投稿分類 微生物

主委發表種類: 口頭

投稿標題(中): Using ISBAR to investigate VRE cluster events - A case study of the medical ICU of a medical center in southern Taiwan, 2023

投稿標題(英): Using ISBAR to investigate VRE cluster events - A case study of the medical ICU of a medical center in southern Taiwan, 2023

投稿摘要: Objective
As medicine has become more progressive over the years, especially antibiotics, super bugs have been on the rise ever since. Vancomycin-resistant Enterococcus is now considered by CDC as a ‘serious threat’. Knowingly, Intensive Care Units house patients who are under antibiotic therapy, immunosuppressed and ventilated therefore increasing likely hood of VRE clusters. However, understanding the exact nature of the cluster’s origins and its spread is very important to infection control. During January to April 2023, 17 cases of VRE were detected at the medical ICU at a South Medical Center, with a continued monthly increase. How to conduct analysis and investigation will become an important task for infection control nurses. The aim of this study was to use the ISBAR method to investigate a VRE cluster event.
Materials and Methods
The ISBAR (Identify, Situation, Background, Assessment, and Recommendation) method was used to analysis, describe (including 5W1H that is who, where, when, what, why, how), and investigate the cluster event of VRE. Mapping of the patients’ admission dates and overlapping hospital stays was carried out to determine whether direct transmission of VRE occurred within the ICU.
Assessment of the ICU environment was done through direct visual assessment of terminal cleaning post discharge of MDRO (VRE) patients, ATP and culture swabbing of high touch points, direct observation, and audits of proper use of isolation/standard precautions during care of MDRO patients, and direct observation of hand hygiene rate and compliance amongst health care staff at the ICU.
Results
As of April, 17 VRE cases were living at the ICU of which it was determined that ten cases were urine, four cases were blood, two cases were wound and one was rectal swab. On average, infection occurred after 20 days (5~42days) in hospital. After investigation, we based on whether there is overlap in the hospitalization interval of the cases, we found the cases from January to February are not related to the cases from March to April. We define this event as two cluster events. In the end, 10 cases also had overlapping stays during their admission at the ICU with high likelihood of contact from one to the next. Among them, 3 of them were cases from January to February. We conducted environmental ATP testing and microbial culture, and monitored the cleaning process of cleaning staff. The environmental culture swabbing did not show any VRE growth. However, the ATP swab of the suction meter and bedside locker failed at ＞200RLU. Hand hygiene rate and compliance was not 100% in April and standard and isolation precautions were not being adhered to. We conducted on-site clinical observation and found that after dumping urine, they only changed gloves but did not wash our hands. And after personnel come into contact with MDRO cases, they often use dry wash hands.
Conclusion:
These results showed that importance to hand hygiene needed to be reiterated and the risks of environmental exposure, improve the implementation of standard and isolation precautions for MDRO patients, strengthen environmental cleanliness and improve adherence to ICU bundle cares to prevent the spread of VRE amongst ICU patients.

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