- Email: [email protected]
In Situ Detection of Residual Protein Contamination on Surgical Instruments for On-the-Spot Monitoring of Decontamination.
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Poster Abstracts / American Journal of Infection Control 40 (2012) e31-e176
with stabilized bromine for 24 hours with repeat flushing and institution of a dual alternating biocide program (oxidizing and non-oxidizing), intermittent positive cultures were found in the cooling towers. We conclude that municipal chloramination is a highly effective method of eliminating Legionella from cultures of potable water in health care facilities. However, even with the increased residual activity and efficacy in biofilms of chloramines, Legionella can persist in cooling towers requiring continued vigilance.
Presentation Number 16-229 Communication of MRSA Status Upon Transfers of LTCF Residents to an Acute Care Hospital Zoran Pikula MD, Infection Control Practitioner, North York General Hospital; Mr. Wil Ng MHSc, Epidemiologist, NYGH; Mr. David Kim, IS specialist, NYGH; Ms. Diane White, Manager of IPAC, NYGH; Dr. Kevin Katz, Medical director of IPAC ID specialist, NYGH University of Toronto Issue: Acute care facilities face challenges with MRSA positive residents transferred from Long Term Care Facilities (LTCFs), particularly if their MRSA status is not known on admission. In 2004 and 2005 our admission screening data showed a high rate of MRSA colonization among residents transferred from LTCFs (35%). As a result, we implemented empiric contact precautions to prevent transmission to other patients, similar to measures in place for high risk direct transfers from out-of-country healthcare facilities. In addition, MRSA PCR testing within 24 hours of transfer was implemented for all LTC transfers and efforts were made to improve communication of MRSA status during the transfer process to our facility. We describe our experience over the last 5 years.
included in the analysis. LTCF residents transferred to NYGH were tested by MRSA PCR and confirmed by culture. MRSA admission screening data for the general patient population (April-July 2008) were also analyzed for comparison reasons. Results: Over the study period, 3,049 residents from various LTCFs in Ontario were transferred to our hospital. The number of these transfers increased steadily from 501 residents in 2006 to 768 residents in 2010 (53% increase) indicating an increased burden for our ER and inpatient units. We identified 373 unknown MRSA cases among them (12%). We found a significant decrease in the percentage of unknown resident MRSA cases detected upon admission to our hospital from LTCF's, from 56% in 2006 to 24% in 2010 (p<0.001). In addition, the percentage of unknown MRSA positive cases among the residents transferred from all LTCFs decreased significantly from 16% in 2006 to 9% in 2010 (p<0.001). This rate, however, is still higher than overall admission MRSA prevalence in all patients without a known history of MRSA colonization (1.4%). Lesson Learned: LTCF transfers to acute care facilities can lead to unwanted MRSA exposures if MRSA status is not well communicated upon transfer. Communication of the status of known MRSA positive residents helps to avoid undesirable MRSA exposures. Effective communication between sectors is required and improvement is possible.
Presentation Number 16-230 In Situ Detection of Residual Protein Contamination on Surgical Instruments for On-the-Spot Monitoring of Decontamination. Helen Baxter PhD, Senior Research Fellow, University of Edinburgh; Dr Anita C Jones, Reader in Physical Chemistry, University of Edinburgh; Robert L. Baxter Professor, Professor of Chemical Biology, University of Edinburgh Background/Objectives: Current methods for detection of residual contamination on reprocessed surgical instruments can no longer be considered adequate for quality control in modern hospital decontamination units. Visual inspection by trained operatives results in rejection of instruments with surface protein loadings of >0.1 ug/mm2. Chemical swabbing' methods are less effective. We have developed a fast and quantitative method for analysis of surface-bound protein on reprocessed surgical instruments. This involves derivatization of surface-bound protein molecules with
Project: Admission and screening data available on LTCF resident transfers from January 2006 to December 2010 were reviewed. We determined the incidence of unknown MRSA cases among residents transferred to our acute care facility from any LTCF. We defined unknown MRSA cases as those cases not identified on the transfer forms. MRSA positive cases whose status was communicated upon transfer were not considered at risk', and therefore not
Fig 1. Residual contamination on a ‘visually clean’ Needle Clamp analysed by SEM & EDX. (a) shows an image of the clean instrument (b) shows an Scanning Electron Microscope backscatter image of residual contamination at the tip of the needle clamp and (c) the Energy Dispersive X-ray spectrum of the reisdue, showing the presence of carbon, nitrogen, oxygen & sulfur d a characteristic profile of protein, and sodium, potassium, chloride & carbonate salts.
APIC 39th Annual Educational Conference & International Meeting j San Antonio, TX j June 4-6, 2012
Poster Abstracts / American Journal of Infection Control 40 (2012) e31-e176
e167
a fluorescent reagent and epifluorescence surface scanning (EFSCAN). This technique gives a quantitative map of sub-nanogramme/ mm2 concentrations of proteins bound to instrument surfaces. Objectives of the Study a) Determining the current status' of residual contamination on reprocessed surgical instruments. b) Configuring the EFSCAN instrumentation to give a pass/fail code for reprocessed surgical instruments.
Fig 2. Epifluorescence surface scanner (EFSCAN). Fig 4. EFSCAN analysis expressed as ng/mm2 of residual protein of 42 reprocessed surgical instruments. 93% of the scanned instruments have a residual contamination below 1.5 ng/mm2; the average level of contamination is 0.57 ng/mm2. Three instruments exhibit much higher than average levels of contamination.
Table 1 EFSCAN analysis as hypothetical quality control list of reprocessed instruments Instrument Code
Fig 3. EFSCAN analysis of a reprocessed needle holder the total surface load of protein is 2.8ug which is equivalent to 2.4 ng/mm2.
Methods: Surgical instruments used in this study were cleaned by conventional procedures by Hospital Sterile Service Departments. Labelling of residual contamination was carried out by immersing the instrument in a (0.1%) solution of fluorescein isothiocyanate (FITC) in carbonate buffer and rinsing with water. EFSCAN was carried out using a custom-built scanner. Excitation of the sample was at 468 nm and the fluorescence was detected collinearly with the excitation. FITC-Bovine serum albumin (BSA), dried onto stainless steel discs, was used for calibration. The limit of detection was <10 pg/mm2. Results: A major problem in the area of surgical instrument reprocessing is the definition of âVeclean'. Figure 1 shows a typical SEM and elemental analysis of a reprocessed surgical instrument, measured during a UK survey in 2004. This instrument had passed visual inspection and chemical swab tests but SEM examination showed it to have significant surface protein contamination (ca 100 ng/mm2). This result was fairly typical (reprocessed instruments normally have 50-120 ng/mm2 protein) but this type of analysis of an instrument takes several hours. Our recently developed EFSCAN
Sci 1 Sci2 NH3 NH G ssP BSH VS OMPss P4(P29) D1 D3 BCI ornf t OJ t it anium NH 4 D5 AC H 3 3_5 AN 511 Sci P44 Sci BC252 NH 5 TC 15.5 TC 24.5 TP 20.5 SP 20.5 R 0.9 Hook 1 hook2 Hook c 3 Csci DuP NH S 8 NH S 7 NH C 8 NH C 9 NH C 10 NH C 11 NH C 12 NH C 13 TH3 Cup P 29
Total Protein (ng)
Protein Density (ng/mm2)
291 87.78 788 307 847 508 224.9 884 402 553.8 259 84 218 95.7 3.8 3.3 187 790 72.7 873 380 551.8 14.9 124 18.1 908.7 103 44 42 79.7 1187.8 58.3 315.9 229.7 288.8 88.5 113 79 2885 225 30.5 198
0.37 0.20 0.91 0.98 0.94 0.70 0.38 0.73 1.57 0.91 0.78 0.24 0.31 0.10 0.07 0.08 0.27 2.98 0.51 1.08 0.38 0.97 0.10 0.19 0.19 1.24 0.87 0.14 0.24 0.33 0.71 0.17 0.34 0.34 0.34 0.19 0.17 0.07 2.48 0.33 0.13 0.28
APIC 39th Annual Educational Conference & International Meeting j San Antonio, TX j June 4-6, 2012
e168
Poster Abstracts / American Journal of Infection Control 40 (2012) e31-e176
technique gives fast and reliable quantitation of residual protein contamination on instrument surfaces. The layout of the scanner is shown in Figure 2. Using this technology we have conducted a survey of reprocessed surgical instruments taken from Scottish hospitals over the past six months. A typical scan of a reprocessed instrument is shown in Figure 3. Sample results for 42 instruments are shown in Figure 4 and Table 1. Gratifyingly, our results show much lower levels of contamination than the UK survey of 2004. Conclusions: We are now developing this technique as a method of quality control where instruments can be validated on a pass/fail (green/red) system. This is exemplified in Table 1 for a hypothetical pass/fail threshold of 1.5 ng/mm2.
Presentation Number 16-231 Multicenter Study of Hand Carriage of Potential Pathogens by Neonatal ICU Providers Yu-hui Ferng MPA, Project Manager, Columbia University School of Nursing; Dr. Sarah Clock PhD, Project Coordinator & Laboratory Supervisor, Columbia University Medical Center; Ms. Jennifer Wong-McLoughlin RN, Research Nurse, Columbia University School of Nursing; Dr. Patricia DeLaMora MD, Assistant Attending Pediatrician, Assistant Professor of Pediatrics, Weill Cornell Medical Center, NewYork-Presbyterian; Dr. Jeffrey Perlman MB, ChB, Professor of Pediatrics, Director of the Divison of Newborn Medicine, Weill Cornell Medical Center; Ms. Kelly Gray RN, Neonatal Clinical Research Coordinator, Christiana Care Health System; Dr. David Paul MD, Associate Professor of Pediatrics, Attending Neonatologist, Christiana Care Health System, Thomas Jefferson University School of Medicine; Ms. Priya Prasad MPH, Research Associate, The Children's Hospital of Philadelphia; Ms. Lauren Miller BA, Research Assistant, The Children's Hospital of Philadelphia; Ms. Julie Fierro BA, Research Technician, The Children's Hospital of Philadelphia; Dr. Theoklis Zaoutis MD, MSCE, Associate Professor of Pediatrics and Epidemiology, Associate Chief, The Children's Hospital of Philadelphia; Ms. Setareh Tabibi BA, Laboratory Technician, Columbia University; Mr. Luis Alba BS, Data Manager, Columbia University; Dr. Susan Whittier PhD, ABMM, Assistant Professor of Clinical Pathology, Associate Director, Clinical Microbiology Service, Columbia University, NewYork-Presbyterian; Dr. Elaine L. Larson RN, PhD, CIC, Associate Dean for Research, Columbia University School of Nursing; Dr. Lisa Saiman MD MPH, Professor of Clinical Pediatrics and Hospital Epidemiologist of Morgan Stanley Children's Hospital, Columbia University Department of Pediatrics Background/Objectives: Hand carriage of potential bacterial pathogens by neonatal ICU (NICU) healthcare providers is well documented and can be associated with infant colonization/infection and outbreaks. We compared the rates and types of hand flora among NICU providers in four level III NICUs. Methods: We performed 4 surveillance efforts in each NICU from April 2010 to November 2011 and obtained cultures from the dominant hand of 50 providers in each study NICU using the glovejuice method (Larson E, et al. Arch Pediatr Adolesc Med 2005; 159:377-83). Eligible participants included those providers with direct patient contact whose primary clinical responsibility was in the study NICUs (e.g., neonatology attending physicians and fellows, nurses, nurse practitioners, respiratory therapists). Names of participants were not collected and participants could be cultured during more than one surveillance effort. Cultures were processed in a central microbiology laboratory.
Results: In all, 800 hand cultures were obtained: 78% from nurses and 94% from women. Most participants (mean 79%, range per effort: 68-90%) reported they had performed hand hygiene within 15 minutes of obtaining hand cultures. The proportion of cultures with normal flora and/or other microorganisms during the four surveillance efforts is shown (Table). The majority of cultures (99%) grew normal skin flora (defined as coagulase negative staphylococci [CoNS] and/or diphtheroids). The rate of recovery of normal flora was similar between sites and surveillance efforts. Six cultures grew methicillin-resistant S aureus and one culture grew vancomycin-resistant enterococci. Among the 14 gram-negative bacilli detected, none were resistant to gentamicin, ceftriaxone or meropenem. The proportion of cultures with specific microorganisms was similar among the study NICUs during each individual surveillance effort and also within individual NICUs over time. However, when results from all of the surveillance efforts were aggregated, the proportion of cultures positive for S aureus or streptococcal species differed among the NICUs (both P¼.001). Distribution of Microorganisms Detected on NICU Provider Hands during Four Surveillance Efforts NICU 1 n¼1892
Microorganism1
Normal flora 187 (99%) Staphylococcus 24 (13%) aureus3 Enteroccocus spp. 9 (5%) Gram-negative 4 3 (2%)5 bacilli Micrococcus spp. 42 (22%) streptococcus 69 (37%) spp.3 Yeast
0
NICU 2 n¼1962 195 (99%)
NICU 3 n¼1932
Total n¼7742
193 (100%) 195 (99%) 770 (99%)
18 (9%) 6 (3%)
16 (8%) 5 (3%)
4 (2%) 5 (3%)
62 (8%) 25 (3%)
5 (3%) 37 (19%)
4 (2%)5 52 (27%)
0 58 (30%)
12 (2%) 189 (24%)
40 (21%)
46 (23%)
222 (29%)
2(1%)
2 (0.2%)
67 (34%) 0
NICU 4 n¼1962
0
1
More than One microorganism could be detected in individual cultures. Excluded surveillance cultures with 'No growth'. Proportion of cultures positive for S. aureus or streptococcal species differed among NICUs (both P¼.001). 4 Includes Klebsiella (n¼5), Enterobacter (n¼3), Pantoea (n¼3), Serratio (n¼2) and Acinetobacter (n¼1) spp. 5 One provider harbored two species of gram-negative bacilli. 2 3
Conclusions: In this multicenter study, few NICU providers harbored potentially pathogenic flora (with the exception of CoNS) and none harbored resistant gram-negative bacilli. Differences in hand flora for some microorganisms, most notably S aureus, were noted among the different NICUs. We speculate that recent performance of hand hygiene by participants removed potentially pathogenic flora.
Presentation Number 16-232 Survey to Determine Compliance with Center for Disease Control Recommendation for Vaccination of Adolescents Christine Kettunen PhD, MSN, RN, CIC, Director of Nursing & Epidemiology, Ashtabula County Health Department; Ms. Rebecca Robinson RN, Public Health Nurse, Ashtabula County Health Department; Ms. Katie McIntrye RN, Public Health Nurse, Ashtabula County Health Department; Mrs. Cindy Anderson BSN, RN, School Nurse, Geneva Area City Schools Issue: The Center for Disease Control & Prevention (CDC) & the Advisory Committee on Immunization Practices (ACIP) recommend that adolescents receive vaccination for protection against tetanus,
APIC 39th Annual Educational Conference & International Meeting j San Antonio, TX j June 4-6, 2012
Poster Abstracts / American Journal of Infection Control 40 (2012) e31-e176
with stabilized bromine for 24 hours with repeat flushing and institution of a dual alternating biocide program (oxidizing and non-oxidizing), intermittent positive cultures were found in the cooling towers. We conclude that municipal chloramination is a highly effective method of eliminating Legionella from cultures of potable water in health care facilities. However, even with the increased residual activity and efficacy in biofilms of chloramines, Legionella can persist in cooling towers requiring continued vigilance.
Presentation Number 16-229 Communication of MRSA Status Upon Transfers of LTCF Residents to an Acute Care Hospital Zoran Pikula MD, Infection Control Practitioner, North York General Hospital; Mr. Wil Ng MHSc, Epidemiologist, NYGH; Mr. David Kim, IS specialist, NYGH; Ms. Diane White, Manager of IPAC, NYGH; Dr. Kevin Katz, Medical director of IPAC ID specialist, NYGH University of Toronto Issue: Acute care facilities face challenges with MRSA positive residents transferred from Long Term Care Facilities (LTCFs), particularly if their MRSA status is not known on admission. In 2004 and 2005 our admission screening data showed a high rate of MRSA colonization among residents transferred from LTCFs (35%). As a result, we implemented empiric contact precautions to prevent transmission to other patients, similar to measures in place for high risk direct transfers from out-of-country healthcare facilities. In addition, MRSA PCR testing within 24 hours of transfer was implemented for all LTC transfers and efforts were made to improve communication of MRSA status during the transfer process to our facility. We describe our experience over the last 5 years.
included in the analysis. LTCF residents transferred to NYGH were tested by MRSA PCR and confirmed by culture. MRSA admission screening data for the general patient population (April-July 2008) were also analyzed for comparison reasons. Results: Over the study period, 3,049 residents from various LTCFs in Ontario were transferred to our hospital. The number of these transfers increased steadily from 501 residents in 2006 to 768 residents in 2010 (53% increase) indicating an increased burden for our ER and inpatient units. We identified 373 unknown MRSA cases among them (12%). We found a significant decrease in the percentage of unknown resident MRSA cases detected upon admission to our hospital from LTCF's, from 56% in 2006 to 24% in 2010 (p<0.001). In addition, the percentage of unknown MRSA positive cases among the residents transferred from all LTCFs decreased significantly from 16% in 2006 to 9% in 2010 (p<0.001). This rate, however, is still higher than overall admission MRSA prevalence in all patients without a known history of MRSA colonization (1.4%). Lesson Learned: LTCF transfers to acute care facilities can lead to unwanted MRSA exposures if MRSA status is not well communicated upon transfer. Communication of the status of known MRSA positive residents helps to avoid undesirable MRSA exposures. Effective communication between sectors is required and improvement is possible.
Presentation Number 16-230 In Situ Detection of Residual Protein Contamination on Surgical Instruments for On-the-Spot Monitoring of Decontamination. Helen Baxter PhD, Senior Research Fellow, University of Edinburgh; Dr Anita C Jones, Reader in Physical Chemistry, University of Edinburgh; Robert L. Baxter Professor, Professor of Chemical Biology, University of Edinburgh Background/Objectives: Current methods for detection of residual contamination on reprocessed surgical instruments can no longer be considered adequate for quality control in modern hospital decontamination units. Visual inspection by trained operatives results in rejection of instruments with surface protein loadings of >0.1 ug/mm2. Chemical swabbing' methods are less effective. We have developed a fast and quantitative method for analysis of surface-bound protein on reprocessed surgical instruments. This involves derivatization of surface-bound protein molecules with
Project: Admission and screening data available on LTCF resident transfers from January 2006 to December 2010 were reviewed. We determined the incidence of unknown MRSA cases among residents transferred to our acute care facility from any LTCF. We defined unknown MRSA cases as those cases not identified on the transfer forms. MRSA positive cases whose status was communicated upon transfer were not considered at risk', and therefore not
Fig 1. Residual contamination on a ‘visually clean’ Needle Clamp analysed by SEM & EDX. (a) shows an image of the clean instrument (b) shows an Scanning Electron Microscope backscatter image of residual contamination at the tip of the needle clamp and (c) the Energy Dispersive X-ray spectrum of the reisdue, showing the presence of carbon, nitrogen, oxygen & sulfur d a characteristic profile of protein, and sodium, potassium, chloride & carbonate salts.
APIC 39th Annual Educational Conference & International Meeting j San Antonio, TX j June 4-6, 2012
Poster Abstracts / American Journal of Infection Control 40 (2012) e31-e176
e167
a fluorescent reagent and epifluorescence surface scanning (EFSCAN). This technique gives a quantitative map of sub-nanogramme/ mm2 concentrations of proteins bound to instrument surfaces. Objectives of the Study a) Determining the current status' of residual contamination on reprocessed surgical instruments. b) Configuring the EFSCAN instrumentation to give a pass/fail code for reprocessed surgical instruments.
Fig 2. Epifluorescence surface scanner (EFSCAN). Fig 4. EFSCAN analysis expressed as ng/mm2 of residual protein of 42 reprocessed surgical instruments. 93% of the scanned instruments have a residual contamination below 1.5 ng/mm2; the average level of contamination is 0.57 ng/mm2. Three instruments exhibit much higher than average levels of contamination.
Table 1 EFSCAN analysis as hypothetical quality control list of reprocessed instruments Instrument Code
Fig 3. EFSCAN analysis of a reprocessed needle holder the total surface load of protein is 2.8ug which is equivalent to 2.4 ng/mm2.
Methods: Surgical instruments used in this study were cleaned by conventional procedures by Hospital Sterile Service Departments. Labelling of residual contamination was carried out by immersing the instrument in a (0.1%) solution of fluorescein isothiocyanate (FITC) in carbonate buffer and rinsing with water. EFSCAN was carried out using a custom-built scanner. Excitation of the sample was at 468 nm and the fluorescence was detected collinearly with the excitation. FITC-Bovine serum albumin (BSA), dried onto stainless steel discs, was used for calibration. The limit of detection was <10 pg/mm2. Results: A major problem in the area of surgical instrument reprocessing is the definition of âVeclean'. Figure 1 shows a typical SEM and elemental analysis of a reprocessed surgical instrument, measured during a UK survey in 2004. This instrument had passed visual inspection and chemical swab tests but SEM examination showed it to have significant surface protein contamination (ca 100 ng/mm2). This result was fairly typical (reprocessed instruments normally have 50-120 ng/mm2 protein) but this type of analysis of an instrument takes several hours. Our recently developed EFSCAN
Sci 1 Sci2 NH3 NH G ssP BSH VS OMPss P4(P29) D1 D3 BCI ornf t OJ t it anium NH 4 D5 AC H 3 3_5 AN 511 Sci P44 Sci BC252 NH 5 TC 15.5 TC 24.5 TP 20.5 SP 20.5 R 0.9 Hook 1 hook2 Hook c 3 Csci DuP NH S 8 NH S 7 NH C 8 NH C 9 NH C 10 NH C 11 NH C 12 NH C 13 TH3 Cup P 29
Total Protein (ng)
Protein Density (ng/mm2)
291 87.78 788 307 847 508 224.9 884 402 553.8 259 84 218 95.7 3.8 3.3 187 790 72.7 873 380 551.8 14.9 124 18.1 908.7 103 44 42 79.7 1187.8 58.3 315.9 229.7 288.8 88.5 113 79 2885 225 30.5 198
0.37 0.20 0.91 0.98 0.94 0.70 0.38 0.73 1.57 0.91 0.78 0.24 0.31 0.10 0.07 0.08 0.27 2.98 0.51 1.08 0.38 0.97 0.10 0.19 0.19 1.24 0.87 0.14 0.24 0.33 0.71 0.17 0.34 0.34 0.34 0.19 0.17 0.07 2.48 0.33 0.13 0.28
APIC 39th Annual Educational Conference & International Meeting j San Antonio, TX j June 4-6, 2012
e168
Poster Abstracts / American Journal of Infection Control 40 (2012) e31-e176
technique gives fast and reliable quantitation of residual protein contamination on instrument surfaces. The layout of the scanner is shown in Figure 2. Using this technology we have conducted a survey of reprocessed surgical instruments taken from Scottish hospitals over the past six months. A typical scan of a reprocessed instrument is shown in Figure 3. Sample results for 42 instruments are shown in Figure 4 and Table 1. Gratifyingly, our results show much lower levels of contamination than the UK survey of 2004. Conclusions: We are now developing this technique as a method of quality control where instruments can be validated on a pass/fail (green/red) system. This is exemplified in Table 1 for a hypothetical pass/fail threshold of 1.5 ng/mm2.
Presentation Number 16-231 Multicenter Study of Hand Carriage of Potential Pathogens by Neonatal ICU Providers Yu-hui Ferng MPA, Project Manager, Columbia University School of Nursing; Dr. Sarah Clock PhD, Project Coordinator & Laboratory Supervisor, Columbia University Medical Center; Ms. Jennifer Wong-McLoughlin RN, Research Nurse, Columbia University School of Nursing; Dr. Patricia DeLaMora MD, Assistant Attending Pediatrician, Assistant Professor of Pediatrics, Weill Cornell Medical Center, NewYork-Presbyterian; Dr. Jeffrey Perlman MB, ChB, Professor of Pediatrics, Director of the Divison of Newborn Medicine, Weill Cornell Medical Center; Ms. Kelly Gray RN, Neonatal Clinical Research Coordinator, Christiana Care Health System; Dr. David Paul MD, Associate Professor of Pediatrics, Attending Neonatologist, Christiana Care Health System, Thomas Jefferson University School of Medicine; Ms. Priya Prasad MPH, Research Associate, The Children's Hospital of Philadelphia; Ms. Lauren Miller BA, Research Assistant, The Children's Hospital of Philadelphia; Ms. Julie Fierro BA, Research Technician, The Children's Hospital of Philadelphia; Dr. Theoklis Zaoutis MD, MSCE, Associate Professor of Pediatrics and Epidemiology, Associate Chief, The Children's Hospital of Philadelphia; Ms. Setareh Tabibi BA, Laboratory Technician, Columbia University; Mr. Luis Alba BS, Data Manager, Columbia University; Dr. Susan Whittier PhD, ABMM, Assistant Professor of Clinical Pathology, Associate Director, Clinical Microbiology Service, Columbia University, NewYork-Presbyterian; Dr. Elaine L. Larson RN, PhD, CIC, Associate Dean for Research, Columbia University School of Nursing; Dr. Lisa Saiman MD MPH, Professor of Clinical Pediatrics and Hospital Epidemiologist of Morgan Stanley Children's Hospital, Columbia University Department of Pediatrics Background/Objectives: Hand carriage of potential bacterial pathogens by neonatal ICU (NICU) healthcare providers is well documented and can be associated with infant colonization/infection and outbreaks. We compared the rates and types of hand flora among NICU providers in four level III NICUs. Methods: We performed 4 surveillance efforts in each NICU from April 2010 to November 2011 and obtained cultures from the dominant hand of 50 providers in each study NICU using the glovejuice method (Larson E, et al. Arch Pediatr Adolesc Med 2005; 159:377-83). Eligible participants included those providers with direct patient contact whose primary clinical responsibility was in the study NICUs (e.g., neonatology attending physicians and fellows, nurses, nurse practitioners, respiratory therapists). Names of participants were not collected and participants could be cultured during more than one surveillance effort. Cultures were processed in a central microbiology laboratory.
Results: In all, 800 hand cultures were obtained: 78% from nurses and 94% from women. Most participants (mean 79%, range per effort: 68-90%) reported they had performed hand hygiene within 15 minutes of obtaining hand cultures. The proportion of cultures with normal flora and/or other microorganisms during the four surveillance efforts is shown (Table). The majority of cultures (99%) grew normal skin flora (defined as coagulase negative staphylococci [CoNS] and/or diphtheroids). The rate of recovery of normal flora was similar between sites and surveillance efforts. Six cultures grew methicillin-resistant S aureus and one culture grew vancomycin-resistant enterococci. Among the 14 gram-negative bacilli detected, none were resistant to gentamicin, ceftriaxone or meropenem. The proportion of cultures with specific microorganisms was similar among the study NICUs during each individual surveillance effort and also within individual NICUs over time. However, when results from all of the surveillance efforts were aggregated, the proportion of cultures positive for S aureus or streptococcal species differed among the NICUs (both P¼.001). Distribution of Microorganisms Detected on NICU Provider Hands during Four Surveillance Efforts NICU 1 n¼1892
Microorganism1
Normal flora 187 (99%) Staphylococcus 24 (13%) aureus3 Enteroccocus spp. 9 (5%) Gram-negative 4 3 (2%)5 bacilli Micrococcus spp. 42 (22%) streptococcus 69 (37%) spp.3 Yeast
0
NICU 2 n¼1962 195 (99%)
NICU 3 n¼1932
Total n¼7742
193 (100%) 195 (99%) 770 (99%)
18 (9%) 6 (3%)
16 (8%) 5 (3%)
4 (2%) 5 (3%)
62 (8%) 25 (3%)
5 (3%) 37 (19%)
4 (2%)5 52 (27%)
0 58 (30%)
12 (2%) 189 (24%)
40 (21%)
46 (23%)
222 (29%)
2(1%)
2 (0.2%)
67 (34%) 0
NICU 4 n¼1962
0
1
More than One microorganism could be detected in individual cultures. Excluded surveillance cultures with 'No growth'. Proportion of cultures positive for S. aureus or streptococcal species differed among NICUs (both P¼.001). 4 Includes Klebsiella (n¼5), Enterobacter (n¼3), Pantoea (n¼3), Serratio (n¼2) and Acinetobacter (n¼1) spp. 5 One provider harbored two species of gram-negative bacilli. 2 3
Conclusions: In this multicenter study, few NICU providers harbored potentially pathogenic flora (with the exception of CoNS) and none harbored resistant gram-negative bacilli. Differences in hand flora for some microorganisms, most notably S aureus, were noted among the different NICUs. We speculate that recent performance of hand hygiene by participants removed potentially pathogenic flora.
Presentation Number 16-232 Survey to Determine Compliance with Center for Disease Control Recommendation for Vaccination of Adolescents Christine Kettunen PhD, MSN, RN, CIC, Director of Nursing & Epidemiology, Ashtabula County Health Department; Ms. Rebecca Robinson RN, Public Health Nurse, Ashtabula County Health Department; Ms. Katie McIntrye RN, Public Health Nurse, Ashtabula County Health Department; Mrs. Cindy Anderson BSN, RN, School Nurse, Geneva Area City Schools Issue: The Center for Disease Control & Prevention (CDC) & the Advisory Committee on Immunization Practices (ACIP) recommend that adolescents receive vaccination for protection against tetanus,
APIC 39th Annual Educational Conference & International Meeting j San Antonio, TX j June 4-6, 2012