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Frequency of Outbreak Investigations in US Hospitals
www.ajicjournal.org Vol. 39 No. 5
E117
Presentation Number 5-026
Frequency of Outbreak Investigations in US Hospitals Emily Rhinehart, RN, MPH, Scott Walker, BA, Healthcare Division, Global Loss Prevention, Atlanta, GA; Karen O’Reilly, BS, MBA, Chief Innovation Officer, Lexington Insurance, Boston, MA; Patty Leeman, BSCE, MCE, MBA, Director, APIC Consulting Services, Inc, APIC, Washington, DC; Denise Murphy, RN, MPH, CIC, Vice President, Quality and Patient Safety; Main Line Health System, Bryn Mawr, PA Background/Objective: Although much data exists related to the incidence of healthcare-associated infections in hospitals, there is little data regarding the frequency of outbreaks and outbreak investigations. A survey of US Infection Preventionists was performed in order to obtain data necessary to estimate the frequency of outbreak investigations. Methods: A 2-part survey was developed and sent via email to APIC members in US hospitals in early 2010. Part 1 of the survey involved information on hospital demographics and the infection prevention/control program; Part 2 included questions about specific outbreak investigations including unit/department closures. The survey could accommodate information for up to 8 outbreak investigations and specified activities within the previous 24 months. Results: A final sample of 822 responses was analyzed representing 386 outbreak investigations in 289 US hospitals. Nearly 60% of the outbreaks were caused by 4 organisms: Norovirus (18%), S. aureus (17%), Acinetobactor spp. (14%) and C. difficile (10%). Norovirus occurred most often in non-acute settings such as behavioral health and rehabilitation/Long Term Acute Care units, while the other organisms occurred more often in medical/surgical units. Unit/department closure was reported in 22.6%of investigations and most often associated with Norovirus. Conclusions: Outbreak investigations are triggered by unusual organisms, rate above baseline for the unit and rate above baseline for the infection site. Investigations were initiated in all types and sizes of hospitals but most frequently in community/non-teaching hospitals and facilities with 201-300 beds. Mean number of confirmed cases was 10; mean duration was 58 days. A wide variety of control strategies were implemented. Norovirus is emerging as an increasingly common hospital-associated organism causing outbreaks in non-acute settings and often leading to unit/department closures. Presentation Number 5-027
Investigation of a Multi-Drug Resistant Klebsiella pneumoniae Outbreak in a Cardiac Surgery Intensive Care Unit (CSICU) Michael Anne Preas, RN, BSN, CIC, Infection Prevention and Control, University of Maryland Medical Center, Baltimore, MD; Laurie Conway, RN, MS, CIC, PhD Student, Columbia University School of Nursing, New York, NY; Joan Hebden, RN, MS, CIC, Director Infection Prevention and Control; Gwen Robinson, BS, Research Supervisor; Mary Lee, BS, Research Associate, University of Maryland Medical Center, Baltimore, MD; J. Kristie Johnson, PhD, Assistant Professor, Department of Pathology; Kerri A. Thom, MD, MS, Assistant Professor Hospital Epidemiology; University of Maryland School of Medicine, Baltimore, MD Background: During a 15 day period in January 2010, 5 patients in a cardiac surgery intensive care unit (CSICU) had clinical cultures positive for a multidrug resistant Klebsiella pneumoniae (MDRKP). All isolates were sensitive to imipenem and Polymixin B, had variable susceptibility to amikacin and other carbepenems (resistant to ertapenem and susceptible or resistant to meropenem), and resistant to all other classes of antibiotics. Modified Hodge test was negative for carbepenemase in all isolates. Clinical infection was confirmed in 4 of 5 patients; 2 had pneumonia, 1 had a symptomatic urinary tract infection (UTI), and the index case had pneumonia, UTI, and secondary bacteremia. The 5th patient was colonized with the organism in the urine. The MDRKP bacteremia in the index patient contributed to their death. A lab query for MDRKP in CSICU patients for the preceding 6 months did not identify any additional cases. Project: Medical records of the case patients were thoroughly reviewed for common procedures, use of equipment/ products, spatial adjacency and host risk factors. Nine clinical isolates from the case patients were typed by pulsed field gel electrophoresis (PFGE) to determine if this was a variable strain or transmission of one common strain. A hospital epidemiologist and infection preventionist met with the CSICU staff and physicians to review basic
E117
Presentation Number 5-026
Frequency of Outbreak Investigations in US Hospitals Emily Rhinehart, RN, MPH, Scott Walker, BA, Healthcare Division, Global Loss Prevention, Atlanta, GA; Karen O’Reilly, BS, MBA, Chief Innovation Officer, Lexington Insurance, Boston, MA; Patty Leeman, BSCE, MCE, MBA, Director, APIC Consulting Services, Inc, APIC, Washington, DC; Denise Murphy, RN, MPH, CIC, Vice President, Quality and Patient Safety; Main Line Health System, Bryn Mawr, PA Background/Objective: Although much data exists related to the incidence of healthcare-associated infections in hospitals, there is little data regarding the frequency of outbreaks and outbreak investigations. A survey of US Infection Preventionists was performed in order to obtain data necessary to estimate the frequency of outbreak investigations. Methods: A 2-part survey was developed and sent via email to APIC members in US hospitals in early 2010. Part 1 of the survey involved information on hospital demographics and the infection prevention/control program; Part 2 included questions about specific outbreak investigations including unit/department closures. The survey could accommodate information for up to 8 outbreak investigations and specified activities within the previous 24 months. Results: A final sample of 822 responses was analyzed representing 386 outbreak investigations in 289 US hospitals. Nearly 60% of the outbreaks were caused by 4 organisms: Norovirus (18%), S. aureus (17%), Acinetobactor spp. (14%) and C. difficile (10%). Norovirus occurred most often in non-acute settings such as behavioral health and rehabilitation/Long Term Acute Care units, while the other organisms occurred more often in medical/surgical units. Unit/department closure was reported in 22.6%of investigations and most often associated with Norovirus. Conclusions: Outbreak investigations are triggered by unusual organisms, rate above baseline for the unit and rate above baseline for the infection site. Investigations were initiated in all types and sizes of hospitals but most frequently in community/non-teaching hospitals and facilities with 201-300 beds. Mean number of confirmed cases was 10; mean duration was 58 days. A wide variety of control strategies were implemented. Norovirus is emerging as an increasingly common hospital-associated organism causing outbreaks in non-acute settings and often leading to unit/department closures. Presentation Number 5-027
Investigation of a Multi-Drug Resistant Klebsiella pneumoniae Outbreak in a Cardiac Surgery Intensive Care Unit (CSICU) Michael Anne Preas, RN, BSN, CIC, Infection Prevention and Control, University of Maryland Medical Center, Baltimore, MD; Laurie Conway, RN, MS, CIC, PhD Student, Columbia University School of Nursing, New York, NY; Joan Hebden, RN, MS, CIC, Director Infection Prevention and Control; Gwen Robinson, BS, Research Supervisor; Mary Lee, BS, Research Associate, University of Maryland Medical Center, Baltimore, MD; J. Kristie Johnson, PhD, Assistant Professor, Department of Pathology; Kerri A. Thom, MD, MS, Assistant Professor Hospital Epidemiology; University of Maryland School of Medicine, Baltimore, MD Background: During a 15 day period in January 2010, 5 patients in a cardiac surgery intensive care unit (CSICU) had clinical cultures positive for a multidrug resistant Klebsiella pneumoniae (MDRKP). All isolates were sensitive to imipenem and Polymixin B, had variable susceptibility to amikacin and other carbepenems (resistant to ertapenem and susceptible or resistant to meropenem), and resistant to all other classes of antibiotics. Modified Hodge test was negative for carbepenemase in all isolates. Clinical infection was confirmed in 4 of 5 patients; 2 had pneumonia, 1 had a symptomatic urinary tract infection (UTI), and the index case had pneumonia, UTI, and secondary bacteremia. The 5th patient was colonized with the organism in the urine. The MDRKP bacteremia in the index patient contributed to their death. A lab query for MDRKP in CSICU patients for the preceding 6 months did not identify any additional cases. Project: Medical records of the case patients were thoroughly reviewed for common procedures, use of equipment/ products, spatial adjacency and host risk factors. Nine clinical isolates from the case patients were typed by pulsed field gel electrophoresis (PFGE) to determine if this was a variable strain or transmission of one common strain. A hospital epidemiologist and infection preventionist met with the CSICU staff and physicians to review basic