The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

At the peak of the coronavirus disease 2019 (COVID-19) pandemic, hand hygiene audits indicated decreased compliance in a 12-bed critical care (CC) area with ventilated COVID-19 patients, where staff used personal protective equipment (PPE), including sessional use of long-sleeved gowns in accordance with the recommendations of Public Health England. There was also a cluster of three central venous catheter (CVC) infections along with increases in the number of patients from whom enteric Gram-negative bacteria (GNB) were isolated from sterile sites. Environmental sampling of near-patient surfaces and frequently touched sites demonstrated that 11.5% of areas were contaminated with enteric GNB in the COVID-19 CC area, compared with 2.6% and 2.7% in COVID-19 and non-COVID-19 general wards, respectively. Following a risk assessment, hospital policy was changed to replace long-sleeved gowns with short-sleeved gowns. The CC unit underwent enhanced cleaning with hypochlorite-based disinfectant and was resampled 8 days later. On resampling, no GNB were isolated from the CC unit. Following this change in PPE, hand hygiene compliance returned to baseline standards and no further CVC infections were identified. Staff reported a preference for short-sleeved gowns. No evidence currently exists that PPE beyond that recommended for pandemic influenza (respiratory protection plus standard PPE) adds to the protection of healthcare workers (HCWs) from severe acute respiratory syndrome coronavirus-2. Long-sleeved gowns prevent HCWs performing hand hygiene effectively. While it is imperative that HCWs are adequately protected, protection of patients from infection hazards is equally important. Further studies are necessary to establish risks from PPE to inform a review of current guidance.

show abstract

“…drains). Outbreaks with these pathogens have been reported predominantly from aqueous sources [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Unintended consequences of long-sleeved gowns in a critical care setting during the COVID-19 pandemic

Meda

Gentry

Reidy

et al. 2020

Journal of Hospital Infection

View full text Add to dashboard Cite

show abstract

“…We found increased presence of Gram-negative bacteria following decolonisation treatment, particularly on the skin of individual patients, which could be indicative of a reduced colonisation resistance ( Figure 1 E). This should be considered a potential risk factor as antibiotic usage at health-care facilities favours and selects for MDR bacterial lineages which complicates treatment considerably [ 38 , 39 ]. High-resolution amplicon-based sequencing approaches and culture-based methods should ideally be used in combination to provide information on how bacterial communities respond to different treatments, along with information on MDR profiles and WGS data on colonising strains.…”

Section: Discussionmentioning

confidence: 99%

Alteration of Bacterial Communities in Anterior Nares and Skin Sites of Patients Undergoing Arthroplasty Surgery: Analysis by 16S rRNA and Staphylococcal-Specific tuf Gene Sequencing

et al. 2020

View full text Add to dashboard Cite

The aim was to study alterations of bacterial communities in patients undergoing hip or knee arthroplasty to assess the impact of chlorhexidine gluconate soap decolonisation and systemic antibiotic prophylaxis. A Swedish multicentre, prospective collection of samples obtained from elective arthroplasty patients (n = 83) by swabbing anterior nares, skin sites in the groin and the site of planned surgery, before and after arthroplasty surgery, was analysed by 16S rRNA (V3-V4) gene sequencing and a complementary targeted tuf gene sequencing approach to comprehensively characterise alterations in staphylococcal communities. Significant reductions in alpha diversity was detected for both bacterial (p = 0.04) and staphylococcal (p = 0.03) groin communities after arthroplasty surgery with significant reductions in relative Corynebacterium (p = 0.001) abundance and Staphylococcus hominis (p = 0.01) relative staphylococcal abundance. In nares, significant reductions occurred for Staphylococcus hominis (p = 0.02), Staphylococcus haemolyticus (p = 0.02), and Staphylococcus pasteuri (p = 0.003) relative to other staphylococci. Staphylococcus aureus colonised 35% of anterior nares before and 26% after arthroplasty surgery. Staphylococcus epidermidis was the most abundant staphylococcal species at all sampling sites. No bacterial genus or staphylococcal species increased significantly after arthroplasty surgery. Application of a targeted tuf gene sequencing approach provided auxiliary staphylococcal community profiles and allowed species-level characterisation directly from low biomass clinical samples.

show abstract

“…We found increased presence of Gram-negative bacteria following decolonisation treatment, particularly on the skin of individual patients, which could be indicative of a reduced colonization resistance ( Figure 1E). This should be considered a potential risk factor as antibiotic usage at health-care facilities favours and selects for MDR bacterial lineages which complicates treatment considerably [34,35]. High-resolution amplicon-based sequencing approaches and culture-based methods can be used in combination to provide information on how COPs respond to different treatments, along with information on MDR profiles of colonising strains, which can help guide the use of more suitable decolonization strategies and hopefully reduce the rate of postoperative infections in the future.…”

Section: Discussionmentioning

confidence: 99%

Alteration of Bacterial Communities in Anterior Nares and Skin Sites of Patients Undergoing Arthroplasty Surgery: Analysis by 16S rRNA and Staphylococcal-Specific <em>tuf</em> Gene Sequencing

Iversen¹,

Johannesen²,

Ingham³

et al. 2020

Preprint

View full text Add to dashboard Cite

The aim was to study alterations of bacterial communities in patients undergoing hip or knee arthroplasty to assess the impact of chlorhexidine gluconate soap decolonisation and systemic antibiotic prophylaxis. A Swedish multicentre, prospective collection of samples obtained from elective arthroplasty patients (n=83) by swabbing anterior nares, skin sites in the groin and the site of planned surgery, before and after arthroplasty surgery, was analysed by 16S rRNA (V3-V4) gene sequencing and a complementary targeted tuf gene sequencing approach to comprehensively characterise alterations in staphylococcal communities. Significant reductions in alpha diversity was detected for both bacterial (p=0.04) and staphylococcal (p=0.03) groin communities after arthroplasty surgery with significant reductions in relative Corynebacterium (p=0.001) abundance and S. hominis (p=0.01) relative staphylococcal abundance. In nares, significant reductions occurred for S. hominis (p=0.02), S. haemolyticus (p=0.02), and S. pasteuri (p=0.003) relative to other staphylococci. S. aureus colonised 35% of anterior nares before and 26% after arthroplasty surgery. S. epidermidis was the most abundant staphylococcal species at all sampling sites. No bacterial genus or staphylococcal species increased significantly after arthroplasty surgery. Application of a targeted tuf gene sequencing approach provided auxiliary staphylococcal community profiles and allowed species-level characterisation directly from low biomass clinical samples.

show abstract

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

Cited by 95 publications

References 66 publications

Unintended consequences of long-sleeved gowns in a critical care setting during the COVID-19 pandemic

Unintended consequences of long-sleeved gowns in a critical care setting during the COVID-19 pandemic

Alteration of Bacterial Communities in Anterior Nares and Skin Sites of Patients Undergoing Arthroplasty Surgery: Analysis by 16S rRNA and Staphylococcal-Specific tuf Gene Sequencing

Alteration of Bacterial Communities in Anterior Nares and Skin Sites of Patients Undergoing Arthroplasty Surgery: Analysis by 16S rRNA and Staphylococcal-Specific <em>tuf</em> Gene Sequencing

Contact Info

Product

Resources

About