Tracking Staphylococcus aureus in the intensive care unit using whole-genome sequencing

Dancer, S.J.; Adams, Colin; Smith, Johan; Pichon, Bruno; Kearns, Angela; Morrison, Donald A.

doi:10.1016/j.jhin.2019.04.016

Cited by 16 publications

(9 citation statements)

References 34 publications

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“…This article describes a detailed study in one ICU in an attempt to identify transmission pathways between patients, staff and the environment using S. aureus ( Figure 5) [2][3][4]. We found a relationship between the amount of times a site was touched and the total burden of microbial soil at that site.…”

Section: Discussionmentioning

confidence: 88%

“…Two of these pairs were highly related, but the relationship between the other two could not be verified because these isolates were EMRSA-15 and The third analysis of data concerned results from whole genomic sequencing (WGS). WGS established 34 S. aureus clusters between reservoirs and patients, with another four pairs showing convincing phenotypical and epidemiological relationships (Table 3) [4]. There were 20 of 34 (59%) pairs that were highly related (<25 SNPs); these pairs linked a carriage strain with a strain causing acquired infection in the same patient, i.e., so-called autogenous or endogenous transmission [13].…”

Section: Pass/fail Agreement % Between Surface and Air Sampling Datamentioning

confidence: 99%

“…Aerobic colony counts (ACC) per cm 2 were categorised as follows: no growth; scanty growth <2.5 cfu/cm 2 ; light growth 2.5-12 cfu/cm 2 ; moderate growth 12-40 cfu/cm 2 ; and heavy growth >40 cfu/cm 2 . Potential coagulase-positive staphylococci were captured from the selective agar, recultured and tested for coagulase production and antibiotic susceptibilities in accordance with routine laboratory protocol [2][3][4][5].…”

Section: Environmental Screeningmentioning

confidence: 99%

“…ICU air stream was directed onto nutrient and selective agar plates for 10 × 1 min [3]. The plates were processed using the same protocols for total bioburden and presence of S. aureus [2][3][4][5].…”

Section: Environmental Screeningmentioning

confidence: 99%

“…This commentary summarises the study; why it was performed, how it was performed, and the main results, which were published in a sequence of three papers by the authors of this article [2][3][4]. The findings suggest the main direction of travel for the study pathogen, S. aureus, as well as highlighting the most important reservoirs in an ICU.…”

Section: Introductionmentioning

confidence: 98%

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Dynamic Transmission of Staphylococcus Aureus in the Intensive Care Unit

Adams

Dancer

2020

IJERPH

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Staphylococcus aureus is an important bacterial pathogen. This study utilized known staphylococcal epidemiology to track S. aureus between patients, surfaces, staff hands and air in a ten-bed intensive care unit (ICU). Methods: Patients, air and surfaces were screened for total colony counts and S. aureus using dipslides, settle plates and an MAS-100 slit-sampler once a month for 10 months. Data were modelled against proposed standards for air and surfaces, and ICU-acquired staphylococcal infection. Whole-cell genomic typing (WGS) demonstrated possible transmission pathways between reservoirs. Results: Frequently touched sites were more likely to be contaminated (>12 cfu/cm2; p = 0.08). Overall, 235 of 500 (47%) sites failed the surface standard (≤2.5 cfu/cm2); 20 of 40 (50%) passive air samples failed the “Index of Microbial Air” standard (2 cfu/9 cm plate/h), and 15/40 (37.5%) air samples failed the air standard (<10 cfu/m3). Settle plate data were closer to surface counts than automated air data; the surface count most likely to reflect pass/fail rates for air was 5 cfu/cm2. Surface counts/bed were associated with staphylococcal infection rates (p = 0.012). Of 34 pairs of indistinguishable S. aureus, 20 (59%) showed autogenous transmission, with another four (12%) occurring between patients. Four (12%) pairs linked patients with hand-touch sites and six (18%) linked airborne S. aureus, staff hands and hand-touch sites. Conclusion: Most ICU-acquired S. aureus infection is autogenous, while staff hands and air were rarely implicated in onward transmission. Settle plates could potentially be used for routine environmental screening. ICU staphylococcal infection is best served by admission screening, systematic cleaning and hand hygiene.

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Section: Discussionmentioning

confidence: 88%

Section: Pass/fail Agreement % Between Surface and Air Sampling Datamentioning

confidence: 99%

Section: Environmental Screeningmentioning

confidence: 99%

Section: Environmental Screeningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Dynamic Transmission of Staphylococcus Aureus in the Intensive Care Unit

Adams

Dancer

2020

IJERPH

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Not in their hands only: hospital hygiene, evidence and collective moral responsibility

Jukola

Bondio

2022

Med Health Care and Philos

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Hospital acquired infections (HAIs) are a major threat to patient safety. This paper addresses the following question: given what is known about the causes of and possible interventions on HAIs, to whom or what should the moral responsibility for preventing these infections be attributed? First, we show how generating robust evidence on the effectiveness of preventive hygiene measures is a complex endeavour and review the existing evidence on the causes of HAIs. Second, we demonstrate that the existing literature on the ethical aspects of infection control has focused on responsibility at the individual-level. Thirdly, we argue that these accounts do not accommodate systemic factors relevant for HAI prevention. We show that the notion of collective responsibility is useful for making understandable how systemic factors, such as employment conditions in hospitals, are both causally and ethically relevant in infection control.

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