RESUMO
BACKGROUND: An increased incidence of P. aeruginosa in microbiological surveillance (MS) cultures from gastrointestinal endoscopes was detected between March 2020 to March 2023 in Tan Tock Seng Hospital Singapore. The aim of this report is to describe the use of whole-genome sequencing (WGS) in this investigation. METHODS: WGS was performed for all P. aeruginosa isolates with pairwise comparison of isolates to assess for genomic linkage. Comprehensive review of reprocessing practices and environmental sampling was performed. FINDINGS: Twenty-two P. aeruginosa isolates were detected from endoscopic MS cultures. Fifteen (68%) isolates were available for WGS. Eighteen pairwise comparisons of isolates were made, of which 10 were found to be genomically linked. One endoscope had P. aeruginosa repeatedly cultured from subsequent MS that were genomically linked and persistent despite repeat endoscopic reprocessing, establishing the persistence of biofilm that could not be eradicated with routine reprocessing. All P. aeruginosa isolates cultured from other different endoscopes were genetically distinct. Investigation into reprocessing practices revealed the use of air/water valves connected to endoscopes during clinical use. Inspection of these valves revealed the presences of cracks and tears. All other environmental samples were negative. CONCLUSIONS: The WGS findings helped to deprioritize common source contamination and supported the hypothesis of biofilm buildup within endoscopes leading to repeatedly positive MS cultures that were genomically linked. This was possibly related to incomplete reprocessing of the damaged air/water valves, resulting in biofilm build up. All faulty valves were changed and subsequently cleaned separately with ultrasonic cleaning followed by sterilization which resolved this incident.
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There is ongoing debate about the efficacy of surgical masks versus N95 respirators for protection against pandemic novel swine-origin influenza A (H1N1)-2009. Our hospital, which is designated to manage outbreaks of emerging infection, has robust surveillance systems to detect infection in staff. The incidence of pandemic H1N1-2009 remained low in staff with use of surgical masks.
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Surtos de Doenças , Pessoal de Saúde/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/prevenção & controle , Máscaras/estatística & dados numéricos , Estudos de Coortes , Humanos , Influenza Humana/epidemiologia , Influenza Humana/transmissão , Vigilância da População , Singapura/epidemiologiaRESUMO
BACKGROUND: Good hand hygiene (HH) prevents health care-associated infections. We compared psychosocial and organizational factors associated with HH compliance and perceived need for improvement among physicians, nurses, and allied health professionals (AHPs). METHODS: We conducted a mixed-methods study in a 1,600-bed adult tertiary-care hospital in Singapore. Seven focus group discussions were conducted and data were analyzed using thematic analysis. The subsequent cross-sectional survey involved 1,064 staff members. Principal components analysis was performed to derive the latent factor structure that was applied in multivariable analyses. RESULTS: All staff members acknowledged that HH was an integral part of their work, but were noncompliant due to competing priorities. Physicians were forgetful but appreciated reminders. Nurses were intrinsically motivated for HH. After adjusting for gender, staff category, seniority, and dermatitis history, having positive knowledge-attitudes-behaviors (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.23-1.69), personal motivators-enablers (OR, 1.60; 95% CI, 1.38-1.86), and emotional motivators (OR, 1.62; 95% CI 1.40-1.88) were positively associated with good HH compliance. Women (OR, 3.91; 95% CI, 1.37-11.11), seniors (OR, 2.88; 95% CI, 1.08-7.68), nurses (OR, 4.05; 95% CI, 1.51-10.87), and staff with personal motivators-enablers for HH (OR, 1.60; 95% CI, 1.08-2.37) were more likely to perceive a need for improvement. CONCLUSIONS: Factors influencing self-reported HH differed between health care professional groups. Group-specific interventions are needed to improve compliance.
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Fidelidade a Diretrizes , Higiene das Mãos/normas , Pessoal de Saúde/psicologia , Recursos Humanos em Hospital/psicologia , Atitude do Pessoal de Saúde , Coleta de Dados , Humanos , Controle de InfecçõesRESUMO
Background: In May 2015, we noticed an increase in carbapenem-resistant Acinetobacter baumannii (CRAB) infections in the Medical Intensive Care Unit (MICU). To investigate this, we studied the extent of environmental contamination and subsequent onward clonal transmission of CRAB. Methods: We conducted a one-day point prevalence screening (PPS) of the patients and environment in the MICU. We screened patients using endotracheal tube aspirates and swabs from nares, axillae, groin, rectum, wounds, and exit sites of drains. We collected environmental samples from patients' rooms and environment outside the patients' rooms. CRAB isolates from the PPS and clinical samples over the subsequent one month were studied for genetic relatedness by whole genome sequencing (WGS). Results: We collected 34 samples from seven patients and 244 samples from the environment. On the day of PPS, we identified 8 CRAB carriers: 3 who screened positive and 5 previously known clinical infections. We detected environmental contamination in nearly two-thirds of the rooms housing patients with CRAB. WGS demonstrated genetic clustering of isolates within rooms but not across rooms. We analysed 4 CRAB isolates from clinical samples following the PPS. One genetically-related CRAB was identified in the respiratory sample of a patient with nosocomial pneumonia, who was admitted to the MICU five days after the PPS. Conclusion: The extensive environmental colonization of CRAB by patients highlights the importance of environmental hygiene. The transmission dynamics of CRAB needs further investigation.
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Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/transmissão , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla/fisiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/classificação , Acinetobacter baumannii/isolamento & purificação , Feminino , Humanos , Higiene , Intubação/efeitos adversos , Masculino , Programas de Rastreamento , Testes de Sensibilidade MicrobianaRESUMO
We conducted a randomized controlled trial in a tertiary-care hospital in a real-time setting to evaluate the effectiveness of 3 hand hygiene protocols in reducing hand carriage of methicillin-resistant and methicillin-sensitive Staphylococcus aureus among health care workers. Our study shows that use of alcohol handrub, either covering all hand surfaces in no particular order or using the 7-step technique, and chlorhexidine handwashing were equally effective in removing hand carriage of these pathogens.
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Álcoois/administração & dosagem , Clorexidina/administração & dosagem , Desinfetantes/administração & dosagem , Desinfecção das Mãos/métodos , Mãos/microbiologia , Pessoal de Saúde , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Humanos , Controle de Infecções/métodos , Centros de Atenção Terciária , Resultado do TratamentoAssuntos
Infecções por Coronavirus/prevenção & controle , Dispositivos de Proteção dos Olhos , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Máscaras , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Singapura/epidemiologiaRESUMO
BACKGROUND: The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend the use of alcohol handrubs to prevent health care-associated infections. However, the efficacy and time effectiveness of different alcohol handrubbing protocols have yet to be evaluated. METHODS: We conducted a randomized controlled trial in the general wards of a 1,300-bed, acute, tertiary care hospital to compare the effectiveness of 3 hand hygiene protocols during routine inpatient care: (1) handrubbing with alcohol covering all hand surfaces, (2) handrubbing with alcohol using the standard 7-step technique, and (3) handwashing with chlorhexidine using the standard 7-step technique. Hand samples were obtained from 60 medical and 60 nursing staff, before and after hand hygiene. Quantitative and qualitative bacterial evaluations were carried out by microbiologists blinded to the protocol. RESULTS: All 3 protocols were effective in reducing hand bacterial load (P < .01). During routine patient care, alcohol handrubbing covering all hand surfaces required less time (median, 26.0 seconds) than alcohol handrubbing using the 7-step technique (median 38.5 seconds; P = .04) and chlorhexidine handwashing (median, 75.5 seconds; P < .001). CONCLUSION: Alcohol handrubbing protocols are as efficacious as chlorhexidine handwashing. Alcohol handrubbing covering all hand surfaces is the most time-effective protocol for routine patient care activities in busy general wards.