Background Stenotrophomonas maltophilia (SMA) is an opportunistic pathogen that causes significant morbidity and mortality and has been associated with outbreaks in various hospital environments. We describe an outbreak of SMA in our intensive care unit (ICU) and highlight the sink drain as the probable source of SMA. Methods Clinical surveillance for hospital-acquired infections due to SMA was instituted in December of 2017, when a cluster of cases was identified in our ICU. We first performed an environmental survey in random sites in our ICU rooms: high-touch surfaces, drains in handwashing sinks, clean water, enteral feeding, and ice machines. SMA was only found in the sink drain. We then performed an environmental survey focused on sink drains and the surrounding areas. We identified rooms where patients positive for SMA were previously hospitalized. Sampling sites were standardized for all rooms: bed rail, sink drain, splash zone, and air near sinks. Bed rails were swabbed with sponge-swabs and sink drains with flocked swabs with liquid Amies transport media. Swab samples were cultured in broth and solid media. Splash zone samples were collected using MacConkey agar plates left for four hours immediately adjacent and at one foot from the sink. Air samples were also collected for 10 minutes onto MacConkey agar plates using EMD Millipore MAS-100 NT impactor air sampler. All media was incubated aerobically at 35-37°C. Identification of all isolated gram-negative organisms was performed using MALDI-TOF MS. Results Five rooms were surveyed (Table 1). All rooms were found to have medical supplies within the splash zone. 100% (5/5) of sink drain samples had SMA recovered in culture, compared to 10% (1/10) of splash zone samples, 20% (1/5) of air samples, and 20% (1/5) of bed rails. In addition, we isolated other gram-negative organisms. We repeated the environmental survey after placing a sink drain cover in rooms found to have SMA in areas other than the drain. In the follow-up survey, we found no growth in cultures except for air samples (Table 2). Conclusion Sink drains pose a risk for SMA, possibly via contamination of medical supplies near sinks. Further investigation, including sequencing of environmental and clinical isolates, is needed to understand the mode of transmission. Disclosures All Authors: No reported disclosures.
Background: In October 2018 a patient presented to hospital A’s emergency department (ED) for a work injury, arm spasms, and inability to drink liquids. He developed rapid neurologic decline and was transferred to hospital B for neurocritical care. He developed a fever, was intubated, and had an unrevealing infectious diseases (ID) consultation. He became comatose, had refractory seizures, and was transferred to hospital C. A second ID consultation revealed that he had many bats in his home, and his symptoms were consistent with rabies encephalitis. Antemortem specimens of serum, CSF, skin biopsy, and saliva were all positive for rabies virus PCR, and/or rabies serologies. Objective: We describe the response of a multihospital system to the exposure of employees across 3 facilities to rabies-infected body fluids. Methods: Three hospitals in 1 system (222 caregivers) cared for the index patient (hospital A, n = 8; hospital B, n = 107; hospital C, n = 107; 19 students and residents), as did 2 additional facilities outside the system. These included physicians (n = 21), registered nurses (n = 57), respiratory therapists (n = 29), imaging technicians (n = 24), phlebotomists (n = 12), laboratorians (n = 8) and others (n = 71). Infection prevention, employee health, and pharmacy leadership created a centralized team to ensure that all exposed caregivers were screened, and if exposed, were vaccinated. An electronic screening tool developed and administered by the Utah Department of Health via Research Electronic Data Capture (Redcap), rapidly assessed caregiver body fluid exposure risks (saliva, tears, neurologic tissue), and use of personal protective equipment in patient care. After completion, caregivers received notification that he or she (1) had no exposure (no further action), (2) had exposure and should report to employee health for vaccination, or (3) had unclear exposure and should contact the employee health department. Results: Caregivers feared that the tool underestimated exposure risk. Many caregivers (n = 48), repeated the assessment more than once, changing answers. The most common reasons cited were incomplete forms (n = 21), caregiver did not recall using personal protective equipment with contact with saliva (n = 8) or did not understand rabies transmission (n = 3). All vaccinations were initiated by 11 of 26 care givers, 18 days after initial deployment of the tool. All exposed caregivers completed the course. No caregivers developed symptoms of rabies encephalitis. Conclusions: An online tool can safely assess large healthcare exposure such as rabies. A team comprising infection preventionists, employee health representatives, pharmacists, and public health department representatives made the assessment of many geographically dispersed caregivers rapid and effective. Caregivers should employ the basic tenets of standard precautions in the daily care of patients to avoid unknown exposures to common bodily fluids.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.