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Identification of Nosocomial Aspergillus fumigatus Using Virtual Surveillance
May 2004
E67
ISSUE: Group Health Cooperative experienced methicillin-resistant Staphylococcus aureus outbreaks during a 12month period in three ambulatory care clinics that perform wound care. Infection Control’s investigation, findings, and interventions are described. PROJECT: IC investigations revealed similar disparities in wound-care procedures that promoted crosscontamination and transmission of microorganisms. These included inadequacies in: personal protective equipment and environmental barrier use, environmental and instrument cleaning and disinfection, and separation of clean versus dirty items and procedures. Several strategies and interventions were implemented, procedures were written, staff education presented, and a multidisciplinary Wound Care Committee was formed that developed a Wound Care Training Program which included infection control principles and practices. RESULTS: Immediate interventions eliminated the outbreaks and transmission. The Wound Care Training that was developed as a result of the infection control assessment and risk identification has been effective in raising the infection control awareness of staff across the continuum of care and has promoted standardization of procedures and supplies and improved patient outcomes. No further outbreaks have occurred. All training and procedures have been applied across the GHC continuum of care (inpatient, home care, outpatient settings). LESSONS LEARNED: Infection control assessment and involvement in wound-care procedures and practice, and wound-care training that includes infection control principles and practices, is imperative in raising the staff infection control awareness and patient risks of multidrug-resistant organism transmission and acquisition that can occur as a direct result of the performance of wound care.
Identification of Nosocomial Aspergillus fumigatus Using Virtual Surveillance L Tellefsen* J Carrizosa C Kaptur Florida Hospital, Orlando, Florida
BACKGROUND: In February 2003, data-mining (DM) surveillance revealed a 190% (p¼0.004) increase from baseline of A. fumigatus respiratory isolates for a total of eight. Upon review of locations, it was found that four of eight isolates had been cultured from two units served by the same air handler. METHODS: Line listings provided by DM confirmed that isolates were hospital-acquired. Lab was consulted to rule out possible contamination of specimens in the laboratory. Since HVAC systems are often suspect in cases of hospital-acquired Aspergillus, the air handlers were examined. Fungal cultures were obtained from the final filters of the suspect HVAC. Cultures grew out A. fumigatus. Physical inspection of the filters revealed that they had not been seated properly, allowing some passage of unfiltered air. The filters were replaced and seated properly. Cultures were repeated and were negative for A. fumigatus. In addition to replacing the filters, engineering staff was reeducated on installation of final filters. RESULTS: Surveillance for hospital-acquired A. fumigatus has been continued. DM confirmed an 80% decrease (p ¼0.034). CONCLUSION: Proper installation of HVAC final filters is essential for prevention of hospital-acquired Aspergillus. DM is beneficial in early identification of potentially serious clusters of isolates and provides enhanced surveillance, which will help organizations meet 2005 JCAHO standards.
Pertussis, the Pediatrician, and the Outbreak S Schweon*
E67
ISSUE: Group Health Cooperative experienced methicillin-resistant Staphylococcus aureus outbreaks during a 12month period in three ambulatory care clinics that perform wound care. Infection Control’s investigation, findings, and interventions are described. PROJECT: IC investigations revealed similar disparities in wound-care procedures that promoted crosscontamination and transmission of microorganisms. These included inadequacies in: personal protective equipment and environmental barrier use, environmental and instrument cleaning and disinfection, and separation of clean versus dirty items and procedures. Several strategies and interventions were implemented, procedures were written, staff education presented, and a multidisciplinary Wound Care Committee was formed that developed a Wound Care Training Program which included infection control principles and practices. RESULTS: Immediate interventions eliminated the outbreaks and transmission. The Wound Care Training that was developed as a result of the infection control assessment and risk identification has been effective in raising the infection control awareness of staff across the continuum of care and has promoted standardization of procedures and supplies and improved patient outcomes. No further outbreaks have occurred. All training and procedures have been applied across the GHC continuum of care (inpatient, home care, outpatient settings). LESSONS LEARNED: Infection control assessment and involvement in wound-care procedures and practice, and wound-care training that includes infection control principles and practices, is imperative in raising the staff infection control awareness and patient risks of multidrug-resistant organism transmission and acquisition that can occur as a direct result of the performance of wound care.
Identification of Nosocomial Aspergillus fumigatus Using Virtual Surveillance L Tellefsen* J Carrizosa C Kaptur Florida Hospital, Orlando, Florida
BACKGROUND: In February 2003, data-mining (DM) surveillance revealed a 190% (p¼0.004) increase from baseline of A. fumigatus respiratory isolates for a total of eight. Upon review of locations, it was found that four of eight isolates had been cultured from two units served by the same air handler. METHODS: Line listings provided by DM confirmed that isolates were hospital-acquired. Lab was consulted to rule out possible contamination of specimens in the laboratory. Since HVAC systems are often suspect in cases of hospital-acquired Aspergillus, the air handlers were examined. Fungal cultures were obtained from the final filters of the suspect HVAC. Cultures grew out A. fumigatus. Physical inspection of the filters revealed that they had not been seated properly, allowing some passage of unfiltered air. The filters were replaced and seated properly. Cultures were repeated and were negative for A. fumigatus. In addition to replacing the filters, engineering staff was reeducated on installation of final filters. RESULTS: Surveillance for hospital-acquired A. fumigatus has been continued. DM confirmed an 80% decrease (p ¼0.034). CONCLUSION: Proper installation of HVAC final filters is essential for prevention of hospital-acquired Aspergillus. DM is beneficial in early identification of potentially serious clusters of isolates and provides enhanced surveillance, which will help organizations meet 2005 JCAHO standards.
Pertussis, the Pediatrician, and the Outbreak S Schweon*