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Antimicrobial Resistance & Infection Control

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Open Access 01-12-2018 | Review

Effectiveness of healthcare worker screening in hospital outbreaks with gram-negative pathogens: a systematic review

Authors: Nikos Ulrich, Petra Gastmeier, Ralf-Peter Vonberg

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2018

Abstract

Background

Identifying the source of an outbreak is the most crucial aspect of any outbreak investigation. In this review, we address the frequently discussed question of whether (rectal) screening of health care workers (HCWs) should be carried out when dealing with outbreaks caused by gram negative bacteria (GNB).

A systematic search of the medical literature was performed, including the Worldwide Outbreak Database and PubMed. Outbreaks got included if a HCW was the source of the outbreak and the causative pathogen was an Escherichia coli, Klebsiella spp., Enterobacter spp., Serratia spp., Pseudomonas aeruginosa, or Acinetobacter baumannii.

This was true for 25 articles in which there were 1196 (2.1%) outbreaks due to GNB, thereof 14 HCWs who were permanently colonized by the outbreak strain. Rectal screening of HCWs was helpful in only 2 of the 1196 (0.2%) outbreaks. Instead, the hands of HCWs served as a reservoir for the outbreak strain in at least 7 articles – especially when they suffered from onychomycosis or used artificial fingernails or rings.

Conclusion

Due to very weak evidence, we do not recommend rectal screening of HCWs in an outbreak situation with GNB. However, besides a critical review of hand hygiene habits, it might be useful to examine the hands of staff carefully. This measure is cheap, quick to perform, and seems to be quite effective.

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Albrich WC, Harbarth S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis. 2008;8:289–301.PubMed

Vonberg RP, Stamm-Balderjahn S, Hansen S, Zuschneid I, Ruden H, Behnke M, Gastmeier P. How often do asymptomatic healthcare workers cause methicillin-resistant Staphylococcus aureus outbreaks? A systematic evaluation. Infect Control Hosp Epidemiol. 2006;27:1123–7.PubMed

Centers for Disease C, Prevention. Nosocomial group a streptococcal infections associated with asymptomatic health-care workers--Maryland and California, 1997. MMWR Morb Mortal Wkly Rep. 1999;48:163–6.

Otter JA, Mutters NT, Tacconelli E, Gikas A, Holmes AH. Controversies in guidelines for the control of multidrug-resistant gram-negative bacteria in EU countries. Clin Microbiol Infect. 2015;21:1057–66.PubMed

Stapleton PJ, Murphy M, McCallion N, Brennan M, Cunney R, Drew RJ. Outbreaks of extended spectrum beta-lactamase-producing Enterobacteriaceae in neonatal intensive care units: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2016;101:F72–8.PubMed

Gastmeier P, Stamm-Balderjahn S, Hansen S, Nitzschke-Tiemann F, Zuschneid I, Groneberg K, Ruden H. How outbreaks can contribute to prevention of nosocomial infection: analysis of 1,022 outbreaks. Infect Control Hosp Epidemiol. 2005;26:357–61.PubMed

Vonberg RP, Weitzel-Kage D, Behnke M, Gastmeier P. Worldwide outbreak database: the largest collection of nosocomial outbreaks. Infection. 2011;39:29–34.PubMed

Snyder GM, D'Agata EM. Diagnostic accuracy of surveillance cultures to detect gastrointestinal colonization with multidrug-resistant gram-negative bacteria. Am J Infect Control. 2012;40:474–6.PubMed

Freire MP, Villela Soares Oshiro IC, Bonazzi PR, Pierrotti LC, de Oliveira LM, Machado AS, Van Der Heijdenn IM, Rossi F, Costa SF, Carneiro D'Albuquerque LA, Abdala E. Surveillance culture for multidrug-resistant gram-negative bacteria: performance in liver transplant recipients. Am J Infect Control. 2017;45:e40-e44.PubMed

10.

Patterson JE, Vecchio J, Pantelick EL, Farrel P, Mazon D, Zervos MJ, Hierholzer WJ Jr. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med. 1991;91:479–83.PubMed

11.

Go ES, Urban C, Burns J, Kreiswirth B, Eisner W, Mariano N, Mosinka-Snipas K, Rahal JJ. Clinical and molecular epidemiology of acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet. 1994;344:1329–32.PubMed

12.

Roberts SA, Findlay R, Lang SD. Investigation of an outbreak of multi-drug resistant Acinetobacter baumannii in an intensive care burns unit. J Hosp Infect. 2001;48:228–32.PubMed

13.

Tena D, Martinez NM, Oteo J, Saez D, Vindel A, Azanedo ML, Sanchez L, Espinosa A, Cobos J, Sanchez R, et al. Outbreak of multiresistant OXA-24- and OXA-51-producing Acinetobacter baumannii in an internal medicine ward. Jpn J Infect Dis. 2013;66:323–6.PubMed

14.

McDonald LC, Walker M, Carson L, Arduino M, Aguero SM, Gomez P, McNeil P, Jarvis WR. Outbreak of Acinetobacter spp. bloodstream infections in a nursery associated with contaminated aerosols and air conditioners. Pediatr Infect Dis J. 1998;17:716–22.PubMed

15.

Archibald LK, Ramos M, Arduino MJ, Aguero SM, Deseda C, Banerjee S, Jarvis WR. Enterobacter cloacae and Pseudomonas aeruginosa polymicrobial bloodstream infections traced to extrinsic contamination of a dextrose multidose vial. J Pediatr. 1998;133:640–4.PubMed

16.

Ehrenkranz NJ, Pfaff SJ. Mediastinitis complicating cardiac operations: evidence of postoperative causation. Rev Infect Dis. 1991;13:803–14.PubMed

17.

van Nierop WH, Duse AG, Stewart RG, Bilgeri YR, Koornhof HJ. Molecular epidemiology of an outbreak of Enterobacter cloacae in the neonatal intensive care unit of a provincial hospital in Gauteng, South Africa. J Clin Microbiol. 1998;36:3085–7.PubMedPubMedCentral

18.

Afza M, Hawker J, Thurston H, Gunn K, Orendi J. An outbreak of Escherichia coli O157 gastroenteritis in a care home for the elderly. Epidemiol Infect. 2006;134:1276–81.PubMedPubMedCentral

19.

Ryder RW, Buxton AE, Wachsmuth IK, Mason E, Barrett FF. Heat-stable enterotoxigenic Escherichia coli and necrotizing enterocolitis: lack of an association. J Pediatr. 1977;91:302–3.PubMed

20.

Taneja N, Das A, Raman Rao DS, Jain N, Singh M, Sharma M. Nosocomial outbreak of diarrhoea by enterotoxigenic Escherichia coli among preterm neonates in a tertiary care hospital in India: pitfalls in healthcare. J Hosp Infect. 2003;53:193–7.PubMed

21.

Curie K, Speller DC, Simpson RA, Stephens M, Cooke DI. A hospital epidemic caused by gentamicin-resistant Klebsiella aerogenes. J Hyg (Lond). 1978;80:115–23.PubMed

22.

Lebessi E, Dellagrammaticas H, Tassios PT, Tzouvelekis LS, Ioannidou S, Foustoukou M, Legakis NJ. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit in the high-prevalence area of Athens, Greece. J Clin Microbiol. 2002;40:799–804.PubMedPubMedCentral

23.

Coovadia YM, Johnson AP, Bhana RH, Hutchinson GR, George RC, Hafferjee IE. Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks. J Hosp Infect. 1992;22:197–205.PubMed

24.

Fukigai S, Alba J, Kimura S, Iida T, Nishikura N, Ishii Y, Yamaguchi K. Nosocomial outbreak of genetically related IMP-1 beta-lactamase-producing Klebsiella pneumoniae in a general hospital in Japan. Int J Antimicrob Agents. 2007;29:306–10.PubMed

25.

Gupta A, Della-Latta P, Todd B, San Gabriel P, Haas J, Wu F, Rubenstein D, Saiman L. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol. 2004;25:210–5.PubMed

26.

Cassettari VC, Silveira IR, Balsamo AC, Franco F. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit linked to onychomycosis in a healthcare worker. J Pediatr. 2006;82:313–6.

27.

Boszczowski I, Nicoletti C, Puccini DM, Pinheiro M, Soares RE, Van der Heijden IM, Costa SF, Barone AA, Levin AS. Outbreak of extended spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a neonatal intensive care unit related to onychomycosis in a health care worker. Pediatr Infect Dis J. 2005;24:648–50.PubMed

28.

Yan JJ, Ko WC, Tsai SH, Wu HM, Wu JJ. Outbreak of infection with multidrug-resistant Klebsiella pneumoniae carrying Bla(IMP-8) in a university medical center in Taiwan. J Clin Microbiol. 2001;39:4433–9.PubMedPubMedCentral

29.

Cassettari VC, da Silveira IR, Dropa M, Lincopan N, Mamizuka EM, Matté MH, Matté GR, Menezes PR. Risk factors for colonisation of newborn infants during an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. J Hosp Infect. 2009;71:340–7.PubMed

30.

Nair D, Gupta N, Kabra S, Ahuja RB, Prakash SK. Salmonella Senftenberg: a new pathogen in the burns ward. Burns. 1999;25:723–7.PubMed

31.

Zawacki A, O'Rourke E, Potter-Bynoe G, Macone A, Harbarth S, Goldmann D. An outbreak of Pseudomonas aeruginosa pneumonia and bloodstream infection associated with intermittent otitis externa in a healthcare worker. Infect Control Hosp Epidemiol. 2004;25:1083–9.PubMed

32.

Falcão DP, Mendonça CP, Scrassolo A, De Almeida BB, Hart L, Farmer LH, Farmer JJ. Nursery outbreak of severe diarrhoea due to multiple strains of Pseudomonas aeruginosa. Lancet. 1972;2:38–40.PubMed

33.

Widmer AF, Wenzel RP, Trilla A, Bale MJ, Jones RN, Doebbeling BN. Outbreak of Pseudomonas aeruginosa infections in a surgical intensive care unit: probable transmission via hands of a health care worker. Clin Infect Dis. 1993;16:372–6.PubMed

34.

McNeil SA, Nordstrom-Lerner L, Malani PN, Zervos M, Kauffman CA. Outbreak of sternal surgical site infections due to Pseudomonas aeruginosa traced to a scrub nurse with onychomycosis. Clin Infect Dis. 2001;33:317–23.PubMed

35.

Kienitz M. Outbreaks and sporadic cases of enteritis due to pseudomonas aeruginosa in premature babies and infants (author's transl). Infection. 1979;7(Suppl 2):S231–5.PubMed

36.

Moolenaar RL, Crutcher JM, San Joaquin VH, Sewell LV, Hutwagner LC, Carson LA, Robison DA, Smithee LM, Jarvis WR. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol. 2000;21:80–5.PubMed

37.

Sebert ME, Manning ML, McGowan KL, Alpern ER, Bell LM. An outbreak of Serratia marcescens bacteremia after general anesthesia. Infect Control Hosp Epidemiol. 2002;23:733–9.PubMed

38.

Wilhelmi I, Bernaldo de Quiros JC, Romero-Vivas J, Duarte J, Rojo E, Bouza E. Epidemic outbreak of Serratia marcescens infection in a cardiac surgery unit. J Clin Microbiol. 1987;25:1298–300.PubMedPubMedCentral

39.

Jepson AP, McDougall C, Clark A, Bateman A, Williamson G, Kaufmann ME. Finger rings should be removed prior to scrubbing. J Hosp Infect. 2006;64:197–8.PubMed

40.

de Vries JJ, Baas WH, van der Ploeg K, Heesink A, Degener JE, Arends JP. Outbreak of Serratia marcescens colonization and infection traced to a healthcare worker with long-term carriage on the hands. Infect Control Hosp Epidemiol. 2006;27:1153–8.PubMed

41.

Passaro DJ, Waring L, Armstrong R, Bolding F, Bouvier B, Rosenberg J, Reingold AW, McQuitty M, Philpott SM, Jarvis WR, et al. Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. J Infect Dis. 1997;175:992–5.PubMed

42.

Haller S, Eller C, Hermes J, Kaase M, Steglich M, Radonic A, Dabrowski PW, Nitsche A, Pfeifer Y, Werner G, et al. What caused the outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstructing transmission with epidemiological analysis and whole-genome sequencing. BMJ Open. 2015;5:e007397.PubMedPubMedCentral

43.

Mutton KJ, Brady LM, Harkness JL. Serratia cross-infection in an intensive therapy unit. J Hosp Infect. 1981;2:85–91.PubMed

44.

Sisson PR, Freeman R, Gould FK, Lightfoot NF. Strain differentiation of nosocomial isolates of Pseudomonas aeruginosa by pyrolysis mass spectrometry. J Hosp Infect. 1991;19:137–40.PubMed

45.

Berlin RKI. Nosokomialer Ausbruch durch ESBL-bildende Klebsiella 310 pneumoniae im Zentrum für Kinderheilkunde Klinikum Bremen-Mitte 2011-2012.

46.

Härtel C, Hartz A, Bahr L, Gille C, Gortner L, Simon A, Orlikowsky T, Müller A, Körner T, Henneke P, et al. Media stories on NICU outbreaks lead to an increased prescription rate of third-line antibiotics in the Community of Neonatal Care. Infect Control Hosp Epidemiol. 2016;37:924–30.PubMed

47.

Decker BK, Lau AF, Dekker JP, Spalding CD, Sinaii N, Conlan S, Henderson DK, Segre JA, Frank KM, Palmore TN. Healthcare personnel intestinal colonization with multidrug-resistant organisms. Clin Microbiol Infect. 2018;24:82 e81–4.

48.

Kelsall NK, Griggs RK, Bowker KE, Bannister GC. Should finger rings be removed prior to scrubbing for theatre? J Hosp Infect. 2006;62:450–2.PubMed

49.

Trick WE, Vernon MO, Hayes RA, Nathan C, Rice TW, Peterson BJ, Segreti J, Welbel SF, Solomon SL, Weinstein RA. Impact of ring wearing on hand contamination and comparison of hand hygiene agents in a hospital. Clin Infect Dis. 2003;36:1383–90.PubMed

50.

Woodhead K, Taylor EW, Bannister G, Chesworth T, Hoffman P, Humphreys H. Behaviours and rituals in the operating theatre. A report from the hospital infection society working party on infection control in operating theatres. J Hosp Infect. 2002;51:241–55.PubMed

51.

Vonberg RP, Gastmeier P. Quality of outbreak descriptions in medical literature. Lancet Infect Dis. 2007;7:699–700.PubMed

52.

Wieland K, Chhatwal P, Vonberg RP. Outbreak reporting a decade after ORION: where do we stand? Lancet Infect Dis. 2017;17:476.PubMed

53.

Stone SP, Cooper BS, Kibbler CC, Cookson BD, Roberts JA, Medley GF, Duckworth G, Lai R, Ebrahim S, Brown EM, et al. The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection. Lancet Infect Dis. 2007;7:282–8.PubMed

54.

D'Agata EM, Gautam S, Green WK, Tang YW. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis. 2002;34:167–72.PubMed

Title: Effectiveness of healthcare worker screening in hospital outbreaks with gram-negative pathogens: a systematic review
Authors: Nikos Ulrich
Petra Gastmeier
Ralf-Peter Vonberg
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Antimicrobial Resistance & Infection Control / Issue 1/2018
Electronic ISSN: 2047-2994
DOI: https://doi.org/10.1186/s13756-018-0330-4

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