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Background:Burkholderia multivorans are gram-negative bacteria typically found in water and soil. B. multivorans outbreaks among patients without cystic fibrosis have been associated with exposure to contaminated medical devices or nonsterile aqueous products. Acquisition can also occur from exposure to environmental reservoirs like sinks or other hospital water sources. We describe an outbreak of B. multivorans among hospitalized patients without cystic fibrosis at 2 hospitals within the same healthcare system in California (hospitals A and B) between August 2021 and July 2022. Methods: We defined confirmed case patients as patients without cystic fibrosis hospitalized at hospital A or hospital B between January 2020 to July 2022 with B. multivorans isolated from any body site matching the outbreak strain. We reviewed medical records to describe case patients and to identify common exposures. We evaluated infection control practices and interviewed staff to detect exposures to nonsterile water. Select samples from water, ice, drains, and sink splash zone surfaces were collected and cultured for B. multivorans in March 2022 and July 2022 from both hospitals. Common aqueous products used among case patients were tested for B. multivorans. Genetic relatedness between clinical and environmental samples was determined using random amplified polymorphic DNA (RAPD) and repetitive extragenic palindromic polymerase chain reaction (Rep-PCR). Results: We identified 23 confirmed case patients; 20 (87%) of these were identified at an intensive care unit (ICU) in hospital A. B. multivorans was isolated from respiratory sources in 18 cases (78%). We observed medication preparation items, gloves, and patient care items stored within sink splash zones in ICU medication preparation rooms and patient rooms. Nonsterile water and ice were used for bed baths, swallow evaluations, and ice packs. B. multivorans was cultured from ice and water dispensed from an 11-year-old ice machine in the ICU at hospital A in March 2022 but no other water sources. Additional testing in July 2022 yielded B. multivorans from ice and a drain pan from a new ice machine in the same ICU location at hospital A. All products were negative. Clinical and environmental isolates were the same strain by RAPD and Rep-PCR. Conclusions: The use of nonsterile water and ice from a contaminated ice machine contributed to this outbreak. Water-related fixtures can serve as reservoirs for Burkholderia, posing infection risk to hospitalized and immunocompromised patients. During outbreaks of water-related organisms, such as B. multivorans , nonsterile water and ice use should be investigated as potential sources of transmission and other options should be considered, especially for critically ill patients.
Background: A multistep algorithm using GDH antigen plus toxin with a reflex PCR is an acceptable method for detecting CDI. The use of the PCR in discordant cases can identify those patients who are colonized from those patients who have nontoxogenic strains of C. difficile. Identification of discordant patients has infection prevention implications. Treatment is not recommended for patients colonized with C. difficile. Methods: A line listing of patients with positive hospital-onset antigen/toxin positive and discordant PCR positive was created. Demographic information was extracted from medical records and the 2 cohorts were compared. Results: There were 59 discordant and 44 positive cases HO CDI cases from October 2017 through September 2019: (1) There was no difference in age and sex between the 2 groups. (2) Positive patients tended to have 3 loose stools before and after testing (57% vs 27%; P = .026). (3) Overall, 82% of positive patients had 1 of 3 signs or symptoms (leukocytosis, abdominal pain, and temperature >38°C) consistent with CDI compared to 66% of discordant patients (P = .038), and 55% of positive patients were more likely to have 2 of 3 signs or symptoms of CDI compared to 17% of discordant patients (P = .00003). (4) Also, 46% of discordant patients were either on the oncology ward or ICU compared to 32% of positive patients (P = .764). (5) There was no difference between in discordant compared to positive patients in non-CDI antimicrobial therapy within 7 days of CDI test submission (81% vs 84%, respectively). Conclusions: (1) Screening for CDI testing should include 3 loose stools and at least 2 of 3 signs or symptoms of CDI. (2) Discordant cases most likely represents colonization because only 17% of discordant patients had 2 of 3 CDI signs or symptoms at presentation. (3) Discordant cases without clinical features of CDI should not receive treatment to minimize antibiotic exposure. (4) Identification of discordant patients have infection prevention ramifications because CD can be indirectly transmitted by colonized patients; therefore, using PCR in addition to toxin testing is favored. (5) Antimicrobial therapy highly associated with CDI should be avoided, should antimicrobial therapy be necessary in PCR-positive discordant patients.
Whole-genome sequencing confirmed the presence of a Malassezia pachydermatis outbreak among neonates in a neonatal intensive care unit. This technology supports the importance of adhering to infection prevention measures.
To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.
The government publishes 3 different public report surgical site infection (SSI) metrics, all called standardized infection ratios (SIRs), that impact perceived hospital quality. We conducted a non-random cross-sectional observational pilot study of 20 California hospitals that voluntarily submitted colon surgery and SSI data. Discordant SIR values, leading to contradictory conclusions, occurred in 35% of these hospitals.
To help facilities prepare for potential future cases of severe acute respiratory syndrome (SARS).
Design and Participants:
The Centers for Disease Control and Prevention (CDC), assisted by members of professional societies representing public health, healthcare workers, and healthcare administrators, developed guidance to help facilities both prepare for and respond to cases of SARS.
The recommendations in the CDC document were based on some of the important lessons learned in healthcare settings around the world during the SARS outbreak of 2003, including that (1) a SARS outbreak requires a coordinated and dynamic response by multiple groups; (2) unrecognized cases of SARS-associated coronavirus are a significant source of transmission; (3) restricting access to the healthcare facility can minimize transmission; (4) airborne infection isolation is recommended, but facilities and equipment may not be available; and (5) staffing needs and support will pose a significant challenge.
Healthcare facilities were at the center of the SARS outbreak of 2003 and played a key role in controlling the epidemic. Recommendations in the CDC's SARS preparedness and response guidance for healthcare facilities will help facilities prepare for possible future outbreaks of SARS.
Patients admitted during the study period to the Sharp Memorial Hospital intensive-care units who required mechanical ventilation were followed prospectively; 15 (10.4%) of 145 acquired ventilator-associated pneumonia (VAP). Duration of prior oral or nasal intubation and H2 receptor antagonists use were longer among patients who developed VAP than among those who did not. Prior cefazolin use was associated with a higher rate of VAP (11 of 63 [17%] versus 4 of 82 [5%], P=.01).
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