Epidemiology of carbapenem-resistant Enterobacteriaceae in hospitals of a large healthcare system in Miami, Florida from 2012 to 2016: Five years of experience with an internal registry.

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) is an urgent public health threat globally. Limited data are available regarding the epidemiology of CRE in South Florida. We describe the epidemiology of CRE within a large public healthcare system in Miami, FL, the experience with an internal registry, active surveillance testing, and the impact of infection prevention practices. METHODS: Retrospective cohort study in 4 hospitals from a large healthcare system in Miami-Dade County, FL from 2012 to 2016. The internal registry included all CRE cases from active surveillance testing from rectal and/or tracheal screening occurring in the intensive care units of 2 of the hospitals and clinical cultures across the healthcare system. All CRE cases were tagged in the electronic medical record and automatically entered into a platform for automatic infection control surveillance. The system alerted about new cases, readmissions, and transfers. RESULTS: A total of 371 CRE cases were identified. The overall prevalence was 0.077 cases per 100 patient-admissions; the admission prevalence was 0.019 per 100 patient-admissions, and the incidence density was 1.46 cases per 10,000 patient-days. Rates increased during the first 3 years of the study and declined later to a lower level than at the beginning of study period. CONCLUSIONS: Active surveillance testing and the use of an internal registry facilitated prompt identification of cases contributing to control increasing rates of CRE by rapid implementation of infection prevention strategies.

Carbapenem-Resistant Acinetobacter baumannii: Concomitant Contamination of Air and Environmental Surfaces.

OBJECTIVE To concomitantly determine the differential degrees of air and environmental contamination by Acinetobacter baumannii based on anatomic source of colonization and type of ICU layout (single-occupancy vs open layout). DESIGN Longitudinal prospective surveillance study of air and environmental surfaces in patient rooms. SETTING A 1,500-bed public teaching hospital in Miami, Florida. PATIENTS Consecutive A. baumannii-colonized patients admitted to our ICUs between October 2013 and February 2014. METHODS Air and environmental surfaces of the rooms of A. baumannii-colonized patients were sampled daily for up to 10 days. Pulsed-field gel electrophoresis (PFGE) was used to type and match the matching air, environmental, and clinical A. baumannii isolates. RESULTS A total of 25 A. baumannii-colonized patients were identified during the study period; 17 were colonized in the respiratory tract and 8 were colonized in the rectum. In rooms with rectally colonized patients, 38.3% of air samples were positive for A. baumannii; in rooms of patients with respiratory colonization, 13.1% of air samples were positive (P=.0001). In rooms with rectally colonized patients, 15.5% of environmental samples were positive for A. baumannii; in rooms of patients with respiratory colonization, 9.5% of environmental samples were positive (P=.02). The rates of air contamination in the open-layout and single-occupancy ICUs were 17.9% and 21.8%, respectively (P=.5). Environmental surfaces were positive in 9.5% of instances in open-layout ICUs versus 13.4% in single-occupancy ICUs (P=.09). CONCLUSIONS Air and environmental surface contaminations were significantly greater among rectally colonized patients; however, ICU layout did not influence the rate of contamination. Infect Control Hosp Epidemiol 2016;37:777-781.

Differential environmental contamination with Acinetobacter baumannii based on the anatomic source of colonization.

BACKGROUND: Acinetobacter baumannii is a pathogen of importance worldwide. METHODS: From January 2011 until January 2012, environmental and surveillance cultures were collected from patients admitted to our intensive care units (ICUs). Surveillance cultures were obtained on admission to the ICU and weekly thereafter. Environmental cultures of high-touch surfaces were performed on an alternating basis every week. A room was designated as contaminated if at least 1 object was positive for carbapenem-resistant A baumannii. We only evaluated the rooms belonging to patients who tested positive for Acinetobacter infection. RESULTS: Five hundred eighty-six rooms were cultured across the 5 ICUs surveyed, of which 134 (22.9%) had patients who tested positive for infection with Acinetobacter. Among patients colonized in the rectum, the odds of having bed rails contaminated with A baumannii were 2.55 times the odds of those with only respiratory colonization (P = .03). The odds of having intravenous pumps contaminated with A baumannii among patients with only respiratory colonization were 2.72 times the odds of contamination among patients colonized in the rectum (P = .03). CONCLUSIONS: There was a significant difference in the degree of contamination of bedrails and intravenous pumps based on the occupant's anatomic source of A baumannii infection.

Control of a two-decade endemic situation with carbapenem-resistant Acinetobacter baumannii: electronic dissemination of a bundle of interventions.

BACKGROUND: Our institution continued to experience a hyperendemic situation with carbapenem-resistant Acinetobacter baumannii despite a bundle of interventions. We aim to describe the effect of the subsequent implementation of electronic dissemination of the weekly findings of a bundle of interventions. METHODS: This was a quasiexperimental study performed at a 1,500-bed, public, teaching hospital. From January 2011 to March 2012, weekly electronic communications were sent to the hospital leadership and intensive care units (ICUs). These communications aimed to describe, interpret, and package the findings of the previous week's active surveillance cultures, environmental cultures, environmental disinfection, and hand cultures. Additionally, action plans based on these findings were shared with recipients. RESULTS: During 42 months and 1,103,900 patient-days, we detected 438 new acquisitions of carbapenem-resistant A baumannii. Hospital wide, the rate of acquisition decreased from 5.13 ± 0.39 to 1.93 ± 0.23 per 10,000 patient-days, during the baseline and postintervention periods, respectively (P < .0001). This effect was also observed in the medical and trauma ICUs, with decreased rates from 67.15 ± 10.56 to 17.4 ± 4.6 (P < .0001) and from 55.9 ± 8.95 to 14.71 ± 4.45 (P = .0004), respectively. CONCLUSION: Weekly and systematic dissemination of the findings of a bundle of interventions was successful in decreasing the rates of carbapenem-resistant A baumannii across a large public hospital.

Environmental exposure to carbapenem-resistant Acinetobacter baumannii as a risk factor for patient acquisition of A. baumannii.

We aimed to determine the association between environmental exposure to carbapenem-resistant Acinetobacter baumannii and the subsequent risk of acquiring this organism. Patients exposed to a contaminated hospital environment had 2.77 times the risk of acquiring carbapenem-resistant A. baumannii than did unexposed patients (relative risk, 2.77 [95% confidence interval, 1.50-5.13]; P = .002).

Interactions between anesthesiologists and the environment while providing anesthesia care in the operating room.

We describe 1,132 contacts between anesthesiologists and the operating room. Objects most commonly touched included anesthesia machines and keyboards. Only 13 hand hygiene events were witnessed during 8 hours of observations. Line insertions, bronchoscopies, or blood exposures were not followed by hand hygiene. Stopcocks were accessed 66 times and only disinfected on 10 (15%) of these occasions.

Aerosolization of Acinetobacter baumannii in a trauma ICU*.

OBJECTIVE: To establish the presence of air contamination with Acinetobacter baumannii in the trauma ICU. DESIGN: Point prevalence microbiological surveillances. SETTINGS: A 1,500-bed public teaching hospital in the Miami metro area. PATIENTS: Trauma ICU patients. MEASUREMENTS: Pulsed field electrophoresis was performed on environmental and clinical isolates to determine the association of any isolates from the air with clinical isolates. MAIN RESULTS: Out of 53 patient areas cultured, 12 (22.6%) had their air positive for A. baumannii. The presence of an A. baumannii-positive patient (underneath the plate) was associated with positive air cultures for A. baumannii (11 of 21 [52.4%] vs 0 of 25 [0%]; p < 0.0001). However, we were not able to find differences in air contamination based on the presence of A. baumannii in respiratory secretions versus absence (p = 1.0). Air and clinical isolates were found to be clonally related. CONCLUSIONS: Aerosolization of A. baumannii in the ICUs is a concern, and its role in the transmission of this organism among patients should be further clarified.

Acinetobacter baumannii: association between environmental contamination of patient rooms and occupant status.

We aimed to determine the association between the presence of Acinetobacter baumannii in patient rooms and the carrier status of the occupants. Fifty-six (39%) of 143 rooms with A. baumannii-positive patients had results positive for A. baumannii. Only 49 (10%) of 485 rooms with A. baumannii-negative patients were positive (odds ratio, 5.72 [95% confidence interval, 3.66-8.96]; [Formula: see text]). Clinical and environmental isolates shared pulsed-field gel electrophoresis patterns.

Associations between bacterial contamination of health care workers' hands and contamination of white coats and scrubs.

BACKGROUND: Uniforms are potential reservoirs for hospital organisms, potentially reinfecting the hands of health care workers (HCWs). The study aimed to determine the association between the bacterial contamination of HCWs' hands and uniforms (white coats and scrubs). METHODS: HCWs working in 5 intensive care units had cultures obtained from their hands and uniforms (white coats or scrubs). Pathogens were defined as any gram-negative bacilli, Staphylococcus aureus, and enterococci. RESULTS: Bacterial growth was detected on 103 hands (86%); 13 (11%) grew S aureus, 7 (6%) grew Acinetobacter spp, 2 (2%) grew enterococci, and 83 (70%) grew only skin flora. The presence of pathogens on the hands was associated with a greater likelihood of the presence of pathogens on white coats (κ = 0.81; P < .001), but not on scrubs (κ = 0.31; P = .036). Similarly, the presence of Acinetobacter on HCWs' hands was associated with a greater likelihood of Acinetobacter contamination of white coats (κ = 0.70; P < .001), but not of scrubs (κ = 0.36; P = .024). CONCLUSIONS: Contamination of provider's hands with pathogens or Acinetobacter baumannii was associated with contamination of white coats. This association was not observed between hands and scrubs, however.

Decreasing operating room environmental pathogen contamination through improved cleaning practice.

OBJECTIVE: Potential transmission of organisms from the environment to patients is a concern, especially in enclosed settings, such as operating rooms, in which there are multiple and frequent contacts between patients, provider's hands, and environmental surfaces. Therefore, adequate disinfection of operating rooms is essential. We aimed to determine the change in both the thoroughness of environmental cleaning and the proportion of environmental surfaces within operating rooms from which pathogenic organisms were recovered. DESIGN: Prospective environmental study using feedback with UV markers and environmental cultures. SETTING: A 1,500-bed county teaching hospital. PARTICIPANTS: Environmental service personnel, hospital administration, and medical and nursing leadership. RESULTS: The proportion of UV markers removed (cleaned) increased from 0.47 (284 of 600 markers; 95% confidence interval [CI], 0.42-0.53) at baseline to 0.82 (634 of 777 markers; 95% CI, 0.77-0.85) during the last month of observations ([Formula: see text]). Nevertheless, the percentage of samples from which pathogenic organisms (gram-negative bacilli, Staphylococcus aureus, and Enterococcus species) were recovered did not change throughout our study. Pathogens were identified on 16.6% of surfaces at baseline and 12.5% of surfaces during the follow-up period ([Formula: see text]). However, the percentage of surfaces from which gram-negative bacilli were recovered decreased from 10.7% at baseline to 2.3% during the follow-up period ([Formula: see text]). CONCLUSIONS: Feedback using Gram staining of environmental cultures and UV markers was successful at improving the degree of cleaning in our operating rooms.