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Both hospital admissions and patient isolation increase during influenza season. Influenza testing methodologies that reduce turnaround time (TAT) could reduce time in isolation.We assessed the impact of a new influenza test on TAT and isolation days. TAT and daily mean isolation days were compared at a single hospital over 2 influenza seasons. An automated real-time reverse-transcription polymerase chain reaction assay (rRT-PCR) with random access replaced a conventional rRT-PCR assay for the second influenza season. Automation and random access allowed continuous testing, rather than once daily testing 3-5 d/wk.Confirmed influenza cases (57 vs 68) and total patient days (66,308 vs. 66,366) were similar for the 2012-2013 and 2013-2014 influenza seasons. TAT fell from 35 to 3.6 hours. Daily mean isolation days (32.9 vs 27.7, P .01) fell, as did days in contact precautions (25.0 vs 19.8, P .01) and droplet precautions (6.0 vs 3.5, P .01). Although daily mean droplet precaution days for confirmed influenza rose slightly (0.86 vs 1.1, P = .16), droplet precaution days for suspected influenza fell 85% (2.7 vs 0.41, P .001).Influenza testing technology that reduced TAT from days to hours resulted in a 42% reduction in droplet precaution days and reduced overall isolation days during influenza season.

Background Carbapenemase-producing Enterobacteriaceae (CPE) can colonize hospital drains and spread from drain to patient. The optimal approach to preventing drain colonization is unknown. We present our hospital's experience with a drain decontamination protocol. Methods Our facility is a 450 bed academic hospital in Toronto. Between 2017 and 2019, we identified 32 CPE positive inpatients 24 of whom were known to carry CPE or were CPE screen positive on admission. We implemented a sink drain protocol to prevent plumbing colonization. CPE patients admitted >48 hours have all drains in their room disinfected weekly and when transferred or discharged. Hydrogen peroxide gel (4.5%) is poured into the drain and flushed after 10 minutes. Drain swabs are collected >48 after disinfection; some rooms were also tested pre-disinfection. If post-disinfection swabs were positive, enhanced disinfection methods were used. Results 4.7% (18/387) sink/drain swabs were CPE positive. Eight positive swabs were collected before and ten after disinfection. These 18 positive swabs were from drains in 8 patient rooms and 2 communal showers. Enterobacter species predominated (5/10) and CPE enzymes included KPC(4), NDM(3), OXA-48(2), and mixed NDM&KPC(1). Positive room drains matched the patient's CPE enzyme for 7 of 8 positive rooms. Drain disinfection was successful for 70% (7/10) of positive sinks/drains. Three drains failed disinfection and required the enhanced disinfection protocol. After successful disinfection, all room drains have remained negative on at least one additional swab performed >1 month after successful disinfection but two communal shower drains reverted to positive with the same CPE enzyme on retesting >6 months post-disinfection. Conclusions Sink drains can become contaminated with CPE. Our disinfection protocol was largely successful in eradicating CPE from drains, although two communal shower drains reverted to positive. Disinfection of drains in CPE rooms routinely and at discharge may prevent drain colonization and reduce CPE transmission risk.

Background Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia. Methods All patients with a confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013 were linked to provincial healthcare administrative data sources and frequency matched to 3 controls based on age, sex, and aggregated diagnosis group. Associations between predictors and VRE bacteremia were estimated by generalized estimating equations and summarized using odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Results In total, 217 cases and 651 controls were examined. In adjusted analyses, patient-level predictors included bone marrow transplant (OR 106.99 [95% CI 12.19–939.26]); solid organ transplant (OR 17.17 [95% CI 4.95–59.54]); any cancer (OR 8.64 [95% CI 3.88–19.21]); intensive care unit (ICU) admission (OR 6.81 [95% CI 3.53–13.13]); heart disease (OR 5.27 [95% CI 2.00–13.90]); and longer length of stay (OR 1.07 per day [95% CI 1.06–1.09]). Hospital-level predictors included hospital size (per increase in 100 beds (OR 1.26 [95% CI 1.07–1.48]) and teaching hospitals (OR 3.87 [95% CI 1.85–8.08]). Conclusions Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the ICU are at highest risk of VRE bacteremia, particularly at large hospitals and teaching hospitals.

Adenovirus-associated epidemic keratoconjunctivitis (A-EKC) is a cause of large and prolonged outbreaks in ophthalmology clinics and can result in substantial morbidity. A-EKC outbreaks are often the result of contaminated ophthalmologic equipment, surfaces, or hands. Contaminated multidose eye drops are also a likely culprit, but few prior studies provide clear epidemiologic evidence that adenovirus transmission resulted from contamination of eye drops. We describe an A-EKC outbreak at a large, hospital-affiliated eye clinic that affected 44 patients. The unique epidemiology of the outbreak provides strong evidence that contaminated multidose dilating eye drops resulted in adenovirus transmission. Removal of multidose eye medication from the clinic, combined with case finding, enhanced infection control and enhanced environmental cleaning, led to rapid control of the outbreak.

Background Wheelchairs are complex equipment that come in close contact with individuals at increased risk of transmitting and acquiring antibiotic-resistant organisms and health care–associated infection. The purpose of this study was to determine the status of wheelchair cleaning and disinfection in Canadian health care facilities. Methods Acute care hospitals (ACHs), chronic care hospitals (CCHs), and long-term care facilities (LTCFs) were contacted and the individual responsible for oversight of wheelchair cleaning and disinfection was identified. A structured interview was conducted that focused on current practices and concerns, barriers to effective wheelchair cleaning and disinfection, and potential solutions. Results Interviews were completed at 48 of the 54 facilities contacted (89%), including 18 ACHs, 16 CCHs, and 14 LTCFs. Most (n = 24) facilities had 50-200 in-house wheelchairs. Respondents were very concerned about wheelchair cleaning as an infection control issue. Specific concerns included the lack of reliable systems for tracking and identifying dirty and clean wheelchairs (71%, 34/48), failure to clean and disinfect wheelchairs between patients (52%, 25/48), difficulty cleaning cushions (42%, 20/48), lack of guidelines (35%, 27/48), continued use of visibly soiled wheelchairs (29%, 14/48) and lack of resources (25%, 12/48). Conclusion Our results suggest that wheelchair cleaning and disinfection is not optimally performed at many Canadian hospitals and LTCFs. Specific guidance on wheelchair cleaning and disinfection is necessary.

Environmental contamination of high-touch surfaces in patient rooms can lead to the transmission of clinically significant pathogens; thus, such surfaces should be cleaned routinely and thoroughly. Fluorescent targeting can be used to provide feedback to frontline cleaning staff on the thoroughness of room cleaning, which can result in substantial improvements in performance. We demonstrate that auditing with fluorescent targeting can be implemented in both the ward and intensive care unit settings using only modest resources, resulting in rapid improvements in cleaning thoroughness.

Background Exposure of health care workers (HCWs) to patients with active TB continues to occur despite implementation of TB control policies. Methods We conducted a root-cause analysis of TB exposures at a tertiary care hospital. Clinical and management details of all confirmed cases identified in 2011 were summarized. Cases were independently reviewed by an expert panel that determined the type (ie, delay in initiating, incorrect use of or premature removal of control measures), preventability, and root cause(s) of each error (exposure). Results Fifteen cases were reviewed. Ten errors were identified in 7 (47%) cases. Cases associated with errors were older than those without errors (68 y vs 40 y; P = .037). Most cases (12/15) were foreign born. A delay in initiating airborne precautions accounted for 70% (7/10) of the errors. The expert panel determined that 80% (8/10) of the errors were preventable or possibly preventable. The most common root causes were failure to consider TB and failure to obtain and interpret imaging. Advanced age, atypical presentation, and presence of comorbid illnesses were common among the preventable cases. Conclusions TB control policies do not prevent all exposures. Our findings suggest that consideration of TB in elderly patients with risk factors, even if their signs and symptoms can be explained by an alternative diagnosis or are atypical, followed by a review of imaging studies, can further reduce this risk.

Background Although scabies outbreaks in hospitals are frequent, the optimal approach to management of these outbreaks has not yet been defined. We describe a hospital scabies outbreak that was successfully controlled without ward closure. Methods An outbreak of scabies at a teaching hospital and subsequent control measures were investigated. Outcomes included the number of cases affecting patients and staff, number of patients and staff requiring prophylaxis, duration of the outbreak, and cost of the outbreak. Outcomes were compared with those in a similar outbreak occurring at the same hospital 20 years earlier and with other published descriptions of hospital scabies outbreaks. Results In January 2010, a patient who had undergone renal transplantation was admitted 3 times to St. Michael’s Hospital, but a diagnosis of scabies was not considered until the final admission. Widespread exposure of patients and staff on 2 wards prompted the establishment of an outbreak management team. Initial interventions focused on isolation and treatment of the index case and on contact tracing to identify and treat secondary cases and to offer prophylaxis to direct contacts. Five symptomatic staff members and 2 patient cases were quickly identified, an outbreak was declared, and mass simultaneous prophylaxis was initiated on the 2 involved wards. A single case occurred 2 weeks after the mass prophylaxis program in a staff member who had not received the prophylaxis. Six weeks after the onset of symptoms, the end of the outbreak was declared. No additional cases have been reported up to the time of publication. The total cost of the outbreak was $20,000. Conclusions Early recognition of crusted scabies is essential to prevent outbreaks. Once an outbreak occurs, prompt control of the index patient and rapid tracing of contacts to identify secondary cases are necessary. When prolonged exposure to a case of crusted scabies results in multiple secondary cases, institution of simultaneous mass prophylaxis is the most efficient strategy for terminating the outbreak and can be implemented without ward closure.

We conducted a systematic review to examine the efficacy of infection control interventions for the control of ESBL-producing Enterobacteriaceae in hospitals in the non-outbreak setting. Although 4 uncontrolled, retrospective studies were included in the review, no well designed prospective studies capable of informing infection control practice were identified, underscoring the urgent need for research in this area.