Successful Management of a Clostridioides difficile Ribotype 027 Outbreak with a Lean Intervention Bundle
| Autor: | Carlo Casanova, Thomas Bodmer, Helena M. B. Seth-Smith, Silvie Burri, Rami Sommerstein, Niccolò Buetti, Adrian Egli, Andrea B Kuenzli, Jonas Marschall |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
Diarrhea medicine.medical_specialty Hand washing 610 Medicine & health Ribotyping Disease Outbreaks 03 medical and health sciences 0302 clinical medicine Intervention (counseling) Epidemiology Health care medicine Infection control Humans 030212 general & internal medicine Phylogeny Aged Aged 80 and over 0303 health sciences Infection Control Whole Genome Sequencing 030306 microbiology business.industry Transmission (medicine) Clostridioides difficile Outbreak General Medicine Middle Aged Hospitals 3. Good health Infectious Diseases Emergency medicine Clostridium Infections business Clostridioides Switzerland |
| Zdroj: | Kuenzli, Andrea B.; Burri, Silvie; Casanova, Carlo; Sommerstein, Rami; Buetti, Niccolo; Seth-Smith, Helena Mb; Bodmer, Thomas; Egli, Adrian; Marschall, Jonas (2020). Successful Management of a Clostridioides difficile Ribotype 027 Outbreak with a Lean Intervention Bundle. The journal of hospital infection, 106(2), pp. 240-245. Elsevier 10.1016/j.jhin.2020.07.034 |
| DOI: | 10.1016/j.jhin.2020.07.034 |
| Popis: | Summary Background In a 2015 point-prevalence study, Clostridioides difficile 027, a hypervirulent ribotype, was absent from healthcare institutions in Switzerland. In late 2016, we detected an outbreak of C. difficile infection (CDI) with ribotype 027 occurring across several hospitals in the same hospital network. Methods The first cases of CDI due to ribotype 027 triggered an outbreak investigation, including whole genome sequencing (WGS) to identify outbreak strains. Findings Twenty-eight patients with CDI caused by ribotype 027 between December 2016 and December 2017 were identified, out of which 20 were caused by a single clone. Commonalities among these patients were hospitalization in the same room or on the same ward, receiving care from the same healthcare workers, and shared toilet areas. In addition to the epidemiological links suggesting possible transmission pathways between cases, WGS confirmed the clonality of this C. difficile 027 outbreak. The outbreak was contained by isolation precautions, raising awareness among healthcare workers, harmonizing diagnostic algorithms, and switching to a sporicidal agent for environmental disinfection. Of note, neither default gowning and gloving nor hand washing with water and soap were implemented. Conclusion This C. difficile 027 outbreak was recognized belatedly due to lack of screening for this ribotype in some hospitals, and was contained by a swift response with simple infection prevention measures and adapting the laboratory approach. In order to have a better understanding of C. difficile epidemiology, diagnostic approaches should be standardized, CDI declared notifiable, and longitudinal data on prevalent ribotypes collected in countries where this is not established. |
| Databáze: | OpenAIRE |
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