Hospital-wide healthcare-associated carbapenemase-producing Enterobacterales outbreak: risks of electric floor scrubbers in catering facilities and kitchens.

BACKGROUND: Carbapenemase-producing Enterobacterales (CPE) are associated with poor clinical outcomes and can spread rapidly in healthcare settings. Environmental reservoirs are increasingly recognized as playing an important part in some nosocomial outbreaks. AIM: To describe the investigation and control of a CPE outbreak, lasting several years, across two separate hospital sites within one organization. METHODS: Investigation of multiple ward-level CPE cross-transmissions with a number of sporadic cases. Environmental sampling of ward environments, catering facilities and electric floor scrubbers was undertaken. FINDINGS: Eleven patients over a 19-month period were identified as carrying healthcare-associated New Delhi metallo-beta-lactamase (NDM)-producing Enterobacter cloacae, and a further patient carried NDM Escherichia coli. E. cloacae isolates were indistinguishable on pulsed-field gel electrophoresis typing, supporting acquisition with a single point source. Environmental sampling found contamination of the electric floor scrubbers used for cleaning the hospital catering facilities and in the associated toilets. Standard outbreak response measures achieved control of ward outbreaks. Sporadic cases and hospital-wide cross-transmission were controlled after interventions on the central food-handling unit and by decommissioning affected floor scrubbers. Electric floor scrubbers were found to have the potential to disperse Gram-negative bacteria into the surrounding environment under experimental conditions. CONCLUSION: This outbreak report demonstrates that catering facilities and kitchens can be involved in widespread healthcare outbreaks of enteric organisms. This is also the first report of the potential role of electric floor scrubbers in causing significant environmental contamination with CPE which may indicate a role in nosocomial transmission.

Outbreak of invasive group A streptococcus: investigations using agar settle plates detect perineal shedding from a healthcare worker.

BACKGROUND: Outbreaks of group A streptococcus (GAS) infections may occur in healthcare settings. Transmission to patients is sometimes linked to colonized healthcare workers (HCWs) and/or a contaminated environment. AIM: To describe the investigation and control of an outbreak of healthcare-associated GAS on an elderly care medical ward, over six months. METHODS: Four patients developed septicaemia due to GAS infection without a clinically obvious site of infection. The outbreak team undertook an investigation involving a retrospective review of GAS cases, prospective case finding, HCW screening and environmental sampling using both swabs and settle plates. Immediate control measures included source isolation and additional cleaning of the ward environment with a chlorine disinfectant and hydrogen peroxide. FINDINGS: Prospective patient screening identified one additional patient with throat GAS carriage. Settle plate positivity for GAS was strongly associated with the presence of one individual HCW on the ward, who was subsequently found to have GAS perineal carriage. Contamination of a fabric-upholstered chair in an office adjacent to the ward, used by the HCW, was also detected. In total, three asymptomatic HCWs had throat GAS carriage and one HCW had both perineal and throat carriage. All isolates were typed as emm 28. CONCLUSION: This is the first outbreak report demonstrating the use of settle plates in a GAS outbreak investigation on a medical ward, to identify the likely source of the outbreak. Based on this report we recommend that both throat and perineal sites should be sampled if HCW screening is undertaken during an outbreak of GAS. Fabric, soft furnishings should be excluded from clinical areas as well as any adjacent offices because pathogenic bacteria such as GAS may contaminate this environment.

Non-slip socks: a potential reservoir for transmitting multidrug-resistant organisms in hospitals?

Non-slip socks are increasingly used to prevent falls in hospitals. Patients use them to walk to various parts of the hospital and also wear them in bed. Fifty-four pairs of socks and 35 environmental floor samples were obtained from seven wards in a tertiary referral hospital. Vancomycin-resistant enterococci (VRE) were detected from 46 (85%) socks and meticillin-resistant Staphylococcus aureus (MRSA) from five (9%). Environmental sampling cultured VRE from 24 (69%) floor samples and MRSA from six (17%) floor samples. Clostridium difficile was not detected from any sample. Non-slip socks may become contaminated with multidrug-resistant pathogens and may form a potential route for cross-transmission.

First UK trial of Xenex PX-UV, an automated ultraviolet room decontamination device in a clinical haematology and bone marrow transplantation unit.

BACKGROUND: There is growing interest in the use of no-touch automated room decontamination devices within healthcare settings. Xenex PX-UV is an automated room disinfection device using pulsed ultraviolet (UV) C radiation with a short cycle time. AIM: To investigate the microbiological efficacy of this device when deployed for terminal decontamination of isolation rooms within a clinical haematology unit. METHODS: The device was deployed in isolation rooms in a clinical haematology unit. Contact plates were applied to common touch points to determine aerobic total colony counts (TCCs) and samples collected using Polywipe™ sponges for detection of vancomycin-resistant enterococci (VRE). FINDINGS: The device was easy to transport, easy to use, and it disinfected rooms rapidly. There was a 76% reduction in the TCCs following manual cleaning, with an additional 14% reduction following UV disinfection, resulting in an overall reduction of 90% in TCCs. There was a 38% reduction in the number of sites where VRE was detected, from 26 of 80 sites following manual cleaning to 16 of 80 sites with additional UV disinfection. CONCLUSIONS: The Xenex PX-UV device can offer a simple and rapid additional decontamination step for terminal disinfection of patient rooms. However, the microbiological efficacy against VRE was somewhat limited.

Investigating the impact of clinical anaesthetic practice on bacterial contamination of intravenous fluids and drugs.

Syringes (N = 426), ventilator machine swabs (N = 202) and intravenous (IV) fluid administration sets (N = 47) from 101 surgical cases were evaluated for bacterial contamination. Cultures from the external surface of syringe tips and syringe contents were positive in 46% and 15% of cases, respectively. The same bacterial species was cultured from both ventilator and syringe in 13% of cases, and was also detected in the IV fluid administration set in two cases. A significant association was found between emergency cases and contaminated syringes (odds ratio 4.5, 95% confidence interval 1.37-14.8; P = 0.01). Other risk factors included not using gloves and failure to cap syringes.

Outbreak of invasive group A streptococcus infection: contaminated patient curtains and cross-infection on an ear, nose and throat ward.

BACKGROUND: Outbreaks of group A streptococcus (GAS) infections may occur in healthcare settings and have been documented in surgical, obstetrics and gynaecology, and burns units. The environment may serve as a reservoir and facilitate transmission via contaminated equipment. AIM: To describe the investigation and control of an outbreak of healthcare-associated GAS infection on an ear, nose and throat (ENT) ward in a tertiary referral centre. METHODS: Two patients with laryngeal cancer developed invasive GAS infection (bacteraemia) with associated tracheostomy wound cellulitis within a 48 h period. The outbreak team undertook an investigation involving a retrospective review of GAS cases, prospective case finding, healthcare worker screening and sampling of patient curtains. Immediate control measures included source isolation, a thorough rolling clean with a chlorine-based disinfectant and hydrogen peroxide decontamination of patient equipment. FINDINGS: Prospective patient screening identified one additional patient with carriage of GAS from a tracheostomy wound swab. Staff screening identified one healthcare worker who acquired GAS during the outbreak and who subsequently developed pharyngitis. Environmental sampling demonstrated that 10 out of 34 patient curtains on the ward were contaminated with GAS and all isolates were typed as emm-1. CONCLUSION: This is the first outbreak report to demonstrate patient curtains as potential source for GAS cross-transmission, with implications in relation to hand hygiene and frequency of laundering. Based on this report we recommend that during an outbreak of GAS infection all patient curtains should be changed as part of the enhanced decontamination procedures.