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Rapid control of vancomycin-resistant Enterrococcus outbreak in an adult hematology unit at a tertiary hospital in Singapore
June 2005
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positive for this organism. One of the five patients had an isolate that was not identical to the nasal spray or the other four patient isolates. CONCLUSIONS: Intrinsic contamination of a nasal spray product (Twice-A-Day 12-hour Nasal Sprayä) with Burkholderia cepacia resulted in nosocomial transmission to four patients at our facility, one of whom had cystic fibrosis. Notification of the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) of this confirmed outbreak resulted in a voluntary product recall. As a result, an investigation by the CDC was undertaken to determine the extent of this outbreak nationwide. Abstract ID 50931 Tuesday, June 21
Rapid control of vancomycin-resistant Enterrococcus outbreak in an adult hematology unit at a tertiary hospital in Singapore KB How ML Ling LC Lee MP Chlebicki Singapore General Hospital, Singapore BACKGROUND/OBJECTIVES: While vancomycin-resistant Enterrococcus (VRE) infection is endemic in U.S. hospitals, little information exists concerning the problem in Southeast Asia. The recent VRE outbreak in our hospital marked the first outbreak in Singapore and called for the need to evaluate antibiotic utilization and strict infection control measures to prevent local epidemics. METHOD: In April 2004, vancomycin-resistant Enterrococcus faecium was cultivated from blood culture samples of two patients from the hematology unit of an acute tertiary-care hospital. Surveillance cultures, including rectal swabs or stool specimens, were then performed for the 14 existing hematology patients in the unit to assess the extent of the outbreak. Four patients yielded epidemiologically identical strains of VRE compared to the two index cases. A case control study was then conducted to determine possible contributory factors and antibiotic usage was analyzed to determine any correlation with the outbreak. Infection control measures instituted then were patient isolation with emphasis on contact precautions, quarantine of patients suspected to have contact with the index patients, ward closure and intensive environmental cleaning. RESULTS: A total of two infected and four colonizer cases were identified with identical pulsed-field gel electrophoresis (PFGE) patterns. The case control study showed that these patients had longer length of stay and received longer courses of antibiotics. Using logistic regression test, the use of metronidazole (p = 0.027) as well as the combination of metronidazole and cephalosporin group (p = 0.027) were significantly associated with the presence of VRE in the patient. CONCLUSION: Our study suggests that strict infection control measures successfully prevented further nosocomial spread of VRE. Further study is needed to determine the effectiveness of specific antibiotic therapy and costeffectiveness of routine screening of VRE in preventing future outbreaks. Abstract ID 50978 Tuesday, June 21
Did you think that it might be scabies? Identification of a case of Norwegian scabies on an acute care medical-surgical unit B Shephard1 M Jordan 2 1 2
Kaiser Santa Rosa Medical Center, Santa Rosa, California Kaiser Permanente San Rafael, San Rafael, California
E111
positive for this organism. One of the five patients had an isolate that was not identical to the nasal spray or the other four patient isolates. CONCLUSIONS: Intrinsic contamination of a nasal spray product (Twice-A-Day 12-hour Nasal Sprayä) with Burkholderia cepacia resulted in nosocomial transmission to four patients at our facility, one of whom had cystic fibrosis. Notification of the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) of this confirmed outbreak resulted in a voluntary product recall. As a result, an investigation by the CDC was undertaken to determine the extent of this outbreak nationwide. Abstract ID 50931 Tuesday, June 21
Rapid control of vancomycin-resistant Enterrococcus outbreak in an adult hematology unit at a tertiary hospital in Singapore KB How ML Ling LC Lee MP Chlebicki Singapore General Hospital, Singapore BACKGROUND/OBJECTIVES: While vancomycin-resistant Enterrococcus (VRE) infection is endemic in U.S. hospitals, little information exists concerning the problem in Southeast Asia. The recent VRE outbreak in our hospital marked the first outbreak in Singapore and called for the need to evaluate antibiotic utilization and strict infection control measures to prevent local epidemics. METHOD: In April 2004, vancomycin-resistant Enterrococcus faecium was cultivated from blood culture samples of two patients from the hematology unit of an acute tertiary-care hospital. Surveillance cultures, including rectal swabs or stool specimens, were then performed for the 14 existing hematology patients in the unit to assess the extent of the outbreak. Four patients yielded epidemiologically identical strains of VRE compared to the two index cases. A case control study was then conducted to determine possible contributory factors and antibiotic usage was analyzed to determine any correlation with the outbreak. Infection control measures instituted then were patient isolation with emphasis on contact precautions, quarantine of patients suspected to have contact with the index patients, ward closure and intensive environmental cleaning. RESULTS: A total of two infected and four colonizer cases were identified with identical pulsed-field gel electrophoresis (PFGE) patterns. The case control study showed that these patients had longer length of stay and received longer courses of antibiotics. Using logistic regression test, the use of metronidazole (p = 0.027) as well as the combination of metronidazole and cephalosporin group (p = 0.027) were significantly associated with the presence of VRE in the patient. CONCLUSION: Our study suggests that strict infection control measures successfully prevented further nosocomial spread of VRE. Further study is needed to determine the effectiveness of specific antibiotic therapy and costeffectiveness of routine screening of VRE in preventing future outbreaks. Abstract ID 50978 Tuesday, June 21
Did you think that it might be scabies? Identification of a case of Norwegian scabies on an acute care medical-surgical unit B Shephard1 M Jordan 2 1 2
Kaiser Santa Rosa Medical Center, Santa Rosa, California Kaiser Permanente San Rafael, San Rafael, California