Dubert M. Guerrero

Contamination of Hands with Methicillin-Resistant Staphylococcus aureus after Contact with Environmental Surfaces and after Contact with the Skin of Colonized Patients

In a study of 40 methicillin-resistant Staphylococcus aureus (MRSA) carriers, hand contamination was equally likely after contact with commonly examined skin sites and commonly touched environmental surfaces in patient rooms (40% vs 45%). These findings suggest that contaminated surfaces may be an important source of MRSA transmission.

Acinetobacter baumannii-Associated Skin and Soft Tissue Infections: Recognizing a Broadening Spectrum of Disease

BACKGROUND Acinetobacter baumannii is gaining importance as a cause of nosocomial infections, but its role in skin and soft tissue infection (SSTI) is not well defined. As a result of the outbreak of A. baumannii occurring in military personnel in Iraq and Afghanistan, reports of severe wound infections and SSTI caused by this pathogen are increasing in frequency. METHODS We describe four cases of monomicrobial and polymicrobial A. baumannii-associated necrotizing SSTI accompanied by A. baumannii bacteremia and offer a review of similar experiences published in the literature. RESULTS Our comparative analysis reveals four unique features associated with necrotizing SSTI associated with A. baumannii: i) Occurs in hosts with underlying comorbidities (e.g., trauma, cirrhosis); ii) is often accompanied by bacteremia; iii) multiple drug resistance and the presence of co-pathogens frequently complicated treatment (64% of cases); iv) the cases reported here and in our review required surgical debridement (84% of cases) and led to substantial mortality (approximately 30%). CONCLUSIONS As the prevalence of A. baumannii continues to increase in our health care system, SSTIs caused by this organism may become more common. Clinicians must be aware that the spectrum of disease caused by A. baumannii could include severe necrotizing SSTI and that vigilance for potential complications is necessary.

Clinical and Infection Control Implications of Clostridium difficile Infection With Negative Enzyme Immunoassay for Toxin

In a prospective study of 132 patients with a diagnosis of Clostridium difficile infection (CDI) by polymerase chain reaction, 43 (32%) had enzyme immunoassay (EIA) results negative for toxin. EIA-negative patients with CDI did not differ in clinical presentation from EIA-positive patients and presented a similar risk for transmission of spores.

Clostridium difficile infection in a Department of Veterans Affairs long-term care facility.

In a Veterans Affairs medical center, 39% of healthcare facility-onset, healthcare facility-associated Clostridium difficile infections had their onset in the affiliated long-term care facility (LTCF). Eighty-five percent of LTCF-onset patients had been transferred from the hospital within the past month. Delays in diagnosis and treatment were common for LTCF-onset patients.

Beyond the Hawthorne Effect: Reduction of Clostridium difficile Environmental Contamination through Active Intervention to Improve Cleaning Practices

Education and passive observation resulted in a significant improvement in housekeeper disinfection of nontoxigenic Clostridium difficile spores artificially inoculated onto surfaces in C. difficile infection rooms. A further significant reduction occurred with direct supervision and real-time feedback, suggesting that optimal disinfection is achieved by working closely with housekeepers.

Potential for transmission of Clostridium difficile by asymptomatic acute care patients and long-term care facility residents with prior C. difficile infection.

Long-Term Care Facility Residents with Prior C. difficile Infection Author(s): Sadao Jinno, MD; Sirisha Kundrapu, MD; Dubert M. Guerrero, MD; Lucy A. Jury, RN, CNP; Michelle M. Nerandzic, BS; Curtis J. Donskey, MD Source: Infection Control and Hospital Epidemiology, Vol. 33, No. 6 (June 2012), pp. 638-639 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/665712 . Accessed: 25/06/2014 07:17

Effectiveness of Routine Patient Bathing to Decrease the Burden of Spores on the Skin of Patients with Clostridium difficile Infection

For 74 patients with Clostridium difficile infection, the quality and frequency of bathing was often limited because of such factors as the presence of devices, decreased mobility, and pain. Routine bathing practices had limited efficacy in decreasing the burden of spores on skin; however, showers were more effective than bed baths.

Acquisition of Clostridium difficile Colonization and Infection After Transfer From a Veterans Affairs Hospital to an Affiliated Long-Term Care Facility.

BACKGROUND Clostridium difficile infection (CDI) and asymptomatic carriage of toxigenic C. difficile are common in long-term care facilities (LTCFs). However, whether C. difficile is frequently acquired in the LTCF versus during acute-care admissions remains unknown. OBJECTIVE To test the hypothesis that LTCF residents often acquire C. difficile colonization and infection in the LTCF DESIGN This 5-month cohort study was conducted to determine the incidence of acquisition of C. difficile colonization and infection in asymptomatic patients transferred from a Veterans Affairs hospital to an affiliated LTCF. METHODS Rectal swabs were cultured for toxigenic C. difficile at the time of transfer to the LTCF and weekly for up to 6 weeks. We calculated the proportion of LTCF-onset CDI cases within 1 month of transfer that occurred in residents colonized on admission versus those with new acquisition in the LTCF. RESULTS Of 110 patients transferred to the LTCF, 12 (11%) were asymptomatically colonized with toxigenic C. difficile upon admission, and 4 of these 12 patients (33%) developed CDI within 1 month, including 3 recurrent and 1 initial CDI episode. Of 82 patients with negative cultures on transfer and at least 1 follow-up culture, 22 (27%) acquired toxigenic C. difficile colonization, and 4 developed CDI within 1 month, including 1 recurrent and 3 initial CDI episodes. CONCLUSION LTCF residents frequently acquired colonization with toxigenic C. difficile after transfer from the hospital, and 3 of 4 initial CDI cases with onset within 1 month of transfer occurred in residents who acquired colonization in the LTCF. Infect Control Hosp Epidemiol 2017;38:1070-1076.