An Outbreak of<i>Pseudomonas aeruginosa</i>Infections Associated with Flexible Bronchoscopes

Srinivasan, Arjun; Wolfenden, Linda L.; Song, Xiaoyan; Mackie, Karen; Hartsell, Theresa L.; Jones, Heather D.; Diette, Gregory B.; Orens, Jonathan B.; Yung, Rex; Ross, Tracy; Merz, William G.; Scheel, Paul J.; Haponik, Edward F.; Perl, Trish M.

doi:10.1056/nejmoa021808

Cited by 194 publications

(43 citation statements)

References 14 publications

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“…These results were similar to what other studies had observed in the similar arrangement [15, 20]. In this study, higher contamination rates were observed in white coats used only during clinical duties when compared to those used both during clinical and non-clinical duties, suggesting a strong relationship between coat usage and patient care management.…”

Section: Discussionsupporting

confidence: 92%

“…This study has also shown that staphylococcus aureus, contamination of white coats in medical, paediatrics and surgical ward was 3 % in all these units. However, Wong et al [13] and Srinivasan et al [20], reported that Staphylococcus aureus was less likely to be isolated from the white coats of health workers in a medical unit than those from a health worker in surgical or other units which was attributed to lower patient contact in the medical wards as compared to other units. However, based on the findings in this study, the low level of contamination in surgical wards could be attributed to the presence of infection prevention and control strategies at the time the study was undertaken.…”

Section: Discussionmentioning

confidence: 99%

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Contamination of health care workers’ coats at the University Teaching Hospital in Lusaka, Zambia: the nosocomial risk

Mwamungule

Chimana

Malama

et al. 2015

J Occup Med Toxicol

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BackgroundHealth care Associated Infections (HAIs) are a major public health problem in both developed and developing countries. They pose a severe impact in resource-poor settings, where the rate of infection is estimated to be relatively high. Therefore, this study was conducted to establish empirical evidence related to HAIs in Zambia.MethodThis was a prospective cross-sectional study conducted from October, 2013 to May 2014 at the University Teaching Hospital (UTH) in Lusaka. A total of 107 white coats worn by health care-workers at UTH were sampled for possible bacteriological contamination.ResultsOf the 107 white coats screened, 94 (72.8 %) were contaminated with bacteria. There was no difference in the contamination levels between white coats worn for more than 60 min (47.8 %) compared to those worn for 30–60 min (46.7 %) (p = 0.612). Further, the antibiotic sensitivity tests indicated that the bacterial isolates were resistant to some of the antibiotics assessed. Isolates of Staphylococcus aureus and Klebsiella pnumoniae exhibited the highest resistance to most of the antibiotics assessed.ConclusionThis study has shown that white coats worn by health care-workers at the University Teaching Hospital generally have high microbial contaminations and hence pose a nosocomial risk. It is therefore, recommended that white coats be regularly sanitized, and health care workers also be sensitized on public health risk of HAIs associated with contaminated coats.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Contamination of health care workers’ coats at the University Teaching Hospital in Lusaka, Zambia: the nosocomial risk

Mwamungule

Chimana

Malama

et al. 2015

J Occup Med Toxicol

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“…The capacity to control these outbreaks varies greatly and dependes on the reservoir. Outbreaks are usually circumscribed in time and attributable to a point source of infection which can be identified in the environment [4-8]. …”

Section: Introductionmentioning

confidence: 99%

A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition

et al. 2011

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BackgroundStudies of recent hospital outbreaks caused by multiresistant P.aeruginosa (MRPA) have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR) Pseudomonas aeruginosa (PA) and evaluate the effectiveness of the surveillance procedures and control measures applied.MethodsPatients with MRPA isolates were prospectively identified (January 2006-May 2008). A combined surveillance procedure (environmental survey, and active surveillance program in intensive care units [ICUs]) and an infection control strategy (closure of ICU and urology wards for decontamination, strict compliance with cross-transmission prevention protocols, and a program restricting the use of carbapenems in the ICUs) was designed and implemented.ResultsThree hundred and ninety patients were identified. ICU patients were the most numerous group (22%) followed by urology patients (18%). Environmental surveillance found that 3/19 (16%) non-ICU environmental samples and 4/63 (6%) ICU samples were positive for the MRPA clonal strain. In addition, active surveillance found that 19% of patients were fecal carriers of MRPA. Significant changes in the trends of incidence rates were noted after intervention 1 (reinforcement of cleaning procedures): -1.16 cases/1,000 patient-days (95%CI -1.86 to -0.46; p = 0.003) and intervention 2 (extensive decontamination): -1.36 cases/1,000 patient-days (95%CI -1.88 to -0.84; p < 0.001) in urology wards. In addition, restricted use of carbapenems was initiated in ICUs (January 2007), and their administration decreased from 190-170 DDD/1,000 patient-days (October-December 2006) to 40-60 DDD/1,000 patient-days (January-April 2007), with a reduction from 3.1 cases/1,000 patient-days in December 2006 to 2.0 cases/1,000 patient-days in May 2007. The level of initial carbapenem use rose again during 2008, and the incidence of MRPA increased progressively once more.ConclusionsIn the setting of sustained MRPA outbreaks, epidemiological findings suggest that patients may be a reservoir for further environmental contamination and cross-transmission. Although our control program was not successful in ending the outbreak, we think that our experience provides useful guidance for future approaches to this problem.

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“…P. aeruginosa biyofilmlerinin otomatik yıkayıcı ve dezenfektörlerden, hasarlı endoskop kanallarından uzaklaştırılması oldukça zordur. P. aeruginosa kolonizasyonu özellikle doku bütünlüğünü bozacak işlemlerde ve bağışıklığı baskılanmış hastalarda ciddi sorun oluşturur (10,13). Bronkoskop kaynaklı P. aeruginosa epidemileri olabilmektedir.…”

Section: İrdelemeunclassified

“…Bulaşma, kontamine aspirasyon valfleri, hasarlı biyopsi kanalları, kontamine topik anestezikler ve kontamine dezenfeksiyon makinelerinden kaynaklanmaktadır. Kontaminasyona bağlı olarak hem gerçek hem de yalancı salgınlar görülmektedir (7)(8)(9)(10).…”

Section: Introductionunclassified

Clinical Microbiology Laboratory in the Control of Healthcare-Associated Infections

Şenol¹,

Coskun²,

Gunduz³

et al. 2012

Klimik Dergisi

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An Outbreak ofPseudomonas aeruginosaInfections Associated with Flexible Bronchoscopes

Abstract: This large outbreak of P. aeruginosa infections related to bronchoscopy was apparently caused by a loose biopsy-port cap in the bronchoscopes. Instrument safety and surveillance methods for bronchoscopy must be improved, and better recall procedures are needed for medical devices.

Cited by 194 publications

References 14 publications

Contamination of health care workers’ coats at the University Teaching Hospital in Lusaka, Zambia: the nosocomial risk

Contamination of health care workers’ coats at the University Teaching Hospital in Lusaka, Zambia: the nosocomial risk

A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition

Clinical Microbiology Laboratory in the Control of Healthcare-Associated Infections

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