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In March 2018, the US Food and Drug Administration (FDA), US Centers for Disease Control and Prevention, California Department of Public Health, Los Angeles County Department of Public Health and Pennsylvania Department of Health initiated an investigation of an outbreak of Burkholderia cepacia complex (Bcc) infections. Sixty infections were identified in California, New Jersey, Pennsylvania, Maine, Nevada and Ohio. The infections were linked to a no-rinse cleansing foam product (NRCFP), produced by Manufacturer A, used for skin care of patients in healthcare settings. FDA inspected Manufacturer A's production facility (manufacturing site of over-the-counter drugs and cosmetics), reviewed production records and collected product and environmental samples for analysis. FDA's inspection found poor manufacturing practices. Analysis by pulsed-field gel electrophoresis confirmed a match between NRCFP samples and clinical isolates. Manufacturer A conducted extensive recalls, FDA issued a warning letter citing the manufacturer's inadequate manufacturing practices, and federal, state and local partners issued public communications to advise patients, pharmacies, other healthcare providers and healthcare facilities to stop using the recalled NRCFP. This investigation highlighted the importance of following appropriate manufacturing practices to minimize microbial contamination of cosmetic products, especially if intended for use in healthcare settings.
One in six nursing home residents and staff with positive SARS-CoV-2 tests ≥90 days after initial infection had specimen cycle thresholds (Ct) <30. Individuals with specimen Ct<30 were more likely to report symptoms but were not different from individuals with high Ct value specimens by other clinical and testing data.
Background: In April 2019, the Montgomery County Office of Public Health (MCOPH) was notified by the Pennsylvania Department of Health (PADOH) of a tier 2 carbapenemase mechanism in a resident of a Pennsylvania skilled nursing facility that was detected through targeted surveillance. Production of the New Delhi metallo-β-lactamase (NDM) carbapenemase was detected using polymerase chain reaction (PCR). The initial follow-up revealed that the patient resided at a 148-bed skilled nursing facility that specializes in spinal cord injury, neurological diseases, ventilator dependence, and pulmonary diseases. MCOPH and PADOH initiated an investigation to identify additional cases and prevent transmission. Methods: Over a series of 9 point-prevalence surveys, we collected 518 specimens for colonization screening. Screening was conducted on the wing of the index case and was later expanded to include the entire unit (n = 90), after evidence of transmission was noted. Perirectal swabs were submitted to the regional antibiotic resistance laboratory for testing using the Cepheid GeneXpert Carba-R assay. Together with screening, MCOPH and PADOH conducted a series of on-site visits involving the completion of the CDC infection control assessment and response (ICAR) tool and direct care observations, including 409 hand hygiene observations. Results: In addition to NDM, Klebsiella pneumoniae carbapenemase (KPC) and Verona integron-encoded metallo-β-lactamase (VIM) were also detected. ICAR results and direct care observations revealed numerous deficiencies in the domains of hand hygiene, personal protective equipment, and environmental cleaning. In addition to 2 cases of carbapenemase-producing organisms (CPO) being detected through clinical specimens, an additional 27 CPO cases were identified through screening coordinated by public health. This large, multimechanism outbreak is attributed to a combination of intrafacility transmission and imported cases. Based on these findings, recommendations for infection prevention and control were provided on site and in writing. Our continued work with this facility lead to improvements in infection control, including a HH success rate improvement of 53%. Conclusions: Novel or targeted multidrug-resistant organisms are effectively contained when healthcare facilities and state and local public health work together to reduce transmission to baseline and to improve infection control practices.
To investigate an outbreak of Pseudomonas aeruginosa infections and colonization in a neonatal intensive care unit.
Infection control assessment, environmental evaluation, and case-control study.
Newly built community-based hospital, 28-bed neonatal intensive care unit.
Neonatal intensive care unit patients receiving care between June 1, 2013, and September 30, 2014.
Case finding was performed through microbiology record review. Infection control observations, interviews, and environmental assessment were performed. A matched case-control study was conducted to identify risk factors for P. aeruginosa infection. Patient and environmental isolates were collected for pulsed-field gel electrophoresis to determine strain relatedness.
In total, 31 cases were identified. Case clusters were temporally associated with absence of point-of-use filters on faucets in patient rooms. After adjusting for gestational age, case patients were more likely to have been in a room without a point-of-use filter (odds ratio [OR], 37.55; 95% confidence interval [CI], 7.16–∞). Case patients had higher odds of exposure to peripherally inserted central catheters (OR, 7.20; 95% CI, 1.75–37.30) and invasive ventilation (OR, 5.79; 95% CI, 1.39–30.62). Of 42 environmental samples, 28 (67%) grew P. aeruginosa. Isolates from the 2 most recent case patients were indistinguishable by pulsed-field gel electrophoresis from water-related samples obtained from these case-patient rooms.
This outbreak was attributed to contaminated water. Interruption of the outbreak with point-of-use filters provided a short-term solution; however, eradication of P. aeruginosa in water and fixtures was necessary to protect patients. This outbreak highlights the importance of understanding the risks of stagnant water in healthcare facilities.
Infect Control Hosp Epidemiol 2017;38:801–808
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