Detection of Pathogen Transmission in Neonatal Nurseries Using DNA Markers as Surrogate Indicators

Oelberg, David G.; Joyner, Sarah E.; Jiang, Xi; Laborde, Danielle J.; Islam, Monica P.; Pickering, Larry K.

doi:10.1542/peds.105.2.311

Cited by 80 publications

(62 citation statements)

References 9 publications

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“…We inferred that, once introduced by HCWs or parents, PFGE-1-ST30 and other clonal MSSA strains were propagated among neonates through direct and indirect hand transmission, which is a notoriously efficient pathway in neonatology. 24 Although vertical transmission from mothers to neonates occurs habitually, 25 this does not explain the striking clonality. S. aureus has been shown to survive for up to 8 weeks on inanimate surfaces.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Methicillin-SusceptibleStaphylococcus aureusin a Neonatology Ward

Achermann

Seidl

Kuster

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVE In-hospital transmission of methicillin-susceptible Staphylococcus aureus (MSSA) among neonates remains enigmatic. We describe the epidemiology of MSSA colonization and infection in a 30-bed neonatal ward. DESIGN Multimodal outbreak investigation SETTING A public 800-bed tertiary care university hospital in Switzerland METHODS Investigations in 2012-2013, triggered by a MSSA infection cluster, included prospective MSSA infection surveillance, microbiologic screening of neonates and environment, onsite observations, and a prospective cohort study. MSSA isolates were characterized by pulsed-field gel electrophoresis (PFGE) and selected isolates were examined for multilocus sequence type (MLST) and virulence factors. RESULTS Among 726 in 2012, 30 (4.1%) patients suffered from MSSA infections including 8 (1.1%) with bacteremia. Among 655 admissions in 2013, 13 (2.0%) suffered from MSSA infections including 2 (0.3%) with bacteremia. Among 177 neonates screened for S. aureus carriage, overall 77 (44%) tested positive. A predominant PFGE-1-ST30 strain was identified in 6 of 30 infected neonates (20%) and 30 of 77 colonized neonates (39%). This persistent clone was pvl-negative, tst-positive and belonged to agr group III. We found no environmental point source. MSSA carriage was associated with central vascular catheter use but not with a particular midwife, nurse, physician, or isolette. Observed healthcare worker behavior may have propagated transmission via hands and fomites. Despite multimodal interventions, clonal transmission and colonization continued and another clone, PFGE-6-ST5, became predominant. CONCLUSIONS Hospital-acquired MSSA clones represent a high proportion of MSSA colonization but not MSSA infections in neonate inpatients. In contrast to persisting MSSA, transmission infection rates decreased concurrently with interventions. It remains to be established whether eradication of hospital-acquired MSSA strains would reduce infection rates further.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Methicillin-SusceptibleStaphylococcus aureusin a Neonatology Ward

Achermann

Seidl

Kuster

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…Around 18% of sites were positive in the remaining five rooms throughout the week, with a similar decline. The most commonly contaminated sites in all six rooms were personnel hands, computers, blood gas analyzers, door and telephone handles, control buttons and knobs, patient monitors, and medical charts (131). Such data specifically highlight the areas that would benefit from more frequent cleaning or disinfection.…”

Section: Critical Surfacesmentioning

confidence: 90%

“…Over the ensuing week, the study team tracked dispersal of the viral pieces around the unit between hand touch sites (131). Before inoculating the telephone, over 30 sites for sampling were chosen in each of six patient rooms according to the risk of direct or indirect transmission of pathogens.…”

Section: Critical Surfacesmentioning

confidence: 99%

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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SUMMARY There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.

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“…For assessments involving ground and surface water transport, coliphages, enteric bacteria, and Bacillus subtilis spores (6,42,56) have often been proposed as live surrogates. Unique approaches, such as laboratory-constructed norovirus capsids, have been used to study virus transport through soil (59), while cauliflower mosaic virus was used as a surrogate to assess virus transport in day care centers (39,55). The transport of an aerosol release of Bacillus anthracis has used aerial insecticide spray of Bacillus thuringiensis as a surrogate (46).…”

Section: Conceptual Decision Frameworkmentioning

confidence: 99%

Criteria for Selection of Surrogates Used To Study the Fate and Control of Pathogens in the Environment

Sinclair

Rose

Hashsham

et al. 2012

Appl Environ Microbiol

136

106

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e This article defines the term surrogate as an organism, particle, or substance used to study the fate of a pathogen in a specific environment. Pathogenic organisms, nonpathogenic organisms, and innocuous particles have been used as surrogates for a variety of purposes, including studies on survival and transport as well as for method development and as "indicators" of certain conditions. This article develops a qualitative surrogate attribute prioritization process and allows investigators to select a surrogate by systematically detailing the experimental process and prioritizing attributes. The results are described through the use of case studies of various laboratories that have used this process. This article also discusses the history of surrogate and microbial indicator use and outlines the method by which surrogates can be used when conducting a quantitative microbial risk assessment. The ultimate goal of selecting a sufficiently representative surrogate is to improve public health through a health-based risk assessment framework. Under-or overestimating the resistance, inactivation, or movement may negatively impact risk assessments that, in turn, will impact health assessments and estimated safety levels. Reducing uncertainty in a risk assessment is one of the objectives of using surrogates and the ultimate motive for any experiment investigating potential exposure of a pathogen.

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Detection of Pathogen Transmission in Neonatal Nurseries Using DNA Markers as Surrogate Indicators

Cited by 80 publications

References 9 publications

Epidemiology of Methicillin-SusceptibleStaphylococcus aureusin a Neonatology Ward

Epidemiology of Methicillin-SusceptibleStaphylococcus aureusin a Neonatology Ward

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

Criteria for Selection of Surrogates Used To Study the Fate and Control of Pathogens in the Environment

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