Hostname: page-component-848d4c4894-xm8r8 Total loading time: 0 Render date: 2024-06-15T13:34:43.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Decrease in Vancomycin-Resistant Enterococcus Colonization After Extensive Renovation of a Unit Dedicated to the Treatment of Hematologic Malignancies and Hematopoietic Stem-Cell Transplantation

Published online by Cambridge University Press:  20 July 2017

Clyde D. Ford ,
Michaela A. Gazdik Stofer ,
Jana Coombs ,
Bert K. Lopansri ,
Brandon J. Webb ,
Gabriela Motyckova  and
Finn Bo Petersen
Clyde D. Ford*
Affiliation:
Intermountain Blood and Marrow Transplant Program, Latter Day Saints Hospital, Salt Lake City, Utah
Michaela A. Gazdik Stofer
Affiliation:
Division of Infectious Diseases and Clinical Epidemiology, Latter Day Saints Hospital, Salt Lake City, Utah Department of Biology, Utah Valley University, Orem, Utah
Jana Coombs
Affiliation:
Division of Infectious Diseases and Clinical Epidemiology, Latter Day Saints Hospital, Salt Lake City, Utah
Bert K. Lopansri
Affiliation:
Division of Infectious Diseases and Clinical Epidemiology, Latter Day Saints Hospital, Salt Lake City, Utah Division of Infectious diseases, the University of Utah, Salt Lake City, Utah
Brandon J. Webb
Affiliation:
Division of Infectious Diseases and Clinical Epidemiology, Latter Day Saints Hospital, Salt Lake City, Utah Division of Infectious diseases, the University of Utah, Salt Lake City, Utah
Gabriela Motyckova
Affiliation:
Intermountain Blood and Marrow Transplant Program, Latter Day Saints Hospital, Salt Lake City, Utah
Finn Bo Petersen
Affiliation:
Intermountain Blood and Marrow Transplant Program, Latter Day Saints Hospital, Salt Lake City, Utah
*
Address correspondence to Clyde D. Ford, MD, Intermountain Blood and Marrow Transplant Program, Latter Day Saints Hospital, Eighth Avenue and C Street, Salt Lake City, UT 84143 (clyde.ford@imail2.org).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

While a direct relation between hospital construction and concomitant infection rates has been clearly established, few data are available regarding the environmental decontamination effects of renovation in which surfaces are replaced and regarding subsequent infection incidence.

DESIGN

Retrospective clinical study with vancomycin-resistant Enterococcus (VRE) molecular strain typing and environmental cultures.

SETTING

A regional referral center for acute leukemia and hematopoietic stem-cell transplantation.

PATIENTS

Overall, 536 consecutive hospital admissions for newly diagnosed acute leukemia or a first autologous or allogeneic stem-cell transplantation were reviewed.

INTERVENTION

During 2009–2010, our unit underwent complete remodeling including replacement of all surfaces. We assessed the effects of this construction on the incidence of hospital-acquired VRE colonization before, during, and after the renovation.

RESULTS

We observed a sharp decrease in VRE colonization rates (hazard ratio, <0.23; 95% confidence interval, 0.18–0.44; P<.0001) during the first year after the renovation, with a return to near baseline rates thereafter. The known risk factors for VRE colonization appeared to be stable over the study interval. Environmental cultures outside of patient rooms revealed several contaminated areas that are commonly touched by unit personnel. Multilocus sequence typing of VRE isolates that were cryopreserved over the study interval showed that dominant strains prior to construction disappeared and were replaced by other strains after the renovation.

CONCLUSIONS

Unit reconstruction interrupted endemic transmission of VRE, which resumed with novel strains upon reopening. Contamination of environmental surfaces and shared equipment may play an important role in endemic transmission of VRE.

Infect Control Hosp Epidemiol 2017;38:1055–1061

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 9 , September 2017 , pp. 1055 - 1061
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Kanamori, H, Rutala, WA, Sickbert-Bennett, EE, Weber, DJ. Review of fungal outbreaks and infection prevention in healthcare settings during construction and renovation. Clin Infect Dis 2015;61:433–444.CrossRefGoogle ScholarPubMed
2. Boix-Palop, L, Nicholas, C, Xercavins, M, et al. Bacillus species pseudo-outbreak: construction works and collateral damage. J Hosp Infect 2017;56:160–165.Google Scholar
3. Drees, M, Snydman, DR, Schmid, CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678–685.Google Scholar
4. Martinez, JA, Ruthazer, R, Hansjosten, K, Barefoot, L, Snydman, DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterocci in patients treated in a medical intensive care unit. Arch Intern Med 2003;163:1905–1912.Google Scholar
5. Homan, WL, Tribe, D, Poznanski, S, et al. Multilocus sequence typing scheme for Enterococcus faecium. J Clin Microbiol 2002;40:1963–1971.Google Scholar
6. Benjamini, Y, Hochberg, Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc 1995;Series B 57:289–300.Google Scholar
7. Ford, CD, Lopansri, BK, Haydoura, S, et al. Frequency, risk factors, and outcomes of vancomycin-resistant Enterococcus colonization and infection in patients with newly diagnosed acute leukemia: different patterns in patients with acute myelogenous and acute lymphoblastic leukemia. Infect Control Hosp Epidemiol 2015;36:47–53.CrossRefGoogle ScholarPubMed
8. Ford, CD, Lopansri, BK, Gazdik, MA, et al. Are the hospital environment and unit colonization pressure risk factors for vancomycin-resistant Enterococcus colonization on contemporary units dedicated to the treatment of hematologic malignancies and hematopoietic stem cell transplantation? Am J Infect Control 2016;44:1110–1115.Google Scholar
9. Ford, CD, Gazdik, MA, Lopansri, BK, et al. Vancomycin-resistant Enterococcus colonization and bacteremia and hematopoietic stem-cell transplantation outcomes. Biol Blood Marrow Transplant 2017;23:340–346.CrossRefGoogle ScholarPubMed
10. Teltsch, DY, Hanley, J, Loo, V, Goldberg, P, Gursahaney, A, Buckeridge, DL. Infection acquisition following intensive care unit room privatization. Arch Intern Med 2011;171:32–38.CrossRefGoogle ScholarPubMed
11. Boswell, TC. Reduction in MRSA environmental contamination with a portable HEPA-filtration unit. J Hosp Infect 2006;63:47–54.Google Scholar
12. Muzslay, M, Moore, G, Turton, JF, Wilson, AP. Dissemination of antibiotic-resistant enterococci within the ward environment: the role of airborne bacteria and the risk posed by unrecognized carriers. Am J Infect Control 2013;41:57–60.Google Scholar
13. Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:1552–1560.Google Scholar
14. Kramer, A, Schwebke, I, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130.CrossRefGoogle Scholar
15. McManus, AT, McManus, WF, Mason, AD, Aitcheson, AR, Pruitt, BA. Microbial colonization in a new intensive care burn unit. Arch Surg 1985;120:217–223.CrossRefGoogle Scholar
16. Michael, KE, No, D, Roberts, MC. VanA-positive multi-drug-resistant Enterococcus spp. isolated from surfaces of a US hospital laundry facility. J Hosp Infect 2017;95:218–223.Google Scholar
17. Bonten, MJ, Slaughter, S, Ambergen, A, et al. The role of “colonization pressure” in the spread of vancomycin-resistant enterococci. Arch Intern Med 1998;158:1127–1132.Google Scholar
18. Harris, AD, Pineles, L, Belton, G, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.Google Scholar
19. Slaughter, S, Hayden, MK, Nathan, C, et al. A comparison of the effect of universal use of gloves and gowns with that of glove use only on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448–456.CrossRefGoogle Scholar