Outbreak of Vancomycin-Resistant Enterococci in a Burn Unit

Falk, Pamela S.; Winnike, J.; Woodmansee, C E; Desai, M. H.; Mayhall, C. Glen

doi:10.1086/501806

Cited by 148 publications

(131 citation statements)

References 31 publications

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“…Methicillin-resistant Staphylococcus aureus (MRSA) may exist on surfaces for as long as 360 days (37,38), and spore-forming bacteria, including Clostridium difficile, can survive for months. The longer a nosocomial pathogen persists on a surface, the longer it may be a source for transmission to a susceptible patient or HCW (5,13,17,21,26,29). Frequently touched surfaces such as doorknobs, push plates, bed rails, faucet handles, and poles supporting intravenous fluid supplies (IV poles) have been identified as reservoirs for the spread of pathogenic microbes (3,27) which can easily contaminate hands and equipment of HCWs, who, in turn, can transmit these pathogens to patients during routine care.…”

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confidence: 99%

Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of Copper

Schmidt

Attaway

Sharpe³

et al. 2012

J Clin Microbiol

184

203

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The contribution of environmental surface contamination with pathogenic organisms to the development of health care-associated infections (HAI) has not been well defined. The microbial burden (MB) associated with commonly touched surfaces in intensive care units (ICUs) was determined by sampling six objects in 16 rooms in ICUs in three hospitals over 43 months. At month 23, copper-alloy surfaces, with inherent antimicrobial properties, were installed onto six monitored objects in 8 of 16 rooms, and the effect that this application had on the intrinsic MB present on the six objects was assessed. Census continued in rooms with and without copper for an additional 21 months. In concert with routine infection control practices, the average MB found for the six objects assessed in the clinical environment during the preintervention phase was 28 times higher (6,985 CFU/ 100 cm 2 ; n ‫؍‬ 3,977 objects sampled) than levels proposed as benign immediately after terminal cleaning (<250 CFU/100 cm 2 ). During the intervention phase, the MB was found to be significantly lower for both the control and copper-surfaced objects. Copper was found to cause a significant (83%) reduction in the average MB found on the objects (465 CFU/100 cm 2 ; n ‫؍‬ 2714 objects) compared to the controls (2,674 CFU/100 cm 2 ; n ‫؍‬ 2,831 objects [P < 0.0001]). The introduction of copper surfaces to objects formerly covered with plastic, wood, stainless steel, and other materials found in the patient care environment significantly reduced the overall MB on a continuous basis, thereby providing a potentially safer environment for hospital patients, health care workers (HCWs), and visitors.

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mentioning

confidence: 99%

Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of Copper

Schmidt

Attaway

Sharpe³

et al. 2012

J Clin Microbiol

184

203

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“…The only other article 2 in the literature that included information on microbial growth on ECg lead wires was an epidemiological investigation of a 13-month-long VRE outbreak in a burn ICU that involved 21 patients. The investigators identified one instance in which a lead wire, swabbed as part of weekly patient surveillance, was positive for VRE.…”

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confidence: 99%

Cleaned, Ready-to-Use, Reusable Electrocardiographic Lead Wires as a Source of Pathogenic Microorganisms

Albert

Hancock

Murray

et al. 2010

American Journal of Critical Care

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Background Cleaned electrocardiographic lead wires are a potential source of microorganisms capable of causing nosocomial infection. Objectives To examine fungal and bacterial growth on cleaned reusable lead wires, determine if microbial growth is associated with hospital site or work environment, determine the prevalence of antibiotic-resistant bacteria, and learn if antibioticresistant bacteria are associated with hospital site and work environment. Methods Cleaned lead wires (N = 320) from critical care and telemetry units, emergency departments, and operating rooms of 4 hospitals were swabbed and the specimens cultured for microbial growth. Bacterial species were grouped by their risk for human infection: at risk (n = 9), potential risk (n = 5), and no risk (n = 10). Work environments were compared by using pairwise contrasts from a generalized estimating equation model. Results Fungi were rare (0.6%). Of 226 cultures from 201 wires (62.8%) with bacterial growth, 121 were of at-or potential-risk bacteria (37.8%). Urban hospitals had less growth (P ≤ .001) and fewer bacterial species per wire (P ≤ .001) than did community hospitals. Presence of any bacteria (P = .02) and number of bacterial species per wire (P = .002) were lowest in operating rooms; emergency departments and telemetry units had more growth than did critical care units. Among specimens of staphylococci and enterococci, 6 each were sensitive to antibiotics; of 4 resistant staphylococcal species, 1 was not a human opportunistic pathogen and 3 were potential-risk species.

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“…10,11 Maintenance of lowlevel endemicity after a large outbreak has been achieved 12,13 as has eradication following a small outbreak 14 and in specific units. [15][16][17] Successful control has also been reported in a healthcare region that included long-term-care facilities. 18 In that report, however, only 38 patients were found to be colonized during a 2-year period.…”

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confidence: 99%

Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

Christiansen

Tibbett

Beresford

et al. 2004

Infect. Control Hosp. Epidemiol.

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Objective:To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.Interventions:Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistantEnterococcus faeciumdespite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection ofvanA andvanBresistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).Results:A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistantE. faecium.Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).Conclusion:Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.

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Outbreak of Vancomycin-Resistant Enterococci in a Burn Unit

Cited by 148 publications

References 31 publications

Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of Copper

Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of Copper

Cleaned, Ready-to-Use, Reusable Electrocardiographic Lead Wires as a Source of Pathogenic Microorganisms

Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

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