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Respiratory syncytial virus (RSV) - A key player for severe infections in special populations
S12
Abstracts of the 7th International Congress of the Asia Pacific Society of Infection Control, Taipei, Taiwan, March 26-29, 2015
SP 3-4
SYMPOSIUM 4 (SP 4) INFECTION CONTROL IN PEDIATRICS
HAI: ACTUAL RISK FROM THE ENVIRONMENT Hung Suet LAM. Hospital Authority Hong Kong, Hong Kong, Special Administrative Region Over decades, controversy whether or not contaminated environmental surfaces contribute to transmission of Health-care Associated Infection (HAI) exists. This aims to have a review about the evidence of the contribution of environmental contamination to HAI. When talking about the risk of HAI from the environment, a number of factors has to be considered including : 1. Surface of the environment frequently contaminated with the HAI pathogens, 2. Pathogen is capable of surviving on surfaces for a prolonged period of time, 3. Likelihood of the surfaces commonly touched by patients and health care workers , 4. Demonstration of transmission of pathogen contaminating the room surfaces of infected/colonized patients to the next patient; 5. Improved environmental cleaning decreased the rate of infections. Since environmental contamination plays an important role in the transmission of HAI and improved cleaning and environmental surfaces decrease the risk of HAI, so interventions to control transmission appears critical. But cleansing practices are often suboptimal. Though, monitoring and providing feedback to cleansing staff can show significant improvement, the improvement is not always sustainable, leading us to new technologies. However until this moment, no studies have been published that demonstrated the installing of such self-disinfecting surfaces reduces HAI while the use of “no etouch” method still requires physical cleaning prior to surface disinfection. Therefore, back to the basic to improve environmental cleaning appears the core of the improvement. Aiming to achieve this goal, an evidence-based care bundle is needed for a successful environmental cleaning and disinfection program. However, as reported in an ICU setting, the contribution of environment contamination to HAI is approximated <20%. So, control of HAI could not rely on environmental decontamination only but other measures like hand hygiene (estimated about 20-e40% ) are also needed to pay special attention. References Al-Hamad A, Maxell S, How clean is clean ? Proposed methods for hospital cleaning assessment. J Hosp Infect 2007;70:328-334. Boyce JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65(S2) :50-54. Carling P. Methods for assessing the adequacy of practices and improveing room disinfection. AJIC 2013(41) :S20-S25. Dettenkofer M; Spencer RC. Importance of environmental decontamination ea critical review. J Hosp Infect 2007;65(S2) :55-57. Dancer SJ. Hospital Cleaning in the 21st century. Eur J Clin Microbiol Infect Dis 2011; 30:1473-1481. Dancer SJ. Control of transmission of infection in hospitals require more than clean hands . ICHE 2010; 31(9) :958-960. Donskey CJ. Does improve surface cleaning and disinfection reduce HAI? AJIC2013; 41:S12-S19. Havill NL. Best practices in disinfection of noncritical surfaces in the health care setting : creating a bundle for success . AJIC 2013 ;41:S26-S30. Kampf G; Kramer A. Epidemiologic background of hand hygiene and evaluation o the most important agents for scrubs and rubs. Clinical Microbiology reviews. 2004863-893. Otter JA; Yezli S; Peri TM; Barbut F; French GL. The role of ‘no-touch’ automated room disinfection systems in infection prevention and control. J Hosp Infect 2013;83 :1-13.. Rutala WA; Weber DJ. Are room decontamination units needed to prevent transmission of environmental pathogens? ICHE 2011; 32(8) :743-747. Weber DJ; Anderson D; Rutala WA. The role of the surface environment in HAI. Curr Opin Infect Dis . 2013, 26:338-344. Weber DJ;Rutala WA. Self-disinfecting surfaces : review of current methologies and future prospects . AJIC 2013(4l):S31-S35. Weinstein RA, Epidemiology and control of Nosocomial infections in Adult ICU. Am J Med 1991 ;91(suppl 3B) 179Se184S.
SP 4-1 RESPIRATORY SYNCYTIAL VIRUS (RSV) - A KEY PLAYER FOR SEVERE INFECTIONS IN SPECIAL POPULATIONS David Greenberg, MD.. The Pediatric Infectious Disease Unit, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Respiratory syncytial virus (RSV) is the most common pathogen in infants with bronchiolitis and can be found in up to 80% of all cases. Infants younger than 12 months of age are more susceptible and can encounter a more severe disease compared to older children. Medical conditions such as prematurity, in particular if associated with chronic lung disease are predisposing factors for more severe disease. Even in late premature infants born 30-e36 weeks of gestational age, RSV can be associated with more severe disease and with complications such as secondary bacterial infection presenting as alveolar pneumonia. Congenital heart disease, chronic lung disease such as cystic fibrosis, neuromuscular diseases, congenital or acquired immune deficiencies, genetic diseases such as Down syndrome are associated with increased risk for RSV complications. Patients infected with RSV are usually contagious for 3-e8 days. However, immunocompromised patients can remain contagious for up to 4 weeks. RSV can spread by droplets directly and indirectly through contact with nasal or oral secretions, via hand contact as well as by contact with contaminated surfaces. Thus, the most effective modalities to prevent the spread of the virus in hospital are hand washing, droplet precautions and cohorting of all infected patients. In addition, in high risk patients it is justified to consider the use of RSV specific treatment and prophylaxis with RSV-Ig. Studies have demonstrated a significant reduction in RSV hospitalization rates following immunization in high-risk patients.
SP 4-2 PREVENTION OF NOSOCOMIAL BACTERIAL INFECTIONS IN PEDIATRICS AND NEONATOLOGY Chia Yin Chong. Senior consultant, Infectious Diseases, Department of Paediatrics, Director, Clinical Quality & Patient Safety, Division of Medicine, KK Women’s and Children’s Hospital (KKH), Singapore Healthcare associated infections (HAI) in children contribute greatly to morbidity, mortality and higher costs. In neonatal intensive care units (NICU), the incidence of HAI is higher than any ICUs due to neonates’ poor immunity, prolonged hospital stay, lack of gastric acidity and need for lifesustaining devices. The degree of compromise in neonates is inversely related to the birth weight and gestational age. The overall HAI rate in VLBW (Very low birth weight < 1500 grams) babies is 20%. Methicillinresistant Staphylococcus aureus (MRSA) central-line associated bloodstream infections continue to be a significant problem in NICU although the incidence in adult ICUs are declining. Nosocomial outbreaks of MRSA in healthy full-term newborns have also been described due to horizontal transmission from healthcare workers. Prevention of further transmission of nosocomial MRSA requires active surveillance and isolation or cohorting, contact precautions, environmental decontamination and decolonization of implicated HCW. Infections in paediatric intensive care units (PICU) almost always involve an invasive device and the frequency of HAI is highest for bloodstream infections, followed by pneumonia and urinary tract infection. HAI in ICUs can be prevented through meticulous hand hygiene, limited use of invasive devices, good compliance to insertion and maintenance bundles for central lines and catheters, early enteral feeding in neonates and antibiotic stewardship. Nosocomial outbreaks in neonates have also been reported involving contaminated milk powder, pasteurizers, and lipid solutions. Nosocomial transmission of pertussis has been described and pertussis vaccination should be strongly advocated for HCW in contact with pediatric patients.
Abstracts of the 7th International Congress of the Asia Pacific Society of Infection Control, Taipei, Taiwan, March 26-29, 2015
SP 3-4
SYMPOSIUM 4 (SP 4) INFECTION CONTROL IN PEDIATRICS
HAI: ACTUAL RISK FROM THE ENVIRONMENT Hung Suet LAM. Hospital Authority Hong Kong, Hong Kong, Special Administrative Region Over decades, controversy whether or not contaminated environmental surfaces contribute to transmission of Health-care Associated Infection (HAI) exists. This aims to have a review about the evidence of the contribution of environmental contamination to HAI. When talking about the risk of HAI from the environment, a number of factors has to be considered including : 1. Surface of the environment frequently contaminated with the HAI pathogens, 2. Pathogen is capable of surviving on surfaces for a prolonged period of time, 3. Likelihood of the surfaces commonly touched by patients and health care workers , 4. Demonstration of transmission of pathogen contaminating the room surfaces of infected/colonized patients to the next patient; 5. Improved environmental cleaning decreased the rate of infections. Since environmental contamination plays an important role in the transmission of HAI and improved cleaning and environmental surfaces decrease the risk of HAI, so interventions to control transmission appears critical. But cleansing practices are often suboptimal. Though, monitoring and providing feedback to cleansing staff can show significant improvement, the improvement is not always sustainable, leading us to new technologies. However until this moment, no studies have been published that demonstrated the installing of such self-disinfecting surfaces reduces HAI while the use of “no etouch” method still requires physical cleaning prior to surface disinfection. Therefore, back to the basic to improve environmental cleaning appears the core of the improvement. Aiming to achieve this goal, an evidence-based care bundle is needed for a successful environmental cleaning and disinfection program. However, as reported in an ICU setting, the contribution of environment contamination to HAI is approximated <20%. So, control of HAI could not rely on environmental decontamination only but other measures like hand hygiene (estimated about 20-e40% ) are also needed to pay special attention. References Al-Hamad A, Maxell S, How clean is clean ? Proposed methods for hospital cleaning assessment. J Hosp Infect 2007;70:328-334. Boyce JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65(S2) :50-54. Carling P. Methods for assessing the adequacy of practices and improveing room disinfection. AJIC 2013(41) :S20-S25. Dettenkofer M; Spencer RC. Importance of environmental decontamination ea critical review. J Hosp Infect 2007;65(S2) :55-57. Dancer SJ. Hospital Cleaning in the 21st century. Eur J Clin Microbiol Infect Dis 2011; 30:1473-1481. Dancer SJ. Control of transmission of infection in hospitals require more than clean hands . ICHE 2010; 31(9) :958-960. Donskey CJ. Does improve surface cleaning and disinfection reduce HAI? AJIC2013; 41:S12-S19. Havill NL. Best practices in disinfection of noncritical surfaces in the health care setting : creating a bundle for success . AJIC 2013 ;41:S26-S30. Kampf G; Kramer A. Epidemiologic background of hand hygiene and evaluation o the most important agents for scrubs and rubs. Clinical Microbiology reviews. 2004863-893. Otter JA; Yezli S; Peri TM; Barbut F; French GL. The role of ‘no-touch’ automated room disinfection systems in infection prevention and control. J Hosp Infect 2013;83 :1-13.. Rutala WA; Weber DJ. Are room decontamination units needed to prevent transmission of environmental pathogens? ICHE 2011; 32(8) :743-747. Weber DJ; Anderson D; Rutala WA. The role of the surface environment in HAI. Curr Opin Infect Dis . 2013, 26:338-344. Weber DJ;Rutala WA. Self-disinfecting surfaces : review of current methologies and future prospects . AJIC 2013(4l):S31-S35. Weinstein RA, Epidemiology and control of Nosocomial infections in Adult ICU. Am J Med 1991 ;91(suppl 3B) 179Se184S.
SP 4-1 RESPIRATORY SYNCYTIAL VIRUS (RSV) - A KEY PLAYER FOR SEVERE INFECTIONS IN SPECIAL POPULATIONS David Greenberg, MD.. The Pediatric Infectious Disease Unit, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Respiratory syncytial virus (RSV) is the most common pathogen in infants with bronchiolitis and can be found in up to 80% of all cases. Infants younger than 12 months of age are more susceptible and can encounter a more severe disease compared to older children. Medical conditions such as prematurity, in particular if associated with chronic lung disease are predisposing factors for more severe disease. Even in late premature infants born 30-e36 weeks of gestational age, RSV can be associated with more severe disease and with complications such as secondary bacterial infection presenting as alveolar pneumonia. Congenital heart disease, chronic lung disease such as cystic fibrosis, neuromuscular diseases, congenital or acquired immune deficiencies, genetic diseases such as Down syndrome are associated with increased risk for RSV complications. Patients infected with RSV are usually contagious for 3-e8 days. However, immunocompromised patients can remain contagious for up to 4 weeks. RSV can spread by droplets directly and indirectly through contact with nasal or oral secretions, via hand contact as well as by contact with contaminated surfaces. Thus, the most effective modalities to prevent the spread of the virus in hospital are hand washing, droplet precautions and cohorting of all infected patients. In addition, in high risk patients it is justified to consider the use of RSV specific treatment and prophylaxis with RSV-Ig. Studies have demonstrated a significant reduction in RSV hospitalization rates following immunization in high-risk patients.
SP 4-2 PREVENTION OF NOSOCOMIAL BACTERIAL INFECTIONS IN PEDIATRICS AND NEONATOLOGY Chia Yin Chong. Senior consultant, Infectious Diseases, Department of Paediatrics, Director, Clinical Quality & Patient Safety, Division of Medicine, KK Women’s and Children’s Hospital (KKH), Singapore Healthcare associated infections (HAI) in children contribute greatly to morbidity, mortality and higher costs. In neonatal intensive care units (NICU), the incidence of HAI is higher than any ICUs due to neonates’ poor immunity, prolonged hospital stay, lack of gastric acidity and need for lifesustaining devices. The degree of compromise in neonates is inversely related to the birth weight and gestational age. The overall HAI rate in VLBW (Very low birth weight < 1500 grams) babies is 20%. Methicillinresistant Staphylococcus aureus (MRSA) central-line associated bloodstream infections continue to be a significant problem in NICU although the incidence in adult ICUs are declining. Nosocomial outbreaks of MRSA in healthy full-term newborns have also been described due to horizontal transmission from healthcare workers. Prevention of further transmission of nosocomial MRSA requires active surveillance and isolation or cohorting, contact precautions, environmental decontamination and decolonization of implicated HCW. Infections in paediatric intensive care units (PICU) almost always involve an invasive device and the frequency of HAI is highest for bloodstream infections, followed by pneumonia and urinary tract infection. HAI in ICUs can be prevented through meticulous hand hygiene, limited use of invasive devices, good compliance to insertion and maintenance bundles for central lines and catheters, early enteral feeding in neonates and antibiotic stewardship. Nosocomial outbreaks in neonates have also been reported involving contaminated milk powder, pasteurizers, and lipid solutions. Nosocomial transmission of pertussis has been described and pertussis vaccination should be strongly advocated for HCW in contact with pediatric patients.