Outbreak of human metapneumovirus infection in psychiatric inpatients: implications for directly observed use of alcohol hand rub in prevention of nosocomial outbreaks

Cheng, Vincent Chi-Chung; Wu, Alan; Cheung, Chris H. Y.; Lau, Susanna K. P.; Woo, Patrick C. Y.; Chan, Kui-Fat; Li, K.S.M.; Ip, Ivanova; Dunn, Eva Lai-Wah; Lee, R.A.; Yam, Loretta Yin‐Chun; Yuen, Kwok‐Yung

doi:10.1016/j.jhin.2007.09.010

Cited by 76 publications

(56 citation statements)

References 18 publications

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“…Psychiatric facilities often have few resources, diagnostic measures and professionals to implement the control of HAIs, which ends up being commonly ignored (30) . However, controlling the infection in a mental health environment is a daunting challenge as there is a gap between the control and practices in this scenario.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals

Piai-Morais

Orlandi

Figueiredo

2015

Rev. esc. enferm. USP

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Objective: Evaluate and correlate individual, work-related and organizational factors that influence adherence to standard precautions among nursing professionals of psychiatric hospitals in São Paulo. Method: An exploratory cross-sectional study conducted with 35 nursing professionals, using the assessment tool for adherence to standard precautions through the Likert scale, ranging from 1 to 5. Results: Knowledge of the precautions received a high score (4.69); adherence received (3.86) and obstacles (3.78), while intermediaries and the scales of organizational factors received low scores (2.61). There was a strong correlation between the magnitude adherence scale and the personal protective equipment availability (r = 0.643; p = 0.000). The training scale for prevention of HIV exposure (p = 0.007) was statistically different between the nurses and nursing assistants. Conclusion: The organizational factors negatively contributed to adherence to standard precautions, indicating that psychiatric institutions lack safe working conditions, ongoing training and management actions to control infections. Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals * Fatores que influenciam a adesão às precauções-padrão entre profissionais de enfermagem em hospital psiquiátrico Factores que influencian la adhesión a las precauciones estándares entre profesionales de enfermería en hospital psiquiátrico DESCRIPTORS

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Section: Discussionmentioning

confidence: 99%

Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals

Piai-Morais

Orlandi

Figueiredo

2015

Rev. esc. enferm. USP

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“…Microbiological laboratory data were also retrieved to identify any unrecognized case and the past incidence of this rare infection. The medical records of the case patients were reviewed by clinical microbiologists and the infection control team as described in our previous outbreak investigations (5,6,7,66). The hematologists were interviewed regarding any change in the chemotherapeutic regimen which might have altered the degree of immunosuppression in this group of patients, and the nursing staffs were inspected for any changes in patient care practice.…”

mentioning

confidence: 99%

Outbreak of Intestinal Infection Due to Rhizopus microsporus

Cheng

Chan²,

Ngan³

et al. 2009

J Clin Microbiol

117

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Sinopulmonary and rhinocerebral zygomycosis has been increasingly found in patients with hematological malignancies and bone marrow transplantation, but intestinal zygomycosis remains very rare in the literature. We investigated an outbreak of intestinal infection due to Rhizopus microsporus in 12 patients on treatment for hematological malignancies over a period of 6 months in a teaching hospital. The intake of allopurinol during hospitalization (P < 0.001) and that of commercially packaged ready-to-eat food items in the preceding 2 weeks (P < 0.001) were found to be independently significant risk factors for the development of intestinal zygomycosis. A total of 709 specimens, including 378 environmental and air samples, 181 food samples, and 150 drug samples, were taken for fungal culture. Among them, 16 samples of allopurinol tablets, 3 prepackaged ready-to-eat food items, and 1 pair of wooden chopsticks were positive for Rhizopus microsporus, which was confirmed by ITS1-5.8S-ITS2 rRNA gene cluster (internal transcribed spacer [ITS]) sequencing. The mean viable fungal counts of allopurinol obtained from wards and pharmacy were 4.22 ؋ 10 3 CFU/g of tablet (range, 3.07 ؋ 10 3 to 5.48 ؋ 10 3 ) and 3.24 ؋ 10 3 CFU/g of tablet (range, 2.68 ؋ 10 3 to 3.72 ؋ 10 3 ), respectively, which were much higher than the mean count of 2 ؋ 10 2 CFU/g of food. Phylogenetic analysis by ITS sequencing showed multiple clones from isolates of contaminated allopurinol tablets and ready-to-eat food, of which some were identical to patients' isolates, and with one isolate in the cornstarch used as an excipient for manufacture of this drug. We attempted to type the isolates by random amplification of polymorphic DNA analysis, with limited evidence of clonal distribution. The primary source of the contaminating fungus was likely to be the cornstarch used in the manufacturing of allopurinol tablets or ready-to-eat food. Rhizopus microsporus is thermotolerant and can multiply even at 50°C. The long holding time of the intermediates during the manufacturing process of allopurinol amplified the fungal load. Microbiological monitoring of drugs manufactured for highly immunosuppressed patients should be considered.Zygomycosis has become an important emerging infection in patients with hematological malignancy undergoing chemotherapy or bone marrow transplantation (24), especially with the availability of voriconazole as antifungal prophylaxis (25,28,44). Breakthrough zygomycosis in patients on voriconazole prophylactic treatment is usually manifested as sinopulmonary or rhinocerebral disease, since the fungal spores are ubiquitously found in the environment and could therefore be acquired through inhalation or traumatic inoculation through the skin or mucosa. Gastrointestinal zygomycosis has been a rare clinical entity (50, 54), but cases or outbreaks of tongue, gastric, or cutaneous zygomycosis due to Rhizopus microsporus after exposure to contaminated wooden tongue depressors have been reported (23,26,33).The Rhizopus microsporus species gr...

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“…Although there have been a few reports of nosocomial hMPV infections involving infants (2, 6, 7), there have been no studies of outbreaks of hMPV infection in pediatric patient populations in acute care hospitals. Most outbreaks of hMPV infection involve elderly patients in longterm care facilities and neuropsychiatry wards (1,3,9,11,12). The objective of this study was to characterize the epidemiology of a nosocomial outbreak of hMPV infection in a pediatric patient population.…”

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confidence: 99%

“…Nosocomial outbreaks of RSV infection in pediatric wards, including neonatal intensive care units, have been previously reported (8,13), but nosocomial outbreaks of hMPV are rarely reported at acute care facilities. There are several reports of outbreaks of hMPV infection among elderly patients institutionalized in long-term care facilities (1,3,11,12). One previous study reported a nosocomial outbreak of hMPV infection among elderly patients in a psychiatric ward (3).…”

mentioning

confidence: 99%

Molecular Epidemiological Investigation of a Nosocomial Outbreak of Human Metapneumovirus Infection in a Pediatric Hemato-Oncology Patient Population

Kim¹,

Sung²,

et al. 2009

J Clin Microbiol

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We report the first nosocomial outbreak of human metapneumovirus (hMPV) infection in a pediatric patient population. Among 15 pediatric hMPV infections from March to May 2007, there was a nosocomial outbreak involving two patients sharing a room in a hemato-oncology ward with a patient with a community-acquired case of hMPV infection. The estimated incubation period was 7 to 9 days for a symptomatic nosocomial case. Sequencing of fusion genes of 15 isolates revealed two clusters belonging to subgroup A2 and one cluster belonging to subgroup B2. Three isolates from the outbreak had sequences identical to those of samples in the A2 cluster. There was also a separate nosocomial case represented by the B2 cluster.

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Outbreak of human metapneumovirus infection in psychiatric inpatients: implications for directly observed use of alcohol hand rub in prevention of nosocomial outbreaks

Cited by 76 publications

References 18 publications

Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals

Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals

Outbreak of Intestinal Infection Due to Rhizopus microsporus

Molecular Epidemiological Investigation of a Nosocomial Outbreak of Human Metapneumovirus Infection in a Pediatric Hemato-Oncology Patient Population

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