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An outbreak of Burkholderia cepacia bloodstream infections in a tertiary-care facility in northern India detected by a healthcare-associated infection surveillance network

Published online by Cambridge University Press:  07 June 2022

Bashir Fomda Open the ORCID record for Bashir Fomda [Opens in a new window] ,
Anoop Velayudhan ,
Valan A. Siromany Open the ORCID record for Valan A. Siromany [Opens in a new window] ,
Gulnaz Bashir ,
Shaista Nazir ,
Aamir Ali ,
Omika Katoch ,
Alphina Karoung ,
Jacinta Gunjiyal  and
Nayeem Wani
...Show all authors
Bashir Fomda
Affiliation:
Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
Anoop Velayudhan
Affiliation:
US Centers for Disease Control and Prevention, New Delhi, India
Valan A. Siromany
Affiliation:
US Centers for Disease Control and Prevention, New Delhi, India
Gulnaz Bashir
Affiliation:
Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
Shaista Nazir
Affiliation:
Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
Aamir Ali
Affiliation:
Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
Omika Katoch
Affiliation:
Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
Alphina Karoung
Affiliation:
Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
Jacinta Gunjiyal
Affiliation:
Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
Nayeem Wani
Affiliation:
Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
Indranil Roy
Affiliation:
US Centers for Disease Control and Prevention, New Delhi, India
Daniel VanderEnde
Affiliation:
US Centers for Disease Control and Prevention, New Delhi, India
Neil Gupta
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
Aditya Sharma
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
Paul Malpiedi
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
Kamini Walia
Affiliation:
Indian Council of Medical Research, New Delhi, India
Purva Mathur*
Affiliation:
Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
*
Author for correspondence: Purva Mathur MD, E-mail: purvamathur@yahoo.co.in
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Abstract

Objective:

The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network.

Setting:

A 780-bed, tertiary-level, public teaching hospital in northern India.

Methods:

After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash.

Results:

Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified.

Conclusions:

Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 3 , March 2023 , pp. 467 - 473
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Healthcare quality, healthcare-associated infections, 2020. US Department of Health & Human Services website. https://health.gov/our-work/health-care-quality/health-care-associated-infections. Published 2020. Accessed May 5, 2022.Google Scholar
Healthcare-associated infections fact sheet 2011. World Health Organization website. https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. Published 2011. Accessed May 5, 2022.Google Scholar
Report on the burden of endemic healthcare-associated infection worldwide, 2011. World Health Organization website. https://apps.who.int/iris/bitstream/handle/10665/80135/9789241501507_eng.pdf. Published 2011. Accessed May 5, 2022.Google Scholar
Henderson, J, Willis, E, Roderick, A, Bail, K, Brideson, GJC. Why do nurses miss infection control activities? A qualitative study. Collegian 2020;27:11–17.CrossRefGoogle Scholar
Sastry, S, Masroor, N, Bearman, G, et al. The 17th International Congress on Infectious Diseases workshop on developing infection prevention and control resources for low-and middle-income countries. Int J Infect Dis 2017;57:138–143.CrossRefGoogle Scholar
Bammigatti, C, Doradla, S, Belgode, HN, Kumar, H, Swaminathan, RP. Healthcare-associated infections in a resource limited setting. J Clin Diagn Res 2017;11:OC01.Google Scholar
LiPuma, JJ. Burkholderia cepacia epidemiology and pathogenesis: implications for infection control. Curr Opin Pulm Med 1998;4:337–341.10.1097/00063198-199811000-00005CrossRefGoogle ScholarPubMed
Shehabi, A, Abu-Al-Soud, W, Mahafzah, A, et al. Investigation of Burkholderia cepacia nosocomial outbreak with high fatality in patients suffering from diseases other than cystic fibrosis. Scand J Infect Dis 2004;36:174–178.CrossRefGoogle ScholarPubMed
Nasser, RM, Rahi, AC, Haddad, MF, Daoud, Z, Irani-Hakime, N, Almawi, WY. Outbreak of Burkholderia cepacia bacteremia traced to contaminated hospital water used for dilution of an alcohol skin antiseptic. Infect Control Hosp Epidemiol 2004;25:231–239.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Notice to readers: manufacturer’s recall of nasal spray contaminated with Burkholderia cepacia complex. Morb Mortal Wkly Rep 2004;53:246.Google Scholar
National Healthcare Safety Network protocol for surveillance of bloodstream infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf. Published 2022. Accessed May 5, 2022.Google Scholar
National Healthcare Safety Network protocol for surveillance of urinary tract infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf. Published 2022. Accessed May 5, 2022.Google Scholar
Surveillance for healthcare-associated infections in intensive care units. India HAI Surveillance Network website. https://www.haisindia.com/upload/fileuploads/1543398274_SOP%20updated%20November%202018.pdf. Updated 2018. Accessed May 5, 2022.Google Scholar
Healthcare-associated outbreak investigation toolkit. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/pdfs/outbreaks/Response_Toolkit_Abstraction_Form-508.pdf. Accessed May 5, 2022.Google Scholar
Core components for infection prevention and control programs. World Health Organization website. https://www.who.int/teams/integrated-health-services/infection-prevention-control/core-components. Published 2019. Accessed May 5, 2022.Google Scholar
Chinn, RY, Sehulster, L. Guidelines for environmental infection control in health-care facilities; recommendations of CDC and Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/pdf/guidelines/environmental-guidelines-P.pdf. Published 2003. Accessed May 5, 2022.Google Scholar
Rawlinson, S, Ciric, L, Cloutman-Green, E. How to carry out microbiological sampling of healthcare environment surfaces? A review of current evidence. J Hosp Infect 2019;103:363–374.CrossRefGoogle ScholarPubMed
WHONET—the microbiology laboratory database software. WHONET website. https://whonet.org/. Published 2018. Accessed May 5, 2022.Google Scholar
Technical notes on drinking-water, sanitation and hygiene in emergencies. World Health Organization website. https://www.susana.org/_resources/documents/default/3-1825-7-1459518474.pdf. Published 2013. Accessed May 5, 2022.Google Scholar
Water treatment manual—disinfection. Irish Environmental Protection Agency website. https://www.epa.ie/publications/compliance--enforcement/drinking-water/advice--guidance/Disinfection2_web.pdf. Published 2011. Accessed May 5, 2022.Google Scholar
Pittet, D, Allegranzi, B, Sax, H, et al. Considerations for a WHO European strategy on healthcare-associated infection, surveillance, and control. Lancet Infect Dis 2005;5:242–250.CrossRefGoogle Scholar
Umscheid, CA, Mitchell, MD, Doshi, JA, et al. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101–114.CrossRefGoogle ScholarPubMed
National Guidelines for Infection Prevention and Control in Healthcare Facilities. India Ministry of Health and Family Welfare website. https://www.mohfw.gov.in/pdf/National%20Guidelines%20for%20IPC%20in%20HCF%20-%20final%281%29.pdf. Published 2020. Accessed May 5, 2022.Google Scholar
Burkholderia cepacia in healthcare settings. US Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/organisms/bcepacia.html. Published 2010. Accessed May 5, 2022.Google Scholar
Trivedi, M, Patil, S, Shettigar, H, Gangwar, M, Jana, S. An effect of biofield treatment on multidrug-resistant Burkholderia cepacia: a multihost pathogen. J Trop Dis 2015;3(3). doi: 10.4172/2329-891X.1000167.Google Scholar
Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.10.1093/oxfordjournals.aje.a113990CrossRefGoogle ScholarPubMed