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Boulesnam SL, Hamaidi-Chergui F, Benamara M, Azrou S. Phenotypical Comparison between Environmental and Clinical Acinetobacter baumannii Strains Isolated from an Intensive Care Unit. Malays J Med Sci 2023; 30:85-93. [PMID: 37655144 PMCID: PMC10467598 DOI: 10.21315/mjms2023.30.4.8] [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: 07/29/2022] [Accepted: 12/05/2022] [Indexed: 09/02/2023] Open
Abstract
Background Acinetobacter baumannii (A. baumannii) causes a variety of nosocomial infections that mainly affect critically ill patients in intensive care units (ICUs). The objective of this study was to assess the prevalence of A. baumannii in the ICU environment and evaluate the antibiotic resistance and biofilm formation ability of the environmental isolates compared to those isolated from ICU patients simultaneously. Methods A total of 166 non-duplicate ICU samples (80 environmental and 86 clinical) were collected between January 2019 and January 2020. Antimicrobial susceptibility detection was determined using the disc diffusion method, and the strains were evaluated for the minimum inhibitory concentration (MIC) of imipenem (IMP) using broth microdilution or metallo-β-lactamase (MBL) detection according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The isolates' capacity to produce biofilms was evaluated using the tube method and the crystal violet microtitre plate-based method. Results A. baumannii was identified in 25 (31.25%) environmental and 30 (34.88%) clinical samples, and beds were the most infected (60%). Both types of isolate demonstrated a rate surpassing 80% resistance to the tested antibiotics. Phenotypically, the environmental and clinical strains were found to be MBL producers. Fourteen environmental (56%) and 15 clinical (50%) strains were found to be moderate biofilm producers, indicating that each isolate has a high biofilm-forming capacity. Conclusion These results show that the spread of multidrug-resistant (MDR) A. baumannii in an ICU setting emphasises the necessity of disinfecting and cleaning medical devices and surfaces to prevent and restrict cross-transmission. Intensive surveillance and infection control methods are also of paramount importance.
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Affiliation(s)
- Saliha Lydia Boulesnam
- Biotechnology, Environment and Health Laboratory, Biology Department, Blida 1 University, Algeria
| | - Fella Hamaidi-Chergui
- Biotechnology, Environment and Health Laboratory, Biology Department, Blida 1 University, Algeria
| | | | - Sihem Azrou
- Microbiology Laboratory, Faculty of Pharmacy of Algiers, Algeria
- Central Laboratory, Beni Messous EPH, Algeria
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Jiang Y, Ding Y, Wei Y, Jian C, Liu J, Zeng Z. Carbapenem-resistant Acinetobacter baumannii: A challenge in the intensive care unit. Front Microbiol 2022; 13:1045206. [PMID: 36439795 PMCID: PMC9684325 DOI: 10.3389/fmicb.2022.1045206] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/24/2022] [Indexed: 07/30/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) has become one of the leading causes of healthcare-associated infections globally, particularly in intensive care units (ICUs). Cross-transmission of microorganisms between patients and the hospital environment may play a crucial role in ICU-acquired CRAB colonization and infection. The control and treatment of CRAB infection in ICUs have been recognized as a global challenge because of its multiple-drug resistance. The main concern is that CRAB infections can be disastrous for ICU patients if currently existing limited therapeutic alternatives fail in the future. Therefore, the colonization, infection, transmission, and resistance mechanisms of CRAB in ICUs need to be systematically studied. To provide a basis for prevention and control countermeasures for CRAB infection in ICUs, we present an overview of research on CRAB in ICUs, summarize clinical infections and environmental reservoirs, discuss the drug resistance mechanism and homology of CRAB in ICUs, and evaluate contemporary treatment and control strategies.
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Gastrointestinal Colonization of Carbapenem-Resistant Acinetobacter baumannii: What Is the Implication for Infection Control? Antibiotics (Basel) 2022; 11:antibiotics11101297. [PMID: 36289955 PMCID: PMC9598245 DOI: 10.3390/antibiotics11101297] [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: 09/09/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
The epidemiology of patients with gastrointestinal colonization of carbapenem-resistant Acinetobacter baumannii (CRAB) has not been systematically analyzed. We aimed to analyze the incidence, risk factors, and clinical outcomes of patients with newly identified gastrointestinal colonization of CRAB in a healthcare region in Hong Kong, where a multi-pronged screening strategy for gastrointestinal colonization of CRAB, together with other multidrug-resistant organisms (MDROs), was conducted by collecting fecal specimens (rectal swab or stool) upon admission and during hospitalization. From 1 October 2015 to 31 December 2019, a total of 161,339 fecal specimens from 63,588 patients, 61,856 (97.3%) of whom were hospitalized patients, and 54,525 (88.1%) were screened upon admission, with 1309 positive for CRAB (2.4% prevalence). Among patients positive for CRAB in fecal specimens, 698 (53.3%) had newly detected gastrointestinal colonization of CRAB, giving an incidence of 10.03 per 10,000 patient admissions and constituting 2646 CRAB colonization days in the general wards. Excluding the 164 patients with co-colonization of other MDROs, 534 patients had gastrointestinal colonization with only CRAB, and 12.5% (67/534) developed symptomatic CRAB infections at a median of 61 days (range: 2 to 671 days), during prospective follow-up for 2 years. Compared with age- and sex-matched controls, patients being referred from residential care homes for the elderly, the presence of indwelling devices, use of beta-lactam/beta-lactamase inhibitors, carbapenems, and proton pump inhibitors in the preceding 6 months, and history of hospitalization in the past 6 months were significantly associated with gastrointestinal colonization with CRAB, as shown by multivariable analysis. Log-rank test showed that cases had significantly shorter survival duration than controls (p < 0.001). The adjusted hazard ratio of gastrointestinal colonization of CRAB was 1.8 (95% CI: 1.5−2.2; p < 0.001), as shown by Cox regression analysis. Whole-genome sequencing of eight patients with CRAB isolates in their blood cultures and rectal swabs during the same episode of hospitalization revealed ST-195 as the predominant type, as shown by multilocus sequencing type. Gastrointestinal colonization of CRAB poses a considerable challenge for infection prevention and control.
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Castelli A, Norville P, Kiernan M, Maillard JY, Evans SL. Review of decontamination protocols for shared non-critical objects in 35 policies of UK NHS Acute Care Organisations. J Hosp Infect 2021; 120:65-72. [PMID: 34767870 DOI: 10.1016/j.jhin.2021.10.021] [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: 08/17/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decontamination of non-critical objects shared by patients is key in reducing HAIs, but it is a complex process that needs precise guidance from UK NHS Acute Care Organisations (ACOs). AIM To review the indications given by NHS ACOs' policies regarding the decontamination of shared non-critical devices. METHODS Detailed lists of decontamination protocols for shared non-critical objects were retrieved from cleaning, disinfection, and decontamination policies of 35 NHS ACOs. Three parameters were considered for each object: decontamination method, decontamination frequency and person responsible for decontamination. FINDINGS 1279 decontamination protocols regarding 283 different shared non-critical objects were retrieved. 689 (54%) did not indicate the person responsible for decontamination, while only 425 (33%), were complete, giving indications for all three parameters analysed. Only 2.5% (32/1279) decontamination protocols were complete and identical in two policies. In policies where cleaning represented the major decontamination method, chemical disinfection was rarely mentioned and vice versa. A general agreement among policies can be found for four main decontamination methods (detergent and water, detergent wipes, disinfectant wipes, use of disposable items), two decontamination frequencies (between events, daily) and two responsible person designations (nurses, domestic staff). CONCLUSIONS Decontamination protocol policies for shared non-critical objects had some similarities but did not concur on how each individual object should be decontaminated. The lack of clear indications regarding the person responsible for the decontamination process put at risk the ability of policies to serve as guidance.
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Affiliation(s)
- Andrea Castelli
- School of Engineering, Cardiff University, Cardiff, Wales, UK; School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; Fellows Research Centre, GAMA Healthcare Ltd., Halifax, UK
| | - Phillip Norville
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; Fellows Research Centre, GAMA Healthcare Ltd., Halifax, UK
| | - Martin Kiernan
- Fellows Research Centre, GAMA Healthcare Ltd., Halifax, UK; School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia; Richard Wells Research Centre, University of West London, Brentford, UK
| | - Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
| | - Sam L Evans
- School of Engineering, Cardiff University, Cardiff, Wales, UK.
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A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associated C. difficile and multidrug-resistant organisms. Infect Control Hosp Epidemiol 2021; 41:691-709. [PMID: 32216852 DOI: 10.1017/ice.2020.45] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cohorting of patients and staff is a control strategy often used to prevent the spread of infection in healthcare institutions. However, a comprehensive evaluation of cohorting as a prevention approach is lacking. METHODS We performed a systematic review of studies that used cohorting as part of an infection control strategy to reduce hospital-acquired infections. We included studies published between 1966 and November 30, 2019, on adult populations hospitalized in acute-care hospitals. RESULTS In total, 87 studies met inclusion criteria. Study types were quasi-experimental "before and after" (n = 35), retrospective (n = 49), and prospective (n = 3). Case-control analysis was performed in 7 studies. Cohorting was performed with other infection control strategies in the setting of methicillin-resistant Staphylococcus aureus (MRSA, n = 22), Clostridioides difficile infection (CDI, n = 6), vancomycin-resistant Enterococcus (VRE, n = 17), carbapenem-resistant Enterobacteriaceae infections (CRE, n = 22), A. baumannii (n = 15), and other gram-negative infections (n = 5). Cohorting was performed either simultaneously (56 of 87, 64.4%) or in phases (31 of 87, 35.6%) to help contain transmission. In 60 studies, both patients and staff were cohorted. Most studies (77 of 87, 88.5%) showed a decline in infection or colonization rates after a multifaceted approach that included cohorting as part of the intervention bundle. Hand hygiene compliance improved in approximately half of the studies (8 of 15) during the respective intervention. CONCLUSION Cohorting of staff, patients, or both is a frequently used and reasonable component of an enhanced infection control strategy. However, determining the effectiveness of cohorting as a strategy to reduce transmission of MDRO and C. difficile infections is difficult, particularly in endemic situations.
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Reynier T, Berahou M, Albaladejo P, Beloeil H. Moving towards green anaesthesia: Are patient safety and environmentally friendly practices compatible? A focus on single-use devices. Anaesth Crit Care Pain Med 2021; 40:100907. [PMID: 34153533 DOI: 10.1016/j.accpm.2021.100907] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Discuss if the use of disposable or reusable medical devices leads to a difference in terms of hospital-acquired infection or bacterial contamination. Determine which solution is less expensive and has less environmental impact in terms of carbon footprint, energy and water consumption and amount of waste. METHODS We carried out a narrative review. Articles published in English and French from January 2000 to April 2020 were identified from PubMed. RESULTS We retrieved 81 articles, including 12 randomised controlled trial, 21 literature reviews, 13 descriptive studies, 6 experimental studies, 9 life-cycle studies, 6 cohort studies, 2 meta-analysis, 4 case reports and 8 other studies. It appears that pathogen transmission in the anaesthesia work area is mainly due to the lack of hand hygiene among the anaesthesia team. The benefit of single-use devices on infectious risk is based on weak scientific arguments, while reusable devices have benefits in terms of costs, water consumption, energy consumption, waste, and reducing greenhouse gas emissions. CONCLUSION Disposable medical devices and attire in the operating theatre do not mitigate the infectious risk to the patients but have a greater environmental, financial and social impact than the reusable ones. This study is the first step towards recommendations for more environmental-friendly practices in the operating theatre.
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Affiliation(s)
- Thibault Reynier
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France
| | - Mathilde Berahou
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
| | - Pierre Albaladejo
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France.
| | - Hélène Beloeil
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
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Dancer SJ, King MF. Systematic review on use, cost and clinical efficacy of automated decontamination devices. Antimicrob Resist Infect Control 2021; 10:34. [PMID: 33579386 PMCID: PMC7881692 DOI: 10.1186/s13756-021-00894-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/21/2021] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND More evidence is emerging on the role of surface decontamination for reducing hospital-acquired infection (HAI). Timely and adequate removal of environmental pathogens leads to measurable clinical benefit in both routine and outbreak situations. OBJECTIVES This systematic review aimed to evaluate published studies describing the effect of automated technologies delivering hydrogen peroxide (H202) or ultra-violet (UV) light on HAI rates. METHODS A systematic review was performed using relevant search terms. Databases were scanned from January 2005 to March 2020 for studies reporting clinical outcome after use of automated devices on healthcare surfaces. Information collected included device type, overall findings; hospital and ward data; study location, length and size; antimicrobial consumption; domestic monitoring; and infection control interventions. Study sponsorship and duplicate publications were also noted. RESULTS While there are clear benefits from non-touch devices in vitro, we found insufficient objective assessment of patient outcome due to the before-and-after nature of 36 of 43 (84%) studies. Of 43 studies, 20 (47%) used hydrogen peroxide (14 for outbreaks) and 23 (53%) used UV technology (none for outbreaks). The most popular pathogen targeted, either alone or in combination with others, was Clostridium difficile (27 of 43 studies: 63%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (16 of 43: 37%). Many owed funding and/or personnel to industry sponsorship (28 of 43: 65%) and most were confounded by concurrent infection control, antimicrobial stewardship and/or cleaning audit initiatives. Few contained data on device costs and rarely on comparable costs (1 of 43: 2%). There were expected relationships between the country hosting the study and location of device companies. None mentioned the potential for environmental damage, including effects on microbial survivors. CONCLUSION There were mixed results for patient benefit from this review of automated devices using H202 or UV for surface decontamination. Most non-outbreak studies lacked an appropriate control group and were potentially compromised by industry sponsorship. Concern over HAI encourages delivery of powerful disinfectants for eliminating pathogens without appreciating toxicity or cost benefit. Routine use of these devices requires justification from standardized and controlled studies to understand how best to manage contaminated healthcare environments.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS, Lanarkshire, G75 8RG, Scotland, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK.
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Soohoo J, Daniels JB, Brault SA, Rosychuk RAW, Schissler JR. Efficacy of three disinfectant formulations and a hydrogen peroxide/silver fogging system on surfaces experimentally inoculated with meticillin-resistant Staphylococcus pseudintermedius. Vet Dermatol 2020; 31:350-e91. [PMID: 32310324 DOI: 10.1111/vde.12858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/08/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective environmental disinfection is necessary to prevent nosocomial infections from meticillin-resistant Staphylococcus pseudintermedius (MRSP). However, there are currently no commercial disinfectant sprays or fogging systems with label claims against MRSP. HYPOTHESIS/OBJECTIVES To evaluate the efficacy of a quaternary ammonium product (QAC), an accelerated hydrogen peroxide product (AHP), a hydrogen peroxide and silver product (HAL), and a hydrogen peroxide and silver fogging system (FOG) against MRSP. METHODS AND MATERIALS Sterile plastic surfaces inoculated with MRSP were treated with 200 µL of QAC, AHP or HAL for the recommended contact times. For FOG, inoculated samples were placed in eight positions within a sealed room before fogging for the recommended contact time. Post-treatment bacterial counts were compared to untreated positive controls. Sterile uninoculated surfaces served as negative controls. RESULTS Least-squares mean reduction (log10 ) in colony forming units (cfu) was 3.55 log10 for QAC (P < 0.0001), 3.60 log10 for AHP (P < 0.0001), 1.66 log10 for HAL (P < 0.0001) and 0.32 log10 for FOG (P = 0.004). QAC, AHP and HAL reduced MRSP cfu by 99.97%, 99.98% and 97.81%, respectively. FOG reduced cfu by 52.14%. CONCLUSIONS AND CLINICAL IMPORTANCE QAC and AHP effectively disinfected surfaces inoculated with MRSP. Although HAL provided lower MRSP reduction, it may be considered clinically acceptable. FOG as a sole means of MRSP disinfection was not supported yet may have utility as an adjunctive disinfectant in clinical areas with bacterial densities lower than our experimental inoculum.
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Affiliation(s)
- Julie Soohoo
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, 300 West Drake Road, Fort Collins, CO, 80523, USA
| | - Joshua B Daniels
- Department of Microbiology, Immunology and Pathology, Colorado State University College of Veterinary Medicine and Biomedical Sciences, 300 West Drake Road, Fort Collins, CO, 80523, USA
| | - Stephanie A Brault
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, 300 West Drake Road, Fort Collins, CO, 80523, USA
| | - Rod A W Rosychuk
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, 300 West Drake Road, Fort Collins, CO, 80523, USA
| | - Jennifer R Schissler
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, 300 West Drake Road, Fort Collins, CO, 80523, USA
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Role of Hydrogen Peroxide Vapor (HPV) for the Disinfection of Hospital Surfaces Contaminated by Multiresistant Bacteria. Pathogens 2020; 9:pathogens9050408. [PMID: 32456303 PMCID: PMC7281489 DOI: 10.3390/pathogens9050408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022] Open
Abstract
The emergence of multiresistant bacterial strains as agents of healthcare-related infection in hospitals has prompted a review of the control techniques, with an added emphasis on preventive measures, namely good clinical practices, antimicrobial stewardship, and appropriate environmental cleaning. The latter item is about the choice of an appropriate disinfectant as a critical role due to the difficulties often encountered in obtaining a complete eradication of environmental contaminations and reservoirs of pathogens. The present review is focused on the effectiveness of hydrogen peroxide vapor, among the new environmental disinfectants that have been adopted. The method is based on a critical review of the available literature on this topic.
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10
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Chia PY, Sengupta S, Kukreja A, S L Ponnampalavanar S, Ng OT, Marimuthu K. The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms. Antimicrob Resist Infect Control 2020; 9:29. [PMID: 32046775 PMCID: PMC7014667 DOI: 10.1186/s13756-020-0685-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
Infections by multidrug-resistant (MDR) Gram-negative organisms (GN) are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasing evidence supports the association between the healthcare environment and transmission of MDRGN to patients and healthcare workers. To better understand the role of the environment in transmission and acquisition of MDRGN, we conducted a utilitarian review based on literature published from 2014 until 2019.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Sharmila Sengupta
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore
| | | | | | - Oon Tek Ng
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore. .,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Rd, Singapore.
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11
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Zimmerman PA, Browne M, Rowland D. Instilling a culture of cleaning: Effectiveness of decontamination practices on non-disposable sphygmomanometer cuffs. J Infect Prev 2018; 19:294-299. [PMID: 38617881 PMCID: PMC11009562 DOI: 10.1177/1757177418780997] [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: 11/29/2017] [Accepted: 05/14/2018] [Indexed: 04/16/2024] Open
Abstract
Background Sphygmomanometers and their cuffs are non-critical items that can act as a fomite for transmission of pathogens which may cause healthcare-associated infection (HAI), leading to an argument that disposable equipment improves patient safety. Aim The aim of this study was to demonstrate that decontamination decreased in microbial contamination of non-disposable sphygmomanometer cuffs, providing evidence to negate the need to purchase, and dispose of, single-patient-use cuffs, reducing cost and environmental impact. Methods A pre-post intervention study of available sphygmomanometer cuffs and associated bedside patient monitors was conducted using a series of microbiological samples in a rural emergency department. A Wilcoxon signed-rank test analysed the effect of the decontamination intervention. To further examine the effect of the decontamination intervention, Mann-Whitney U-tests were conducted for each aspect. Findings Contamination was significantly higher before decontamination than afterwards (Z = -5.14, U = 55.0, P < 0.001, η2 = 0.61 inner; Z = -5.05, U = 53.5, P < 0.001, η2 = 0.59 outer). Discussion Decontamination of non-disposable sphygmomanometer cuffs decreases microbial load and risk of HAI, providing evidence to negate arguments for disposable cuffs while being environmentally sensitive and supportive of a culture of patient safety and infection control.
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Affiliation(s)
- Peta-Anne Zimmerman
- School of Nursing and Midwifery, Menzies Health Institute, Queensland
- Griffith University, Gold Coast, QLD, Australia
- Department of Infection Prevention and Control, Gold Coast Hospital and Health Service, QLD, Australia
| | | | - Dale Rowland
- First Peoples Health Unit, Griffith University, Gold Coast, QLD, Australia
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12
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Raro OHF, Gallo SW, Ferreira CAS, Oliveira SDD. Carbapenem-resistant Acinetobacter baumannii contamination in an intensive care unit. Rev Soc Bras Med Trop 2017; 50:167-172. [DOI: 10.1590/0037-8682-0329-2016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/08/2017] [Indexed: 11/22/2022] Open
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Bahador A, Raoofian R, Pourakbari B, Taheri M, Hashemizadeh Z, Hashemi FB. Genotypic and Antimicrobial Susceptibility of Carbapenem-resistant Acinetobacter baumannii: Analysis of is Aba Elements and bla OXA-23-like Genes Including a New Variant. Front Microbiol 2015; 6:1249. [PMID: 26617588 PMCID: PMC4643144 DOI: 10.3389/fmicb.2015.01249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/27/2015] [Indexed: 01/08/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CR-AB) causes serious nosocomial infections, especially in ICU wards of hospitals, worldwide. Expression of blaOXA genes is the chief mechanism of conferring carbapenem resistance among CR-AB. Although some blaOXA genes have been studied among CR-AB isolates from Iran, their blaOXA-23-like genes have not been investigated. We used a multiplex-PCR to detect Ambler class A, B, and D carbapenemases of 85 isolates, and determined that 34 harbored blaOXA-23-like genes. Amplified fragment length polymorphism (AFLP) genotyping, followed by DNA sequencing of blaOXA-23-like amplicons of CR-AB from each AFLP group was used to characterize their blaOXA-23-like genes. We also assessed the antimicrobial susceptibility pattern of CR-AB isolates, and tested whether they harbored insertion sequences ISAba1 and ISAba4. Sequence comparison with reference strain A. baumannii (NCTC12156) revealed five types of mutations in blaOXA-23-like genes; including one novel variant and four mutants that were already reported from China and the USA. All of the blaOXA-23-like genes mutations were associated with increased minimum inhibitory concentrations (MICs) against imipenem. ISAba1 and ISAba4 sequences were detected upstream of blaOXA-23 genes in 19 and 7% of isolates, respectively. The isolation of CR-AB with new blaOXA-23 mutations including some that have been reported from the USA and China highlights CR-AB pervasive distribution, which underscores the importance of concerted national and global efforts to control the spread of CR-AB isolates worldwide.
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Affiliation(s)
- Abbas Bahador
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences Tehran, Iran
| | - Reza Raoofian
- Legal Medicine Research Center, Legal Medicine Organization Tehran, Iran ; Innovative Medical Research Center, Islamic Azad University Mashhad, Iran
| | - Babak Pourakbari
- Pediatrics Infectious Disease Research Center, School of Medicine, Tehran University of Medical Sciences Tehran, Iran
| | - Mohammad Taheri
- Department of Microbiology and Virology, Shiraz University of Medical Sciences Shiraz, Iran
| | - Zahra Hashemizadeh
- Department of Microbiology and Virology, Shiraz University of Medical Sciences Shiraz, Iran
| | - Farhad B Hashemi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences Tehran, Iran
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Wong H, Eso K, Ip A, Jones J, Kwon Y, Powelson S, de Grood J, Geransar R, Santana M, Joffe AM, Taylor G, Missaghi B, Pearce C, Ghali WA, Conly J. Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review. Syst Rev 2015; 4:152. [PMID: 26546048 PMCID: PMC4636845 DOI: 10.1186/s13643-015-0131-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though often used to control outbreaks, the efficacy of ward closure is unclear. This systematic review sought to identify studies defining and describing ward closure in outbreak control and to determine impact of ward closure as an intervention on outbreak containment. METHODS We searched these databases with no language restrictions: MEDLINE, 1946 to 7 July 2014; EMBASE, 1974 to 7 July 2014; CINAHL, 1937 to 8 July 2014; and Cochrane Database of Systematic Reviews, 2005 to May 2014. We also searched the following: IndMED; LILACS; reference lists from retrieved articles; conference proceedings; and websites of the CDCP, the ICID, and the WHO. We included studies of patients hospitalized in acute care facilities; used ward closure as a control measure; used other control measures; and discussed control of the outbreak(s) under investigation. A component approach was used to assess study quality. RESULTS We included 97 English and non-English observational studies. None included a controlled comparison between ward closure and other interventions. We found that ward closure was often used as part of a bundle of interventions but could not determine its direct impact separate from all the other interventions whether used in parallel or in sequence with other interventions. We also found no universal definition of ward closure which was widely accepted. CONCLUSIONS With no published controlled studies identified, ward closure for control of outbreaks remains an intervention that is not evidence based and healthcare personnel will need to continue to balance the competing risks associated with its use, taking into consideration the nature of the outbreak, the type of pathogen and its virulence, mode of transmission, and the setting in which it occurs. Our review has identified a major research gap in this area.
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Affiliation(s)
- Holly Wong
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Katherine Eso
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Ada Ip
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Jessica Jones
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Yoojin Kwon
- Health Sciences Library, Libraries and Cultural Resources, University of Calgary, HSC 1450, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Susan Powelson
- Health Sciences Library, Libraries and Cultural Resources, University of Calgary, HSC 1450, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Jill de Grood
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Rose Geransar
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Maria Santana
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - A Mark Joffe
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2D3.05 WMC, Edmonton, Alberta, Canada, T6G 2B7
| | - Geoffrey Taylor
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2D3.05 WMC, Edmonton, Alberta, Canada, T6G 2B7
| | - Bayan Missaghi
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Craig Pearce
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9
| | - William A Ghali
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,O'Brien Institute for Public Health, 3280 Hospital Drive NW, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - John Conly
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9. .,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Snyder Institute for Chronic Diseases, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,O'Brien Institute for Public Health, 3280 Hospital Drive NW, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.
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15
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Touchless Technologies for Decontamination in the Hospital: a Review of Hydrogen Peroxide and UV Devices. Curr Infect Dis Rep 2015; 17:498. [DOI: 10.1007/s11908-015-0498-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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16
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Wiwanitkit V. Multidrug-resistant Acinetobacter baumanniiinfection in the intensive care unit. Korean J Anesthesiol 2014; 67:153. [PMID: 25237455 PMCID: PMC4166390 DOI: 10.4097/kjae.2014.67.2.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Viroj Wiwanitkit
- Department of Sanitation, Hainan Medical University, Haikou, China
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