- Email: [email protected]
Parainfluenza III Outbreak in a Veterans’ Affairs affiliated Nursing Home
S34
Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
field gel electrophoresis results were indistinguishable. Environmental samples of tap water grew Mycobacterium phocaicum/mucogenicum and the device flush grew Bacillus cereus group species. The ICAR identified numerous infectious control breaches. CONCLUSIONS: This investigation found that a breach in infection control took place, specifically associated with improper aseptic technique, inadequate disinfection and sterilization of equipment, batch compounding, and environmental cleaning. Because the jet injector was consistently cleaned with tap water, the cultured organisms support the possibility of an infection control breach, namely Mycobacterium chelonae.
Presentation Number OIPH-116 Evaluation of Nursing Home Infection Control Programs: A pre- and post- study Mansi Agarwal PhD, MPH, Columbia University School of Nursing; Patricia W. Stone PhD, RN, FAAN; Andrew Dick PhD, The RAND Corporation BACKGROUND: In 2016, the Centers for Medicare and Medicaid Services (CMS) issued a federal rule to improve quality and infection control in the nursing home population. Through a phased rollout of requirements, nursing homes must now have an infection control and prevention (ICP) program incorporating antibiotic stewardship policies and a trained infection preventionist (IP). The aim of this study was to evaluate the infection control program changes made by nursing homes in response to these requirements. METHODS: Two cross-sectional surveys were conducted in nursing homes, the first in 2013-2014 (n=988) and the second in 2017-2018 (n=892). Directors of Nursing were asked about ICP program characteristics, IP training, and workforce stability. Chi-squared tests were used to determine whether there were significant differences between baseline and post-CMS rule in ICP programs. RESULTS: We found significant improvements in the proportion of nursing homes who had antibiotic stewardship policies from 2013 to 2018 (80% to 99%, p<0.0001). The proportion of IPs with any specific infection control training increased from 42% to 57% (p<0.0001) and IPs certified in infection control increased from 2.6% to 7.4% (p<0.0001). Participation in infection prevention collaboratives also increased (p<0.0001). In addition, we found greater stability in the workforce with less turnover of IPs (37% to 25%, p<0.0001), Directors of Nursing (39% to 28%, p<0.0001), and administrators (36% to 21%, p<0.0001). CONCLUSIONS: Nursing homes are rapidly improving their infection control programs in line with CMS requirements. Once CMS rule is fully implemented, it will be critical to evaluate if these changes impact infection and antibiotic usage rates in nursing homes.
Presentation Number OIPH-117 Happy hours: could chips and nuts be vector of food-borne outbreaks? Francesco Gori MD, Post Graduate School of Public Health, University of Siena; Manuel Santamaria, University of Siena; Claudia Cuccaro MD, Post Graduate School of Public Health, University of Siena; Rosa Cardaci, Department of Molecular and Developmental Medicine, University of Siena; Sandra Burgassi, Department of Molecular and Developmental Medicine, University of Siena; Gabriele Messina MD, DrPH, MSc, Post Graduate School of Public Health (UNISI) BACKGROUND: The global interest in handling food has increased over the years. Greater handling raises the risk of contamination, also
in the backed food. The aim of this study is to understand the type and level of microbial contamination in the food that is served along happy hour in the bars/coffee. METHODS: This pilot study was performed from April to May 2018 in a city of central Italy (<60,000 citizens). Ten bars were randomly selected. Samples of peanuts and potatoes were obtained in three different moments, at beginning (T0), in the middle (T1), at the end (T2) of aperitifs. Collection of specimens was obtained using sterile kit and laboratory analysis was conduced in the University lab. The samples were located on selective medium and the growth of microbial pathogens were checked at 24 and 48?hours. The tested microorganisms were Enterococci, Staphylococci, Coliforms bacteria and yeasts. The statistical analyses were conducted using Wilcoxon test for statistical significance (p<0,05). RESULTS: A significant yeasts contamination appeared only on potatoes at T0 (p<0,05), while within T0 and T1 we found a significant increase of Enterococci, Staphylococci and yeasts (p<0,05) both in peanuts and potatoes. Comparing T1 and T2 only yeasts showed a significant growth in potatoes (p=0,04). Between T0 and T2 we highlighted a growth of Enterococci, Staphylococci and yeasts (p<0,05) in both sample types, but we also found a growth of coliforms bacteria in peanuts (p=0,03). CONCLUSIONS: We showed an increase in the microbial load associated with food handling, mostly of Enterococci. Long time of exposition increased the likelihood of contamination and the possibility to exceed the dose for the occurrence of disease. Offering small portions of handling food would reduce the manipulation by participants and the risk of food-borne outbreaks.
Presentation Number OIPH-118 Parainfluenza III Outbreak in a Veterans’ Affairs affiliated Nursing Home Florence M. Ford MSN, BSN, BS, RN, Northport VAMC; Nancy R. Barrett RN, MS, CIC; Monique Thorne EdD, MS, RN-BC, Northport VAMC; Lisa C. Bailey RN, BSN, MS, CIC, Northport VAMC; Mary Creed MS MT ASCP, VA Medical Center of Northport; Shing Shing Yeh MD, PHD, Northport Veterans Affairs Medical Center; Zeena Lobo MD, Northport Veterans Affairs Medical Center; George Psevdos MD; Olga Kaplun MD, Stony Brook University Hospital BACKGROUND: Parainfluenza III is one of the four serotypes of the parainfluenza virus (PIV) that causes upper respiratory tract infections (URI) in adults. Clinical presentation can range from mild URI to pneumonia, to death. We report a cluster of respiratory illness due to PIV III in a Community Living Center, (CLC) Nursing Unit. METHODS: An outbreak of PIV III URI occurred at a VAMC CLC - 30 bed unit in June 2018. Cases were confirmed via nasopharyngeal respiratory viral real-time PCR panel. Case definition included a resident with new onset respiratory complaints and positive PCR test. Clinical presentation, laboratory data and outcome were reviewed in each case. RESULTS: Ten residents tested positive for PIV III from 6/2 to 6/26, 2018. All residents were men with ages ranging from 59 to 84?years. The index case occurred on 6/2 with temperature of 102.30F. Thereafter, a health care provider presented with symptoms of URI but continued to work. The Infection control team was notified on five cases detected on 6/12; 4 cases were detected 6/18 to 6/26. One patient required hospitalization due to post-viral bacterial pneumonia. No deaths occurred. Five healthcare providers presented with symptoms of URI during this outbreak. Aggressive infection control measures were implemented: temporally halting admissions; high index of suspicion for symptomatic patients with obtaining viral panel; encouraging them to remain in their room; and teaching respiratory etiquette;
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019
Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
enforcing hand hygiene and symptomatic patients leaving the nursing unit had to wear a mask; terminal cleaning of virus-contaminated surfaces/objects; discouraging floating of staff, directing ill employees to stay home. CONCLUSIONS: PIV III can cause a serious outbreak in nursing homes. Therefore, Infection Control Preventionists can have an instrumental role in rapid recognition of an outbreak and strategically implementing targeted measures to halt the outbreak.
Presentation Number OIPH-119 Infection Control Assessment and Response (ICAR) in Michigan: Past, Present and Future Noreen Mollon MS, CIC, Michigan Department of Health and Human Services BACKGROUND: The Michigan Department of Health and Human Services (MDHHS) Surveillance for Healthcare Associated and Resistant Pathogens (SHARP) unit secured grant funds in 2015 to improve statewide preparedness and infection control practices and programs across the continuum of care. The program goal was to increase patient safety and expand infection control consultation. The SHARP unit focused on acute care and long-term acute care hospitals, long-term care facilities and outpatient clinics, including dental clinics. METHODS: SHARP unit staff used Centers for Disease Control and Prevention?(CDC) provided ICAR tools to conduct infection control needs assessments at the different facility types. This collaborative, non-regulatory, technical assistance focused on quality, process improvement. All sites volunteered. Staff provided recommendations at the time of the visit and provided a report back to the individual facility with key findings. Each report identified strengths and areas for opportunity to improve. RESULTS: Results were compiled into aggregate state findings, both as a whole and broken down by facility type. Eighty infection prevention needs assessments were conducted from January 2016-December 2018. 70% were done in person. Strengths included having an identified infection preventionist and a foundation for staff training and education. The main areas of opportunity identified were infection prevention training, providing competency-based training programs both upon hire and annually and creating sustainable audit/feedback programs across the identified disciplines. CONCLUSIONS: Now that the 3-year ebola supplemental funding period is done, the ICAR program will continue but will move in a new direction. Moving forward, the ICAR will be offered to facilities that have a healthcare-associated infection outbreak or identification of novel resistance. The ICAR is a tool in the infection preventionist toolbox. No infection prevention program is perfect and there is always room for improvement.
Presentation Number OIPH-120 Norovirus Outbreak at a Small Acute Care Hospital Jamie M. Pelletier MPH, CIC, Children’s Health; Michael E. Sebert MD; Patricia Jackson RN, MA, CIC, FAPIC BACKGROUND: Our 35-bed acute care pediatric hospital with a specialization in therapy and rehabilitation services experienced an outbreak of norovirus. We describe the measures implemented to prevent secondary transmission.
S35
METHODS: Once laboratory testing confirmed that norovirus was responsible for the outbreak, additional cases were identified using clinical criteria of either abrupt onset of vomiting followed by diarrhea, or acute diarrhea without vomiting. RESULTS: In total 38 staff members, 14 patients, and 5 family members were affected over a period of 17?days. All patients, whether symptomatic or not, were placed on contact precautions. New admissions were postponed and visitor restrictions were implemented. Only soap and water was used for hand hygiene. The environmental disinfectants were confirmed to have Environmental Protection Agency kill claims for norovirus. Cleaning was done three times daily on high-touch surfaces, patient rooms, hallways, bathrooms, and staff work stations. Supplemental ultraviolet light disinfection (UVD) was deployed. Congregating in the cafeteria was discouraged by providing meals to patients and families in their rooms. We eliminated group activities in common spaces. Staff were instructed not to share food and to utilize disposable lunch containers. Symptomatic staff were furloughed for 48 hours; food handlers were furloughed for seven days. Auditing by infection prevention was initiated to assess personal protective equipment (PPE) use and hand hygiene. Measured compliance with PPE use was 96% and with hand hygiene was 95%. CONCLUSIONS: While the route by which infection was introduced was not identified, factors that may have contributed to the spread of disease include: sharing of food among staff, close contact during therapy, hardiness of norovirus in the environment, and low infectious dose. Lessons learned include: importance of frequent environmental cleaning, ensuring disinfectants have norovirus kill claims, staff understanding precautions and having one staff member dedicated to UVD.
Presentation Number OIPH-121 When a pandemic influenza lands in your community: A planned response to maintain a safe facility Mary Kay Foster BSN, RN, Indiana University Health-Academic Health Center; Jane Forni MSN, RN, CIC, CHEP, Indiana University Health West Hospital BACKGROUND: Our healthcare system’s pandemic plan, although reviewed annually, had remained an antiquated process originally designed for the 2009 H1N1 pandemic outbreak. Our healthcare system has grown to 17 facilities with 2.7?million outpatient visits per year and 2,600 inpatient beds. State and local health departments recommend response plans for healthcare settings related to the number of cases, clinical severity and how the outbreak spreads; however, facilities should have their own risk-based mitigation strategies that can be promptly initiated when indicated. We realized we needed a more localized response as our facilities cross four health preparedness districts within the state. METHODS: Data analyzed within a large health system showed that the outbreak of influenza peaked at different times yearly across the state. We developed a standardized plan defining the safety measures necessary for pandemic planning that allowed for phased and tailored implementation of various strategies such as fever clinics, masking all personnel, and cancelling non-essential procedures. Interventions can By sharing the same plan across the system, we are better able to leverage resources and quickly implement strategies to minimize the spread of the disease. RESULTS: This tailored approach allows for a more focused, regional approach with interventions that are based on how the pandemic expands. With large healthcare systems spread across multiple state or
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019
Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
field gel electrophoresis results were indistinguishable. Environmental samples of tap water grew Mycobacterium phocaicum/mucogenicum and the device flush grew Bacillus cereus group species. The ICAR identified numerous infectious control breaches. CONCLUSIONS: This investigation found that a breach in infection control took place, specifically associated with improper aseptic technique, inadequate disinfection and sterilization of equipment, batch compounding, and environmental cleaning. Because the jet injector was consistently cleaned with tap water, the cultured organisms support the possibility of an infection control breach, namely Mycobacterium chelonae.
Presentation Number OIPH-116 Evaluation of Nursing Home Infection Control Programs: A pre- and post- study Mansi Agarwal PhD, MPH, Columbia University School of Nursing; Patricia W. Stone PhD, RN, FAAN; Andrew Dick PhD, The RAND Corporation BACKGROUND: In 2016, the Centers for Medicare and Medicaid Services (CMS) issued a federal rule to improve quality and infection control in the nursing home population. Through a phased rollout of requirements, nursing homes must now have an infection control and prevention (ICP) program incorporating antibiotic stewardship policies and a trained infection preventionist (IP). The aim of this study was to evaluate the infection control program changes made by nursing homes in response to these requirements. METHODS: Two cross-sectional surveys were conducted in nursing homes, the first in 2013-2014 (n=988) and the second in 2017-2018 (n=892). Directors of Nursing were asked about ICP program characteristics, IP training, and workforce stability. Chi-squared tests were used to determine whether there were significant differences between baseline and post-CMS rule in ICP programs. RESULTS: We found significant improvements in the proportion of nursing homes who had antibiotic stewardship policies from 2013 to 2018 (80% to 99%, p<0.0001). The proportion of IPs with any specific infection control training increased from 42% to 57% (p<0.0001) and IPs certified in infection control increased from 2.6% to 7.4% (p<0.0001). Participation in infection prevention collaboratives also increased (p<0.0001). In addition, we found greater stability in the workforce with less turnover of IPs (37% to 25%, p<0.0001), Directors of Nursing (39% to 28%, p<0.0001), and administrators (36% to 21%, p<0.0001). CONCLUSIONS: Nursing homes are rapidly improving their infection control programs in line with CMS requirements. Once CMS rule is fully implemented, it will be critical to evaluate if these changes impact infection and antibiotic usage rates in nursing homes.
Presentation Number OIPH-117 Happy hours: could chips and nuts be vector of food-borne outbreaks? Francesco Gori MD, Post Graduate School of Public Health, University of Siena; Manuel Santamaria, University of Siena; Claudia Cuccaro MD, Post Graduate School of Public Health, University of Siena; Rosa Cardaci, Department of Molecular and Developmental Medicine, University of Siena; Sandra Burgassi, Department of Molecular and Developmental Medicine, University of Siena; Gabriele Messina MD, DrPH, MSc, Post Graduate School of Public Health (UNISI) BACKGROUND: The global interest in handling food has increased over the years. Greater handling raises the risk of contamination, also
in the backed food. The aim of this study is to understand the type and level of microbial contamination in the food that is served along happy hour in the bars/coffee. METHODS: This pilot study was performed from April to May 2018 in a city of central Italy (<60,000 citizens). Ten bars were randomly selected. Samples of peanuts and potatoes were obtained in three different moments, at beginning (T0), in the middle (T1), at the end (T2) of aperitifs. Collection of specimens was obtained using sterile kit and laboratory analysis was conduced in the University lab. The samples were located on selective medium and the growth of microbial pathogens were checked at 24 and 48?hours. The tested microorganisms were Enterococci, Staphylococci, Coliforms bacteria and yeasts. The statistical analyses were conducted using Wilcoxon test for statistical significance (p<0,05). RESULTS: A significant yeasts contamination appeared only on potatoes at T0 (p<0,05), while within T0 and T1 we found a significant increase of Enterococci, Staphylococci and yeasts (p<0,05) both in peanuts and potatoes. Comparing T1 and T2 only yeasts showed a significant growth in potatoes (p=0,04). Between T0 and T2 we highlighted a growth of Enterococci, Staphylococci and yeasts (p<0,05) in both sample types, but we also found a growth of coliforms bacteria in peanuts (p=0,03). CONCLUSIONS: We showed an increase in the microbial load associated with food handling, mostly of Enterococci. Long time of exposition increased the likelihood of contamination and the possibility to exceed the dose for the occurrence of disease. Offering small portions of handling food would reduce the manipulation by participants and the risk of food-borne outbreaks.
Presentation Number OIPH-118 Parainfluenza III Outbreak in a Veterans’ Affairs affiliated Nursing Home Florence M. Ford MSN, BSN, BS, RN, Northport VAMC; Nancy R. Barrett RN, MS, CIC; Monique Thorne EdD, MS, RN-BC, Northport VAMC; Lisa C. Bailey RN, BSN, MS, CIC, Northport VAMC; Mary Creed MS MT ASCP, VA Medical Center of Northport; Shing Shing Yeh MD, PHD, Northport Veterans Affairs Medical Center; Zeena Lobo MD, Northport Veterans Affairs Medical Center; George Psevdos MD; Olga Kaplun MD, Stony Brook University Hospital BACKGROUND: Parainfluenza III is one of the four serotypes of the parainfluenza virus (PIV) that causes upper respiratory tract infections (URI) in adults. Clinical presentation can range from mild URI to pneumonia, to death. We report a cluster of respiratory illness due to PIV III in a Community Living Center, (CLC) Nursing Unit. METHODS: An outbreak of PIV III URI occurred at a VAMC CLC - 30 bed unit in June 2018. Cases were confirmed via nasopharyngeal respiratory viral real-time PCR panel. Case definition included a resident with new onset respiratory complaints and positive PCR test. Clinical presentation, laboratory data and outcome were reviewed in each case. RESULTS: Ten residents tested positive for PIV III from 6/2 to 6/26, 2018. All residents were men with ages ranging from 59 to 84?years. The index case occurred on 6/2 with temperature of 102.30F. Thereafter, a health care provider presented with symptoms of URI but continued to work. The Infection control team was notified on five cases detected on 6/12; 4 cases were detected 6/18 to 6/26. One patient required hospitalization due to post-viral bacterial pneumonia. No deaths occurred. Five healthcare providers presented with symptoms of URI during this outbreak. Aggressive infection control measures were implemented: temporally halting admissions; high index of suspicion for symptomatic patients with obtaining viral panel; encouraging them to remain in their room; and teaching respiratory etiquette;
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019
Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
enforcing hand hygiene and symptomatic patients leaving the nursing unit had to wear a mask; terminal cleaning of virus-contaminated surfaces/objects; discouraging floating of staff, directing ill employees to stay home. CONCLUSIONS: PIV III can cause a serious outbreak in nursing homes. Therefore, Infection Control Preventionists can have an instrumental role in rapid recognition of an outbreak and strategically implementing targeted measures to halt the outbreak.
Presentation Number OIPH-119 Infection Control Assessment and Response (ICAR) in Michigan: Past, Present and Future Noreen Mollon MS, CIC, Michigan Department of Health and Human Services BACKGROUND: The Michigan Department of Health and Human Services (MDHHS) Surveillance for Healthcare Associated and Resistant Pathogens (SHARP) unit secured grant funds in 2015 to improve statewide preparedness and infection control practices and programs across the continuum of care. The program goal was to increase patient safety and expand infection control consultation. The SHARP unit focused on acute care and long-term acute care hospitals, long-term care facilities and outpatient clinics, including dental clinics. METHODS: SHARP unit staff used Centers for Disease Control and Prevention?(CDC) provided ICAR tools to conduct infection control needs assessments at the different facility types. This collaborative, non-regulatory, technical assistance focused on quality, process improvement. All sites volunteered. Staff provided recommendations at the time of the visit and provided a report back to the individual facility with key findings. Each report identified strengths and areas for opportunity to improve. RESULTS: Results were compiled into aggregate state findings, both as a whole and broken down by facility type. Eighty infection prevention needs assessments were conducted from January 2016-December 2018. 70% were done in person. Strengths included having an identified infection preventionist and a foundation for staff training and education. The main areas of opportunity identified were infection prevention training, providing competency-based training programs both upon hire and annually and creating sustainable audit/feedback programs across the identified disciplines. CONCLUSIONS: Now that the 3-year ebola supplemental funding period is done, the ICAR program will continue but will move in a new direction. Moving forward, the ICAR will be offered to facilities that have a healthcare-associated infection outbreak or identification of novel resistance. The ICAR is a tool in the infection preventionist toolbox. No infection prevention program is perfect and there is always room for improvement.
Presentation Number OIPH-120 Norovirus Outbreak at a Small Acute Care Hospital Jamie M. Pelletier MPH, CIC, Children’s Health; Michael E. Sebert MD; Patricia Jackson RN, MA, CIC, FAPIC BACKGROUND: Our 35-bed acute care pediatric hospital with a specialization in therapy and rehabilitation services experienced an outbreak of norovirus. We describe the measures implemented to prevent secondary transmission.
S35
METHODS: Once laboratory testing confirmed that norovirus was responsible for the outbreak, additional cases were identified using clinical criteria of either abrupt onset of vomiting followed by diarrhea, or acute diarrhea without vomiting. RESULTS: In total 38 staff members, 14 patients, and 5 family members were affected over a period of 17?days. All patients, whether symptomatic or not, were placed on contact precautions. New admissions were postponed and visitor restrictions were implemented. Only soap and water was used for hand hygiene. The environmental disinfectants were confirmed to have Environmental Protection Agency kill claims for norovirus. Cleaning was done three times daily on high-touch surfaces, patient rooms, hallways, bathrooms, and staff work stations. Supplemental ultraviolet light disinfection (UVD) was deployed. Congregating in the cafeteria was discouraged by providing meals to patients and families in their rooms. We eliminated group activities in common spaces. Staff were instructed not to share food and to utilize disposable lunch containers. Symptomatic staff were furloughed for 48 hours; food handlers were furloughed for seven days. Auditing by infection prevention was initiated to assess personal protective equipment (PPE) use and hand hygiene. Measured compliance with PPE use was 96% and with hand hygiene was 95%. CONCLUSIONS: While the route by which infection was introduced was not identified, factors that may have contributed to the spread of disease include: sharing of food among staff, close contact during therapy, hardiness of norovirus in the environment, and low infectious dose. Lessons learned include: importance of frequent environmental cleaning, ensuring disinfectants have norovirus kill claims, staff understanding precautions and having one staff member dedicated to UVD.
Presentation Number OIPH-121 When a pandemic influenza lands in your community: A planned response to maintain a safe facility Mary Kay Foster BSN, RN, Indiana University Health-Academic Health Center; Jane Forni MSN, RN, CIC, CHEP, Indiana University Health West Hospital BACKGROUND: Our healthcare system’s pandemic plan, although reviewed annually, had remained an antiquated process originally designed for the 2009 H1N1 pandemic outbreak. Our healthcare system has grown to 17 facilities with 2.7?million outpatient visits per year and 2,600 inpatient beds. State and local health departments recommend response plans for healthcare settings related to the number of cases, clinical severity and how the outbreak spreads; however, facilities should have their own risk-based mitigation strategies that can be promptly initiated when indicated. We realized we needed a more localized response as our facilities cross four health preparedness districts within the state. METHODS: Data analyzed within a large health system showed that the outbreak of influenza peaked at different times yearly across the state. We developed a standardized plan defining the safety measures necessary for pandemic planning that allowed for phased and tailored implementation of various strategies such as fever clinics, masking all personnel, and cancelling non-essential procedures. Interventions can By sharing the same plan across the system, we are better able to leverage resources and quickly implement strategies to minimize the spread of the disease. RESULTS: This tailored approach allows for a more focused, regional approach with interventions that are based on how the pandemic expands. With large healthcare systems spread across multiple state or
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019