Christine Moore

Outbreak of Extended-Spectrum β-Lactamase-producing Klebsiella oxytoca Infections Associated with Contaminated Handwashing Sinks 1

Sinks are a potential reservoir for environment-to-patient and patient-to-patient transmission.

Patterns of handwashing behavior and visits to patients on a general medical ward of healthcare workers.

OBJECTIVE To obtain accurate data regarding the handwashing behavior and patterns of visits to patients by healthcare workers (HCWs). METHODS All visits by HCWs to selected patient rooms were recorded for 3 days and 2 nights. Additionally, 5 nurses were observed for 1 day each and 2 nurses were observed for 1 night each. Nurses were observed for their entire shifts and all of their activities were recorded. SETTING A general medical ward in a tertiary-care hospital. PARTICIPANTS Convenience samples of HCWs and patients. RESULTS Patients were visited every 25 minutes on average. Monitoring rooms and observing nurses resulted in similar rates of patient visits. The highest level of risk was contact with body fluids in 11% of visits and skin in 40% of visits. The overall rate of handwashing was 46%; however, the rate was higher for visits involving contact with body fluids (81%) and skin (61%). Nurses returned immediately to the same patient 45% of the time. The rate of handwashing was higher for the last of a series of visits to a patients room (53% vs 30%, P < .0001). CONCLUSIONS Nurses adjusted their handwashing rates in accordance with the risk level of each visit. Monitoring patient rooms and observing nurses yielded similar estimates of patient visits and proportions of visits involving contact with skin or body fluids. Education programs about hand hygiene may be more effective if patterns of care and levels of risk are incorporated into recommendations.

Prevalence of colonization and infection with methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus and of Clostridium difficile infection in Canadian hospitals.

OBJECTIVE To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile infection (CDI) in Canadian hospitals. DESIGN National point prevalence survey in November 2010. SETTING Canadian acute care hospitals with at least 50 beds. PATIENTS Adult inpatients colonized or infected with MRSA or VRE or with CDI. METHODS The prevalence (per 100 inpatients) of MRSA, VRE, and CDI was determined. Associations between prevalence and institutional characteristics and infection control policies were evaluated. RESULTS One hundred seventy-six hospitals (65% of those eligible) participated. The median (range) prevalence rates for MRSA and VRE colonization or infection and CDI were 4.2% (0%-22.1%), 0.5% (0%-13.1%), and 0.9% (0%-8.6%), respectively. Median MRSA and VRE infection rates were low (0.3% and 0%, respectively). MRSA, VRE, and CDI were thought to have been healthcare associated in 79%, 96%, and 84% of cases, respectively. In multivariable analysis, routine use of a private room for colonized/infected patients was associated with lower median MRSA infection rate (prevalence ratio [PR], 0.44 [95% confidence interval (CI), 0.22-0.88]) and VRE prevalence (PR, 0.26 [95% CI, 0.12-0.57]). Lower VRE rates were also associated with enhanced environmental cleaning (PR, 0.52 [95% CI, 0.36-0.75]). Higher bed occupancy rates were associated with higher rates of CDI (PR, 1.02 [95% CI, 1.01-1.03]). CONCLUSIONS These data provide the first national prevalence estimates for MRSA, VRE, and CDI in Canadian hospitals. Certain infection prevention and control policies were found to be associated with prevalence and deserve further investigation.

Is the prevalence of antibiotic-resistant organisms changing in Canadian hospitals? Comparison of point-prevalence survey results in 2010 and 2012

A national point-prevalence survey for infection or colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), and for Clostridium difficile infection (CDI) was done in Canadian hospitals in 2010. A follow-up survey was done in November 2012 to determine whether there were any changes in the prevalence of these organisms; we also determined the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CREs). Associations between prevalence and infection prevention and control policies were evaluated in logistic regression models. A total of 143 (67% of eligible facilities) hospitals with 29 042 adult inpatients participated in the survey, with representation from all 10 provinces; 132 hospitals participated in 2010 and 2012. There were no significant changes in the median prevalence of MRSA in 2010 (4.3%) compared to 2012 (3.9%), or of CDI in 2010 (0.8%) compared to 2012 (0.9%). A higher median prevalence of VRE was identified in 2012 (1.3%) compared to 2010 (0.5%) (p 0.04), despite decreased VRE screening in 2012. The median prevalence of ESBLs was 0.7% and was 0 for CREs; CREs were reported from only 10 hospitals (7.0%). A policy of routinely caring for patients with MRSA or VRE in a private isolation room was associated with lower prevalence of these organisms. Targeted screening of high-risk patients at admission was associated with lower MRSA prevalence; better hand hygiene compliance was associated with lower VRE prevalence. These data provide national prevalence rates for antibiotic-resistant organisms among adults hospitalized in Canadian hospitals. Certain infection prevention and control policies were associated with prevalence.

Hand hygiene opportunities on Canadian acute-care inpatient units: A multicenter observational study

In this multicenter observational study, medical and surgical inpatient rooms were randomized to receive 1 hour of continuous direct observation to determine hand hygiene opportunities (HHOs). After multivariable adjustment, HHOs were similar across inpatient units and hospitals. This estimate could serve to calibrate electronic hand hygiene monitoring systems for Canadian medical and surgical units.

902Hospital Characteristics and Infection Prevention and Control Strategies Associated with Methicillin-Resistant Staphylococcus aureus (MRSA) and Clostridium difficile Infection (CDI) in Canadian Hospitals

Strategies Associated with Methicillin-Resistant Staphylococcus aureus (MRSA) and Clostridium difficile Infection (CDI) in Canadian Hospitals Victoria Williams, BSc, BASc, MPH, CIC; Andrew E. Simor, MD, FRCPC, FACP; Alex Kiss, PhD; Allison Mcgeer, MD, MSc, FRCPC; Guanghong Han, PhD; Zahir Hirji, MSc; Oscar E. Larios, MD; Christine Moore, BSc, MLT; Karl Weiss, MD, MSc, FRCPC; Infection Prevention and Control Canada; Sunnybrook Health Sciences Centre Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Provincial Infection Control Network of British Columbia, Vancouver, BC, Canada; The Scarborough Hospital, Toronto, ON, Canada; University of Calgary, Calgary, AB, Canada; Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada