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de la Rosa-Zamboni D, Villa-Guillén M, Bustos-Hamdan A, Rosas-Mateos MI, Medina-Pelcastre M, Torres-García M, Franco-Hernández MI, Del Carmen Castellanos-Cruz M, Parra-Ortega I, Fest-Parra E, Casillas-Casillas MC, Guerrero-Díaz AC. Effect of UV-C disinfection and copper plating on healthcare-associated infections in a NICU with high ESBL infections. Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00117-5. [PMID: 38705751 DOI: 10.1016/j.eimce.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/18/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Healthcare-associated infections (HCAIs) in neonates are frequent and highly lethal, in particular those caused by extended spectrum beta-lactamase (ESBL) producing bacteria. We evaluated the beneficial effects of ultraviolet C (UV-C) disinfection and copper adhesive plating on HCAIs in the Neonatal Intensive Care Unit (NICU) of a third level paediatric hospital in Mexico City, both in combination of hand-hygiene (HH) and prevention bundles. METHODS All NICU patients were included. There were 4 periods (P): P1: HH monitoring and prevention bundles; P2: P1+UV-C disinfection; P3: P2+Copper adhesive plating on frequent-contact surfaces and P4: Monitoring of P3 actions. RESULTS 552 neonates were monitored during 15,467 patient days (PD). HCAI rates decreased from 11.03/1000 PD in P1 to 5.35/1000 PD in P4 (p=0.006). HCAIs with bacterial isolates dropped from 5.39/1000 PD in PI to 1.79/1000 PD in P4 (p=0.011). UV-C and copper were associated with significant HCAI prevention (RR 0.49, CI95% 0.30-0.81, p=0.005) and with lesser HCAIs with bacterial isolates (RR 0.33, CI95% 0.14-0.77, p=0.011). CONCLUSIONS Copper adhesive plating combined with UV-C disinfection were associated with a drop in HCAI rates and with the elimination of ESBL-caused HCAIs. Hence, we propose that these strategies be considered in MDRO proliferation preventions.
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Affiliation(s)
| | - Mónica Villa-Guillén
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | - Anaíd Bustos-Hamdan
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | | | - Marisol Medina-Pelcastre
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | - Margarita Torres-García
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | | | | | - Israel Parra-Ortega
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | - Edmedt Fest-Parra
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | | | - Ana Carmen Guerrero-Díaz
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
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Vurayai M, Strysko J, Kgomanyane K, Bayani O, Mokomane M, Machiya T, Arscott-Mills T, Goldfarb DM, Steenhoff AP, McGann C, Nakstad B, Gezmu A, Richard-Greenblatt M, Coffin S. Characterizing the bioburden of ESBL-producing organisms in a neonatal unit using chromogenic culture media: a feasible and efficient environmental sampling method. Antimicrob Resist Infect Control 2022; 11:14. [PMID: 35074019 PMCID: PMC8785036 DOI: 10.1186/s13756-021-01042-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/05/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Infections due to extended spectrum beta-lactamase producing organisms (ESBL) have emerged as the leading cause of sepsis among hospitalized neonates in Botswana and much of sub-Saharan Africa and south Asia. Yet, ESBL reservoirs and transmission dynamics within the neonatal intensive care unit (NICU) environment are not well-understood. This study aimed to assess the efficiency and feasibility of a chromogenic-culture-media-based environmental sampling approach to characterize the ESBL bioburden within a NICU. METHODS A series of four point-prevalence surveys were conducted at a 36-bed NICU at a public tertiary referral hospital in Botswana from January-June 2021. Samples were collected on 4 occasions under semi-sterile technique using 1) flocked swabs & templates (flat surfaces); 2) sterile syringe & tubing (water aspiration); and 3) structured swabbing techniques (hands & equipment). Swabs were transported in physiological saline-containing tubes, vortexed, and 10 µL was inoculated onto chromogenic-agar that was selective and differential for ESBL (CHROMagar™ ESBL, Paris, France), and streaking plates to isolate individual colonies. Bacterial colonies were quantified and phenotypically characterized using biochemical identification tests. RESULTS In total, 567 samples were collected, 248 (44%) of which grew ESBL. Dense and consistent ESBL contamination was detected in and around sinks and certain high-touch surfaces, while transient contamination was demonstrated on medical equipment, caregivers/healthcare worker hands, insects, and feeding stations (including formula powder). Results were available within 24-72 h of collection. To collect, plate, and analyse 50 samples, we estimated a total expenditure of $269.40 USD for materials and 13.5 cumulative work hours among all personnel. CONCLUSIONS Using basic environmental sampling and laboratory techniques aided by chromogenic culture media, we identified ESBL reservoirs (sinks) and plausible transmission vehicles (medical equipment, infant formula, hands of caregivers/healthcare workers, & insects) in this NICU environment. This strategy was a simple and cost-efficient method to assess ESBL bioburden and may be feasible for use in other settings to support ongoing infection control assessments and outbreak investigations.
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Affiliation(s)
- Moses Vurayai
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.
| | - Jonathan Strysko
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Botswana-UPenn Partnership, Gaborone, Botswana
| | | | - One Bayani
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Margaret Mokomane
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Tonya Arscott-Mills
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Botswana-UPenn Partnership, Gaborone, Botswana
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Andrew P Steenhoff
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Botswana-UPenn Partnership, Gaborone, Botswana.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Carolyn McGann
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Britt Nakstad
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alemayehu Gezmu
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Susan Coffin
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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