012] [Indexed: 01/05/2023]
Abstract
UNLABELLED Reports of hepatitis B virus (HBV) and hepatitis C virus (HCV) transmission associated with unsafe medical practices have been increasing in the United States. However, the contribution of healthcare exposures to the burden of new infections is poorly understood outside of recognized outbreaks. We conducted a case-control study at three health departments that perform enhanced viral hepatitis surveillance in New York and Oregon. Reported cases of symptomatic acute hepatitis B and hepatitis C occurring in persons≥55 years of age from 2006 to 2008 were enrolled. Controls were identified using telephone directories and matched to individual cases by age group (55-59, 60-69, and ≥70 years) and residential postal code. Data collection covered exposures within 6 months before symptom onset (cases) or date of interview (controls). Forty-eight (37 hepatitis B and 11 hepatitis C) case and 159 control patients were enrolled. Case patients were more likely than controls to report one or more behavioral risk exposures, including sexual or household contact with an HBV or HCV patient, >1 sex partner, illicit drug use, or incarceration (21% of cases versus 4% of controls exposed; matched odds ratio [mOR]=7.1; 95% confidence interval [CI]: 2.1, 24.1). Case patients were more likely than controls to report hemodialysis (8% of cases; mOR=13.0; 95% CI: 1.5, 115), injections in a healthcare setting (58%; mOR=2.7; 95% CI: 1.3, 5.3), and surgery (33%; mOR=2.3; 95% CI: 1.1, 4.7). In a multivariate model, behavioral risks (adjusted OR [aOR]=5.4; 95% CI: 1.5, 19.0; 17% attributable risk), injections (aOR=2.7; 95% CI: 1.3, 5.8; 37% attributable risk), and hemodialysis (aOR=11.5; 95% CI: 1.2, 107; 8% attributable risk) were associated with case status. CONCLUSION Healthcare exposures may represent an important source of new HBV and HCV infections among older adults.
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Affiliation(s)
- Joseph F Perz
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Patient notification for bloodborne pathogen testing due to unsafe injection practices in the US health care settings, 2001-2011. Med Care 2012; 50:785-91. [PMID: 22525612 DOI: 10.1097/mlr.0b013e31825517d4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syringe reuse and other unsafe injection practices can expose patients to bloodborne pathogens (eg, hepatitis B and C viruses and human immunodeficiency virus). Evidence of such infection control lapses has resulted in patient notifications, but the scope and magnitude of these events have not been well characterized. OBJECTIVES To summarize patient notification events resulting from unsafe injection practices in the US health care settings. METHODS We examined records of events that involved communications to groups of patients, conducted during 2001-2011, advising bloodborne pathogen testing stemming from potential exposures to unsafe injection practices. RESULTS We identified 35 patient notification events related to unsafe injection practices in at least 17 states, resulting in an estimated total of 130,198 patients notified. Among the identified notification events, 83% involved outpatient settings and 74% occurred since 2007, including the 4 largest events (>5000 patients per event). The primary breach identified (≥16 events; 44%) was syringe reuse to access shared medications (eg, single-dose or multidose vials). Twenty-two (63%) notifications stemmed from the identification of viral hepatitis transmission, whereas 13 (37%) were prompted by the discovery of unsafe injection practices, absent evidence of bloodborne pathogen transmission. CONCLUSIONS Unsafe injection practices represent a form of medical error that have manifested as large-scale adverse events, affecting thousands of patients in a wide variety of health care settings. Our findings suggest that increased oversight and attention to basic infection control are needed to maintain patient safety, along with research to identify best practices for triggering and managing patient notifications.
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Abstract
BACKGROUND Unsafe injection practices in health-care settings often result in notification of potentially affected patients, to disclose the error and recommend blood-borne pathogens testing. Few studies have assessed public perceptions and preferences for patient notification. METHODS Six focus groups were conducted during Fall 2009, with residents of Atlanta, GA, and New York City, NY. Questions focused on preferences for receiving health information, knowledge of safe injection practices, and responses to and preferences for a patient notification letter. A mixed-method analysis was performed for qualitative themes and descriptive statistics. RESULTS A total of 53 individuals participated; only 2 had ever heard of the term safe injection practices. After identification of unsafe injection practices, participants preferred to be notified via telephone, letter/mailing, email, or face-to-face from the facility where the incident occurred. More than 25 different types of information were mentioned as elements to be placed in a patient notification letter including: corrective actions by the facility, course of action for the patient, assurance of medical coverage, and how it happened/reason for the incident. Participants preferred that the tone of the letter be empathetic; nearly all indicated it was "very likely" that they would seek testing if notified. CONCLUSIONS Facilities and health departments should strive to assure the notification process is conducted swiftly, clearly guiding affected patients to the necessary course of action. Notification letters are not "one size fits all," and some preferences expressed by patients may not be feasible in all situations. Prevention efforts should be complemented by research on improving effective patient communications when unsafe injection practices necessitate patient notification.
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