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BACKGROUNDVancomycin-resistant enterococci (VRE) have spread worldwide.OBJECTIVETo systematically review VRE outbreaks and estimate the pooled basic reproductive rate (R0) of VRE.METHODSEligible studies criteria were (1) published within 10 years, (2) report outbreak details, (3) involve 1 center, (4) estimate epidemic duration, and (5) concern adults. Descriptive analysis included number of index cases, secondary cases, and screened patients; infection control measures; and definition of contact patients. R0was estimated by the equation R0=(ln2) D/td+1, with Das the generation time and tdas the doubling time.RESULTSThirteen VRE outbreaks were retained from 180 articles and, among them, 10 were kept for R0calculation. The mean (range) number of index cases was 2.3 (1–8) and the mean (range) number of secondary cases was 15 (3–56). The mean (range) number of screened patients was 174 (32–509), with pooled VRE prevalence of 5.4% (95% CI, 4.5%–6.3%). Contact precautions were reported in 12 studies (92%), wards were closed in 7 (54%), with cohorting in 6 (46%). Two major screening policies were implemented: (1) a surveillance program in the unit or hospital (7 studies [54%]) and (2) screening of selected contact patients (6 studies [46%]). The pooled R0of VRE was 1.32 (interquartile range, 1.03–1.46).CONCLUSIONWe discerned considerable heterogeneity in screening policies during VRE outbreaks. Pooled R0was higher than 1, confirming the epidemic nature of VRE.Infect. Control Hosp. Epidemiol.2016;37(3):289–394

The possible transmission of pathogens to 236 persons exposed to an endoscope processed in a flawed automated endoscope washer-disinfector in a gastrointestinal endoscopy unit was investigated. During 6 months, 197 patients (83.5%) were followed up, and no cases of acute human immunodeficiency virus, hepatitis C virus, or hepatitis B virus infection were observed. This event created the conditions for improvements in safety procedures.

AbstractObjective:To investigate the relationship between hygienic measures reported for the prevention of hospital-acquired diarrhea and incidence rates of hospital-acquired diarrhea.Design:A survey of hospital-acquired diarrhea was conducted between January 1 and March 31, 1999. Multivariate analysis of reported measures of hygiene according to the observed incidence rates of hospital-acquired diarrhea was performed.Setting:Thirty-one pediatric or neonatal wards located in hospitals in the southeast of France, selected as a convenience sample of wards volunteering to participate.Patients:A total of 6,726 children younger than 5 years.Results:The overall incidence rate of hospital-acquired diarrhea was 3.6%. Rotavirus was responsible for 69% of the cases of hospital-acquired diarrhea. Among the hygienic measures reported by the wards for preventing hospital-acquired diarrhea were using a single room or cohorting (77.4%), washing hands (83.9%), wearing gowns (80.6%), and wearing disposable single-use gloves for diapering a patient (51.6%). By multivariate analysis, the variables statistically associated with a lower incidence of hospital-acquired diarrhea were restricting the patient's mobility outside his or her room, keeping the patient's door closed, and having fewer than 20 beds in the ward, with adjusted odds ratios of 0.34 (95% confidence interval [CL95], 0.18 to 0.65), 0.33 (CI95, 0.23 to 0.47), and 0.42 (CI95, 0.30 to 0.60), respectively.Conclusion:Simple preventive measures can decrease the rate of hospital-acquired diarrhea in pediatric wards (Infect Control Hosp Epidemiol2003;24:520-525)

A fatal nosocomial infection with Legionella pneumophilaserogroup 5 occurred in a patient with leukemia. Isolates recovered from both the potable water supply and the patient showed an identical genomic profile. With no other exposure identified, the water from the washbasin was evidently the source of infection.