Outbreak of<i>Enterobacter cloacae</i>Related to Understaffing, Overcrowding, and Poor Hygiene Practices

Harbarth, Stéphan Juergen; Sudre, Philippe; Dharan, Sasi; Cadenas, Mercedes; Pittet, Didier

doi:10.1086/501677

Cited by 278 publications

(137 citation statements)

References 36 publications

(19 reference statements)

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“…Zahlreiche Studien aus der Neonatologie und aus anderen Fachdisziplinen bestätigen dies übereinstimmend [196,197,198,199,200,201,202,203,204] [196]. F Es ist wissenschaftlich gesichert, dass eine nicht angemessene Ausstattung der NIPS mit qualifiziertem und vor Ort eingearbeitetem Personal das Risiko nosokomialer Infektionen erhöht (Kategorie IA).…”

Section: Konsequenzen Personeller Unterbesetzungunclassified

Empfehlung zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1500 g

2007

Bundesgesundheitsbl.

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Abkürzungsverzeichnis BAL Publizierte Daten aus Surveillance-SystemenJede Infektion, die sich erstmals mehr als 72 Stunden nach der Geburt manifestiert, wird als "nosokomiale Infektion" (NI) bezeichnet [1, 21, 32, 33]. Diese Infektionen werden auch als "Late-onset"-Infektionen bezeichnet ("Late-onset-Sepsis") [18, 19, 20, 34]. Eine Auswahl der bislang publizierten Studien mit Angaben zum Spektrum der NI zeigt . Tabelle 1 [35]. (46 von 88 FG) P < 0,0001) und 24,2% bei GG < 1500 g (vs. 12,7% ≥1500g; P < 0,0001). NEO-KISS

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Section: Konsequenzen Personeller Unterbesetzungunclassified

Empfehlung zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1500 g

2007

Bundesgesundheitsbl.

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“…The paper by Harbath et al in this issue identifies and measures the effects of understaffing, overcrowding, and handwashing on an outbreak of Enterobacter cloacae in a neonatal intensive care unit (ICU). 2 The authors conclude that these factors had a primary role in sustaining the outbreak, which was only brought under control when they were changed.Molecular epidemiology provides an opportunity to examine cross-infections in a scientific manner, and organisms such as E cloacae lend themselves to this kind of investigation. 3 Because most infection control practitioners, if not all physicians, are trained that hand washing is the single most important factor in the prevention of nosocomial infections, the facts are often fit to the hypothesis.…”

mentioning

confidence: 98%

mentioning

confidence: 98%

Too Many or Too Few Hands?

Heseltine¹

1999

Infect. Control Hosp. Epidemiol.

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In 1975, Haley investigated a series of neonatal infections at a large municipal hospital and determined that understaffing and overcrowding had contributed significantly to the outbreak. 1 Almost 25 years later, though intuitive to infection control practitioners, surprisingly little controlled evidence exists to support this concept. The paper by Harbath et al in this issue identifies and measures the effects of understaffing, overcrowding, and handwashing on an outbreak of Enterobacter cloacae in a neonatal intensive care unit (ICU). 2 The authors conclude that these factors had a primary role in sustaining the outbreak, which was only brought under control when they were changed.Molecular epidemiology provides an opportunity to examine cross-infections in a scientific manner, and organisms such as E cloacae lend themselves to this kind of investigation. 3 Because most infection control practitioners, if not all physicians, are trained that hand washing is the single most important factor in the prevention of nosocomial infections, the facts are often fit to the hypothesis. Identical organisms can be tracked from patient to patient, observations are made of poor handwashing technique, and the conclusion is reached that these are cause and effect. Undoubtedly, cross-infections account for many nosocomial infections in ICUs. Almost all published reports of observations of hand washing by physicians and nurses lament their performance at this most basic of aseptic practices 45 ; but, if epidemiology is about measurement, where are there data that describe the magnitude of the effect that these practices (or their lack) have on the occurrence of epidemics?If we are to assign time and resources to hand washing and isolation, should we not quantify how much of these is necessary to prevent an outbreak? If we cannot maintain an absolute standard of hand washing between each and every patient contact, what is a reasonable median that will achieve what we need? Are there differences among organisms in their capacity to be spread from patient to patient in this manner? What is the role of antibiotic prescribing in contributing to the colonization and so the reservoir of epidemic resistant organisms?Modern ICUs present an environment remarkably well suited to the transmission of infection. Although patients are increasingly immunocompromised and thus susceptible to infection, many units were designed with inadequate space for all the equipment in current use and the procedures that are likely to occur. As an example, peritoneal lavage through an abdominal zipper is common in many surgical ICUs, affording an opportunity to contaminate much of the immediate environment with fecal organisms. When an epidemic is caused by an easily recognized organism such as a drug-resistant Salmonella species or Clostridium difficile, the contribution to the outbreak of the contaminated environment is easily recognized 67 ; but, when the organisms causing infections are not so easily distinguished from "normal" ICU patient flora, the ease...

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“…Understaffing has also been linked to several hospital outbreaks, including those caused by resistant microorganisms [155][156][157][158]. Measuring workload is difficult; at least the severity of illness of the patients (case-mix), the educational level of the staff (HCW skill-mix) and organizational factors (e.g., working shift schedule, mental stress) are likely to affect the workload [159].…”

Section: Outbreaks In Neonatal Intensive Care Unitsmentioning

confidence: 99%

“…Measuring workload is difficult; at least the severity of illness of the patients (case-mix), the educational level of the staff (HCW skill-mix) and organizational factors (e.g., working shift schedule, mental stress) are likely to affect the workload [159]. In single NICU studies, various crude approaches have been used, such as calculating nurse-to-patient ratios [155] or nurse-hours per patient per day [151], and calculating the proportion of extra staff [156]. Additionally, the number of potentially hazardous contact routes, not the nurse-topatient ratio alone, could be a deciding factor in overcrowding situations; cohorting the nurses so that each nurse cares for a certain cohort of patients helps to minimize staff-patient contact [160].…”

Section: Outbreaks In Neonatal Intensive Care Unitsmentioning

confidence: 99%

314 Healthcare-Associated Infections in Pediatrics

SpringerReference

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Helsinki 2008 P u b l i c a t i o n s o f t h e N a t i o n a l P u b l i c H e a l t h I n s t i t u t e K T L A 1 1 / 2 0 0 8 Dr. Alexander Langmuir, 1963 Emmi Sarvikivi, Healthcare-associated infections in pediatrics Publications of the National Public Health Institute, A11/2008, 93 Pages ISBN 978-951-740-803-5; 978-951-740-804-2 (pdf-version) ISSN 0359-3584; 1458-6290 (pdf-version) http://www.ktl.fi/portal/4043 ABSTRACT Background and aims. Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions, such as patients treated in intensive care units, or patients who have undergone medical procedures, e.g., surgery. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery.Methods. The Hospital for Children and Adolescents of the Helsinki University Central Hospital has participated in the BSI surveillance of the Finnish Hospital Infection Program since 1999. These data were utilized in all studies. The epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined. The S. marcescens isolates were genotyped with pulsed-field gel electrophoresis and the C. parapsilosis blood culture isolates (obtained between the years 1990 and 2002) with Southern blot hybridization by use of a DNA fingerprinting probe. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for those patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs after open-heart surgery.Results. During 1999During -2006, the overall annual BSI rate was 1.6/1,000 patient-days (range by year, 1.2-2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient-days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. No common source was identified for either of the outbreaks, but the NICU was overcrowded during the S. marcescens clusters. In both investigations, low birth we...

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Outbreak ofEnterobacter cloacaeRelated to Understaffing, Overcrowding, and Poor Hygiene Practices

Abstract: OBJECTIVE: To determine the cause and mode of transmission of a cluster of infections due to Enterobacter cloacae.

Cited by 278 publications

References 36 publications

Empfehlung zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1500 g

Empfehlung zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1500 g

Too Many or Too Few Hands?

314 Healthcare-Associated Infections in Pediatrics

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