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Klebsiella Pneumoniae Experience in an Urban Panamanian Hospital: Environmental Decontamination and a Role in Reduction of Hospital-acquired Infection Rates
S154
Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166
patient room episodes to identify those visiting a potential source room and then directly visiting a potential secondary case room without a recorded hand washing between patient room visits utilizing soap. Incorporating patient admission data, identifiers and room Numbers, we also assessed for both patient to patient cross transmission and environmental spread opportunities.
CONCLUSIONS: Through an unconventional application of an automated HH monitoring system, we were able to use objective data to defined clear improvement opportunities related to our isolation processes and our selection of hand cleansing solutions in special clinical circumstances specifically related to C.Diff patients. This investigation led the hospital to refine their prevention strategy and provided specific data for education and behavior modification.
Publication Number 10-338 Investigation of Vancomycin Resistant Enterococcus and Extended Spectrum Beta-lactamase Infections in End Stage Liver Disease After Endoscopic Retrograde Cholangiopancreatography Tessie Rakoczy RN, BSN, CIC, Infection Preventionist, UMMC/ UMACH; Christine Hendrickson RN, BS, CIC, University of Minnesota Medical Center, Fairview; Susan Kline MD, MPH, University of Minnesota Medical Center; Andy Streifel MPH, REHS, University of Minnesota; Amanda Guspiel MPH, University of Minnesota, Fairview; Annastasia Gross MT (ASCP), University of Minnesota, Fairview
ISSUE: Endoscopic retrograde cholangiopancreatograpy (ERCP) is a specialized endoscopic procedure that treats problems of bile and pancreatic ducts. ERCP’s can be used for evaluation and treatment of End Stage Liver Disease (ESLD) patients who are pre or post liver transplantation. Documented complications of ERCP include pancreatitis, hemorrhage, perforation, bacteremia, and abscess. In 2012, an increase in Vancomycin-Resistant Enterococcus (VRE) and Extended Spectrum Beta-lactamase (ESBL) bloodstream infections were identified in ESLD patients post ERCP. PROJECT: Routine unit based multiple-drug resistant organism surveillance revealed an increase in VRE and ESBL healthcare associated infections above an individual unit’s baseline. The infections identified as bacteremia and abscess. For the purpose of the investigation, the focus was on the bacteremia cases. Case investigation identified infections occurring in ESLD patients following ERCP. Additional Investigation efforts included the review of all 2012 and retrospective 2011 ESLD patients who received ERCP procedures; including VRE and ESBL bacteremias, cases reviewed with gastroenterology, and a review of all practices related to ERCP procedures; including scope reprocessing. RESULTS: In 2012, a total of 1,149 ERCP’s were performed, 24.9% were in ESLD patients. Of the 24.9%, 3.15% patients had VRE or ESBL in the blood within 7 days post ERCP. Analysis of ESLD patients post ERCP with VRE and ESBL bacteremia in 2012 and retrospectively in 2011 revealed 1.08% (2/185). And all ERCP processes and procedures were in good compliance with no link to infections. Of the total ERCPs in 2012, patients with ESLD were at greater risk for infection with VRE or ESBL. The P value is 0.000692, and the result is significant at p < 0.05. LESSON LEARNED: Bacteremia with VRE or ESBL developed within 7 days post ERCP; with most occurring within 48 to 72 hours. Following case review with gastroenterology; the occurrence of new cases was reduced. The risk of infection status post ERCP for ESLD patients colonized with VRE or ESBL is significant. Prescreening for VRE and/or ESBL in ESLD patients (pre and post liver transplant) prior to ERCP and early physician engagement may provide opportunities for prevention of infection.
Publication Number 10-339 Klebsiella Pneumoniae Experience in an Urban Panamanian Hospital: Environmental Decontamination and a Role in Reduction of Hospital-acquired Infection Rates Halden S. Shane, Retired Podiatric Surgeon, Retired Physician/ Current Chairman and CEO, TOMI; John F. Koerner MPH, CIH, Science Advisor, TOMI Environmental Solutions ISSUE: Pan-American Health Organization (PAHO) and US Centers for Disease Control and Prevention (CDC) recognize the role drug-resistant organisms play in increasing patient morbidity and mortality. In response to increased nosocomial Klebsiella pneumoniae incidence in a Panamanian hospital, the Health Ministry implemented programmatic approaches to infection prevention and control in the facility including: intake screening, restricted visits, hand-hygiene programs, and employment of PAHO and CDC guidance for surveillance, cleaning, and monitoring of surface decontamination. PROJECT: A key intervention employed in the facility was extensive cleaning and decontamination in critical patient care areas after patient isolation, limited use of surgical suites and transfer of patients from high-risk rooms until affected spaces could be addressed. This Presentation discusses the protocol for application
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014
Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166
of activated hydrogen peroxide for room decontamination as an adjunct to mechanical reduction of biomass/bioburden on surfaces. More traditional terminal cleaning Methods had previously proven to be ineffective. Following development of specific protocols, efficacy of decontamination was independently investigated and evaluated by the Health Ministry using laboratory-based microbiology culture techniques. RESULTS: Data presented shows significant reduction of various bacteria on critical surfaces (non-fermenting bacteria e ventilator 2,500CFU/50cm2 to <1 CFU/50cm2; Enterobacter cloacae e food table - 1,400CFU/cm2 to <1CFU/cm2; and Enterobacter cloacae and Citrobacter freundii 310CFU to <1CFU). In the year prior to program implementation, the Health Ministry detected 71 cases (40 fatalities) of Klebsiella pneumoniae and 65 (28 fatalities) new cases in the month the program was implemented. The Health Ministry reported that in the 2 months following implementation, 6 new cases were detected and surveillance conducted 8 months later showed no new cases in the 2-months observed. LESSON LEARNED: Klebsiella pneumoniae outbreaks can be managed using a programmatic infection control approach integrating adequate environmental controls and verification, patient screening and surveillance, proper treatment, and hygiene. Traditional means and materials used for cleaning and thought to achieve sufficient reduction in surface contamination cannot be relied upon in the absence of such a program. Laboratory assay can quantify field efficacy of environmental decontamination and reduced HAI incidence is a metric for overall program effectiveness.
Publication Number 10-340 Surveillance System for Surgical Site Infections Including Post discharge Surveillance, in Central Norway Regional Health Authority Anita Boerseth, Master of public health, Infection Control Practitioner, Regional Center for Disease Control in Central Norway Regional Health Authority, Trondheim University Hospital; Kirsti Hermstad, Master of public health, Infection Control Practitioner, Department for infection Control, Trondheim University Hospital ISSUE: Background: Since 2005 the Norwegian surveillance system for health care associated infections (NOIS) was introduced by the government. All public hospitals that provide surgical procedures like coronary artery bypass graph, caesarean section, primary hip prosthesis, appendectomy, cholecystectomy and colon surgery undergo mandatory surveillance. PROJECT: The eight hospitals in Central Norway Regional Health Authority have developed a common electronic infection surveillance modules that harvest data from the hospital system. Patients are obtained in the surveillance system by the surgery code (NOMESCO) included surgery related data such as antibiotics, ASA, EUROSCORE, surgical wound classification, surgery time, BMI, surgeon, surgery time etc. At discharge the ward verifies the patient infectious status. The infection control team follows the patients thirty days after surgery by sending the patient follow up letter asking about infectious status. A post discharge infection has to be confirmed by physicians. RESULTS: During the period 2006-2011 (from September to November) the complete follow-up in Central Norway Regional Health Authority is 98,4 %. The result shows that 80 % (138 of 71) of the surgical site infections are recorded after discharge, despite the infections are deep, organ/space or superficial.
S155
LESSON LEARNED: The surveillance in Central Norway Regional Health Authority shows that post discharge surveillance is important.
Publication Number 10-341 Colon Surgical Site Infection Case Control Risk Factor Analysis Raya Khoury MPH, Epidemiologist/Analyst, BJC HealthCare; Richard Lumor, Analyst, Performance Measurement, BJC HealthCare; Jeanne A. Yegge RN, BSN, MPH, CIC, Infection Prevention Specialist, Missouri Baptist Medical Center; Kathleen Gase MPH, CIC, Manager Infection Prevention and Quality Patient Care, BJC HealthCare System; Melinda Hohrein, Data Analyst, BJC HealthCare; Hilary Babcock MD, MPH, Associate Professor of Medicine, Infectious Diseases, Washington University School of Medicine BACKGROUND/OBJECTIVES: Colon surgical site infections (SSI) are a major source of postoperative illness and are associated with increased hospital length of stay, increased risk of mortality, and decreased health related quality of life. While adherence to infection prevention standards should reduce colon SSI, there may be other risk factors that could contribute to increased rates. Identifying these risk factors could help identify additional prevention strategies. METHODS: A retrospective 1:3 matched case control study was performed using data from January-December 2012 from a multi-facility healthcare system. Colon SSI cases were determined using National Healthcare Safety Network (NHSN) definitions. All colon SSI cases identified during the study period (n¼58) were matched on procedure type (ICD-9) and procedure month (within 30 days of case procedure date) to 169 controls. Demographic and clinical data, including medical history, preoperative, intraoperative and wound data, were abstracted from patient electronic medical records. Logistic regression analysis was performed. RESULTS: The multivariate model identified the following significant variables: colon surgery within the past 3 months (OR 3.32 [95% CI, 1.27-9.01]), preoperative skin cleansing (OR 0.26 [95% CI, 0.081-0.811]), and use of saline for intraoperative wound irrigation (OR 0.189, [95% CI, 0.094-0.380]). CONCLUSIONS: Having a prior colon surgery was associated with a significant risk of colon SSI. Conversely, performing preoperative skin cleansing, regardless of product used, is a protective factor. Additionally, using saline (vs. antibiotic irrigation or no irrigation documented) for wound irrigation appears to be protective. However, this may be confounded by documentation Issues as well as patients at higher risk of infection receiving antibiotic irrigation.
Publication Number 10-342 Challenges of Managing a Non-invasive GAS Outbreak on an Inpatient Psychiatric Unit Danielle M. Deloughery MT, ASCP, CIC, Infection Preventionist, Albany Medical Center; Dylan Johns MS, Infection Preventionist, Albany Medical Center; Donna Kent RN, CIC, Director of Epidemiology, Albany Medical Center; Sarah Elmendorf MD, Hospital Epidemiologist, Albany Medical Center; Megan Helmecke MT (ASCP), CIC, Infection Preventionist, Albany Medical Center; Debra Simmerly RN, CIC, Healthcare Epidemiology and Infection Control Program, NYSDOH; Lisa Thompson MPS, Assistant Research Scientist, Wadsworth Center
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014
Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166
patient room episodes to identify those visiting a potential source room and then directly visiting a potential secondary case room without a recorded hand washing between patient room visits utilizing soap. Incorporating patient admission data, identifiers and room Numbers, we also assessed for both patient to patient cross transmission and environmental spread opportunities.
CONCLUSIONS: Through an unconventional application of an automated HH monitoring system, we were able to use objective data to defined clear improvement opportunities related to our isolation processes and our selection of hand cleansing solutions in special clinical circumstances specifically related to C.Diff patients. This investigation led the hospital to refine their prevention strategy and provided specific data for education and behavior modification.
Publication Number 10-338 Investigation of Vancomycin Resistant Enterococcus and Extended Spectrum Beta-lactamase Infections in End Stage Liver Disease After Endoscopic Retrograde Cholangiopancreatography Tessie Rakoczy RN, BSN, CIC, Infection Preventionist, UMMC/ UMACH; Christine Hendrickson RN, BS, CIC, University of Minnesota Medical Center, Fairview; Susan Kline MD, MPH, University of Minnesota Medical Center; Andy Streifel MPH, REHS, University of Minnesota; Amanda Guspiel MPH, University of Minnesota, Fairview; Annastasia Gross MT (ASCP), University of Minnesota, Fairview
ISSUE: Endoscopic retrograde cholangiopancreatograpy (ERCP) is a specialized endoscopic procedure that treats problems of bile and pancreatic ducts. ERCP’s can be used for evaluation and treatment of End Stage Liver Disease (ESLD) patients who are pre or post liver transplantation. Documented complications of ERCP include pancreatitis, hemorrhage, perforation, bacteremia, and abscess. In 2012, an increase in Vancomycin-Resistant Enterococcus (VRE) and Extended Spectrum Beta-lactamase (ESBL) bloodstream infections were identified in ESLD patients post ERCP. PROJECT: Routine unit based multiple-drug resistant organism surveillance revealed an increase in VRE and ESBL healthcare associated infections above an individual unit’s baseline. The infections identified as bacteremia and abscess. For the purpose of the investigation, the focus was on the bacteremia cases. Case investigation identified infections occurring in ESLD patients following ERCP. Additional Investigation efforts included the review of all 2012 and retrospective 2011 ESLD patients who received ERCP procedures; including VRE and ESBL bacteremias, cases reviewed with gastroenterology, and a review of all practices related to ERCP procedures; including scope reprocessing. RESULTS: In 2012, a total of 1,149 ERCP’s were performed, 24.9% were in ESLD patients. Of the 24.9%, 3.15% patients had VRE or ESBL in the blood within 7 days post ERCP. Analysis of ESLD patients post ERCP with VRE and ESBL bacteremia in 2012 and retrospectively in 2011 revealed 1.08% (2/185). And all ERCP processes and procedures were in good compliance with no link to infections. Of the total ERCPs in 2012, patients with ESLD were at greater risk for infection with VRE or ESBL. The P value is 0.000692, and the result is significant at p < 0.05. LESSON LEARNED: Bacteremia with VRE or ESBL developed within 7 days post ERCP; with most occurring within 48 to 72 hours. Following case review with gastroenterology; the occurrence of new cases was reduced. The risk of infection status post ERCP for ESLD patients colonized with VRE or ESBL is significant. Prescreening for VRE and/or ESBL in ESLD patients (pre and post liver transplant) prior to ERCP and early physician engagement may provide opportunities for prevention of infection.
Publication Number 10-339 Klebsiella Pneumoniae Experience in an Urban Panamanian Hospital: Environmental Decontamination and a Role in Reduction of Hospital-acquired Infection Rates Halden S. Shane, Retired Podiatric Surgeon, Retired Physician/ Current Chairman and CEO, TOMI; John F. Koerner MPH, CIH, Science Advisor, TOMI Environmental Solutions ISSUE: Pan-American Health Organization (PAHO) and US Centers for Disease Control and Prevention (CDC) recognize the role drug-resistant organisms play in increasing patient morbidity and mortality. In response to increased nosocomial Klebsiella pneumoniae incidence in a Panamanian hospital, the Health Ministry implemented programmatic approaches to infection prevention and control in the facility including: intake screening, restricted visits, hand-hygiene programs, and employment of PAHO and CDC guidance for surveillance, cleaning, and monitoring of surface decontamination. PROJECT: A key intervention employed in the facility was extensive cleaning and decontamination in critical patient care areas after patient isolation, limited use of surgical suites and transfer of patients from high-risk rooms until affected spaces could be addressed. This Presentation discusses the protocol for application
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014
Poster Abstracts / American Journal of Infection Control 42 (2014) S29-S166
of activated hydrogen peroxide for room decontamination as an adjunct to mechanical reduction of biomass/bioburden on surfaces. More traditional terminal cleaning Methods had previously proven to be ineffective. Following development of specific protocols, efficacy of decontamination was independently investigated and evaluated by the Health Ministry using laboratory-based microbiology culture techniques. RESULTS: Data presented shows significant reduction of various bacteria on critical surfaces (non-fermenting bacteria e ventilator 2,500CFU/50cm2 to <1 CFU/50cm2; Enterobacter cloacae e food table - 1,400CFU/cm2 to <1CFU/cm2; and Enterobacter cloacae and Citrobacter freundii 310CFU to <1CFU). In the year prior to program implementation, the Health Ministry detected 71 cases (40 fatalities) of Klebsiella pneumoniae and 65 (28 fatalities) new cases in the month the program was implemented. The Health Ministry reported that in the 2 months following implementation, 6 new cases were detected and surveillance conducted 8 months later showed no new cases in the 2-months observed. LESSON LEARNED: Klebsiella pneumoniae outbreaks can be managed using a programmatic infection control approach integrating adequate environmental controls and verification, patient screening and surveillance, proper treatment, and hygiene. Traditional means and materials used for cleaning and thought to achieve sufficient reduction in surface contamination cannot be relied upon in the absence of such a program. Laboratory assay can quantify field efficacy of environmental decontamination and reduced HAI incidence is a metric for overall program effectiveness.
Publication Number 10-340 Surveillance System for Surgical Site Infections Including Post discharge Surveillance, in Central Norway Regional Health Authority Anita Boerseth, Master of public health, Infection Control Practitioner, Regional Center for Disease Control in Central Norway Regional Health Authority, Trondheim University Hospital; Kirsti Hermstad, Master of public health, Infection Control Practitioner, Department for infection Control, Trondheim University Hospital ISSUE: Background: Since 2005 the Norwegian surveillance system for health care associated infections (NOIS) was introduced by the government. All public hospitals that provide surgical procedures like coronary artery bypass graph, caesarean section, primary hip prosthesis, appendectomy, cholecystectomy and colon surgery undergo mandatory surveillance. PROJECT: The eight hospitals in Central Norway Regional Health Authority have developed a common electronic infection surveillance modules that harvest data from the hospital system. Patients are obtained in the surveillance system by the surgery code (NOMESCO) included surgery related data such as antibiotics, ASA, EUROSCORE, surgical wound classification, surgery time, BMI, surgeon, surgery time etc. At discharge the ward verifies the patient infectious status. The infection control team follows the patients thirty days after surgery by sending the patient follow up letter asking about infectious status. A post discharge infection has to be confirmed by physicians. RESULTS: During the period 2006-2011 (from September to November) the complete follow-up in Central Norway Regional Health Authority is 98,4 %. The result shows that 80 % (138 of 71) of the surgical site infections are recorded after discharge, despite the infections are deep, organ/space or superficial.
S155
LESSON LEARNED: The surveillance in Central Norway Regional Health Authority shows that post discharge surveillance is important.
Publication Number 10-341 Colon Surgical Site Infection Case Control Risk Factor Analysis Raya Khoury MPH, Epidemiologist/Analyst, BJC HealthCare; Richard Lumor, Analyst, Performance Measurement, BJC HealthCare; Jeanne A. Yegge RN, BSN, MPH, CIC, Infection Prevention Specialist, Missouri Baptist Medical Center; Kathleen Gase MPH, CIC, Manager Infection Prevention and Quality Patient Care, BJC HealthCare System; Melinda Hohrein, Data Analyst, BJC HealthCare; Hilary Babcock MD, MPH, Associate Professor of Medicine, Infectious Diseases, Washington University School of Medicine BACKGROUND/OBJECTIVES: Colon surgical site infections (SSI) are a major source of postoperative illness and are associated with increased hospital length of stay, increased risk of mortality, and decreased health related quality of life. While adherence to infection prevention standards should reduce colon SSI, there may be other risk factors that could contribute to increased rates. Identifying these risk factors could help identify additional prevention strategies. METHODS: A retrospective 1:3 matched case control study was performed using data from January-December 2012 from a multi-facility healthcare system. Colon SSI cases were determined using National Healthcare Safety Network (NHSN) definitions. All colon SSI cases identified during the study period (n¼58) were matched on procedure type (ICD-9) and procedure month (within 30 days of case procedure date) to 169 controls. Demographic and clinical data, including medical history, preoperative, intraoperative and wound data, were abstracted from patient electronic medical records. Logistic regression analysis was performed. RESULTS: The multivariate model identified the following significant variables: colon surgery within the past 3 months (OR 3.32 [95% CI, 1.27-9.01]), preoperative skin cleansing (OR 0.26 [95% CI, 0.081-0.811]), and use of saline for intraoperative wound irrigation (OR 0.189, [95% CI, 0.094-0.380]). CONCLUSIONS: Having a prior colon surgery was associated with a significant risk of colon SSI. Conversely, performing preoperative skin cleansing, regardless of product used, is a protective factor. Additionally, using saline (vs. antibiotic irrigation or no irrigation documented) for wound irrigation appears to be protective. However, this may be confounded by documentation Issues as well as patients at higher risk of infection receiving antibiotic irrigation.
Publication Number 10-342 Challenges of Managing a Non-invasive GAS Outbreak on an Inpatient Psychiatric Unit Danielle M. Deloughery MT, ASCP, CIC, Infection Preventionist, Albany Medical Center; Dylan Johns MS, Infection Preventionist, Albany Medical Center; Donna Kent RN, CIC, Director of Epidemiology, Albany Medical Center; Sarah Elmendorf MD, Hospital Epidemiologist, Albany Medical Center; Megan Helmecke MT (ASCP), CIC, Infection Preventionist, Albany Medical Center; Debra Simmerly RN, CIC, Healthcare Epidemiology and Infection Control Program, NYSDOH; Lisa Thompson MPS, Assistant Research Scientist, Wadsworth Center
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014