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      O088: Bad design, bad practices, bad bugs – Elizabethkingia meningoseptica outbreak in ICU

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      1 , , 2 , 1 , 1 , 1
      Antimicrobial Resistance and Infection Control
      BioMed Central
      2nd International Conference on Prevention and Infection Control (ICPIC 2013)
      25-28 June 2013

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          Abstract

          Introduction Elizabethkingia meningoseptica is a nosocomial-adapted, Gram negative bacillus with intrinsic resistance to most antibiotics. An outbreak investigation was commenced when five patients developed E. meningoseptica bacteraemia within a three week period in the Cardiothoracic Intensive Care Unit (CTICU) and Surgical ICU (SICU). Methods Analysis of laboratory data, case reviews, workflows within CTICU and extensive environmental sampling of surfaces and taps within four ICU wards, four general wards, two dialysis units and eight operating theatres were performed. Results Upon review laboratory data revealed an unrecognized subtle increasing trend of E. meningoseptica clinical infections in all ICUs over the preceding 3 years. E. meningoseptica was cultured from aerators of 44% (35/79) taps. Taps in sinks frequently used for non-sanctioned practices were more likely to be contaminated (95% CI 1.2-2.3, p<0.003). Elizabethkingia was not cultured from any other surfaces within patient rooms. Investigation of ICU nursing practice revealed introduction of non-sanctioned practices regarding disposal of patient respiratory secretions and cleaning of patient equipment in designated hand hygiene sinks within patient rooms. An urgent education programme was instituted to change these practices. Rooms underwent terminal cleaning. Faucets were systematically cleaned and aerators were changed. No further cases occurred in SICU or CT-ICU over the following three months. One month after aerator change, new aerators remained free of E. meningoseptica. Conclusion Introduction of non-sanctioned practices due to suboptimal unit design may have unintended consequences for vulnerable patients. Nursing workflows must also be practical to ensure proper waste disposal and cleaning of medical equipment. Disclosure of interest None declared.

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          Author and article information

          Conference
          Antimicrob Resist Infect Control
          Antimicrob Resist Infect Control
          Antimicrobial Resistance and Infection Control
          BioMed Central
          2047-2994
          2013
          20 June 2013
          : 2
          : Suppl 1
          : O88
          Affiliations
          [1 ]Infection Control Team, National University Hospital Singapore, Singapore, Singapore
          [2 ]Microbiology, National University Hospital Singapore, Singapore, Singapore
          Article
          2047-2994-2-S1-O88
          10.1186/2047-2994-2-S1-O88
          3687847
          f27c25fe-59cd-4f44-9ca5-7243389fa2e8
          Copyright ©2013 Salmon et al; licensee BioMed Central Ltd.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

          2nd International Conference on Prevention and Infection Control (ICPIC 2013)
          Geneva, Switzerland
          25-28 June 2013
          History
          Categories
          Oral Presentation

          Infectious disease & Microbiology
          Infectious disease & Microbiology

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