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Hospital acquired vancomycin-resistant Enterococcus faecium in a neonatal intensive care unit
AJIC April 1999
2 0 2 Abstracts
CONCLUSION: A high rate of recidivism in 10% of our institution's HCWs accounted for the majority of injuries (69%). Interventions to reduce the incidence of injuries due to needle-sticks or other sharp objects need to be targeted to specific sub-populations of HCWs. Only 22% of all injuries at our institution are reported. Anonymous surveys may provide a more accurate method of determining the incidence of needle-stick and other sharp object injuries.
MANAGEMENT OF THERAPEUTIC A C T M T I E S FOR PATIENTS COLONIZED/INFECTED WITH VIlE IN ACUTE REHABILITATION SETTING. S. Vyhlidal, RN,
MSN, CIC, R. Killeen, MA, CIC,* R. Penn, MD. Methodist Hospital, Omaha, Nebraska. Since the early 1940s when antibiotics first became available to fight infections, microorganisms have been changing to develop resistance to antibiotics. One of the most important resistant microorganisms in hospitals today is enterococcus, having developed resistance to multiple antibiotics. The acute rehabilitation setting presents challenges for providing and optimizing therapy to individuals colonized or infected with vancomyin-resistant enterococcus (VRE). Due to the potential extensive contact of colonized patients with other patients and patient care equipment in the acute rehabilitation setting, preventing the spread of VRE became a priority. The purpose of this multidrug resistant organism study was to facilitate a proactive approach to identification, isolation and provision of therapies for the patient colonized or infected with VRE, and to prevent the transmission of multi-drug resistant microorganisms from patient to patient in the acute rehabilitation setting. A three-fold protocol was developed which included: 1) pre-admission rectal or stool cultures for VRE, 2) development of policies and procedures for patients with VRE to participate in therapeutic activities outside of the patient room, and 3) environmental cleaning and management. Surveillance data on screening culture results and nosocomial colonization or infection was collected and analyzed following a 6-month trial of the protocol with no identified cross-transmission of VRE among the acute rehabilitation population.
HOSPITAL ACQUIRED VANCOMYCIN-RESISTANT ENTEROCOCCUS FAECIUM IN A NEONATAL INTENSIVE CARE UNIT. R. Burke, RN, MA, CIC,* G. Garvin,
R_N, MEd, CIC, C. Korn, RN, MPH, CIC, K. P e r ~ m a n , RN, MSN, C. Sulis, MD. Boston Medical Center, Boston, MA. OBJECTIVE: To describe a cluster of vancomycinresistant Enterococcus faecium (VRE) and factors that contributed to this cluster. SETTING: A 15-bed neonatal intensive care unit (NICU) in a university medical center. MEASUREMENTS: Clinical data, environmental cultures, and genetic typing of microbiological isolates. PATIENTS: Eight n e o n a t e s with VRE colonization. DESCRIPTION: The index case, during an 8-day transfer
to a neighboring pediatric facility, was cultured for routine surveillance purposes. On 6/21/98, six days after readmission to the NICU at Boston Medical Center (BMC), the staff was notified that the baby's stool culture was positive for VRE. Eleven n e o n a t e s p o t e n t i a l l y exposed and still hospitalized on 6/22 were cultured and 6 were found to have stool cultures positive for VRE. A seventh was stool culture positive on 6/29, VRE colonization was associated with an increased duration of hospitalization, 38.5 c o m p a r e d with 26.8 days, but not with vancomycin usage. Control measures instituted immediately included; staff re-education regarding strict handwashing, coborting of patients and staff, and contact precautions for neonates colonized with VRE. Additional cultures were done of environmental surfaces and 6 of 12 were VRE positive including: electronic thermometer, touch screen used to access the drug storage cart, doorknob of soiled utility room, baby scale, diaper scale, and bedside chart. Restriction endonuclease analysis of plasmid DNA identified 2 strains; the first was retrieved from 3 babies and 3 environmental sites, the second from 4 babies and the other 3 environmental sites. The strain from 1 remaining baby was not determined. After contamination of the environment was recognized, additional control m e a s u r e s included; extensive e n v i r o n m e n t a l cleaning by housekeeping services, removal of manual push tops on waste receptacles, dedicated stethoscopes for each neonate, and emphasis on disinfection of shared equipment. Location of charting activities was modified to reduce the risk of environmental contamination. Bedside charts were restricted from the central charting area, and medical records could not be taken to the bedside. No VRE infection was identified in any neonate. CONCLUSION: This cluster represents the first time VRE has been identified in the NICU at BMC, and the source remains unclear. Both handwashing practices and environmental contamination appear to have been contributing factors. Surveillance for new isolates continues.
Employee Health TUBERCULOSIS RESPIRATORY PROTECTION PRACTICES IN ACUTE MEDICAL FACILITIES IN THE STATE OF WYOMING. K. Olson, RN, MSN, CIC.* Department of
Veterans Affairs Medical Center, Sheridan, WY. PURPOSE: To assess the content of tuberculosis respiratory protection programs in acute medical facilities in the State of Wyoming, comparing actual practices in use to proposed Occupational Safety and Health Administration (OSHA) standards for TB control and prevention. METHODS: A descriptive survey utilizing a mailed questionnaire was sent to all acute medical facilities in the state of Wyoming. Telephone follow-up for clarification of responses or to contact non-responders was also utilized. Survey results were compared with the proposed OSHA TB standard to determine the readiness of Wyoming facilities to meet proposed guidelines.
2 0 2 Abstracts
CONCLUSION: A high rate of recidivism in 10% of our institution's HCWs accounted for the majority of injuries (69%). Interventions to reduce the incidence of injuries due to needle-sticks or other sharp objects need to be targeted to specific sub-populations of HCWs. Only 22% of all injuries at our institution are reported. Anonymous surveys may provide a more accurate method of determining the incidence of needle-stick and other sharp object injuries.
MANAGEMENT OF THERAPEUTIC A C T M T I E S FOR PATIENTS COLONIZED/INFECTED WITH VIlE IN ACUTE REHABILITATION SETTING. S. Vyhlidal, RN,
MSN, CIC, R. Killeen, MA, CIC,* R. Penn, MD. Methodist Hospital, Omaha, Nebraska. Since the early 1940s when antibiotics first became available to fight infections, microorganisms have been changing to develop resistance to antibiotics. One of the most important resistant microorganisms in hospitals today is enterococcus, having developed resistance to multiple antibiotics. The acute rehabilitation setting presents challenges for providing and optimizing therapy to individuals colonized or infected with vancomyin-resistant enterococcus (VRE). Due to the potential extensive contact of colonized patients with other patients and patient care equipment in the acute rehabilitation setting, preventing the spread of VRE became a priority. The purpose of this multidrug resistant organism study was to facilitate a proactive approach to identification, isolation and provision of therapies for the patient colonized or infected with VRE, and to prevent the transmission of multi-drug resistant microorganisms from patient to patient in the acute rehabilitation setting. A three-fold protocol was developed which included: 1) pre-admission rectal or stool cultures for VRE, 2) development of policies and procedures for patients with VRE to participate in therapeutic activities outside of the patient room, and 3) environmental cleaning and management. Surveillance data on screening culture results and nosocomial colonization or infection was collected and analyzed following a 6-month trial of the protocol with no identified cross-transmission of VRE among the acute rehabilitation population.
HOSPITAL ACQUIRED VANCOMYCIN-RESISTANT ENTEROCOCCUS FAECIUM IN A NEONATAL INTENSIVE CARE UNIT. R. Burke, RN, MA, CIC,* G. Garvin,
R_N, MEd, CIC, C. Korn, RN, MPH, CIC, K. P e r ~ m a n , RN, MSN, C. Sulis, MD. Boston Medical Center, Boston, MA. OBJECTIVE: To describe a cluster of vancomycinresistant Enterococcus faecium (VRE) and factors that contributed to this cluster. SETTING: A 15-bed neonatal intensive care unit (NICU) in a university medical center. MEASUREMENTS: Clinical data, environmental cultures, and genetic typing of microbiological isolates. PATIENTS: Eight n e o n a t e s with VRE colonization. DESCRIPTION: The index case, during an 8-day transfer
to a neighboring pediatric facility, was cultured for routine surveillance purposes. On 6/21/98, six days after readmission to the NICU at Boston Medical Center (BMC), the staff was notified that the baby's stool culture was positive for VRE. Eleven n e o n a t e s p o t e n t i a l l y exposed and still hospitalized on 6/22 were cultured and 6 were found to have stool cultures positive for VRE. A seventh was stool culture positive on 6/29, VRE colonization was associated with an increased duration of hospitalization, 38.5 c o m p a r e d with 26.8 days, but not with vancomycin usage. Control measures instituted immediately included; staff re-education regarding strict handwashing, coborting of patients and staff, and contact precautions for neonates colonized with VRE. Additional cultures were done of environmental surfaces and 6 of 12 were VRE positive including: electronic thermometer, touch screen used to access the drug storage cart, doorknob of soiled utility room, baby scale, diaper scale, and bedside chart. Restriction endonuclease analysis of plasmid DNA identified 2 strains; the first was retrieved from 3 babies and 3 environmental sites, the second from 4 babies and the other 3 environmental sites. The strain from 1 remaining baby was not determined. After contamination of the environment was recognized, additional control m e a s u r e s included; extensive e n v i r o n m e n t a l cleaning by housekeeping services, removal of manual push tops on waste receptacles, dedicated stethoscopes for each neonate, and emphasis on disinfection of shared equipment. Location of charting activities was modified to reduce the risk of environmental contamination. Bedside charts were restricted from the central charting area, and medical records could not be taken to the bedside. No VRE infection was identified in any neonate. CONCLUSION: This cluster represents the first time VRE has been identified in the NICU at BMC, and the source remains unclear. Both handwashing practices and environmental contamination appear to have been contributing factors. Surveillance for new isolates continues.
Employee Health TUBERCULOSIS RESPIRATORY PROTECTION PRACTICES IN ACUTE MEDICAL FACILITIES IN THE STATE OF WYOMING. K. Olson, RN, MSN, CIC.* Department of
Veterans Affairs Medical Center, Sheridan, WY. PURPOSE: To assess the content of tuberculosis respiratory protection programs in acute medical facilities in the State of Wyoming, comparing actual practices in use to proposed Occupational Safety and Health Administration (OSHA) standards for TB control and prevention. METHODS: A descriptive survey utilizing a mailed questionnaire was sent to all acute medical facilities in the state of Wyoming. Telephone follow-up for clarification of responses or to contact non-responders was also utilized. Survey results were compared with the proposed OSHA TB standard to determine the readiness of Wyoming facilities to meet proposed guidelines.