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Postexposure rabies prophylaxis in a state psychiatric hospital following exposure in a community pet shop
122 Abstracts
AJlC April 1995
RISK OF INFECTION D U E TO INTRAOPERATIVE AUTOLOGOUS BLOOD TRANSFUSION IN CARDIAC SURGERY. E Heeg, MD,* D. Hayer, MD, K. Decker, MD. University Hospital, Tfibingen, Germany. Due to possible exogenous contamination of the patient's blood, reservations were expressed against the use of intraoperative autologous blood transfusion (IABT) during heart surgery. To answer this question, samples were taken from different parts of the IABT system (e.g., blood, salvaged at different stages of the operation, waste bag fluid, erythrocyte suspension) of 32 patients. To study the role of airborne transmission, air was sampled at different positions in the OR during the operation. In addition, concentrations of preoperatively administered cefazolin in the erythrocyte suspension, ready for retransfusion, were determined. From a total of 384 samples, only enrichment cultures from erythrocyte suspensions of seven patients showed microbial growth. Staphylococcus epidermidis was isolated from five cultures, followed by Propionibacterium acnes (one) and PeJ)tococcussp. (one). No signs of infection were observed in the seven patients with contaminated IABT, whereas three patients with sterile IABT developed postoperative infection. From the remaining 22 patients without infection all cultures were negative. No relationship could be found between the number of microorganisms in the air and the contamination of the IABT system, although considerable volumes of air are aspirated by surgical suction. Serum levels of cefazolin decreased continuously during surgery, but bactericidal concentrations were still present in the erythrocyte suspension prior to retransfusion. It is concluded that nosocomial infection after cardiac surgery due to IABT is very unlikely.
POSTEXPOSURE RABIES PROPHYLAXIS IN A STATE PSYCHIATRIC H O S P I T A L F O L L O W I N G EXPOSURE IN A COMMUNITY PET SHOP. S. E Keady, MS, RN, CNA,* D. Hill, RNC, R. Luckoor, MD, J. Matthews, RNC. New Hampshire Hospital, Concord, NH. In October 1994, a case of rabies in a 10-week-old kitten prompted the investigation of the largest single-source rabies exposure in the United States to date. Over 600 people in a community of 36,000 received postexposure prophylaxis. The kitten was purchased at a pet shop one block from the campus of the state psychiatric hospital. Patients and staff often visited the pet shop and handled kittens there. Fourteen patients reported significant exposure to a kitten from the pet shop during a 5-week period. All 14 received postexposure prophylaxis with human rabies immune globulin and rabies vaccine. Postexposure prophylaxis was well accepted and well tolerated in this inpatient population. The incident promoted the review of hospital policies on pet therapy and outbreak investigation, and the development of a rabies prevention policy. OOO RISKS FOR ENTEROCOCCAL URINARY TRACT COLONIZATION/INFECTION IN A REHABILITATION FACILITY. S. Lloyd, MT (ASCP), CIC,* M. Zervos, MD, R. Mahayni, MD, T. Lundstrom, MD. Wayne State University, Rehabilitation Institute of Michigan, Detroit, MI. We observed in surveillance data that 35% of nosocomial urinary tract infections (UTI) in a 155-bed rehabilitation facility in
Southeastern Michigan were due to enterococcus (E) compared to 5%-15% in an adjacent tertiary care university hospital. We attempted to define the risk fiictors for nosocomial EUTI or colonization in our facility by performing a prospective case-control observational study. A sample size of 50 EUTI patients was needed for statistical comparison (CI 95%, SD 2.5, UTI rate 4.9%). A control was defined as the next patient colonized/infected with a nonenterococcal (NE) organism. Data collected included: age, sex, unit, admitting diagnosis, date of admission, voiding habits, symptoms, urinalysis, peripheral leukocyte count, date of colonization/infection, prior antibiotics, bacteremi a, and outcome. Infection was defined using National Nosocomial Infections Surveillance Systems (NNIS) criteria. There was no difference between the EUTI and NEUTI groups with respect to age, unit, admitting diagnosis, voiding habits, symptoms, length of stay prior to diagnosis or bacteremia. Prior antibiotic use was much more frequent in the EUTI than in the NEUTI group, 78% vs 41% respectively. In our facility, the major risk factor for EUTI appears to be prior antibiotic use regardless of class of antibiotic used. e~e A M U L T I P L E S O U R C E O U T B R E A K OF R E S I S T A N T PSEUDOMONAS AERUGINOSA INFECTIONS IN A BURN INTENSIVE CARE UNIT. B. Moody, RN, CIC, J. Luby, MD, E.
Siler, RN, CIC.* Parkland Memorial Hospital, Dallas, TX. Investigation in the burn intensive care unit (BICU) followed identification of multiply resistant Pseudomonas with identical antibiograms (six wounds and three sputa in 2 months). The organisms were probably transmitted indirectly. Potential reservoirs included multipatient use items: a water tank for splint molding, safety straps on hydrotherapy stretchers, electronic thermometers, plus disinfection to the BICU of respiratory therapy equipment, laryngoscopes and bronchoscopes, and lack of a handwashing sink in the tank room. Current practice was to dip all patient splints into the same tank for molding, without disinfection of splints or tank between patients. Literature identifies potential contamination in the splint molding process. Control measures included proper disinfection, decreasing multipatient use items, contact isolation, enforcement of handwashing, and alerting staff of each new case. Priority was working with Occupational Therapy and the splint-molding process. The outbreak (22 cases total) subsided as "in-house seeders" were discharged and recommendations implemented in stages. Condusions: The hot water tank temperature (158 ° F) should kill Pseudomonas over time. However, frequent reinoculation from splints, the presence of blood and body fluids, and turning off the tank, interferes with rapid or complete bacterial inactivation. Recommendations: Burn units, Occupational Therapy, and water baths need infection control evaluation regularly. Curricula for OTs should include microbiology and infection control. Mulripatient use items should be kept to a minimum and regularly disinfected. Equipment disinfection within patient care areas should be carefully evaluated and must comply with hospital standards. eee
NOSOCOMIAL TRANSMISSION OF TINEA CORPORIS ON A PEDIATRICS WARD AT BOSTON CITY HOSPITAL. J. A. Calcutt, RN, BSN, CIC,* S. Goucher-Wilson, RNC, MSN, C. A. Sulis, MD. Boston City Hospital, Boston, MA.
AJlC April 1995
RISK OF INFECTION D U E TO INTRAOPERATIVE AUTOLOGOUS BLOOD TRANSFUSION IN CARDIAC SURGERY. E Heeg, MD,* D. Hayer, MD, K. Decker, MD. University Hospital, Tfibingen, Germany. Due to possible exogenous contamination of the patient's blood, reservations were expressed against the use of intraoperative autologous blood transfusion (IABT) during heart surgery. To answer this question, samples were taken from different parts of the IABT system (e.g., blood, salvaged at different stages of the operation, waste bag fluid, erythrocyte suspension) of 32 patients. To study the role of airborne transmission, air was sampled at different positions in the OR during the operation. In addition, concentrations of preoperatively administered cefazolin in the erythrocyte suspension, ready for retransfusion, were determined. From a total of 384 samples, only enrichment cultures from erythrocyte suspensions of seven patients showed microbial growth. Staphylococcus epidermidis was isolated from five cultures, followed by Propionibacterium acnes (one) and PeJ)tococcussp. (one). No signs of infection were observed in the seven patients with contaminated IABT, whereas three patients with sterile IABT developed postoperative infection. From the remaining 22 patients without infection all cultures were negative. No relationship could be found between the number of microorganisms in the air and the contamination of the IABT system, although considerable volumes of air are aspirated by surgical suction. Serum levels of cefazolin decreased continuously during surgery, but bactericidal concentrations were still present in the erythrocyte suspension prior to retransfusion. It is concluded that nosocomial infection after cardiac surgery due to IABT is very unlikely.
POSTEXPOSURE RABIES PROPHYLAXIS IN A STATE PSYCHIATRIC H O S P I T A L F O L L O W I N G EXPOSURE IN A COMMUNITY PET SHOP. S. E Keady, MS, RN, CNA,* D. Hill, RNC, R. Luckoor, MD, J. Matthews, RNC. New Hampshire Hospital, Concord, NH. In October 1994, a case of rabies in a 10-week-old kitten prompted the investigation of the largest single-source rabies exposure in the United States to date. Over 600 people in a community of 36,000 received postexposure prophylaxis. The kitten was purchased at a pet shop one block from the campus of the state psychiatric hospital. Patients and staff often visited the pet shop and handled kittens there. Fourteen patients reported significant exposure to a kitten from the pet shop during a 5-week period. All 14 received postexposure prophylaxis with human rabies immune globulin and rabies vaccine. Postexposure prophylaxis was well accepted and well tolerated in this inpatient population. The incident promoted the review of hospital policies on pet therapy and outbreak investigation, and the development of a rabies prevention policy. OOO RISKS FOR ENTEROCOCCAL URINARY TRACT COLONIZATION/INFECTION IN A REHABILITATION FACILITY. S. Lloyd, MT (ASCP), CIC,* M. Zervos, MD, R. Mahayni, MD, T. Lundstrom, MD. Wayne State University, Rehabilitation Institute of Michigan, Detroit, MI. We observed in surveillance data that 35% of nosocomial urinary tract infections (UTI) in a 155-bed rehabilitation facility in
Southeastern Michigan were due to enterococcus (E) compared to 5%-15% in an adjacent tertiary care university hospital. We attempted to define the risk fiictors for nosocomial EUTI or colonization in our facility by performing a prospective case-control observational study. A sample size of 50 EUTI patients was needed for statistical comparison (CI 95%, SD 2.5, UTI rate 4.9%). A control was defined as the next patient colonized/infected with a nonenterococcal (NE) organism. Data collected included: age, sex, unit, admitting diagnosis, date of admission, voiding habits, symptoms, urinalysis, peripheral leukocyte count, date of colonization/infection, prior antibiotics, bacteremi a, and outcome. Infection was defined using National Nosocomial Infections Surveillance Systems (NNIS) criteria. There was no difference between the EUTI and NEUTI groups with respect to age, unit, admitting diagnosis, voiding habits, symptoms, length of stay prior to diagnosis or bacteremia. Prior antibiotic use was much more frequent in the EUTI than in the NEUTI group, 78% vs 41% respectively. In our facility, the major risk factor for EUTI appears to be prior antibiotic use regardless of class of antibiotic used. e~e A M U L T I P L E S O U R C E O U T B R E A K OF R E S I S T A N T PSEUDOMONAS AERUGINOSA INFECTIONS IN A BURN INTENSIVE CARE UNIT. B. Moody, RN, CIC, J. Luby, MD, E.
Siler, RN, CIC.* Parkland Memorial Hospital, Dallas, TX. Investigation in the burn intensive care unit (BICU) followed identification of multiply resistant Pseudomonas with identical antibiograms (six wounds and three sputa in 2 months). The organisms were probably transmitted indirectly. Potential reservoirs included multipatient use items: a water tank for splint molding, safety straps on hydrotherapy stretchers, electronic thermometers, plus disinfection to the BICU of respiratory therapy equipment, laryngoscopes and bronchoscopes, and lack of a handwashing sink in the tank room. Current practice was to dip all patient splints into the same tank for molding, without disinfection of splints or tank between patients. Literature identifies potential contamination in the splint molding process. Control measures included proper disinfection, decreasing multipatient use items, contact isolation, enforcement of handwashing, and alerting staff of each new case. Priority was working with Occupational Therapy and the splint-molding process. The outbreak (22 cases total) subsided as "in-house seeders" were discharged and recommendations implemented in stages. Condusions: The hot water tank temperature (158 ° F) should kill Pseudomonas over time. However, frequent reinoculation from splints, the presence of blood and body fluids, and turning off the tank, interferes with rapid or complete bacterial inactivation. Recommendations: Burn units, Occupational Therapy, and water baths need infection control evaluation regularly. Curricula for OTs should include microbiology and infection control. Mulripatient use items should be kept to a minimum and regularly disinfected. Equipment disinfection within patient care areas should be carefully evaluated and must comply with hospital standards. eee
NOSOCOMIAL TRANSMISSION OF TINEA CORPORIS ON A PEDIATRICS WARD AT BOSTON CITY HOSPITAL. J. A. Calcutt, RN, BSN, CIC,* S. Goucher-Wilson, RNC, MSN, C. A. Sulis, MD. Boston City Hospital, Boston, MA.