RESUMO
Candida auris, an emerging multi-drug resistant organism, is an urgent public health threat. We report on a C. auris outbreak investigation at a Virginia ventilator skilled nursing facility. During October 2020-June 2021, we identified 28 cases among residents in the ventilator unit. Genomic evidence suggested ≥2 distinct C. auris introductions to the facility. We identified multiple infection and prevention control challenges, highlighting the importance of strengthening multi-drug resistant organism prevention efforts at ventilator skilled nursing facilities.
Assuntos
Candida , Candidíase , Estados Unidos , Humanos , Candida/genética , Candidíase/tratamento farmacológico , Candida auris , Instituições de Cuidados Especializados de Enfermagem , Farmacorresistência Fúngica Múltipla , Virginia/epidemiologia , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Surtos de DoençasRESUMO
BACKGROUND: The main study aim was to track infections, evaluate performance, and identify opportunities for improved practice since infections, especially those associated with multidrug-resistant organisms, are the second most common cause of death among end-stage renal disease patients. METHODS: This study describes the establishment of baseline dialysis event surveillance at a large dialysis center. Every month, the dialysis center staff reported the total number of maintenance hemodialysis patients to the department of infection control and hospital epidemiology. The surveillance system for dialysis events included monthly monitoring of hemodialysis patients in outpatient settings for positive blood cultures, intravenous antimicrobial initiation, and local vascular access infections. RESULTS: We calculated the pooled mean rates of positive blood cultures, intravenous antimicrobial initiation, and local vascular access infections during the period from June 1, 2014 to September 30, 2017. Results indicated more dialysis events were attributed to the CVC than any other dialysis vascular access. Regardless of vascular access type, intravenous antimicrobial initiation was the most commonly reported dialysis-associated event. CONCLUSIONS: Dialysis events surveillance can be used to produce a decrease in both morbidity and mortality rates in hemodialysis patients.
Assuntos
Fístula Arteriovenosa/microbiologia , Bacteriemia/microbiologia , Infecções Bacterianas/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Falência Renal Crônica/terapia , Diálise Renal , Administração Intravenosa , Adulto , Idoso , Antibacterianos/uso terapêutico , Fístula Arteriovenosa/tratamento farmacológico , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/prevenção & controle , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Hemocultura , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Pacientes Ambulatoriais , Estudos Retrospectivos , Vancomicina/uso terapêuticoRESUMO
Cleaning and disinfection practices of environmental surfaces are critical interventions for reducing health care-associated infections. We studied the value of ready-to-use cleaning and disinfection wipes compared with the traditional towel and bucket method. When using ready-to-use wipes, we found compliance to be significantly higher, a more rapid cleaning and disinfection process, and potential cost savings. Facilities should consider these products when making environmental services product selections.
Assuntos
Desinfetantes/administração & dosagem , Desinfecção/métodos , Desinfecção/estatística & dados numéricos , Microbiologia Ambiental , Fidelidade a Diretrizes/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Fatores de TempoRESUMO
A man with dilated cardiomyopathy presented with decompensated heart failure and marked eosinophilia. After extensive clinical and laboratory evaluation for hypereosinophilic syndrome, including a myocardial biopsy, it was determined by means of rechallenge (second dobutamine infusion) that the patient was afflicted with dobutamine-induced eosinophilia. This report is important because of the high utilization rate of this drug in a sick population. Simply discontinuing it or switching to another agent can avert the high cost and risk of the evaluation for hypereosinophilic syndrome in this compromised group of patients.
