An outbreak of multidrug-resistant Pseudomonas aeruginosa in a burns service in the North of England: challenges of infection prevention and control in a complex setting.

BACKGROUND: Burns patients are at high risk of nosocomial infection, and Pseudomonas aeruginosa is one of the most common causes of wound and systemic infections resulting in significant morbidity and mortality in burns patients. AIM: To describe an outbreak of multidrug-resistant P. aeruginosa (MDR-Pa) at a specialist burns service and highlight the challenges in identifying the reservoir of infection despite extensive epidemiological, microbiological, and environmental investigations. METHODS: Multi-disciplinary outbreak control investigation. FINDINGS: Following an inter-hospital transfer of a burns patient from another country, an admission screen revealed that the patient was colonized with MDR-Pa. Subsequently nine more patients contracted MDR-Pa in the period from November 2015 to September 2017. Given the relatively long gap between confirmation of the index and subsequent cases, it was not possible to identify with certainty the reservoirs and mechanisms of spread of infection, although contamination of the burns service environment and equipment are likely to be contributory factors. CONCLUSION: Preventing infection transmission in specialist burns services is highly challenging, and it may not always be possible to identify and eradicate the reservoirs of infection for P. aeruginosa outbreaks. Our study supports the literature, providing additional evidence that inanimate, common contact surfaces play an important role in nosocomial transmission of P. aeruginosa. These surfaces should either be decontaminated efficiently between patient contacts or be single patient use. Enhanced vigilance is crucial, and, with strict adherence to infection prevention and control procedures, it is possible to reduce the risk of acquisition and spread of infection in patients.

An ongoing large outbreak of measles in Merseyside, England, January to June 2012.

From 1 January to 30 June 2012, 359 confirmed and 157 probable cases of measles were reported in Merseyside, England. The most affected age groups were children under five years and young adults from 15 years of age. Most cases have been sporadic. There have been few outbreaks in nurseries; however, no outbreaks have been reported in schools. Of the cases eligible for vaccination, only 3% of the confirmed cases were fully immunised.

Costs of a limited patient notification exercise following infection control failures in a dental surgery.

In February 2008, a primary care trust in Cheshire Merseyside was notified of failures in the infection control practises of a dentist working in a large group practice. On advice from national experts, a look-back was undertaken to identify any patients infected with hepatitis followed by a notification exercise of patients who had received invasive treatment immediately afterwards. One patient with hepatitis C (HCV) was identified. Sixty patients were notified by letter and offered advice and HCV screening. The total cost of the patient notification exercise (PNE) was estimated at £85,936, equating to £1,562.47 per patient who responded to the notification (55), or £2,455.31 per patient screened (35). All results were negative. While this adds to evidence that the risk to patients in such incidents is small, failing to investigate the possibility that BBV transmission has occurred would carry public health, reputational and legal risks. Conducting a PNE in the first instance for those patients at highest risk, with the option of extending it if evidence of patient-to-patient transmission is found, ensures that the total costs of dealing appropriately with such incidents - while still substantial - are at least kept to a minimum.

Exploration of cost effectiveness of active vaccination in the control of a school outbreak of hepatitis A in a deprived community in the United Kingdom.

In January 2006, an outbreak of hepatitis A occurred in a socio-economically deprived area of Liverpool, in the United Kingdom (UK), where extensive community outbreaks of hepatitis had previously occurred. A total of nine cases were confirmed. Five of these were linked within a primary school. The outbreak initially occurred among a close social contact group, but there was evidence of subsequent person-to-person transmission within a local primary school. The school was attended by 221 pupils (age range 4-12 years) with a total of 37 teaching and other staff (age range 22-71 years). Following local risk assessment, mass hepatitis A virus (HAV) vaccination was offered to all staff and pupils, as all were judged to be likely to have been in close contact with the affected pupils. A total of 188 of 217 eligible children (87%), and 33 of 37 staff (89%) were vaccinated. A salivary seroprevalence survey was conducted at the same time as vaccination to assess the benefit of this intervention in the school population. The survey confirmed high levels of susceptibility to hepatitis A in this setting (97.8%, 95% CI 91.6 to 99.62). The direct costs of intervention were estimated as euro5,000. The cost effectiveness of intervention varies widely (euro60.50 to euro2,099 per case avoided) depending on the expected attack rate, which is difficult to estimate due to heterogeneity in published studies.