Extensively Drug-Resistant Pseudomonas aeruginosa Outbreak Associated With Artificial Tears.

BACKGROUND: Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug-resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak. METHODS: Cases were defined as a US patient's first isolation of P. aeruginosa sequence type 1203 with carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to the Centers for Disease Control and Prevention during 1 January 2022-15 May 2023. We conducted a 1:1 matched case-control study at the post-acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination. RESULTS: We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and 4 (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears versus controls (crude matched OR, 5.0; 95% CI, 1.1-22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. Food and Drug Administration inspection of the manufacturing plant identified likely sources of contamination. CONCLUSIONS: A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the United States. The clinical impacts from this outbreak underscore the need for improved requirements for US OTC product importers.

Candida auris in US Correctional Facilities.

Candida auris is an emerging fungal pathogen that typically affects patients in healthcare settings. Data on C. auris cases in correctional facilities are limited but are needed to guide public health recommendations. We describe cases and challenges of providing care for 13 patients who were transferred to correctional facilities during January 2020-December 2022 after having a positive C. auris specimen. All patients had positive specimens identified while receiving inpatient care at healthcare facilities in geographic areas with high C. auris prevalence. Correctional facilities reported challenges managing patients and implementing prevention measures; those challenges varied by whether patients were housed in prison medical units or general population units. Although rarely reported, C. auris cases in persons who are incarcerated may occur, particularly in persons with known risk factors. Measures to manage cases and prevent C. auris spread in correctional facilities should address setting-specific challenges in healthcare and nonhealthcare correctional environments.

Development and implementation of learning collaboratives for infection prevention and control education in long-term care facilities.

Infections in long-term care facilities pose a critical challenge, with 1 to 3 million serious infections annually and up to 380,000 associated deaths. The vulnerability of aging populations and inadequate infection prevention and control programs underscore the need for intervention. This initiative provided tailored continuing education through 8 virtual learning collaboratives serving 541 infection preventionists. The project also developed 9 infection prevention and control toolkits and a manual to further support long-term care facilities' infection prevention efforts.

Infection Prevention and Control in Long-term Care Facilities in Florida: A Needs Assessment Survey.

BACKGROUND: Although several surveys of infection prevention and control (IPC) practices have been conducted in the United States, none have focused on the state of Florida, which has the fourth largest number of certified nursing facilities in the country. A needs assessment survey was conducted to better understand the specific needs and practices of individuals responsible for IPC in long-term care facilities (LTCFs) in Florida. METHODS: In November and December of 2022, a 90-question online survey was distributed to individuals responsible for IPC activities at 3,690 LTCFs in Florida. After omitting incomplete responses, 304 survey responses were analyzed using descriptive statistics. RESULTS: Survey responses regarding hand hygiene, sharps safety, and staff training reflect compliance with recommended IPC practices. Staffing shortages for Registered Nurses, Licensed Practical Nurses, and Certified Nursing Assistants were high among respondents (30%), while few reported shortages of Personal Protective Equipment (5%). Only 11% of respondents state their facility requires flu vaccines despite the high-risk environment of LTCFs. Concerning the built environment, the results suggest Infection Preventionists have limited awareness of the scope of heating, ventilation, and air conditioning systems in their facilities. CONCLUSION: Some areas of compliance with IPC best practices were noted, but multiple opportunities for education and training on IPC best practices were identified.