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Similar to NVMM 2015: Environmental contamination with Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae during an outbreak in The Nederlands
Similar to NVMM 2015: Environmental contamination with Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae during an outbreak in The Nederlands (20)
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NVMM 2015: Environmental contamination with Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae during an outbreak in The Nederlands
- 1. Environmental contamination with Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae during an outbreak in The Nederlands V. Weterings1, E. Thewessen2, J. Kluytmans1,3, J. Veenemans1 1 Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda 2De Riethorst Stromenland, Geertruidenberg 3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht
- 2. Disclosure of speaker’s interests (Potential) conflict of interest none Potentially relevant company relationships in connection with event 1 N/A Sponsorship or research funding2 Fee or other (financial) payment3 Shareholder4 Other relationship, i.e. …5 N/A
- 3. Outbreak Transfer Index patient Dutch hospital 24/6/2013 Jun AugJul Nov 5/7/2013 Second patient; pleural fluid 2 Klebsiella pneumoniae, KPC-2, ST258 pan resistant, including colistin 1 Sept Oct • One transmission was detected despite contact precautions • After upgrading to strict isolation no further spread was found
- 4. Outbreak Transfer Index patient Dutch hospital 24/6/2013 Jun AugJul Nov 5/7/2013 Second patient; pleural fluid 2 Index patient: NH Patient 2: home 5/8/2013 1 Sept Oct Klebsiella pneumoniae, KPC-2, ST258 pan resistant, including colistin
- 5. Outbreak Transfer Index patient Dutch hospital 24/6/2013 Jun AugJul Nov 5/7/2013 Second patient; pleural fluid 2 Index patient: NH Patient 2: home 5/8/2013 7/11/2013 Third patient; Rectal swab 31 Sept Oct Klebsiella pneumoniae, KPC-2, ST258 pan resistant, including colistin
- 6. 5 Outbreak Transfer Index patient Dutch hospital 24/6/2013 Jun AugJul Nov 5/7/2013 Second patient; pleural fluid 2 Index patient: NH Patient 2: home 5/8/2013 7/11/2013 Third patient; Rectal swab 31 4 Sept Oct • Despite contact precautions three further transmissions occurred • Cohorting to one side of the ward with dedicated nursing staff Klebsiella pneumoniae, KPC-2, ST258 pan resistant, including colistin
- 7. 5 Outbreak Transfer Index patient Dutch hospital 24/6/2013 Jun AugJul Nov 5/7/2013 Second patient; pleural fluid 2 Index patient: NH Patient 2: home 5/8/2013 7/11/2013 Third patient; Rectal swab 31 4 6 Sept Oct Klebsiella pneumoniae, KPC-2, ST258 pan resistant, including colistin
- 8. 5 Outbreak Transfer Index patient Dutch hospital 24/6/2013 Jun AugJul Nov 5/7/2013 Second patient; pleural fluid 2 Index patient: NH Patient 2: home 5/8/2013 7/11/2013 Third patient; Rectal swab 31 4 6 Sept Oct • Transfer of all five KPC-KP positive residents to a separate facility • Dedicated nursing team Klebsiella pneumoniae, KPC-2, ST258 pan resistant, including colistin
- 9. Methods
- 10. Nursing home
- 11. Nursing home Rehabilitation ward Elevator Shared area 1 34 5 A single measurement - one day after cohort was implemented 48 samples of frequently touched surfaces and equipment o 24 samples on the cohorting site o 24 samples on the non-cohorting site
- 13. Separate facility 1 3 6 4 5 Nurse office Living room Kitchen Bedpan washer Linen room Two zones: A. Patient rooms HCWs donned gloves and gown before entering, and removed before leaving room
- 14. 1 3 6 4 5 Nurse office Living room Kitchen Bedpan washer Linen room Two zones: A. Patient rooms HCWs donned gloves and gown before entering, and removed before leaving room B. Communal area Standard precautions Separate facility
- 15. 1 3 6 4 5 Nurse office Living room Kitchen Bedpan washer Linen room Two zones: A. Patient rooms HCWs donned gloves and gown before entering, and removed before leaving room B. Communal area Standard precautions Patient rooms and communal area were cleaned daily, and disinfected 3x per week. Weekly environmental sampling from predefined items: • Patient rooms (n =3/room) • Communal area (n = 8) Separate facility
- 16. Microbiology • Sterile gauzes (10x10cm) moistened with sterile saline • Selective broth enrichment and selective screening agars were used for KPC detection
- 17. Results
- 18. Nursing home
- 19. Nursing home Elevator Shared area 1 34 5 Night cabin 0/24 samples4/24 KPC-KP positive (16,7%) Night cabin + Door knob Glucose meter
- 20. Separate facility Patient rooms 1. Bed 2. Door handles bathroom 3. Door handles wardrobe Index 1 2 3 5-12-2013 10-12-2013 20-12-2013 23-12-2013 01-01-2014 10-01-2014 21-01-2014 7-2-2014 12-2-2014 KPC positive KPC negative Not determined
- 21. Separate facility 1 3 2 Bed Door handles wardrobe Door handles bathroom Index 1 2 3 5-12-2013 10-12-2013 20-12-2013 23-12-2013 01-01-2014 10-01-2014 21-01-2014 7-2-2014 12-2-2014 [3] 1 2 3 [5] 1 2 3 [4] 1 2 3 [6] 1 2 3 KPC positive KPC negative Not determined Patient rooms
- 22. Separate facility 1 3 2 Bed Door handles wardrobe Door handles bathroom Index 1 2 3 5-12-2013 10-12-2013 20-12-2013 23-12-2013 01-01-2014 10-01-2014 21-01-2014 7-2-2014 12-2-2014 [3] 1 2 3 [5] 1 2 3 [4] 1 2 3 [6] 1 2 3 KPC positive KPC negative Not determined Patient rooms [3] Bedridden; faeces incontinence, urine catheter
- 23. Separate facility 1 3 2 Bed Door handles wardrobe Door handles bathroom Index 1 2 3 5-12-2013 10-12-2013 20-12-2013 23-12-2013 01-01-2014 10-01-2014 21-01-2014 7-2-2014 12-2-2014 [3] 1 2 3 [5] 1 2 3 [4] 1 2 3 [6] 1 2 3 KPC positive KPC negative Not determined Patient rooms [3] Bedridden; faeces incontinence, urine catheter [5] servere unhygienic behavior, urine catheter
- 24. Separate facility 5-12-2013 10-12-2013 20-12-2013 23-12-2013 01-01-2014 10-01-2014 21-01-2014 7-2-2014 12-2-2014 [3 & 4] KPC positive KPC negative Not determined Patient Lift [5]
- 25. KPC positive KPC negative Not determined Kitchen Table + chairs Bedpan washer Office nurse DECT Glucose meter 5-12-2013 10-12-2013 20-12-2013 23-12-2013 01-01-2014 10-01-2014 21-01-2014 7-2-2014 12-2-2014 Communal area Separate facility
- 27. Conclusion • Extensive environmental contamination was found in all settings • KPC-KP was also detected outside the direct patient environment • The environment can act as important reservoir for transmission during KPC- KP outbreaks • VW: eigenlijk kunnen we niet hard maken dat door het onhygienisch gedrag er meer omgevingscontaminatie is, omdat we vb. Niet gekeken hebben naar ‘KPC-KP rectal concentration’ (CMI, lerner 2015). Daarom niet benoemd op deze slide
- 28. Discussion • Contact isolation according to our national guideline, include wearing gloves when touching the patient and the patient’s immediate environment • Our findings suggest contact isolation – as disclosed in the national guideline - is not sufficient to prevent transmission of KPC-producing Klebsiella pneumoniae ST258 • We advise to implement wearing a gown and gloves upon entry to a room of a patient/resident colonized or infected with KPC-KP as stated in the ESCMID guideline1 1 Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug- resistant gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014;20(Suppl 1):1–55. http://dx.doi. org/10.1111/1469-0691.12427
- 29. Acknowledgements • My collegues of the Laboratoria Microbiology and Infection Control Amphia Hospital Breda • Staff of the nursing home Riethorst Stromenlanden, Geertruidenberg