Re: ‘A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit’ by Valentin et al.

Eveillard, Matthieu; Lemarié, Carole

doi:10.1016/j.cmi.2021.04.032

Cited by 6 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sites particularly associated with KPC-E colonisation included sluices, sluice sinks, mop sinks and shower/bath drains, supported by other studies 5 , and consistent with these representing a major interface between human faeces and premise plumbing. Toilets were less likely to be KPC-E-positive, perhaps because of regular flushing or particular cleaning protocols; consistent with this, several studies have demonstrated that daily bleach application decontaminated wastewater sites 32, 33 .…”

Section: Discussionmentioning

confidence: 53%

Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of bla_KPC-carbapenemase-producing Enterobacterales in a hospital setting

Stoesser

George

Aiken

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundHealthcare-associated wastewater reservoirs and asymptomatic gastrointestinal patient colonisation by carbapenemase-producing Enterobacterales (CPE) can be important in nosocomial CPE dissemination and infection. We characterised these niches and within-niche diversity in a blaKPC-associated CPE (KPC-E) endemic healthcare setting, to better understand transmission potential.MethodsWe systematically sampled wastewater sites and patients across three units (six wards) over 6-12 months in 2016 in a KPC-E endemic hospital. We used Illumina sequencing to characterise up to five isolates per sample. Recombination-adjusted phylogenies were used to define genetically related strains; assembly and mapping-based typing approaches were used to characterise antimicrobial resistance gene and insertion sequence profiles, and Tn4401 types/target site sequences. The wider accessory genome was evaluated in a subset of the largest clusters, and those crossing niches.FindingsWastewater site KPC-E-positivity was substantial (101/349 sites [28.9%] positive, 319/4,488 [7.1%] sampling events positive); 183/4,425 (4.1%) of patients were CPE culture-positive over the same timeframe. 13 species and 109 KPC-E strains were observed across niches, and 24% of wastewater and 26% of patient KPC-E-positive samples harboured ≥1 strain. Most diversity was explained by the individual niche, suggesting highly localised factors are important in selection and spread. Tn4401+target site sequence (TSS) diversity was greater in wastewater sites (p<0.001), suggesting these might favour Tn4401-associated transposition/evolution and dissemination. Shower/bath and sluice/mop-associated sites were more likely to be KPC-E-positive (Adjusted Odds Ratio [95% CI]: 2.69 [1.44-5.01], p=0.0019 and 2.60 [1.04-6.52], p=0.0410, respectively). Different strains had different transmission and blaKPC dissemination dynamics.InterpretationThere may be substantial KPC-E colonisation of wastewater sites and patients in KPC-E-endemic healthcare settings. Niche-specific factors, and different strains with different transmission dynamics influence carbapenemase gene dissemination. New transmission models incorporating complex, multi-level dynamics are needed to better quantify CPE dissemination to inform interventions and reduce transmission.FundingThis study was supported by the National Institute for Health Research, UK.RESEARCH IN CONTEXTEvidence before this studyWe searched PubMed to identify previous studies using whole genome sequencing (WGS) to characterise in-hospital dissemination and persistence of carbapenemase-producing Enterobacterales (CPEs) or the presence of CPEs in hospital wastewater reservoirs. In our search (01/Jan/1996-30/Sep/2021) we used the terms ((((CPE) OR (KPC)) AND (healthcare-associated OR nosocomial OR hospital-associated)) AND (genom*) AND ((environment OR patient))). We had no restrictions on language. We found sixty-six studies, but these were limited by: (i) evaluating single species or lineages only (n=34), (ii) including patients or environmental outbreaks only, and not both (n=23), (iii) sampling only small numbers (n<50) of patients or environmental sites (n=26), or (iv) performing no evaluation of within-niche diversity (n=64). 13 studies were not relevant (e.g. investigating non-hospital locations, ex vivo or in vivo evolution), two studies did not use WGS, and one study was not primary research.Added value of this studyWe provide a comprehensive assessment of healthcare-associated CPE dissemination and persistence in hospital wastewater reservoirs through systematic sampling of a large number of environmental sites (n=349 sites, n=4,488 samples) and patients (n=4,425) over 6-12 months in a single hospital. For all CPE-positive environmental samples (n=319) and a subset of CPE-positive patient samples (n=97/399 [24.3%] samples from 76/183 [41.5%] CPE-positive patients), we sampled up to five CPE isolates per sample to capture within-niche diversity, and used short-read Illumina WGS (n=1,732 isolates successfully sequenced) to characterise within-niche diversity, changes in colonisation over time, and genetic overlap between patient and environmental niches.Implications of all the available evidenceThrough a detailed and resource-intensive study we captured the dynamics of seeding and dissemination of important carbapenemase genes amongst patients and environmental reservoirs within a hospital. We found differential colonisation and dissemination dynamics for different species and lineages within and between niches. Improved approaches incorporating variable within-niche diversity, accessory distances and horizontal gene transfer in transmission evaluations are required to better understand CPE dissemination and persistence, in order to direct interventions limiting transmission.

show abstract

Section: Discussionmentioning

confidence: 53%

Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of bla_KPC-carbapenemase-producing Enterobacterales in a hospital setting

Stoesser

George

Aiken

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Unlike most studies in which the handwashing sink was sampled during an cluster period, this study was conducted during a non-cluster period in the included ICUs. The results showed that the contamination rate of handwashing sinks ranged from 0 to 63.6% in different ICUs, while other investigations did not nd CRAB contamination in handwashing sinks during non-cluster scenarios [23,24]. It has been well documented in the literature that the contamination level of handwashing sinks is related to the improper use, the size and depth of the sink, and the frequency of environmental cleaning [25].…”

Section: Discussionmentioning

confidence: 86%

Handwashing Sink as a Reservoir of Carbapenem-Resistant Acinetobacter baumannii in the Intensive Care Unit: A Prospective Multicenter Study

Wei,

Feng,

Lin

et al. 2024

Preprint

View full text Add to dashboard Cite

Background The extent to which sinks are contaminated by carbapenem-resistant Acinetobacter baumannii (CRAB) in intensive care units (ICUs) and the association between these contaminated sinks and hospital acquired CRAB infections during non-cluster period remains largely unknown . Methods A prospective multicenter study was performed in 16 ICUs, including 9 general ICUs (GICUs) and 7 neonatal ICUs (NICUs), at 11 tertiary hospitals in Chengdu from March 2019 to January 2020. Sampling of the sinks was performed once, and CRAB clinical isolates recovered within two weeks before and three months after the sampling date were collected. Whole-genome sequencing was used to analyze the isolates and determine their clones. Results A total of 789 swabs were collected from 158 sinks, and 16 CRAB isolates were recovered from 16 sinks, resulting in a contamination rate of 10.16% (95% CI, 5.40%~14.83%). Twenty-seven clinical isolates were collected during the study period. The majority (97.67%, 42/43) of the CRAB isolates belonged to ST2 and 36 (83.72%) of them had both blaOXA−23 and blaOXA−66. The 43 strains belonged to 12 clones. One certain clone caused multiple contaminations of 7 sinks in one GICU. Two clones of ST2 blaOXA−23 and blaOXA−66-carrying sink strains were likely the sources of the two clusters in the two GICUs, respectively. Five ST2 blaOXA−23-carrying isolates were found to be a common clone but were recovered from two hospitals. Conclusion: The contamination rate of CRAB in handwashing sinks is high in some local ICUs, and the contaminated sinks can serve as environmental reservoirs for CRAB clusters.

show abstract

“…A prospective study (Valentin et al, 2021) on the incidence of and risk factors for sink contamination with multi-drug resistant P.aeruginosa and Enterobacterales found that sinks disinfected daily with bleach had lower contamination rates than those disinfected with quaternary ammonium compounds and sinks with no disinfection. We believe introducing hypochlorite spray to the cleaning regimen further minimised sink contamination.…”

Section: Discussionmentioning

confidence: 99%

Outbreak of Pseudomonas aeruginosa on a neonatal intensive care unit: Lessons from a Qatari setting

Petkar,

Caseres-Chiuco,

Al-Shaddad

et al. 2024

Journal of Infection Prevention

View full text Add to dashboard Cite

Background Pseudomonas aeruginosa is a major cause of morbidity and mortality in neonatal intensive care units (NICUs). Robust infection prevention and control is key to reducing risk. Aims We describe lessons learnt from an NICU outbreak of P.aeruginosa in the main maternity hospital in the country. Methods Cases were identified from clinical samples and active screening. Clinical information was collected from the electronic patient record. Infection prevention and control (IPC) practice observations were made using organisational checklists and unit observations. Microbiological testing was by conventional microbiological methods. Statistical analyses were performed using R program. Associations were assessed using the Mann–Whitney U or Fisher exact test. Isolates were typed by pulsed field gel electrophoresis; gel was analysed in Bionumerics software from Applied Maths, Belgium. Results Five cases were identified – one was excluded as maternal acquisition. Typing showed a polyclonal outbreak. Widespread contamination of tap outlets of handwashing sinks in clinical areas was found. Main contributing factors were extensive misuse of hand wash sinks for waste disposal, improper sink cleaning, poor hand hygiene compliance and inadequate environmental cleaning. Discussion Successful management required a multi-disciplinary approach. All potential water sources and moist environments within and outside the unit were investigated. Interventions successfully addressed the main contributing factors, supported by good communication and robust auditing. With a diverse workforce, the challenge was to ensure housekeeping staff understood handwash sink cleaning procedures; existing training programmes were delivered in multiple languages tailored to the workforce.

show abstract

Re: ‘A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit’ by Valentin et al.

Cited by 6 publications

References 5 publications

Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of bla_KPC-carbapenemase-producing Enterobacterales in a hospital setting

Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of bla_KPC-carbapenemase-producing Enterobacterales in a hospital setting

Handwashing Sink as a Reservoir of Carbapenem-Resistant Acinetobacter baumannii in the Intensive Care Unit: A Prospective Multicenter Study

Outbreak of Pseudomonas aeruginosa on a neonatal intensive care unit: Lessons from a Qatari setting

Contact Info

Product

Resources

About

Re: ‘A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit’ by Valentin et al.

Cited by 6 publications

References 5 publications

Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of blaKPC-carbapenemase-producing Enterobacterales in a hospital setting

Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of blaKPC-carbapenemase-producing Enterobacterales in a hospital setting

Handwashing Sink as a Reservoir of Carbapenem-Resistant Acinetobacter baumannii in the Intensive Care Unit: A Prospective Multicenter Study

Outbreak of Pseudomonas aeruginosa on a neonatal intensive care unit: Lessons from a Qatari setting

Contact Info

Product

Resources

About

Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of bla_KPC-carbapenemase-producing Enterobacterales in a hospital setting

Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of bla_KPC-carbapenemase-producing Enterobacterales in a hospital setting