V erona-integron-encoded metallo-β-lactamaseproducing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) and other carbapenemaseproducing organisms (CPOs) are emerging public health threats. CPOs cause infections that are often extensively drug-resistant and associated with substantial rates of illness and death. By colonizing faucet aerators and wastewater plumbing systems, CPOs can spread rapidly within healthcare facilities, including to patients (1-9). VIM is a carbapenemase, a type of enzyme that inactivates carbapenems and other β-lactam antimicrobial drugs that are frequently encoded on mobile genetic elements, which in turn can lead to horizontal spread. VIM-CRPA is uncommon in the United States; <150 isolates are reported to CDC annually (10). During June 2017-November 2019, in a city of 250,000 residents in western Texas, USA (city A), 36 patients with VIM-CRPA were identified. Most were hospitalized for >1 night at an acute-care hospital (hospital A) in the 6 months before VIM-CRPA was isolated, but patients did not have overlapping hospital stays or common procedures. We assessed water sources and plumbing in hospital A to identify potential VIM-CRPA reservoirs.Beginning in June 2017, the Texas Department of State Health Services asked clinical laboratories to voluntarily submit clinical P. aeruginosa isolates resistant to imipenem, meropenem, or doripenem to the Texas Department of State Health Services Laboratory for mechanism testing through the Antibiotic Resistance Laboratory Network (https:// www.cdc.gov/drugresistance/ar-lab-networks/ domestic.html). The 2 clinical laboratories that served hospitals in city A began submitting all CRPA for mechanism testing in June 2017 (hospital A) and April 2018 (hospital B). During July 2017-January 2019, a total of 36 patients with VIM-CRPA isolated from clinical cultures were identified from city laboratories; 21 (58%) had been admitted to hospital A for >1 night in the 6 months before culture collection.We reviewed medical records from hospital A of patients with VIM-CRPA. Median patient age was 57 (range 9-84) years; 57% were male. VIM-CRPA was isolated from wounds in 9 (43%) patients, respiratory sources in 7 (33%), and urine in 5 (24%). Most patients primarily received care on
Background: The Texas Department of State Health Services Healthcare Safety (HCS) Investigation Team began investigating a cluster of positive carbapenem-resistant Pseudomonas aeruginosa (CRPA) results in August 2017. These CRPA isolates contained the novel carbapenemase Verona integron-encoded metallo-β-lactamase (VIM). This cluster became an outbreak that spanned >2 years and involved multiple healthcare facilities in and around northern Texas. In response to positive results, infection control assessments were conducted, which exposed common infection control gaps including inadequate hand hygiene performance, environmental cleaning issues, and poor communication during interfacility patient transfers. As part of the ongoing investigation efforts, a regional containment strategy was developed to prevent the spread of multidrug-resistant organisms. Methods: Beginning in October 2018, the HCS Investigation Team made site visits to participating facilities every 6 months to provide targeted infection control support and hand hygiene performance and environmental cleaning observations. An initial kick-off meeting was held in February 2019 for facilities to begin collaboration on the containment strategy. This strategy became known as BOOT, an acronym meaning: Being prompt in response to positive cases, Obtaining isolates for testing, Optimizing infection prevention, and Transferring patients using a designated form. An interfacility transfer form to reduce the risk of transmission of multidrug-resistant organisms when patients are transferred between healthcare facilities was developed by a work group that consisted of the local health department, the Public Health Region healthcare-associated infections epidemiologist, and multiple healthcare facilities. Results: Facilities have increased communication with other facilities and with the health departments since the implementation of the BOOT strategy. The local health department is contacted when facilities do not receive a transfer form, and follow-up is initiated to ensure appropriate understanding and compliance. Facility handwashing rates and environmental cleaning results have improved with each visit, and access to alcohol-based hand sanitizing dispensers has increased in select facilities. Conclusions: The regional containment strategy is dynamic and ongoing, and changes are implemented as obstacles are encountered. Implementation has resulted in a successful decrease of positive VIM results in the local area by ∼50% since the first half of 2019. This program has led to greater collaboration among healthcare facilities, health departments, and a neighboring state. This investigation and its products have been used as a model for the implementation of containment strategies in other regions of Texas. The HCS Investigation Team hopes to create and implement an interfacility transfer form that can be used in healthcare facilities statewide.Funding: NoneDisclosures: None
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.