Development and implementation of a cleaning standard algorithm to monitor the efficiency of terminal cleaning in removing adenovirus within a pediatric hematopoietic stem cell transplantation unit

Cloutman-Green, Elaine; Canales, Melisa; Pankhurst, Louise; Evenor, Tessia; Malone, Deirdre; Klein, Nigel; Ciric, Lena; Hartley, John C.

doi:10.1016/j.ajic.2015.05.016

Cited by 6 publications

(7 citation statements)

References 9 publications

(7 reference statements)

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“…This tertiary referral center already has robust IPC precautions in place for high-risk patients; single room isolation with en-suite facilities and environmental screening post-discharge (Cloutman-Green et al, 2015). Despite these precautions, we were still able to confirm that 21 patients (28%) were involved in a nosocomial transmission cluster, and 15 patients (20%) ordinarily would have gone unnoticed or unlinked (Table 1).…”

Section: Discussionmentioning

confidence: 85%

“…Extensive efforts are employed to prevent adenovirus infection, modified to account for local suspected transmission routes. In our unit, we have implemented rigorous IPC policies including environmental screening (Pankhurst et al, 2014;Cloutman-Green et al, 2015), but transmission is still suspected. In our hospital, over a 20-month period, seven HAdV outbreaks have been investigated by the IPC team, two of them were associated with the HSCT unit, and there had been five adenovirus-associated deaths.…”

Section: Introductionmentioning

confidence: 99%

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Using Whole Genome Sequences to Investigate Adenovirus Outbreaks in a Hematopoietic Stem Cell Transplant Unit

et al. 2021

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A recent surge in human mastadenovirus (HAdV) cases, including five deaths, amongst a haematopoietic stem cell transplant population led us to use whole genome sequencing (WGS) to investigate. We compared sequences from 37 patients collected over a 20-month period with sequences from GenBank and our own database of HAdVs. Maximum likelihood trees and pairwise differences were used to evaluate genotypic relationships, paired with the epidemiological data from routine infection prevention and control (IPC) records and hospital activity data. During this time period, two formal outbreaks had been declared by IPC, while WGS detected nine monophyletic clusters, seven were corroborated by epidemiological evidence and by comparison of single-nucleotide polymorphisms. One of the formal outbreaks was confirmed, and the other was not. Of the five HAdV-associated deaths, three were unlinked and the remaining two considered the source of transmission. Mixed infection was frequent (10%), providing a sentinel source of recombination and superinfection. Immunosuppressed patients harboring a high rate of HAdV positivity require comprehensive surveillance. As a consequence of these findings, HAdV WGS is being incorporated routinely into clinical practice to influence IPC policy contemporaneously.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Using Whole Genome Sequences to Investigate Adenovirus Outbreaks in a Hematopoietic Stem Cell Transplant Unit

et al. 2021

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“…. Monitoring of HAdV DNA in the environment after cleaning may be a way of preventing insufficient cleaning and environmental transmission of HAdV180,181 . Houldcraft et al reported of a cluster of four patients with HAdV A31, who seemed to be part of a nosocomial transmission, which was supported by whole genome sequencing (WGS), although two of the patients had been admitted three years apart.…”

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confidence: 99%

Hepatitis E virus is an infrequent but potentially serious infection in allogeneic hematopoietic stem cell transplant recipients

Swartling

Nordén

Samuelsson

et al. 2020

Bone Marrow Transplant

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Gastrointestinal symptoms, and elevated liver enzymes, are common after HSCT, often due to drug toxicity, graft-versus-host disease (GVHD) or infections. It is essential to distinguish between GVHD and infection, since both conditions may progress to lethal disease, but require opposite strategies for the immunosuppressive treatment. Several of the viral gastrointestinal infections are easily transmitted and can cause outbreaks in health care facilities. Annika Allard för lärorikt samarbete i adenovirus-studien, och Annika Tiveljung, Mats Remberger och Mikael Sundin för samarbetet med första norovirus studien Rickard Nordén, Ebba Samuelsson, Helene Norder och Johan Westin för vårt samarbete, och allt ni lärt mig i samband med hepatit E studien Lennart Svensson och Johan Norgren, för ett roligt och bra samarbete med det senare norovirus-projektet Olle, Mona-Lisa, Mikael och Elda för vår fina gemenskap med kursen i pediatriska infektioner, och alla roliga kurs-utvärderingar hos Olle, till fantastiska måltider! Mina kollegor i "Opportunisterna" för våra väldigt trevliga möten (= terminens höjdpunkt) sedan minst 10 år tillbaka. Jag har lärt mig massor av er alla! Mina vänner, det går ofta lång tid mellan varven, men så glad att ni finns. Mina kära bröder Torbjörn, Gunnar och Janne, och mina svägerskor Christina, Sara och Johanna. För att ni är en så bra familj. Min kära mamma, för all kärlek och värme, och för din stora nyfikenhet och intresse för andra människor. Det är alltid roligt att vara med dig. Pappa, för din positiva livssyn, kärlek, och det kloka stöd du alltid gav. Jag saknar dig. Sist, men allra mest, min älskade familj, Patrik, Maj, David, Felix och Albin. För allt roligt, och för att ni är precis dom ni är.

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“…This tertiary referral centre already has robust IPC precautions in place for high risk patients; single room isolation with en-suite facilities and environmental screening post discharge (22). Despite these precautions we were still able to confirm 21 patients (28%) were involved in a nosocomial transmission cluster, 15 patients (20%) ordinarily would have gone unnoticed or unlinked (Table 1.).…”

Section: Discussionmentioning

confidence: 99%

“…In our hospital over a 20-month period, seven HAdV outbreaks have been investigated by the IPC team; two were associated with the HSCT unit and included five deaths. This was despite rigorous IPC policies including environmental screening (21,22). In response, we undertook extensive epidemiological investigation and sequencing of isolates from the HSCT unit to determine what proportion were transmitted.…”

Section: Introductionmentioning

confidence: 99%

Using Whole Genome Sequences to Investigate Adenovirus Outbreaks, Including Five Deaths in a Haematopoietic Stem Cell Transplant Unit

Myers

Houldcroft

Roy

et al. 2020

Preprint

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BackgroundHuman mastadenoviruses (HAdV) are associated with significant morbidity and mortality amongst the immunocompromised population. A recent surge in HAdV cases, including five deaths, amongst a haematopoietic stem cell transplant population led us to use whole genome sequencing (WGS) to investigate.MethodsTo gain a complete transmission picture, we compared outbreak and non-outbreak sequences (54 sequences from 37 patients) with GenBank sequences and our own database of previously sequenced HAdVs (132 sequences from 37 patients). An improved bait set for WGS was used. Maximum likelihood trees and pairwise differences were used to evaluate genotypic relationships paired with epidemiological data from routine Infection, Prevention and Control (IPC) activity.ResultsNine monophyletic clusters were identified, seven of which were corroborated by epidemiological evidence and by comparison of single nucleotide polymorphisms. Two incomplete patient clusters were identified by IPC over the same time period. Of the five patients who died, one had a mixed HAdV infection and two were the source of transmission events.ConclusionsThe clinical consequences of unmitigated HAdV transmission events are high. Focusing on two high risk wards using WGS we identified six transmission events, over prolonged periods, that would have gone unnoticed using traditional polymerase chain reaction and epidemiology. Mixed infection is frequent (10% of patients), providing a sentinel source of recombination and superinfection. Immunosuppressed patients harbouring a high rate of HAdV positivity require comprehensive surveillance. As a consequence of these findings, HAdV WGS is being incorporated routinely into a clinical algorithm to prevent transmission and influence IPC policy in real-time.SummaryWhole genome sequencing of adenovirus, direct from clinical samples, can be used to identify cryptic health care associated transmission events, and to resolve transmission suspected by traditional epidemiology. It can also identify mixed genotype infections in immunocompromised patient populations.

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Development and implementation of a cleaning standard algorithm to monitor the efficiency of terminal cleaning in removing adenovirus within a pediatric hematopoietic stem cell transplantation unit

Cited by 6 publications

References 9 publications

Using Whole Genome Sequences to Investigate Adenovirus Outbreaks in a Hematopoietic Stem Cell Transplant Unit

Using Whole Genome Sequences to Investigate Adenovirus Outbreaks in a Hematopoietic Stem Cell Transplant Unit

Hepatitis E virus is an infrequent but potentially serious infection in allogeneic hematopoietic stem cell transplant recipients

Using Whole Genome Sequences to Investigate Adenovirus Outbreaks, Including Five Deaths in a Haematopoietic Stem Cell Transplant Unit

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