Nuala H. O'Connell
University of Limerick
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Journal of Hospital Infection | 2015
Cormac O'Connor; James Powell; Cathriona Finnegan; A. O'Gorman; S. Barrett; Katie L. Hopkins; Bruno Pichon; Robert Hill; Lorraine Power; Neil Woodford; J. C. Coffey; Angela M. Kearns; Nuala H. O'Connell; Colum P. Dunne
AIM To report the first Irish outbreak of cfr-mediated linezolid-resistant Staphylococcus epidermidis. METHODS Linezolid-resistant S. epidermidis isolated at University Hospital Limerick from four blood cultures, one wound and four screening swabs (from nine patients) between April and June 2013 were characterized by pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST) and staphylococcal cassette chromosome (SCCmec) typing. Antibiotic susceptibilities were determined according to the guidelines of the British Society for Antimicrobial Chemotherapy. The outbreak was controlled through prohibiting prescription and use of linezolid, adherence to infection prevention and control practices, enhanced environmental cleaning, isolation of affected patients, and hospital-wide education programmes. FINDINGS PFGE showed that all nine isolates represented a single clonal strain. MLST showed that they belonged to ST2, and SCCmec typing showed that they encoded a variant of SCCmecIII. All nine isolates were cfr positive, and eight isolates were positive for the G2576T 23S rRNA mutation commonly associated with linezolid resistance. Isolates exhibited multiple antibiotic resistances (i.e. linezolid, gentamicin, methicillin, clindamycin, ciprofloxacin, fusidic acid and rifampicin). The adopted infection prevention intervention was effective, and the outbreak was limited to the affected intensive care unit. CONCLUSIONS This is the first documented outbreak of cfr-mediated linezolid-resistant S. epidermidis in the Republic of Ireland. Despite this, and due to existing outbreak management protocols, the responsible micro-organism and source were identified efficiently. However, it became apparent that staff knowledge of antimicrobial susceptibilities and appropriate hygiene practices were suboptimal at the time of the outbreak, and that educational interventions (and re-inforcement) are necessary to avoid occurrence of antimicrobial resistance and outbreaks such as reported here.
Journal of Hospital Infection | 2017
Barry Linnane; Louise Collins; Neidin Bussmann; Nuala H. O'Connell; Colum P. Dunne
As recently reported, there is increasing association between the opportunistic pathogen Stenotrophomonas maltophilia and pulmonary exacerbations in cystic fibrosis (CF) . There has been further literature regarding approaches for surveillance of S. maltophilia in this patient population, potential prediction of clinical outcomes based on such monitoring and, in light of escalating incidence of multidrug resistance , the potential benefit of subsequent early and appropriate antimicrobial treatment 3 .
Journal of Hospital Infection | 2018
Suzanne S. Dunne; Merja Ahonen; Martina Modic; Francy Crijns; Minna M. Keinänen-Toivola; R. Meinke; C. W. Keevil; J. Gray; Nuala H. O'Connell; Colum P. Dunne
Recognized issues with poor hand hygiene compliance among healthcare workers and reports of recontamination of previously chemically disinfected surfaces through hand contact emphasize the need for novel hygiene methods in addition to those currently available. One such approach involves antimicrobial (nano) coatings (AMCs), whereby integrated active ingredients are responsible for elimination of micro-organisms that come into contact with treated surfaces. While widely studied under laboratory conditions with promising results, studies under real-life healthcare conditions are scarce. The views of 75 contributors from 30 European countries were collated regarding specialized cleaning associated with AMCs for reduction of healthcare-associated infection. There was unanimous agreement that generation of scientific guidelines for cleaning of AMCs, using traditional or new processes, is needed. Specific topics included: understanding mechanisms of action of cleaning materials and their physical interactions with conventional coatings and AMCs; that assessments mimic the life cycle of coatings to determine the impact of repetitive cleaning and other aspects of ageing (e.g. exposure to sunlight); determining concentrations of AMC-derived biocides in effluents; and development of effective de-activation and sterilization treatments for cleaning effluents. Further, the consensus opinion was that, prior to widespread implementation of AMCs, there is a need for clarification of the varying responsibilities of involved clinical, healthcare management, cleaning services and environmental safety stakeholders.
Clinical Biochemistry | 2017
Hugh Brady; Laura Piggott; Suzanne S. Dunne; Nuala H. O'Connell; Colum P. Dunne
BACKGROUND There is increasing emphasis on understanding the rate, and avoidable costs, of inappropriate laboratory testing in hospitals, especially associated with duplication of tests following transfer of patients from one hospital to another. While studies of inappropriate testing have been reported previously, there are no published data relevant to Ireland. AIMS To determine the baseline rate of inappropriate testing for a subset of clinical parameters, specifically, full blood counts (FBC), biochemistry profiles (Bio) and coagulation (Coag) screens for geriatric patients transferring to and from University Hospital Limerick (UHL). Prospective pilot-scale implementation of five clustered interventions, and assessment of their effect. METHODS Baseline testing levels were determined between October 2013 and January 2014. A patient survey was conducted to evaluate patient awareness of the blood tests they underwent. Five interventions were trialed sequentially each month between January and May 2014. These included: educational poster, intern training, presentations and communication to consultants; automated prompt in the Lab Information Technology system; highlighting of patient survey results to medical staff; inclusion of laboratory test details on patient transfer document; patient booklet promoting empowerment. Impact was assessed by determining rates of inappropriate laboratory testing monthly, and associated actual cost reductions were calculated. RESULTS Approximately two-thirds of geriatric inpatients were unaware of why they underwent blood tests. Baseline numbers of inappropriate duplicate FBCs, Bio profiles and Coag tests were 758, 749 and 268 respectively for patients transferring to and from UHL. Following the interventions, these numbers dropped to 85, 84 and 0, respectively. CONCLUSION The interventions resulted in sustained reduction in rates of inappropriate testing by May 2014. Extrapolated cost reductions exceed two million Euro annually. The most effective intervention involved staff education.
Journal of Hospital Infection | 2016
Liz M. Kingston; Nuala H. O'Connell; Colum P. Dunne
1. Kingston L, O’Connell NH, Dunne CP. Hand hygiene-related clinical trials reported since 2010: a systematic review. J Hosp Infect 2016;92:309e320. 2. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions, Version 5.1.0 (updated March 2011). The Cochrane Collaboration; 2011. Available at: http://handbook. cochrane.org [last accessed June 2016]. 3. Gould DJ, Moralejo D, Drey N, Chudleigh JH. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2010;(9):CD005186. 4. Koff MD, Corwin HL, Beach ML, Surgenor SD, Loftus RW. Reduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program. J Crit Care 2011;26:489e495. 5. Marshall C, Richards M, McBryde E. Do active surveillance and contact precautions reduce MRSA acquisition? A prospective interrupted time series. Plos One 2013;8:e58112. 6. Naikoba S, Hayward A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers e a systematic review. J Hosp Infect 2001;47:173e180. 7. Huis A, van Achterberg T, de Bruin M, Grol R, Schoonhoven L, Hulscher M. A systematic review of hand hygiene improvement strategies: a behavioural approach. Implement Sci 2012;7:92. 8. Yeung WK, Tam WSM, Wong TW. Clustered randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities. Infect Control Hosp Epidemiol 2011;32:67e76.
Journal of Hospital Infection | 2016
Liz M. Kingston; Nuala H. O'Connell; Colum P. Dunne
Journal of Hospital Infection | 2016
Cormac O'Connor; Martin Cormican; T.W. Boo; E. McGrath; Barbara L Slevin; A. O'Gorman; M. Commane; S. Mahony; E. O'Donovan; James Powell; R. Monahan; Cathriona Finnegan; Miranda G. Kiernan; J. C. Coffey; Lorraine Power; Nuala H. O'Connell; Colum P. Dunne
Journal of Hospital Infection | 2016
Ciara O'Connor; Nuala H. O'Connell; Marion Commane; E. O'Donovan; Lorraine Power; Colum P. Dunne
Nurse Education Today | 2017
Liz M. Kingston; Nuala H. O'Connell; Colum P. Dunne
JMM Case Reports | 2015
Ciara O'Connor; Liam F. Casserly; Junaid Qazi; Lorraine Power; Cathriona Finnegan; Nuala H. O'Connell; Colum P. Dunne