[Show abstract][Hide abstract] ABSTRACT: Determine the impact of three stepwise interventions on the rate of central catheter-associated bloodstream infections.
Three surgical intensive care units (general surgery, trauma, and neurosurgery) at a 1500-bed county teaching hospital in the Miami metro area.
All consecutive central catheter-associated bloodstream infection cases as determined by the Infection Control Department.
Three interventions aimed at catheter maintenance were implemented at different times in the units: chlorhexidine "scrub-the-hub," chlorhexidine daily baths, and daily nursing rounds aimed at assuring compliance with an intensive care unit goal-oriented checklist.
The primary outcome was the monthly intensive care unit rate of central catheter-associated bloodstream infections (infections per 1000 central catheter days). Over 33 months of follow-up (July 2008 to March 2011), we found decreased rates in each of the three intensive care units evaluated during the interventions, especially after implementation of chlorhexidine daily baths. Rates in unit A decreased from a rate of 8.6 to 0.5, unit B from 6.9 to 1.6, and unit C from 7.8 to 0.6. Secondary bloodstream infection rates remained unchanged throughout the observation period in units A and B; however, unit C had a decrease in its rates over time.
We report the progressive reduction of central catheter-associated bloodstream infection rates after the stepwise implementation of chlorhexidine "scrub-the-hub" and daily baths in surgical intensive care units, suggesting effectiveness of these interventions.
Critical care medicine 05/2012; 40(5):1464-9. · 6.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We describe the investigation and control of a Klebsiella pneumoniae carbapenemase-producing K. pneumoniae outbreak in a 20-bed surgical intensive care unit during the period from January 1, 2009 through January 1, 2010. Nine patients were either colonized or infected with a monoclonal strain of K. pneumoniae. The implementation of a bundle of interventions on July 2009 successfully controlled the further horizontal spread of this organism.
Infection Control and Hospital Epidemiology 10/2010; 31(10):1074-7. · 4.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Klebsiella pneumoniae carbapenemases (KPC) are enzymes that confer resistance against most beta-lactams. Despite having been identified worldwide, studies describing successful control of KPC outbreaks are few.
Objective: Characterization of the epidemiology and infection control measures of a KPC-producing K. pneumoniae outbreak.
Methods: The intervention was conducted at a 1,500 bed public, urban, teaching hospital in the
Miami metro area. Using the Microbiology database, all ertapenem resistant K. pneumoniae obtained from clinical specimens from January 1, 2009 to November 1, 2009 were identified. Additionally, 2 point prevalence surveys (using rectal cultures) were performed. Environmental cultures were also obtained.
Ertapenem-resistant enteric Gram negative rods identified by Vitek II underwent a modified Hodge test, KPC PCR and PFGE. Colistin susceptibilities were done by broth microdilution.
Because all infections were identified in the SICU, a bundle intervention was enforced in this unit on 7/10/09 consisting of daily 2% chlorhexidine baths, point prevalence surveys and environmental cultures, enhanced environmental cleaning, contact precautions, and staff education. One-to-one ratio was implemented among all environmental, respiratory, and nursing personnel assigned to KPC rooms.
Results: Between January 1 and November 1, 2009 a total of 9 patients (7 men) carrying KPC-producing K. pneumoniae were identified in the SICU. Six patients were identified prior to the bundle intervention. The last KPC was identified on August 11, 2009. Median age of patients was 60 yrs (range: 25-75). Length of stay ranged from 15 to 150 days (mean, 84.2). Seven of 9 pts (77.7%) underwent surgical intervention during their admission, and 5/9 (71.4%) had solid organ transplants (2 liver, 1 kidney, 1 pancreas, 1 multi-visceral). The mean Apache II score was 18.3 (range, 7-28) and the Charlson comorbidity index ranged between 1-7 (mean, 5.3). A total of 6 patients (67%) died during hospitalization; 1 is still hospitalized. Four of 9 patients died from sepsis. Subsequent rectal surveys done in 8/09 among all SICU patients failed to show colonization with KPC producing enteric Gram negative rods.
KPC K. pneumoniae strains were isolated from the lungs (5), abdominal fluid (2), blood (1) and urine (1). These strains were also isolated from mattresses, bed rails, ventilator tubing, intravenous pole, vitals monitors and TV monitors. Nine clinical isolates underwent KPC PCR and PFGE. All K. pneumoniae were found to be monoclonal KPC-3 producers. Colistin susceptibilities were <=1, except in one isolate which had an MIC of 16. Additionally, an imipenem-resistant Pseudomonas aeruginosa found during one rectal survey was found to be KPC-3 producer.
Conclusions: A monoclonal KPC-3 producing K. pneumoniae outbreak in a SICU was successfully controlled by a bundle intervention.
Fifth Decennial International Conference on Health-Care Related Infections 2010; 03/2010