The epidemiology of a large single-strain outbreak of vancomycin-resistant Enterococcus faecium vanB in an Australian teaching hospital

Pearman, J.W.; Peterson, Allison; Lee, Rosie C; Orrell, C Terri; Perry, Peta; Kosaras, Frank P; O’Brien, Frances

doi:10.1071/hi03077

Cited by 4 publications

(10 citation statements)

References 15 publications

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“…5 During the following 30-month period, 1 January 2002 to 30 June 2004, the same epidemic strain (contour-clamped homogenous electric field electrophoresis pattern 10) caused small outbreaks in two hospitals which are 21 km apart (Table IV). Both outbreaks were initiated by ward contacts of the first RPH outbreak (eight and 12 months previously), each of whom subsequently had four negative rectal swabs (Table IV).…”

Section: Hospital Outbreaks Of the Epidemic Strain Of Vref Since 2001mentioning

confidence: 96%

“…All infections were hospital acquired and each was associated with an invasive procedure; fortunately, no deaths were attributable to VREF. 5 In addition, 64 patients were colonized. In view of this crisis, the objectives (immediate and long term) had to be redefined as immediate objectives (Box 3) and long-term objectives (Box 4).…”

Section: Crisismentioning

confidence: 99%

“…The slow detection of carriers allowed environmental contamination and nosocomial transmission to occur before carriers were detected and isolated. 5 Developmental work showed that a rapid provisional diagnosis of VRE could be made within 30e 48 h by performing the multiplex PCR directly on the broth enrichment cultures, but broth enrichment had to be incubated at 35 AE 1 C for at least 24 h before performing PCR in order to achieve high sensitivity. 9,10 Early PCR not only gives a rapid provisional positive result; a negative PCR result 'weeds out' false-positive screening enrichment broth results, thereby eliminating a lot of unnecessary laboratory work at an early stage.…”

Section: Immediate Objectivesmentioning

confidence: 99%

“…5 Targeted active surveillance cultures are particularly important and cost-effective for controlling both MRSA and VRE in hospitals. 14,18e22 Following the single-strain outbreak at the RPH, WA hospitals have screened the following patients for VRE 5 5,6 ).…”

Section: Long-term Objectivesmentioning

confidence: 99%

“…5 The index patient was isolated under strict contact precautions. All patients on the ICU were screened for VRE and one patient, in the bed next to the index patient, was positive ( Figure 1).…”

Section: Index Patientmentioning

confidence: 99%

See 4 more Smart Citations

2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci – from disaster to ongoing control

Pearman¹

2006

Journal of Hospital Infection

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Section: Hospital Outbreaks Of the Epidemic Strain Of Vref Since 2001mentioning

confidence: 96%

Section: Crisismentioning

confidence: 99%

Section: Immediate Objectivesmentioning

confidence: 99%

Section: Long-term Objectivesmentioning

confidence: 99%

Section: Index Patientmentioning

confidence: 99%

See 3 more Smart Citations

2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci – from disaster to ongoing control

Pearman¹

2006

Journal of Hospital Infection

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The epidemiology of a large single-strain outbreak of vancomycin-resistant Enterococcus faecium vanB in an Australian teaching hospital

Pearman

Peterson

Lee³

et al. 2003

Australian Infection Control

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An assessment of high touch object cleaning thoroughness using a fluorescent marker in two Australian hospitals

Murphy

Macbeth

Derrington

et al. 2011

Healthcare infection

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Objective: We needed to better understand the usefulness of different methods of monitoring and achieving sustained improvement in cleaning. Common elements of successful international approaches included a covert nature, the use of a method to visually identify and highlight deficiencies in the cleaning of high touch objects (HTOs) and the provision of feedback and education before re-evaluation. The specific purpose of this study was to evaluate fluorescent marking, education and feedback for assessing and improving HTO cleaning in a typical Australian inpatient hospital setting. Methods: A three-phase, prospective study was conducted in two acute care hospitals over 17 weeks. For each phase, in a set of 37 specific single-inpatient rooms, seven predefined HTOs were marked with a liquid isopropyl alcohol and optical brightener formulation targeting material solution containing a fluorescent marker (FM), known as DAZO ® , designed specifically for the purpose of evaluating surface cleaning. In each hospital we targeted rooms located in the four wards with the greatest de novo multidrug resistant organism burden. Forty-eight hours after applying the FM we used a black-light to indicate the mark's presence or removal. In phase 1 only, HTOs were swabbed before marking. Also only in the first phase and immediately following initial assessment, each HTO was cleaned, remarked and reassessed at 48 h. Between phases 1 and 2, investigators provided results to environmental services staff (EVS) leadership and staff after each phase. Education was provided to EVS staff after phase 1 only. Results: A total of 986 marks were evaluated. The cleaning scores for individual HTOs in phases 1-3 ranged from 9.4 to 77.8%, 10.8 to 93% and 13.5 to 67.7% respectively. In phase 3, three HTOs scored lower than their phase 1 level. The mean overall cleaning scores for phases 1-3 were 34%, 53% and 41% respectively. Conclusions: The FM was useful to assess HTO cleaning thoroughness. It facilitated relevant feedback and education and motivated staff to strive for continual improvements in environmental cleaning. Without ongoing education, preliminary improvements were unsustained. However, investigators better understood flaws in cleaning and policy/procedure conflicts.

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The epidemiology of a large single-strain outbreak of vancomycin-resistant Enterococcus faecium vanB in an Australian teaching hospital

Cited by 4 publications

References 15 publications

2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci – from disaster to ongoing control

2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci – from disaster to ongoing control

The epidemiology of a large single-strain outbreak of vancomycin-resistant Enterococcus faecium vanB in an Australian teaching hospital

An assessment of high touch object cleaning thoroughness using a fluorescent marker in two Australian hospitals

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