An outbreak of Burkholderia contaminans at a quaternary children's hospital linked to equipment reprocessing.

Burkholderia cepacia complex (BCC) has been increasingly implicated in local and multistate outbreaks in both adult and pediatric healthcare settings. However, a lack of source identification may be common for BCC outbreak investigations. We describe, in detail, the investigation of an outbreak of BCC (B. contaminans) among pediatric patients at a large quaternary-care children's hospital and our system-level changes and outcomes.

Reduced male fertility of an Antarctic mite following extreme heat stress could prompt localized population declines.

Climate change is leading to substantial global thermal changes, which are particularly pronounced in polar regions. Therefore, it is important to examine the impact of heat stress on the reproduction of polar terrestrial arthropods, specifically, how brief extreme events may alter survival. We observed that sublethal heat stress reduces male fecundity in an Antarctic mite, yielding females that produced fewer viable eggs. Females and males collected from microhabitats with high temperatures showed a similar reduction in fertility. This impact is temporary, as indicated by recovery of male fecundity following return to cooler, stable conditions. The diminished fecundity is likely due to a drastic reduction in the expression of male-associated factors that occur in tandem with a substantial increase in the expression of heat shock proteins. Cross-mating between mites from different sites confirmed that heat-exposed populations have impaired male fertility. However, the negative impacts are transient as the effect on fertility declines with recovery time under less stressful conditions. Modeling indicated that heat stress is likely to reduce population growth and that short bouts of non-lethal heat stress could have substantial reproductive effects on local populations of Antarctic arthropods.

Maximizing efficiency in a high occupancy setting to utilize ultraviolet disinfection for isolation rooms.

BACKGROUND: Ultraviolet (UV) disinfection decreases nosocomial disease rates in acute care settings; effective program implementation is poorly understood. We developed a program to UV-disinfect rooms following discharge of patients in transmission-based precautions (TBP) and assessed its effect on hospital-acquired infection (HAI) rates. METHODS: An isolation room housed a patient in any type of TBP. A priority room was an isolation room in TBP for multidrug resistant organisms or Clostridioides difficile infection. Percent rooms disinfected and HAI rates were calculated monthly. The two-robot program was started by Infection Prevention utilizing a single environmental services employee. Efficiency was increased by granting environmental services' personnel oversight, increasing coverage, and modifying shift-based goals. Our primary goal was disinfection of all discharged priority rooms. Our secondary goal was disinfection of all discharged isolation rooms. RESULTS: The program achieved 6-month disinfection averages of 85.7% of isolation, and 87.7% priority rooms, respectively. Using a dedicated UV disinfection team and setting isolation room per shift goals improved coverage. HAI rates decreased by 16.2% following program implementation. CONCLUSIONS: We implemented an effective UV disinfection program, and observed HAI reduction, by focusing on broad coverage and efficient deployment of assets without affecting patient flow or expanding the robot fleet.

Reduced isolation room turnover time using Lean methodology.

OBJECTIVE: To prevent environmental transmission of pathogens, hospital rooms housing patients on transmission-based precautions are cleaned extensively and disinfected with ultraviolet (UV) light. To do so consistently requires time and coordination, and these procedures must avoid patient flow delays and associated safety risks. We sought to improve room turnover efficiency to allow for UV disinfection. DESIGN: A 60-day quality improvement and implementation project. SETTING: A quaternary academic pediatric referral facility. INTERVENTIONS: A multidisciplinary healthcare team participated in a 60-day before-and-after trial that followed the Toyota Production System Lean methodology. We used value-stream mapping and manual time studies to identify areas for improvement. Areas addressed included room breakdown, room cleaning, and wait time between cleaning and disinfection. Room turnover was measured as the time in minutes from a discharged patient exiting an isolation room to UV disinfection completion. Impact was measured using postintervention manual time studies. RESULTS: Median room turnover decreased from 130 minutes (range, 93-294 minutes) to 65 minutes (range, 48-95 minutes; P < .0001). Other outcomes included decreased median time between room breakdown to cleaning start time (from 10 to 3 minutes; P = .004), room cleaning complete to UV disinfection start (from 36 to 8 minutes; P < .0001), and the duration of room cleaning and curtain changing (from 57 to 37 minutes; P < .0001). CONCLUSION: We decreased room turnover time by half in 60 days by decreasing times between and during routine tasks. Utilizing Lean methodology and manual time study can help teams understand and improve hospital processes and systems.