Impact of discontinuation of contact precautions on central-line associated bloodstream infections in an academic children's hospital.

We investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children's hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.

Alternative doffing strategies of personal protective equipment to prevent self-contamination in the health care setting.

BACKGROUND: Health care workers routinely contaminate skin and clothing when doffing personal protective equipment (PPE). Alternative doffing strategies, such as hand hygiene on gloved hands and double gloving, have been suggested but not validated by comparison against the standard Centers for Disease Control and Prevention procedures. METHODS: Participants were assigned to doff PPE following 1 of 4 specific strategies. Prior to doffing, PPE was "contaminated" with Glo Germ and fluorescing Staphylococcus epidermidis at the recommended level of 1.5 × 108 colony forming units/mL. After doffing, areas of self-contamination were detected using a black light. Cultures were taken from these areas using cotton swabs, inoculated onto blood agar plates, and incubated for 48hours. Each participant completed a survey regarding usability. The Fisher exact test and the Kruskal-Wallis test were used for data analysis with SAS 9.4. RESULTS: There were 51 participants who completed the study. Breaches in PPE were observed in only 5 of 51 doffs (10%). However, 46 of 51 (90%) had areas of self-contamination that was apparent by transfer of Glo Germ to skin or clothing. A subset (16%) of these sites also grew fluorescing S epidermidis. Assigned doffing strategy was associated with bacterial contamination (P = .0151), but not usability (P = .2372). CONCLUSIONS: Participants experienced self-contamination when doffing PPE with both a surrogate marker and live bacteria. Close attention to doffing technique is necessary for optimal results, and one-step procedures may be more effective.

Carbapenem-resistant Enterobacteriaceae at a low prevalence tertiary care center: Patient-level risk factors and implications for an infection prevention strategy.

Limited treatment options and a growing global threat from carbapenem-resistant Enterobacteriaceae (CRE) infections illustrate the importance of understanding the epidemiology of CRE. Using a retrospective chart review and point prevalence testing demonstrated specific patient risk factors for CRE-positive clinical cultures in a tertiary medical center with a low CRE prevalence.

Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities.

Candida spp. are among the most frequent nosocomial pathogens, contributing significantly to morbidity and mortality. Longitudinal data on the epidemiology of Candida bloodstream infections (BSIs) are still limited. Isolates and clinical data from 1218 episodes of Candida BSI were prospectively collected from patients in 52 hospitals in the USA between 1998 and 2006. Susceptibilities to amphotericin B, flucytosine, fluconazole, posaconazole, voriconazole, anidulafungin, caspofungin and micafungin were determined for 1077 Candida isolates by the CLSI reference broth microdilution method using the recently published species-specific clinical breakpoints. Candida albicans was the most prevalent species (50.7%), followed by Candida parapsilosis (17.4%), Candida glabrata (16.7%) and Candida tropicalis (10.2%). The prevalence of non-albicans Candida spp. increased over time. Patients had a mean age of 51 years and a mean length of hospital stay prior to BSI of 22 days. The main underlying conditions were gastrointestinal (20.1%) and pulmonary (13.0%) diseases. Intravenous catheters (19.1%) and the urinary tract (8.0%) were the most frequently determined likely sources, whilst in the majority of patients (61.1%) no source could be identified. Overall mortality was 38.1%. Of the isolates studied, 0.8% of C. albicans, 100.0% of C. glabrata, 2.9% of C. parapsilosis and 4.9% of C. tropicalis were non-susceptible to fluconazole, and 0.6% of C. albicans, 5.0% of Candida krusei, 7.6% of C. parapsilosis and 9.8% of C. tropicalis were non-susceptible to voriconazole. All echinocandins showed good activity against most Candida spp., including the majority of C. parapsilosis isolates, but only 38.1% of C. glabrata tested susceptible to caspofungin.

Are gym surfaces reservoirs for Staphylococcus aureus? A point prevalence survey.

We sought to identify staphylococcal contamination of gymnasium surfaces. Various environmental surfaces were cultured at a university fitness center. Ten out of 99 samples yielded Staphylococcus aureus, all of which were methicillin-susceptible. Gym surfaces may be colonized with staphylococci and could play a role in community transmission of staphylococcal species.

Central venous catheter colonization by linezolid-resistant, vancomycin-susceptible Enterococcus faecalis.

Resistance to linezolid is rare in clinical isolates of Enterococcus faecalis. A strain resistant to this antimicrobial but susceptible to vancomycin was found to cause central venous catheter colonization in a patient who never received linezolid.