Outbreak of New Delhi Metallo-Beta-lactamase Carbapenemase Producing Enterobacterales on a bone marrow transplant unit: Role of the environment

Abstract

Background Carbapenemase Producing Enterobacterales (CPE) are a global health concern. Nosocomial outbreaks have been reported globally with patient-to-patient transmission felt to be the most frequent route of cross-transmission. Aim To describe the investigation and control of an outbreak of healthcare-associated New Delhi Metallo-beta-lactamase (NDM) CPE on a haematology ward, over 2 months. Methods Four patients acquired CPE; all had gastrointestinal tract colonisation with two subsequently developing bacteraemias. The outbreak team performed a retrospective review, prospective case finding and environmental sampling using swabs, settle plates, air and water sampling. Immediate control measures were implemented including appropriate isolation of cases and additional ward cleaning with chlorine disinfectant, ultra-violet light decontamination and hydrogen peroxide. Findings Following two cases of nosocomial acquired CPE prospective case finding identified two further cases. 4.6% of the initial environmental samples were positive for CPE including from waste water sites, the ward sluice and the ward kitchen. Three of the four CPE isolates were identical on pulse field gel electrophoresis (PFGE) typing. Detection of the CPE from the ward kitchen environmental samples suggests a possible role for cross transmission. Conclusion This is the first CPE outbreak report to highlight the role of a ward kitchen as a possible source of cross-transmission. In view of this we suggest ward kitchens are reviewed and investigated in nosocomial CPE outbreaks.

Drains and the periphery of the water system – what do you do when the guidance is outdated?

“…The toilet in en suite bathrooms can be used for disposal of fluids, etc., provided the person is trained to understand the importance of minimizing the risk of splashing/aerosol generation [ 20 ]. In drug preparation area rooms, we would suggest exploring the possibility of using disposable sealable boxes containing absorbent granules.…”

Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

“…High prevalence of CRE isolated from sink drains of health care facilities were observed recently from Pakistan [ 21 ]. Similarly, carbapenemase-producing Enterobacterales originating from kitchen of hematology ward were implicated in resistance transmission [ 22 ]. Global reports about nosocomial outbreaks of carbapenemase-producing strains showed its association with different clinical wards such as the VIM-producing Enterobacter cloacae outbreak in association with an ICU from France [ 23 ], IMP-6 CPE from Japan [ 24 ], KPC-2-producing K. pneumoniae from Greece and China [ 25 , 26 ], OXA-23-carrying carbapenem-resistant Acinetobacter baumannii ( A. baumannii ) in an ICU ward from China [ 27 ] and NDM-1-producing K. pneumoniae associated with an ICU from a Portuguese hospital and France [ 28 , 29 ].…”

Role of the kitchen environment

“…initiating a debate on the involvement of the ward kitchen environment in transmission events to patients. [ 1 ].…”