Comparison of methods for sampling and detection of carbapenemase-producing organisms in clinical hand wash basin drains in healthcare.

There are currently no standardised methods for the sampling and testing of clinical hand wash basin (HWB) samples for the detection of carbapenemase-producing organisms (CPO). Methods of sampling (drain aspirate versus swab from top of drain) and detection of CPO in clinical HWB drains in two different healthcare settings, one which was dealing with a hospital wide outbreak of CPO (hospital A) and another with no reported outbreaks (hospital B) were compared. Drain aspirates and swabs from HWB drains were tested using multiplex PCR together with culture-based methods. No significant difference in detection of CPO was found between drain aspirate or swab methods of sampling. Direct PCR on samples detected significantly more carbapenemase genes than culture on CARBA agar (p < 0.0001 and 0.0045 respectively). A higher percentage of HWB drains were positive in hospital A both by culture and direct PCR, and a significantly higher number of carbapenemase genes were detected in hospital A HWB drain aspirate both by PCR and culture (p = 0.014 and 0.0071 respectively). There was a high correlation between drain swab positivity by PCR and culture in hospital A (91%) compared to hospital B where it was only 33%. No difference could be found in drain contamination rates when HWB with rear drain was compared against those with drain directly below the tap. Colonisation of HWB at the top of the drain may be related to risk of cross transmission of CPO from healthcare environment to patients.

Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature.

BACKGROUND: Healthcare-associated Clostridium difficile infection (CDI) in pregnant/postpartum women is underreported, especially outside of North America. We report a cluster of cases in 2 neighboring secondary care hospitals in South-East England. The objective of this study was to identify the epidemiology and risk factors for infection. METHODS: An investigation into a cluster of cases of confirmed CDI in pregnant/postpartum women was performed over a 12-month period, from June 2016 to June 2017. RESULTS: Eleven cases, in 10 patients, were identified, including 1 patient who had a relapse. Eight of 10 patients developed symptoms after hospital discharge. All patients had received broad-spectrum antibiotics prior to CDI onset. Environmental vectors, such as labor room mattresses, that were found difficult to effectively decontaminate after heavy contamination with blood, feces, and other body fluids may have been possible reservoirs. An infection control care bundle was successful in preventing further cases. CONCLUSIONS: Antibiotic use and exposure to the organism in a contaminated labor room environment are likely risk factors for healthcare-associated CDI in postpartum women. Active surveillance is necessary to prevent these infections, as these cases often present after hospital discharge.