Application of the forensic Luminol for blood in infection control.

Transmission of hepatitis C virus occurs frequently in haemodialysis units. A possible route of transmission is indirectly via the hospital environment although this has never been recorded. We investigated the haemodialysis unit in Deventer Hospital, Deventer, The Netherlands, with the forensic Luminol test. With this test, invisible traces of blood can be visualised based on the principle of biochemiluminescence. We demonstrated extensive contamination of the environment with traces of blood. The aim of this article is to introduce this method to infection control professionals, so it can be used to monitor cleaning and disinfection procedures, and alert healthcare workers to the possibility of contamination of the hospital environment with blood.

[Outbreak of multi-resistant Escherichia coli on a surgical ward: course, measures and consequences for future admissions of contaminated patients]. / Multiresistente Escherichia coli-epidemie op een chirurgische afdeling: verloop, maatregelen en consequenties voor toekomstige opnamen van besmette patiënten.

In the period July-September 2003, a multi-resistant Escherichia coli strain caused an outbreak on a surgical ward in the Deventer Hospital, the Netherlands. This strain produced a beta-lactamase with an extended spectrum, making it resistant to third generation cephalosporins. Furthermore, the strain was resistant to trimethoprim-sulphamethoxazole (co-trimoxazole), gentamicin and quinolones, so that only treatment with carbapenems was possible. 8 patients were colonised. Genotyping of the strains by means of amplified fragment length polymorphism indicated the spread of a single strain. A multidisciplinary crisis team coordinated the infection control measures and the communication to involved persons and the press. Control measures consisted of contact isolation of colonised patients and extra attention to hand hygiene. After this proved to be ineffective, all patients on the ward were screened and the ward was closed for several days. The outbreak was stopped by strict cohorting ofthe colonised patients. There were no indications for transmission of resistance genes by plasmids. Several months later, on visiting the outpatient clinic, 3 other patients appeared to have been colonised by the epidemic E. coli strain during their admission. They had not been screened because they had already been discharged when all patients on the ward were screened for colonisation. In a follow-up study 9 months after the outbreak, 3 of the 6 investigated patients, who had in the meantime returned home, were still found to be colonised. Such patients constitute a risk for the re-introduction of multi-resistant bacteria into the hospital and should be preventively screened and isolated on admission.

[Use and adverse reactions of local antibiotics and disinfectants on the skin]. / Nut en gevaren van op de huid toegepaste antibiotica en desinfectantia.

The local antibiotics are an important addition to the treatment of moderately severe skin infections. Development of contact allergy and bacterial resistance, however, are some of the adverse reactions that may occur. Fusidic acid and tetracycline are the most suitable products for the treatment of superficial primary infections of the skin caused by Gram-positive cocci and secondary infected dermatoses. In case of insufficient effect mupirocin may be tried. Mupirocin is an effective antibiotic in the treatment of nasal carriage of Staphylococcus aureus in cases of increased risk of infection (haemodialysis, continuous peritoneal dialysis, after thoracic surgery). Besides it is an important local antibiotic in the treatment of meticillin-resistant staphylococci in the nose. In order to prevent development of bacterial resistance its further use has to be restricted. Silver sulfadiazine is a good option for the local treatment of infections by Pseudomonas aeruginosa and other Gram-negative bacteria. Erythromycin and clindamycin are useful local antibiotics for the treatment of mild acne vulgaris. Disinfectants are mainly suitable for the use on the intact skin.

The sink as a correctable source of extended-spectrum ß-lactamase contamination for patients in the intensive care unit.

Between December 2010 and April 2012, intensive care unit (ICU) patients in our hospital were infrequently colonized with extended-spectrum ß-lactamase-positive bacteria (ESBLs). We hypothesized that these ESBLs originated from patients' room sinks, and this was prospectively investigated by weekly culturing of patients and sinks during a 20-week period. ESBLs were isolated from all 13 sinks. Four patients became colonized with ESBLs that were genetically identical to ESBLs that had previously been isolated from the sink. One of these patients died of pneumonia caused by the ESBL. Transmission from sinks to patients was stopped by integrating self-disinfecting siphons to all sinks on the ICU.

Severe hepatitis with coagulopathy due to HSV-1 in an immunocompetent man.

Severe hepatitis due to herpes simplex virus type 1 (HSV-1) in immunocompetent patients is a very rare event. The acute hepatitis may lead to fulminant deterioration of liver function and can be rapidly fatal. The diagnosis should be considered in case of severe hepatitis of unknown cause. Early consideration of HSV-1 hepatitis in the differential diagnosis in an adult patient, also with an apparently normal immune system, is important and early initiation of antiviral treatment may be lifesaving in this situation.

Isolation of vancomycin-resistant enterococci in haematologic patients.

After the occurrence of septicaemia with a vancomycin-resistant Enterococcus faecalis strain in a patient, it was decided to determine the number of carriers of vancomycin-resistant cocci among haematologic patients. During a period of six months 135 stool samples from 25 children, and 400 samples from 70 adults were studied. All samples from the children were negative for vancomycin-resistant cocci. Nine of the adult patients had cultures positive for cocci, all identified as enterococci, which were highly resistant to vancomycin (MIC greater than 250 micrograms/ml), sensitive to amoxicillin, moderately resistant to gentamicin, slightly resistant to teicoplanin, and sensitive to daptomycin. None of these patients had been given vancomycin prior to the isolation of the vancomycin-resistant enterococci.

Vancomycin-resistant Enterococcus faecalis in a bone-marrow transplant recipient.

Since 1988 a number of reports on the emergence of vancomycin-resistant enterococci have been published. We describe an additional case of colonization of and subsequent infection with a vancomycin-resistant Enterococcus faecalis in a bone-marrow transplant recipient, who had never before received vancomycin therapy. The strain was resistant to most antibiotics tested, including low-level resistance to gentamicin and cross-resistance to teicoplanin. It was sensitive to amoxicillin and the lipopeptide antibiotic daptomycin. The origin, the mode of acquisition and the incidence of vancomycin-resistant enterococci are still unknown. The clinical and bacteriological features of the cases reported thus far and the genetic and biochemical basis of vancomycin resistance are discussed.

Prevention of primary cytomegalovirus infection in patients with hematologic malignancies by intensive white cell depletion of blood products.

The effect of white cell depletion of red cells and platelet concentrates on the transmission of cytomegalovirus (CMV) was studied retrospectively in 150 patients treated intensively for acute leukemia or non-Hodgkin's lymphoma. CMV infection was diagnosed on the basis of IgM and IgG antibody responses to CMV late antigen (CMV-LA). Before cytoreductive therapy for their underlying disease, 59 patients were CMV seronegative and 91 were CMV seropositive. None of the 59 CMV-seronegative patients showed persistent seroconversion 2 months after the cytoreductive treatment. The comparison group, consisting of 312 cardiac surgery patients, showed a significantly higher incidence of primary CMV infections: 10 of 86 (11.6%, p = 0.004). Twenty-five percent of the CMV-seronegative patients and controls had transient IgG antibodies to CMV-LA without IgM antibodies, which is indicative of antibodies passively acquired via blood products. These results indicate that white cell-poor blood products carry a very low risk, if any, of CMV transmission. The policy of transfusing white cell-poor blood products provides a useful alternative to the selection of CMV-seronegative donors.