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Houkes KMG, Stohr JJJM, Gast KB, Couderé K, Weterings V, Mutsaers - van Oudheusden A, Buiting AGM, Verweij JJ. A pseudo-outbreak of MRSA due to laboratory contamination related to MRSA carriage of a laboratory staff member. Antimicrob Resist Infect Control 2023; 12:1. [PMID: 36604672 PMCID: PMC9814305 DOI: 10.1186/s13756-022-01207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Methicillin resistant Staphylococcus aureus (MRSA) is a major burden for hospitals globally. However, in the Netherlands, the MRSA prevalence is relatively low due to the 'search and destroy' policy. Routine multiple-locus variable-number of tandem repeat analysis (MLVA) of MRSA isolates supports outbreak detection. However, whole genome multiple locus sequence typing (wgMLST) is superior to MLVA in identifying (pseudo-)outbreaks with MRSA. The present study describes a pseudo-outbreak of MRSA at the bacteriology laboratory of a large Dutch teaching hospital. METHODS All staff members of the bacteriology laboratory of the Elisabeth-TweeSteden hospital were screened for MRSA carriage, after a laboratory contamination with MRSA was suspected. Clonal relatedness between the index isolate and the MRSA isolates from laboratory staff members and all previous MRSA isolates from the Elisabeth-TweeSteden hospital with the same MLVA-type as the index case was examined based on wgMLST using whole genome sequencing. RESULTS One of the staff members was identified as the probable source of the laboratory contamination, because of carriage of a MRSA possessing the same MLVA-type as the index case. Eleven other isolates with the same molecular characteristics were found in the database, of which seven were retrospectively suspected of contamination. Clonal relatedness was found between ten isolates, including the isolate found in the staff member and the MRSA found in the index patient with a maximum of eleven alleles difference. All isolates were epidemiologically linked through the laboratory staff member, who had worked on all these cultures. CONCLUSIONS The present study describes a MRSA pseudo-outbreak over a 2.5-year period due to laboratory contamination caused by a MRSA carrying laboratory staff member involving nine patients. In case of unexpected bacteriological findings, the possibility of a laboratory contamination should be considered.
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Affiliation(s)
- Karlijn M. G. Houkes
- grid.416373.40000 0004 0472 8381Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Joep J. J. M. Stohr
- grid.416373.40000 0004 0472 8381Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Karin B. Gast
- grid.416373.40000 0004 0472 8381Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands ,grid.415868.60000 0004 0624 5690Present Address: Reinier de Graaf Hospital, Delft, The Netherlands
| | - Karen Couderé
- grid.416373.40000 0004 0472 8381Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Veronica Weterings
- grid.413711.10000 0004 4687 1426Department of Infection Prevention, Amphia Hospital, Breda, The Netherlands
| | - Anne Mutsaers - van Oudheusden
- grid.416373.40000 0004 0472 8381Department of Infection Prevention, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Anton G. M. Buiting
- grid.416373.40000 0004 0472 8381Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands ,grid.416373.40000 0004 0472 8381Department of Infection Prevention, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Jaco J. Verweij
- grid.416373.40000 0004 0472 8381Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
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Weterings V, van den Bijllaardt W, Bootsma M, Hendriks Y, Kilsdonk L, Mulders A, Kluytmans J. Duration of rectal colonization with extended-spectrum beta-lactamase-producing Escherichia coli: results of an open, dynamic cohort study in Dutch nursing home residents (2013–2019). Antimicrob Resist Infect Control 2022; 11:98. [PMID: 35841002 PMCID: PMC9287922 DOI: 10.1186/s13756-022-01132-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/28/2022] [Indexed: 11/26/2022] Open
Abstract
Background In 2016, a study in a Dutch nursing home showed prolonged colonization duration of extended-spectrum β-lactamase-producing (ESBL)-ST131 compared to ESBL-non-ST131. In this study, we assessed the duration of rectal ESBL-producing E. coli (ESBL-EC) colonization in residents in the same nursing home for an extended period of six years. We aimed to estimate the influence of a possible bias when follow up is started during an outbreak. Methods Between 2013 and 2019, repetitive point prevalence surveys were performed by culturing rectal or faecal swabs from all residents. Kaplan–Meier survival analysis was performed to calculate the median time to clearance of ESBL-EC with a log-rank analysis to test for differences between ESBL-ST131 and ESBL-non-ST131. Results The study showed a median time to clearance of 13.0 months (95% CI 0.0–27.9) for ESBL-ST131 compared to 11.2 months (95% CI 4.8–17.6) for ESBL-non-ST131 (p = 0.044). In the subgroup analysis of residents who were ESBL-EC positive in their first survey, the median time to clearance for ST131 was 59.7 months (95% CI 23.7–95.6) compared to 16.2 months (95% CI 2.1–30.4) for ESBL-non-ST131 (p = 0.036). In the subgroup analysis of residents who acquired ESBL-EC, the median time to clearance for ST131 was 7.2 months (95% CI 2.1–12.2) compared to 7.9 months (95% CI 0.0–18.3) for ESBL-non-ST131 (p = 0.718). The median time to clearance in the ESBL-ST131 group was significantly longer in residents who were ESBL-ST131 colonised upon entering the study than in residents who acquired ESBL-ST131 during the study (p = 0.001). Conclusion A prolonged colonization with ESBL-ST131 was only found in the subgroup who was ESBL-EC positive upon entering the study. The prolonged duration with ESBL-ST131 in the previous study was probably biased by factors that occured during (the start of) the outbreak. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01132-9.
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Verelst M, Willemsen I, Weterings V, De Waegemaeker P, Leroux-Roels I, Nieuwkoop E, Saegeman V, van Alphen L, van Kleef-van Koeveringe S, Kluytmans-van den Bergh M, Kluytmans J, Schuermans A. Implementation of the Infection Risk Scan (IRIS) in nine hospitals in the Belgian-Dutch border region (i-4-1-Health project). Antimicrob Resist Infect Control 2022; 11:43. [PMID: 35227333 PMCID: PMC8887653 DOI: 10.1186/s13756-022-01083-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background A tool, the Infection Risk Scan has been developed to measure the quality of infection control and antimicrobial use. This tool measures various patient-, ward- and care-related variables in a standardized way. We describe the implementation of this tool in nine hospitals in the Dutch/Belgian border area and the obtained results.
Methods The IRIS consists of a set of objective and reproducible measurements: patient comorbidities, (appropriate) use of indwelling medical devices, (appropriate) use of antimicrobial therapy, rectal carriage of Extended-spectrum beta-lactamase producing Enterobacterales and their clonal relatedness, environmental contamination, hand hygiene performance, personal hygiene of health care workers and presence of infection prevention preconditions. The Infection Risk Scan was implemented by an expert team. In each setting, local infection control practitioners were trained to achieve a standardized implementation of the tool and an unambiguous assessment of data. Results The IRIS was implemented in 34 wards in six Dutch and three Belgian hospitals. The tool provided ward specific results and revealed differences between wards and countries. There were significant differences in the prevalence of ESBL-E carriage between countries (Belgium: 15% versus The Netherlands: 9.6%), environmental contamination (median adenosine triphosphate (ATP) level Belgium: 431 versus median ATP level The Netherlands: 793) and calculated hand hygiene actions based on alcohol based handrub consumption (Belgium: 12.5/day versus The Netherlands: 6.3/day) were found. Conclusion The Infection risk Scan was successfully implemented in multiple hospitals in a large cross-border project and provided data that made the quality of infection control and antimicrobial use more transparent. The observed differences provide potential targets for improvement of the quality of care.
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Affiliation(s)
- Martine Verelst
- Department of Infection Control, University Hospital Leuven, Leuven, Belgium.
| | - Ina Willemsen
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Veronica Weterings
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | | | | | - Ellen Nieuwkoop
- Department of Infection Control, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Veroniek Saegeman
- Department of Infection Control, University Hospital Leuven, Leuven, Belgium
| | - Lieke van Alphen
- Departement of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Marjolein Kluytmans-van den Bergh
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Annette Schuermans
- Department of Infection Control, University Hospital Leuven, Leuven, Belgium
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Weterings V, van Oosten A, Nieuwkoop E, Nelson J, Voss A, Wintermans B, van Lieshout J, Kluytmans J, Veenemans J. Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014-2017: successful control using a restrictive screening strategy. Antimicrob Resist Infect Control 2021; 10:38. [PMID: 33602300 PMCID: PMC7893727 DOI: 10.1186/s13756-021-00906-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background The emergence of vancomycin resistant enterococci poses a major problem in healthcare settings. Here we describe a hospital-wide outbreak of vancomycin-resistant Enterococcus faecium in a general hospital in The Netherlands in the period December 2014–February 2017. Due to late detection of the outbreak, a large cohort of approximately 25,000 (discharged) patients was classified as ‘VRE suspected’. Hereupon a mitigated screening and isolation policy, as compared with the national guideline, was implemented to control the outbreak. Methods After the outbreak was identified, a screening policy consisting of a single rectal swab culture (with enrichment broth) to discontinue isolation and removing ‘VRE suspected’ label in the electronic patient files for readmitted VRE suspected patients, was implemented. In addition to the on admission screening, periodic hospital-wide point prevalence screening, measures to improve compliance with standard infection control precautions and enhanced environmental cleaning were implemented to control the outbreak. Results Between September 2014 and February 2017, 140 patients were identified to be colonised by vanA mediated vancomycin-resistant Enterococcus faecium (VREfm). Two of these patients developed bacteraemia. AFLP typing showed that the outbreak was caused by a single clone. Extensive environmental contamination was found in multiple wards. Within nine months after the detection of the outbreak no new VRE cases were detected. Conclusion We implemented a control strategy based on targeted screening and isolation in combination with implementation of general precautions and environmental cleaning. The strategy was less stringent than the Dutch national guideline for VRE control. This strategy successfully controlled the outbreak, while it was associated with a reduction in the number of isolation days and the number of cultures taken. Supplementary information The online version contains supplementary material available at 10.1186/s13756-021-00906-x.
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Affiliation(s)
- Veronica Weterings
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
| | - Anita van Oosten
- Department of Infection Control, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA, Goes, The Netherlands
| | - Ellen Nieuwkoop
- Department of Infection Control, Elisabeth-TweeSteden Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Jolande Nelson
- Department of Infection Control, Elisabeth-TweeSteden Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Bas Wintermans
- Department of Infection Control, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA, Goes, The Netherlands.,Laboratory for Microbiology, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA, Goes, The Netherlands
| | - Joris van Lieshout
- Department of Infection Control, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA, Goes, The Netherlands
| | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.,Microvida Laboratory for Microbiology, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Jacobien Veenemans
- Department of Infection Control, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA, Goes, The Netherlands.,Laboratory for Microbiology, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA, Goes, The Netherlands
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Weterings V, Veenemans J, Kleefman A, den Bergh MKV, Mulder P, Verhulst C, Willemsen I, Kluytmans J. Evaluation of an in vitro model with a novel statistical approach to measure differences in bacterial survival of extended-spectrum β-lactamase-producing Escherichia coli on an inanimate surface. Antimicrob Resist Infect Control 2019; 8:106. [PMID: 31244997 PMCID: PMC6582696 DOI: 10.1186/s13756-019-0558-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/10/2019] [Indexed: 01/01/2023] Open
Abstract
Background The role of environmental contamination in the transmission of Enterobacteriaceae is increasingly recognized. However, factors influencing the duration of survival in the environment have not yet been extensively studied. In this study, we developed and evaluated an in vitro model with a novel statistical approach to accurately measure differences in bacterial survival, that can be used to model the effects of multiple factors/conditions in future experiments. Methods Two extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) isolates were used for this in vitro experiment: a CTX-M-15-producing E. coli sequence type (ST) 131 and a CTX-M-1-producing E. coli ST10 isolate. Each strain was 1:1 diluted in sterile water, sterile saline or sheep blood. Cover glasses (18 × 18 mm) were inoculated with the dilution and subsequently kept at room temperature. Bacterial survival on the glasses was determined hourly during the first day, once daily during the following 6 days, and from day 7 on, once weekly up to 100 days. The experiment was repeated six times for each strain, per suspension fluid. Results Viable bacteria could be detected up to 70 days. A biphasic survival curve for all suspension fluids was observed, whereby there was a rapid decrease in the number of viable bacteria in the first 7 h, followed by a much slower decrease in the subsequent days. Conclusions We found a difference in survival probability between E. coli ST10 and ST131, with a higher proportion of viable bacteria remaining after 7 h for ST131, particularly in sheep blood.
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Affiliation(s)
- Veronica Weterings
- 1Department of Infection Control, Amphia Hospital, P.O. box 90158, 4800 AK Breda, The Netherlands.,2Medical Microbiology, Radboud University Medical Centre, P.O. box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jacobien Veenemans
- Laboratory for Microbiology, Admiraal De Ruyter Hospital, P.O. box 15, 4460 AA Goes, The Netherlands
| | - Amanda Kleefman
- 4Avans University of Applied Sciences, P.O. box 90116, 4800 RA Breda, The Netherlands
| | - Marjolein Kluytmans-van den Bergh
- 5Amphia Academy Infectious Disease Foundation, Amphia Hospital, P.O. box 90158, 4800 AK Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. box 85500, 3508 GA Utrecht, the Netherlands
| | - Paul Mulder
- 7Amphia Academy, Amphia Hospital, P.O. box 90158, 4800 AK Breda, The Netherlands
| | - Carlo Verhulst
- 8Microvida Laboratory for Microbiology, Amphia Hospital, P.O. box 90158, 4800 AK Breda, The Netherlands
| | - Ina Willemsen
- 1Department of Infection Control, Amphia Hospital, P.O. box 90158, 4800 AK Breda, The Netherlands
| | - Jan Kluytmans
- 1Department of Infection Control, Amphia Hospital, P.O. box 90158, 4800 AK Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. box 85500, 3508 GA Utrecht, the Netherlands.,8Microvida Laboratory for Microbiology, Amphia Hospital, P.O. box 90158, 4800 AK Breda, The Netherlands
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Weterings V, Veenemans J, van Rijen M, Kluytmans J. Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus in patients at hospital admission in The Netherlands, 2010-2017: an observational study. Clin Microbiol Infect 2019; 25:1428.e1-1428.e5. [PMID: 30928560 DOI: 10.1016/j.cmi.2019.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We determined the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage upon hospital admission, among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. We also aimed to evaluate the prevalence of MRSA carriers without the standard risk factors. METHODS We conducted an observational study to determine the prevalence of MRSA nasal carriage among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. Samples of cardiothoracic patients were tested by polymerase chain reaction (PCR), other samples were cultured using chromogenic agar plates. A Poisson regression model with robust error variance was used to assess whether there was a trend in the prevalence of MRSA over time. RESULTS In total, 31 093 nasal swabs were obtained from 25 660 patients. Three-hundred and seventy-five swabs (1.2%) had an invalid result. Therefore, 30 718 swabs (98.8%) were included in our analysis. Overall, S. aureus was detected in 7981/30 718 patients (26.0% 95% CI 25.5-26.5%) of whom 41 were MRSA (0.13% 95% CI 0.10-0.18%). The MRSA prevalence varied from 0.03% to 0.17% over the years without evidence of a changing trend over time (p = 0.40). Results of the questionnaire revealed that 30 of the 41 patients (73.2%) had no known risk factors for MRSA carriage (0.10%; 95% CI 0.07-0.14%). CONCLUSION Our study revealed a sustained low prevalence of MRSA carriage upon hospital admission over 7 years. This supports the effectiveness of the Dutch Search and Destroy policy, in combination with a restrictive antibiotic prescription policy.
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Affiliation(s)
- Veronica Weterings
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands; Medical Microbiology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
| | - Jacobien Veenemans
- Laboratory for Microbiology, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA Goes, the Netherlands
| | - Miranda van Rijen
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands
| | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands; Microvida Laboratory for Microbiology, Amphia Hospital, P.O. Box 90158, Breda, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500 3508 GA, Utrecht University, Utrecht, the Netherlands
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Tartari E, Weterings V, Gastmeier P, Rodríguez Baño J, Widmer A, Kluytmans J, Voss A. Patient engagement with surgical site infection prevention: an expert panel perspective. Antimicrob Resist Infect Control 2017; 6:45. [PMID: 28507731 PMCID: PMC5427557 DOI: 10.1186/s13756-017-0202-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/03/2017] [Indexed: 12/11/2022] Open
Abstract
Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs) remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved. The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs) and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations. Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.
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Affiliation(s)
- E Tartari
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - V Weterings
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charite ´ University Medicine in Berlin, Berlin, Germany
| | - J Rodríguez Baño
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - A Widmer
- University Hospital and University of Basel, Division of infectious diseases & hospital epidemiology, Basel, Switzerland
| | - J Kluytmans
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - A Voss
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Weterings V, Arens D, Verhulst C, Kluytmans J. Preoperative prevalence of methicilline-resistant Staphylococcus aureus (MRSA) in non-hospitalized population in the Netherlands during a 5-year period. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474651 DOI: 10.1186/2047-2994-4-s1-o4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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