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Objectives: Clinical utility of carbapenem antibiotics is under threat because of the emergence of acquired metallo-beta-lactamase (MBL) genes. We describe an outbreak in an intensive care unit (ICU) possibly associated with contaminated sinks. Design, setting and participants: Four clusters of gram-negative bacteria harbouring the MBL gene blaIMP-4 were detected in the ICU at Dandenong Hospital between November 2009 and July 2012. Epidemiological investigations were undertaken in order to identify a common point source. During September 2012, screening using rectal swabs for all ICU patients, and environmental swabs targeting all ICU handwashing sinks and taps were collected. Samples were cultured onto selective carbapenem-resistant Enterobacteriaceae (CRE) agar. Suspected CRE isolates were further characterised using the modified Hodge test and VITEK 2 and confirmed by polymerase chain reaction and sequencing of MBL genes. Clinical and environmental CRE isolates were typed by pulsed-field gel electrophoresis. Result(s): Ten clinical isolates and one screening isolate of CRE (consisting of Klebsiella pneumoniae [5], Serratia marcescens [4], Enterobacter cloacae [1] and Escherichia coli [1]) were detected with the blaIMP-4 gene over the 30-month period. S. marcescens was isolated persistently from the grating and drain of eight central sinks. Molecular typing confirmed that clinical and environmental isolates were related. Tap water cultures were negative. Several attempts to clean and decontaminate the sinks using detergents and steam cleaning proved unsuccessful. Conclusion(s): This report highlights the importance of identification of potential environmental reservoirs, such as sinks, for control of outbreaks of environmentally hardy multiresistant organisms.

Objectives: Clinical utility of carbapenem antibiotics is under threat because of the emergence of acquired metallo-beta-lactamase (MBL) genes. We describe an outbreak in an intensive care unit (ICU) possibly associated with contaminated sinks. Design, setting and participants: Four clusters of gram-negative bacteria harbouring the MBL gene blaIMP-4 were detected in the ICU at Dandenong Hospital between November 2009 and July 2012. Epidemiological investigations were undertaken in order to identify a common point source. During September 2012, screening using rectal swabs for all ICU patients, and environmental swabs targeting all ICU handwashing sinks and taps were collected. Samples were cultured onto selective carbapenem-resistant Enterobacteriaceae (CRE) agar. Suspected CRE isolates were further characterised using the modified Hodge test and VITEK 2 and confirmed by polymerase chain reaction and sequencing of MBL genes. Clinical and environmental CRE isolates were typed by pulsed-field gel electrophoresis. Result(s): Ten clinical isolates and one screening isolate of CRE (consisting of Klebsiella pneumoniae [5], Serratia marcescens [4], Enterobacter cloacae [1] and Escherichia coli [1]) were detected with the blaIMP-4 gene over the 30-month period. S. marcescens was isolated persistently from the grating and drain of eight central sinks. Molecular typing confirmed that clinical and environmental isolates were related. Tap water cultures were negative. Several attempts to clean and decontaminate the sinks using detergents and steam cleaning proved unsuccessful. Conclusion(s): This report highlights the importance of identification of potential environmental reservoirs, such as sinks, for control of outbreaks of environmentally hardy multiresistant organisms.

Objective: To determine the risk and timing of a broad range of infective outcomes and mortality after splenectomy. Design, setting and participants: Analysis of a non-identifiable linked hospital discharge administrative dataset for splenectomy cases between July 1998 and December 2006 in Victoria, Australia. Main Outcome Measure(s): Age, sex, indication for splenectomy, infectious events and death. Patients splenectomised for trauma were compared with patients splenectomised for other indications. Infectious risk was established using Cox proportional hazards models. Result(s): A total of 2574 patients underwent splenectomy (with 8648 personyears follow-up). Paediatric cases were excluded, leaving 2472 adult cases for analysis. The most common reasons for splenectomy were trauma (635 [25.7%]) and therapeutic haematological indications (583 [23.6%]). After splenectomy, 644 adult patients (26.0%) had a severe infection, with a rate of 8.0 per 100 person-years (95% CI, 7.2-8.4). The risk of severe infection was highest among patients aged >= 50 years (1.9 per 100 person-years; 95% CI, 1.6-2.7) and those splenectomised for malignancy (14.2 per 100 person-years; 95% CI, 11.8-17.1). Gram-negative infections represented the most frequent causative organism group, accounting for 698 (51%) of bacterial pathogens. Staphylococcus aureus was the second most common causative organism. Conclusion(s): The incidence of severe infection and all-cause mortality differed according to age and underlying reason for splenectomy, was highest among the elderly and those with malignancy, and was lowest among trauma patients. This highlights the need for targeted prevention programs.

Hand hygiene is the most important measure to prevent hospital-acquired infection, yet hand hygiene compliance rates are poor in intensive care units (ICUs). Hand profiling using fingertip imprints was used to demonstrate the effectiveness of alcohol hand rub (AHR) on reducing bacterial carriage and to assess AHR application as an additional educational tool in the ICU setting. At each hand hygiene opportunity, fingertip imprints, from both hands of the Director of the ICU, were plated and organisms cultured during a patient examination. Micro-organisms were counted and speciated. Hands were examined for general condition and details documented. After presenting the evidence of the value of appropriate hand hygiene to the unit head, the plating activity (hand profiling) was made available to any ICU staff. Nearly twice the number of micro-organisms were plated from the dominant hand fingertips of the Director of the ICU compared with his non-dominant hand. Following the application of AHR, the number of organisms reduced but the right thumb consistently grew micro-organisms. An examination of his hand hygiene technique demonstrated the need to focus on his right thumb when applying AHR. Sixty-five ICU and visiting clinical staff participated in assessing hand hygiene technique after AHR application. Twenty-four staff were recommended for follow-up review of their hand hygiene technique. Through hand profiling, an improvement in application of AHR was demonstrated after the technique was corrected. Hand profiling is a useful educational tool and could be made available to clinical staff to maximise the efficacy of AHR application. © 2009 Australian Infection Control Association.

Objective: To determine the risk and timing of a broad range of infective outcomes and mortality after splenectomy. Design, setting and participants: Analysis of a non-identifiable linked hospital discharge administrative dataset for splenectomy cases between July 1998 and December 2006 in Victoria, Australia. Main Outcome Measure(s): Age, sex, indication for splenectomy, infectious events and death. Patients splenectomised for trauma were compared with patients splenectomised for other indications. Infectious risk was established using Cox proportional hazards models. Result(s): A total of 2574 patients underwent splenectomy (with 8648 personyears follow-up). Paediatric cases were excluded, leaving 2472 adult cases for analysis. The most common reasons for splenectomy were trauma (635 [25.7%]) and therapeutic haematological indications (583 [23.6%]). After splenectomy, 644 adult patients (26.0%) had a severe infection, with a rate of 8.0 per 100 person-years (95% CI, 7.2-8.4). The risk of severe infection was highest among patients aged >= 50 years (1.9 per 100 person-years; 95% CI, 1.6-2.7) and those splenectomised for malignancy (14.2 per 100 person-years; 95% CI, 11.8-17.1). Gram-negative infections represented the most frequent causative organism group, accounting for 698 (51%) of bacterial pathogens. Staphylococcus aureus was the second most common causative organism. Conclusion(s): The incidence of severe infection and all-cause mortality differed according to age and underlying reason for splenectomy, was highest among the elderly and those with malignancy, and was lowest among trauma patients. This highlights the need for targeted prevention programs.

Hand hygiene is the most important measure to prevent hospital-acquired infection, yet hand hygiene compliance rates are poor in intensive care units (ICUs). Hand profiling using fingertip imprints was used to demonstrate the effectiveness of alcohol hand rub (AHR) on reducing bacterial carriage and to assess AHR application as an additional educational tool in the ICU setting. At each hand hygiene opportunity, fingertip imprints, from both hands of the Director of the ICU, were plated and organisms cultured during a patient examination. Micro-organisms were counted and speciated. Hands were examined for general condition and details documented. After presenting the evidence of the value of appropriate hand hygiene to the unit head, the plating activity (hand profiling) was made available to any ICU staff. Nearly twice the number of micro-organisms were plated from the dominant hand fingertips of the Director of the ICU compared with his non-dominant hand. Following the application of AHR, the number of organisms reduced but the right thumb consistently grew micro-organisms. An examination of his hand hygiene technique demonstrated the need to focus on his right thumb when applying AHR. Sixty-five ICU and visiting clinical staff participated in assessing hand hygiene technique after AHR application. Twenty-four staff were recommended for follow-up review of their hand hygiene technique. Through hand profiling, an improvement in application of AHR was demonstrated after the technique was corrected. Hand profiling is a useful educational tool and could be made available to clinical staff to maximise the efficacy of AHR application. © 2009 Australian Infection Control Association.

Objective: To determine whether identity badges and lanyards worn by health care workers (HCWs) are capable of harbouring potentially pathogenic bacteria. Design, setting and participants: Cross-sectional study of 71 HCWs (59 clinical ward staff and 12 infection control staff) at Monash Medical Centre, a university teaching hospital. Samples from lanyards, identity badge surfaces and connections (eg, clips, keys, pens) were cultured. The study was conducted from July to August 2006. Main Outcome Measure(s): Presence of pathogenic bacteria on identity badges and lanyards; differences in bacterial counts on items carried by nurses and doctors. Result(s): A total of 27 lanyards were identified with pathogenic bacteria, compared with 18 badges. Analysing lanyards and badges as a combined group, seven had methicillin-resistant Staphylococcus aureus, 29 had methicillin-sensitive S. aureus (MSSA), four had Enterococcus spp and five had aerobic gram-negative bacilli. Lanyards were found to be contaminated with 10 times the median bacterial load per area sampled compared with identity badges. There were no significant differences between nurses and doctors in total median bacterial counts on items carried, but doctors had 4.41 times the risk of carrying MSSA on lanyards (95% CI, 1.14-13.75). Conclusion(s): Identity badges and lanyards worn by HCWs may be contaminated with pathogenic bacteria, which could be transmitted to patients. In view of this finding we suggest appropriate infection control interventions.

Objective: To determine whether identity badges and lanyards worn by health care workers (HCWs) are capable of harbouring potentially pathogenic bacteria. Design, setting and participants: Cross-sectional study of 71 HCWs (59 clinical ward staff and 12 infection control staff) at Monash Medical Centre, a university teaching hospital. Samples from lanyards, identity badge surfaces and connections (eg, clips, keys, pens) were cultured. The study was conducted from July to August 2006. Main Outcome Measure(s): Presence of pathogenic bacteria on identity badges and lanyards; differences in bacterial counts on items carried by nurses and doctors. Result(s): A total of 27 lanyards were identified with pathogenic bacteria, compared with 18 badges. Analysing lanyards and badges as a combined group, seven had methicillin-resistant Staphylococcus aureus, 29 had methicillin-sensitive S. aureus (MSSA), four had Enterococcus spp and five had aerobic gram-negative bacilli. Lanyards were found to be contaminated with 10 times the median bacterial load per area sampled compared with identity badges. There were no significant differences between nurses and doctors in total median bacterial counts on items carried, but doctors had 4.41 times the risk of carrying MSSA on lanyards (95% CI, 1.14-13.75). Conclusion(s): Identity badges and lanyards worn by HCWs may be contaminated with pathogenic bacteria, which could be transmitted to patients. In view of this finding we suggest appropriate infection control interventions.