Subject(s)
Clostridioides difficile , Clostridium Infections , Fidaxomicin , Humans , Recurrence , Tertiary Care Centers , United KingdomABSTRACT
BACKGROUND: Mycobacterium tuberculosis is a major health burden worldwide. The disease may present as an individual case, community outbreak, or more rarely as a nosocomial outbreak. Even in countries with a low prevalence such as the UK, tuberculosis (TB) presents a risk to healthcare workers (HCWs). AIM: To report an outbreak which manifested 12 months after a patient with pulmonary tuberculosis was admitted to Queen Elizabeth Hospital Birmingham. METHODS: We present the epidemiological and outbreak investigations; the role of whole genome sequencing (WGS) in identifying the outbreak and control measures to prevent further outbreaks. FINDINGS: Subsequent to a diagnosis of open TB in a patient, transmission was confirmed in one HCW who had active TB; HCWs with latent TB infection (LTBI) were also identified among seven HCW contacts of the index patient. Of note, all the LBTI patients had other risk factors for TB. Routine use of WGS identified the outbreak link between the index patient and the HCW with active TB disease, and informed our investigations. CONCLUSION: Exposure most likely occurred during an aerosol-generating procedure (AGP) which was done in accordance with national guidance at that time without using respiratory protection. Enhanced control measures were implemented following the outbreak.
Subject(s)
Cross Infection/epidemiology , Disease Outbreaks , Disease Transmission, Infectious , Health Personnel , Mycobacterium tuberculosis/isolation & purification , Tuberculosis/epidemiology , Adult , Child, Preschool , Cross Infection/transmission , Female , Humans , Infant , Infection Control/methods , Male , Middle Aged , Molecular Epidemiology , Molecular Typing , Mycobacterium tuberculosis/classification , Mycobacterium tuberculosis/genetics , Prevalence , Risk Factors , Tuberculosis/transmission , United Kingdom/epidemiology , Whole Genome SequencingSubject(s)
Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Hematologic Diseases/complications , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/drug effects , Selection, Genetic , beta-Lactam Resistance , Cross Infection/epidemiology , Cross Infection/microbiology , Disease Transmission, Infectious , Hospital Departments , Hospitals, University , Humans , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa/isolation & purification , United Kingdom , Water MicrobiologySubject(s)
Bacteremia/prevention & control , Catheter-Related Infections/complications , Escherichia coli Infections/prevention & control , Infection Control/methods , Secondary Care/methods , Urinary Tract Infections/complications , Bacteremia/epidemiology , Catheter-Related Infections/epidemiology , England/epidemiology , Escherichia coli Infections/epidemiology , Humans , Prevalence , Urinary Tract Infections/epidemiologySubject(s)
Gram-Positive Bacterial Infections , Vancomycin-Resistant Enterococci , Adult , Humans , Risk FactorsSubject(s)
Bacterial Proteins/genetics , Carbon-Oxygen Ligases/genetics , Gram-Positive Bacterial Infections/epidemiology , Vancomycin-Resistant Enterococci/isolation & purification , Disease Outbreaks , Environmental Microbiology , Gram-Positive Bacterial Infections/microbiology , Hematology , Humans , Polymerase Chain Reaction , United Kingdom , Vancomycin-Resistant Enterococci/geneticsABSTRACT
Pseudomonas aeruginosa is an important nosocomial pathogen widely colonizing hospital water supplies. The Department of Health (England) Health Technical Memorandum (HTM) 04-01 addresses the risk posed by recommending water-testing in augmented care areas including outpatient haemodialysis. We discuss how two teaching hospitals independently reviewed the risk to outpatient haemodialysis patients, drawing the same conclusion. The highest number of infection episodes with P. aeruginosa was observed in critical care followed by burns and haematology, with the lowest in haemodialysis. Based on these results, we suggest that water sampling should be undertaken in areas such as critical care, burns, and haematology, but not in outpatient haemodialysis.
Subject(s)
Cross Infection/microbiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/isolation & purification , Water Microbiology , Burns , Dialysis Solutions , England/epidemiology , Guidelines as Topic , Hospital Departments , Hospitals, Teaching , Humans , Pseudomonas Infections/epidemiology , Renal DialysisABSTRACT
BACKGROUND: Hepatitis C virus (HCV) infection is a major health burden worldwide. A patient with no history of HCV infection while on a renal unit was found to seroconvert to HCV. AIM: To report the use of sequencing to postulate how transmission of HCV occurred in a healthcare setting, and how this guided our outbreak investigation. FINDINGS: Based on infection control inspections the transmission event was surmised to be due to ward environmental contamination with blood and subsequent inoculation from intravenous interventions on the patient acquiring HCV. We discuss the interventions put in place in response to the outbreak investigation findings. CONCLUSION: Sequencing of healthcare-acquired HCV infections should be undertaken as routine practice in outbreak investigations.
Subject(s)
Genotype , Hepacivirus/classification , Hepacivirus/genetics , Hepatitis C/virology , Molecular Epidemiology/methods , Renal Dialysis/adverse effects , Whole Genome Sequencing/methods , Hepacivirus/isolation & purification , Hepatitis C/epidemiology , Humans , Infection Control/methodsSubject(s)
Burns/complications , Cross Infection/epidemiology , Disease Outbreaks , Methicillin-Resistant Staphylococcus aureus/classification , Molecular Typing , Sequence Analysis, DNA , Staphylococcal Infections/epidemiology , Burn Units , Cross Infection/microbiology , Genome, Bacterial , Humans , Methicillin-Resistant Staphylococcus aureus/genetics , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Molecular Epidemiology , Staphylococcal Infections/microbiologySubject(s)
Cross Infection/prevention & control , Disease Transmission, Infectious/prevention & control , Infection Control/methods , Pseudomonas Infections/prevention & control , Pseudomonas aeruginosa/isolation & purification , Water Microbiology , Humans , Pseudomonas aeruginosa/classification , Pseudomonas aeruginosa/genetics , Staining and Labeling/methodsABSTRACT
Pseudomonas aeruginosa is an important nosocomial pathogen, colonizing hospital water supplies including taps and sinks. We report a cluster of P. aeruginosa acquisitions during a period of five months from tap water to patients occupying the same burns single room in a critical care unit. Pseudomonas aeruginosa cultured from clinical isolates from four different patients was indistinguishable from water strains by pulsed-field gel electrophoresis. Water outlets in critical care may be a source of P. aeruginosa despite following the national guidance, and updated guidance and improved control measures are needed to reduce the risks of transmission to patients.
Subject(s)
Cross Infection/transmission , Disease Transmission, Infectious , Intensive Care Units , Pseudomonas Infections/transmission , Pseudomonas aeruginosa/isolation & purification , Water Microbiology , Cross Infection/epidemiology , Electrophoresis, Gel, Pulsed-Field , Genotype , Humans , Molecular Epidemiology , Molecular Typing , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa/classification , Pseudomonas aeruginosa/geneticsABSTRACT
BACKGROUND: Non-tuberculosis mycobacteria such as Mycobacterium chimaera are found widely in hospital water systems. Invasive M. chimaera infections have recently been attributed to heater-cooler units (HCUs) of cardiopulmonary bypass equipment. AIM: To assess the extent of microbiological contamination within the HCUs and to inform decontamination strategies for reducing the microbial load. METHODS: Water samples taken from HCUs used at University Hospitals Birmingham for cardiopulmonary bypass surgery were sampled to determine the number of micro-organisms by membrane filtration. Various decontamination processes were used throughout the study, all based on the manufacturer's guidance. FINDINGS: Total viable counts >300cfu per 100mL containing a wide variety of micro-organisms were obtained from water inside the HCUs. Working with the manufacturers, we significantly reduced the microbial load of the water within the HCUs by removing the internal tubing soiled with biofilm followed by a weekly decontamination regimen with peracetic acid. CONCLUSION: A decontamination cycle including an initial replacement of internal tubing with weekly microbiological water samples is required to maintain the water quality within HCUs at an acceptable level.
Subject(s)
Decontamination/methods , Equipment and Supplies/microbiology , Infection Control/methods , Nontuberculous Mycobacteria/isolation & purification , Bacterial Load , Cardiopulmonary Bypass/adverse effects , Filtration , Hospitals, University , Humans , Mycobacterium Infections, Nontuberculous/prevention & control , Surgical Wound Infection/prevention & control , United Kingdom , Water MicrobiologyABSTRACT
Over the last decade, carbapenemase-producing organisms (CPOs) have spread worldwide, becoming a major public health concern. This article reports the authors' experience in dealing with a burns patient infected with CPOs, and the decontamination methods employed to render a burns shock room safe for re-use. The shock room was cleaned after being vacated, but environmental sampling cultured multiple CPOs. A second decontamination was undertaken comprising a detergent, steam and hypochlorite clean followed by hydrogen peroxide misting, and no CPOs were cultured after subsequent environmental sampling. A burns patient harbouring CPOs contaminates the surroundings heavily, so standard cleaning is insufficient to reduce the environmental bioburden.
Subject(s)
Bacterial Proteins/metabolism , Burns/complications , Cross Infection/prevention & control , Disease Transmission, Infectious/prevention & control , Disinfection/methods , Gram-Negative Bacteria/enzymology , Gram-Negative Bacterial Infections/prevention & control , beta-Lactamases/metabolism , Cross Infection/microbiology , Cross Infection/transmission , Environmental Microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/transmission , Humans , Patients' RoomsABSTRACT
BACKGROUND: Intracranial neoplasia of dogs is frequently encountered in veterinary medicine, but large-scale studies on prevalence are lacking. OBJECTIVES: To determine the prevalence of intracranial neoplasia in a large population of dogs examined postmortem and the relationship between breed, age, and weight with the presence of primary intracranial neoplasms. ANIMALS: All dogs that underwent postmortem examination from 1986 through 2010 (n = 9,574), including dogs with a histopathologic diagnosis of primary (n = 227) and secondary (n = 208) intracranial neoplasia. METHODS: Retrospective evaluation of medical records from 1986 through 2010. RESULTS: Overall prevalence of intracranial neoplasia in this study's population of dogs was 4.5%. A statistically significant higher prevalence of primary intracranial neoplasms was found in dogs with increasing age and body weights. Dogs ≥15 kg had an increased risk of meningioma (odds ratio 2.3) when compared to dogs <15 kg. The Boxer, Boston Terrier, Golden Retriever, French Bulldog, and Rat Terrier had a significantly increased risk of primary intracranial neoplasms while the Cocker Spaniel and Doberman Pinscher showed a significantly decreased risk of primary intracranial neoplasms. CONCLUSIONS AND CLINICAL IMPORTANCE: Intracranial neoplasia in dogs might be more common than previous estimates. The study suggests that primary intracranial neoplasia should be a strong differential in older and larger breed dogs presenting with signs of nontraumatic intracranial disease. Specific breeds have been identified with an increased risk, and others with a decreased risk of primary intracranial neoplasms. The results warrant future investigations into the role of age, size, genetics, and breed on the development of intracranial neoplasms.