1
|
Abstract
Hospital-acquired infections are a known menace to the primary disease, for which a patient is admitted. These infections are twenty times more common in developing countries than in the developed ones. Surveillance for colonised patients can be passive or active process. In many hospitals, active surveillance culture for certain sentinel organisms followed by contact precautions for the same is an important part of infection control policy. Specific measures can be taken on early detection of multidrug-resistant organism, allowing prevention of widespread transmission in hospitals. Cultures are the most conventional and economical microbiological method of detection. The cost of active surveillance is a major challenge, especially for developing nations. These nations lack basic infrastructure and have logistic issues. The guidelines regarding this are not very clearly delineated for developing countries. Each hospital has its own challenges and the process is to be tailor-made accordingly. The following review delineates the various aspects of active surveillance for the colonisation of various organisms and the advantages and disadvantages of the same.
Collapse
Affiliation(s)
- Manisha Biswal
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rimjhim Kanaujia
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
2
|
Valencia-Martín R, Gonzalez-Galan V, Alvarez-Marín R, Cazalla-Foncueva AM, Aldabó T, Gil-Navarro MV, Alonso-Araujo I, Martin C, Gordon R, García-Nuñez EJ, Perez R, Peñalva G, Aznar J, Conde M, Cisneros JM. A multimodal intervention program to control a long-term Acinetobacter baumannii endemic in a tertiary care hospital. Antimicrob Resist Infect Control 2019; 8:199. [PMID: 31827780 PMCID: PMC6894224 DOI: 10.1186/s13756-019-0658-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022] Open
Abstract
Background Acinetobacter baumannii causes frequently nosocomial infections worldwide. Its ability to survive on dry surfaces facilitates its spread and the persistence of endemic situations, especially in the intensive care units (ICUs). The objective of this paper is to describe a multicomponent intervention program designed to control a hyperendemic persistence of multidrug-resistant A. baumannii (MDR-Ab) and to characterize its impact. Methods Design: Quasi-experimental intervention study based on open cohorts. Setting: Public tertiary referral centre. Period: January 2009–August 2017. Intervention: multifaceted program based on environmental decontamination, hand hygiene, antimicrobial stewardship, contact precautions, active surveillance, weekly reports and regular meetings. Analysis: joinpoint regression and interrupted time-series analysis. Results The intervention was successfully implemented. Through the study period, the compliance with contact precautions changed from 0 to 100% and with hand hygiene, from 41.8 to 82.3%. Between 2012 and 2016, the antibiotic consumption decreased from 165.35 in to 150.44 daily-defined doses/1000 patients-days in the ICU. The incidence density of MDR-Ab in the ICU was 10.9 cases/1000 patients-days at the beginning of the intervention. After this moment, the evolution of the incidence density of MDR-Ab was: between months 0 and 6°, it remained stable; between months 7° and 10°: there was an intense decrease, with an average monthly percentage change (AMPC) = − 30.05%; from 11° month until the end, the decrease was lighter but continuous (AMPC:-2.77%), achieving an incidence density of 0 cases/1000 patients-days on the 18° month, without any new case for 12 months. From the 30° month until the end of the study period, several little outbreaks of MDR-Ab were detected, all of them rapidly controlled. The strains of MDR-Ab isolated during these outbreaks were not clonally related with the previously endemic one, which supports its eradication from the environmental reservoirs. Conclusion The multicomponent intervention performed by a multidisciplinary team was effective to eradicate the endemic MDR-Ab.
Collapse
Affiliation(s)
- R Valencia-Martín
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - V Gonzalez-Galan
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - R Alvarez-Marín
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - A M Cazalla-Foncueva
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - T Aldabó
- 2Department of Intensive Care, University Hospital Virgen del Rocío, Seville, Spain
| | - M V Gil-Navarro
- 3Department of Pharmacy, University Hospital Virgen del Rocío, Seville, Spain
| | - I Alonso-Araujo
- 2Department of Intensive Care, University Hospital Virgen del Rocío, Seville, Spain
| | - C Martin
- 2Department of Intensive Care, University Hospital Virgen del Rocío, Seville, Spain
| | - R Gordon
- 4Cleaning Service, University Hospital Virgen del Rocío, Seville, Spain
| | | | - R Perez
- 5University Hospital Virgen del Rocío, Seville, Spain
| | - G Peñalva
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - J Aznar
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - M Conde
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - J M Cisneros
- 1Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | | |
Collapse
|