Outbreaks in Health Care Settings

Sood, Geeta; Perl, Trish M.

doi:10.1016/j.idc.2016.04.003

Cited by 38 publications

(44 citation statements)

References 111 publications

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“…The mean coverage stops at 18.08% (95% CI 17.09–19.07), a value that is lower than that registered in the previous edition of the survey (20.8%, 95% CI 19.7–21.9) [ 16 ], with rates as low as 7.04% in the younger age group. This result is in agreement with previous studies revealing that knowledge of recommended vaccinations, as well as coverage, may be insufficient in Italian HCWs [ 13 , 14 , 15 , 16 ], thus representing a risk for healthcare safety and outbreaks surge [ 21 , 22 ]. Results are in line with previous studies, where lower VC has been associated with limited awareness of the cost-effectiveness (CE) profile of influenza vaccination in adults, as HCWs tend to have a better knowledge of recommendations for higher risk groups [ 23 ].…”

Section: Discussionsupporting

confidence: 93%

Gender, Socioeconomic, and Health Characteristics Associated with Influenza Vaccination Coverage (VC) among Italian Healthcare Workers: Secondary Analysis of a National Cross-Sectional Survey

et al. 2020

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Influenza epidemics pose a great overload over health-care facilities with an increase in the burden of disease for patients and healthcare costs. Despite a well-established amount of research in the area, vaccination rates show room for improvement and more research is needed in finding systematic interventions useful in improving healthcare workers (HCWs) vaccination coverage (VC). The purpose of this study was to describe the self-reported frequency of influenza immunization in HCWs and to identify demographic, socioeconomic, lifestyle, and health factors associated with this practice in Italy. Data about 5823 workers participating in the Italian national survey about health and healthcare services utilization are analyzed in the present study. Overall, 18.8% of HCWs reported being vaccinated against seasonal flu. In the multilevel regression, older workers had a higher likelihood of vaccine uptake (OR: 6.07; 95% CI 4.72–7.79), similar to those with chronic conditions or poor self-perceived health status (OR: 2.18 95% CI 1.17–4.09). On the other hand, the results highlighted a lower rate of VC in female HCWs (OR: 0.73 95% CI 0.61–0.86). Data confirm the low compliance towards flu immunization among Italian HCWs and highlight an important gap to be investigated in women.

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Section: Discussionsupporting

confidence: 93%

Gender, Socioeconomic, and Health Characteristics Associated with Influenza Vaccination Coverage (VC) among Italian Healthcare Workers: Secondary Analysis of a National Cross-Sectional Survey

et al. 2020

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“…Our data indicates the importance of 2 locally spread resistant clones in spite of low antibiotic consumption; tackling the main spreading routes of these clones could significantly reduce the burden of CR/MDR-PA. Because both the spreading clones had been isolated from respiratory secretions and associated with mechanical ventilation or bronchoscopy, the procedures related to the maintenance of the airway should be the focal point in the prevention of colonization and infections with CR/MDR-PA. Updating both the knowledge and skills of basic hand hygiene and isolation methods, improving oral hygiene practices, and revising bronchoscope cleaning techniques, including disinfection processes, can be effective in aborting PA outbreaks [ 35 ]. Infection control measures could be significantly improved by implementing high resolution molecular identification techniques (egg.…”

Section: Discussionmentioning

confidence: 99%

Multidrug resistant Pseudomonas aeruginosa in Estonian hospitals

et al. 2018

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BackgroundWe aimed to identify the main spreading clones, describe the resistance mechanisms associated with carbapenem- and/or multidrug-resistant P. aeruginosa and characterize patients at risk of acquiring these strains in Estonian hospitals.MethodsNinety-two non-duplicated carbapenem- and/or multidrug-resistant P. aeruginosa strains were collected between 27th March 2012 and 30th April 2013. Clinical data of the patients was obtained retrospectively from the medical charts. Clonal relationships of the strains were determined by whole genome sequencing and analyzed by multi-locus sequence typing. The presence of resistance genes and beta-lactamases and their origin was determined. Combined-disk method and PCR was used to evaluate carbapenemase and metallo-beta-lactamase production.ResultsForty-three strains were carbapenem-resistant, 11 were multidrug-resistant and 38 were both carbapenem- and multidrug-resistant. Most strains (54%) were isolated from respiratory secretions and caused an infection (74%). Over half of the patients (57%) were ≥ 65 years old and 85% had ≥1 co-morbidity; 96% had contacts with healthcare and/or had received antimicrobial treatment in the previous 90 days.Clinically relevant beta-lactamases (OXA-101, OXA-2 and GES-5) were found in 12% of strains, 27% of which were located in plasmids. No Ambler class B beta-lactamases were detected. Aminoglycoside modifying enzymes were found in 15% of the strains. OprD was defective in 13% of the strains (all with CR phenotype); carbapenem resistance triggering mutations (F170 L, W277X, S403P) were present in 29% of the strains. Ciprofloxacin resistance correlated well with mutations in topoisomerase genes gyrA (T83I, D87N) and parC (S87 L). Almost all strains (97%) with these mutations showed ciprofloxacin-resistant phenotype.Multi-locus sequence type analysis indicated high diversity at the strain level – 36 different sequence types being detected. Two sequence types (ST108 (n = 23) and ST260 (n = 18)) predominated. Whereas ST108 was associated with localized spread in one hospital and mostly carbapenem-resistant phenotype, ST260 strains occurred in all hospitals, mostly with multi-resistant phenotype and carried different resistance genotype/machinery.ConclusionsDiverse spread of local rather than international P. aeruginosa strains harboring multiple chromosomal mutations, but not plasmid-mediated Ambler class B beta-lactamases, were found in Estonian hospitals.Trial registrationThis trial was registered retrospectively in ClinicalTrials.gov (NCT03343119).Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3421-1) contains supplementary material, which is available to authorized users.

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“…With an average duration of 11 months VRE outbreaks in hematology and oncology departments show an extraordinary long course compared to nosocomial outbreaks caused by other pathogens or by VRE in other patient populations ( Satilmis et al, 2016 ; Sood and Perl, 2016 ; Stapleton et al, 2016 ). Several factors may contribute to this observation.…”

Section: Discussionmentioning

confidence: 99%

Outbreaks caused by vancomycin-resistant Enterococcus faecium in hematology and oncology departments: A systematic review

Ulrich

Vonberg

Gastmeier

2017

Heliyon

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BackgroundVancomycin-resistance in Enterococcus faecium (VRE) poses a major threat in health care settings. It is well known that patients in hematology and oncology departments are especially at risk of nosocomial VRE acquisition. This systematic review of the literature provides data on the main sources, transmission modes and potential risk factors for VRE acquisition as well as appropriate infection control measures in order to terminate such nosocomial outbreaks.MethodsData on nosocomial VRE outbreaks on hematology and oncology wards was retrieved from the Outbreak Database and PubMed.ResultsA total of 35 VRE outbreaks describing 757 affected patients and 77 deaths were included in this review. The most frequent site of pathogen detection were stool samples or rectal swabs (57% of all isolation sites), followed by blood cultures (30%). The most common outbreak source was an index patient. The main modes of transmission were 1) hands of health care workers, 2) contact to a contaminated environment and 3) patient-to-patient contact. The most common risk factor for VRE positivity was prior antibiotic treatment. The most common infection control measures performed were screening and isolating or cohorting of patients.ConclusionA rational use of antibiotics in hematology and oncology units is recommended in order to reduce selection pressure on resistant pathogens such as VRE. In addition the importance of hand hygiene should be stressed to all staff whenever possible.

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Outbreaks in Health Care Settings

Cited by 38 publications

References 111 publications

Gender, Socioeconomic, and Health Characteristics Associated with Influenza Vaccination Coverage (VC) among Italian Healthcare Workers: Secondary Analysis of a National Cross-Sectional Survey

Gender, Socioeconomic, and Health Characteristics Associated with Influenza Vaccination Coverage (VC) among Italian Healthcare Workers: Secondary Analysis of a National Cross-Sectional Survey

Multidrug resistant Pseudomonas aeruginosa in Estonian hospitals

Outbreaks caused by vancomycin-resistant Enterococcus faecium in hematology and oncology departments: A systematic review

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