Search

peer-reviewed, The cumulative incidence of candidaemia in an Irish intensive care unit (ICU) setting between January 2004 and August 2018 was 17/1000 ICU admissions. Candida albicans was responsible for 55% (N=41) of cases. C. glabrata (N=21, 28%) was the next most prevalent species, and has been identified most frequently since 2012. C. glabrata was associated with a higher mortality rate (57%) than C. albicans (29%). All isolates were susceptible to caspofungin (0.05 μg/mL). Notably, 37% of C. glabrata isolates were resistant to fluconazole, with 13% resistant to amphotericin B, highlighting the need for prudent antifungal stewardship to impede development of multi-drug-resistant C. glabrata in the ICU setting., ACCEPTED, peer-reviewed

peer-reviewed, Background: In Ireland, the setting for this study, the national prevalence rate of health careassociated infection (HCAI) in acute-care facilities is 5.2%. Hand hygiene and in particular hand rubbing using alcohol-based hand rub (ABHR) is highly efficacious in preventing HCAI transmission. Yet, compliance among healthcare professionals is sub-optimal. Less is known about the practices of nursing and medical students and no study comparing practices among these groups in Ireland was found. Hence, the aim of this study was to provide insight into the current hand hygiene and hand rubbing practices of nursing and medical students in Ireland and, by doing so, contribute to the broader understanding of this topic. Methods: This observational study employed a cross-sectional, self-reported design. An electronically administered questionnaire was sent to all nursing and medical students from one university. Data were analysed using appropriate software. Results: The response rate was 37% (323/872). Higher compliance with the World Health Organisation ‘my five moments for hand hygiene’ model was reported among nursing students (NS) than medical students (MS), with scope for improvement in both disciplines identified. Hand hygiene compliance was highest after body fluid exposure (99.5% NS, 91% MS) and lowest after touching a patient’s surroundings (61.5 % NS, 57.5% MS). Attitudes towards hand rubbing were largely positive in both disciplines. 16% of NS were not aware of the clinical contraindications to ABHR use, compared to 45% of MS. 9% of NS did not know when to use soap and water and when to use ABHR, compared to 36% of MS. In contrast, more medical students (46%) than nursing students (22%) were routinely using alcohol-based hand rub for decontamination of hands as recommended. Conclusions: Results suggest scope to review current hand hygiene curricula focusing on the knowledge gaps, the practice deficits and the barriers to ABHR usage identified., ACCEPTED, peer-reviewed

peer-reviewed, Background: Hand hygiene is the cornerstone of infection prevention and control practices, and reduces healthcare-associated infections significantly. However, international evidence suggests that medical doctors demonstrate poor compliance. Aim: To explore and compare practices and attitudes towards hand hygiene, particularly hand rubbing using alcohol-based hand rub (ABHR), among hospital-based physicians in Ireland between 2007 and 2015. Methods: In 2007, a random sample of doctors in a large teaching hospital was invited to complete a postal survey using a validated questionnaire. In 2015, the study was replicated among all doctors employed in a university hospital group, including the setting of the original study, using an online survey. Data were analysed using SPSS and Survey Monkey. Findings: Predominately positive and improving attitudes and practices were found, with 86% of doctors compliant with hand hygiene before patient contact in 2015, compared with 58% in 2007. Ninety-one percent of doctors were compliant after patient contact in 2015, compared with 76% in 2007. In 2015, only 39% of respondents reported that they ‘almost always’ used ABHR for hand hygiene. However, this represents 13.5% more than in 2007. Stated barriers to use of ABHR included dermatological issues, poor acceptance, tolerance and poor availability of ABHR products. Conclusion: Greater awareness of hand hygiene guidelines and greater governance appear to have had a positive impact on practice. However, despite this, practice remains suboptimal and there is scope for substantial improvement. Continued and sustained efforts are required in order to build on progress achieved since the World Health Organization hand hygiene guidelines were published in 2009., ACCEPTED, peer-reviewed

peer-reviewed, Recognized issues with poor hand hygiene compliance among healthcare workers and reports of recontamination of previously chemically disinfected surfaces through hand contact emphasize the need for novel hygiene methods in addition to those currently available. One such approach involves antimicrobial (nano) coatings (AMCs), whereby integrated active ingredients are responsible for elimination of micro-organisms that come into contact with treated surfaces. While widely studied under laboratory conditions with promising results, studies under real-life healthcare conditions are scarce. The views of 75 contributors from 30 European countries were collated regarding specialized cleaning associated with AMCs for reduction of healthcare-associated infection. There was unanimous agreement that generation of scientific guidelines for cleaning of AMCs, using traditional or new processes, is needed. Specific topics included: understanding mechanisms of action of cleaning materials and their physical interactions with conventional coatings and AMCs; that assessments mimic the life cycle of coatings to determine the impact of repetitive cleaning and other aspects of ageing (e.g. exposure to sunlight); determining concentrations of AMC-derived biocides in effluents; and development of effective de-activation and sterilization treatments for cleaning effluents. Further, the consensus opinion was that, prior to widespread implementation of AMCs, there is a need for clarification of the varying responsibilities of involved clinical, healthcare management, cleaning services and environmental safety stakeholders., peer-reviewed

peer-reviewed, Sir, Philip Larkin wrote “man hands on misery to man”. The poet was born in 1922 at the birth of the modern “antibiotic era” and, while he was not referring to infection, the phrase reflects the microbiological phenomenon. Early career doctors, nurses and IPC professionals should feel empowered to report their work and not be over-awed by perceived restrictions or hierarchical clinical and management structures. However, their early career focus is likely to be dominated by ambition for professional success. Controversy, “rocking of boats” and association with incidents of emerging drug resistance may, perhaps, be viewed as best avoided. And such was the case, in 2005, when a 15 year old male cystic fibrosis patient presented with a linezolid-resistant methicillin-sensitive Staphylococcus aureus G2576T mutation secondary to the prolonged use of linezolid by his attending physican in the absence of any specialist advice. Although now superceded by reports in 2006 and 2010 1,2 of similar incidences, at that time we did not publish our learning regarding risks associated with prolonged monotherapy in this setting, ineffective dosing and subsequent bacteriostatic activity., ACCEPTED, peer-reviewed

peer-reviewed, Letter to editor, ACCEPTED, peer-reviewed

peer-reviewed, Background Carbapenemase-producing Enterobacteriaceae (CPE) can cause healthcare–associated infections with high mortality rates. New Delhi metallo-beta-lactamase-1 (NDM-1) is amongst the most recently discovered carbapenemases. Aim To report the first outbreak of NDM-1 CPE in Ireland, including microbiological and epidemiological characteristics, and assessing the impact of infection prevention and control measures. Methods Retrospective microbiological and epidemiological review. Cases were defined as patients with a CPE positive culture. Contacts were designated as roommates or ward mates. Findings This outbreak involved ten patients, with a median age of 71 years (range 45-90 years), located in three separate but affiliated healthcare facilities. One patient was infected (the index case); the nine others were colonised. Nine NDM-1-producing Klebsiella pneumoniae, a NDM-1-producing Escherichia coli and a K. pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae were detected between week 24 2014 and week 37 2014. Pulsed field gel electrophoresis demonstrated similarity. NDM-1 positive isolates were meropenem resistant with MICs ranging from 12 to 32 μg/ml. All were tigecycline susceptible (MICs ≤1 μg/ml). One isolate was colistin resistant (MIC 4.0 μg/ml; mcr-1 gene not detected). In 2015, four further NDM-1 isolates were detected. Conclusions The successful management of this outbreak was achieved via the prompt implementation of enhanced infection prevention and control practices to prevent transmission. These patients did not have a history of travel outside of Ireland, but a number had frequent hospitalisations in Ireland, raising concerns regarding the possibility of increasing but unrecognised prevalence of NDM-1 and potential decline in value of travel history a marker of colonisation risk., ACCEPTED, peer-reviewed

peer-reviewed, Letter to Editor, ACCEPTED, peer-reviewed

peer-reviewed, Background: Escherichia coli (E. coli) comprise part of the normal vaginal microflora. Transfer from mother to neonate can occur during delivery resulting, sometimes, in neonatal bacterial disease. Here, we aim to report the first outbreak of CTX-M ESBL-producing E. coli with evidence of mother-to-neonate transmission in an Irish neonatal intensive care unit (NICU) followed by patient-to-patient transmission. Methods: Investigation including molecular typing was conducted. Infection was defined by clinical and laboratory criteria and requirement for antimicrobial therapy with or without positive blood cultures. Colonisation was determined by isolation without relevant symptoms or indicators of infection. Results: Index case was an 8-day-old baby born at 34 weeks gestation who developed ESBL-producing E. coli infections at multiple body sites. Screening confirmed their mother as colonised with ESBL-producing E. coli. Five other neonates, in the NICU simultaneously with the index case, also tested positive. Of these, four were colonised while one neonate developed sepsis, requiring antimicrobial therapy. The second infected neonate’s mother was also colonised by ESBL-producing E. coli. Isolates from all eight positive patients (6 neonates, 2 mothers) were compared using pulsed-field gel electrophoresis (PFGE). Two distinct ESBL-producing strains were implicated, with evidence of transmission between mothers and neonates for both strains. All isolates were confirmed as CTX-M ESBL-producers. There were no deaths associated with the outbreak. Conclusions: Resources were directed towards control interventions focused on hand hygiene and antimicrobial stewardship, which ultimately proved successful. Since this incident, all neonates admitted to the NICU have been screened for ESBL-producers and expectant mothers are screened at their first antenatal appointment. To date, there have been no further outbreaks., PUBLISHED, peer-reviewed

peer-reviewed, no abstract available, ACCEPTED, peer-reviewed

peer-reviewed, Background The Mid-West of Ireland has higher than average national rates of invasive extended-spectrum beta-lactamase (ESBL) bloodstream infections and carbapenemase-producing Enterobacteriaceae (CPE), with increasing numbers of ESBL isolates detected in community-dwelling patients. Aims To conduct a point prevalence study in a convenience sample of the Mid-West population with the aim of determining the extent of ESBL colonisation Methods Utilising anonymised community stool samples that had completed routine analysis, we conducted a point prevalence study over a four-week period on all samples that met defined inclusion and exclusion criteria. Limited epidemiological data was recorded: (1) age of patient, (2) gender, (3) sender location. From these stool specimens, rectal swabs were inoculated (eSwab™ 480CE, Copan, Italy), which were subsequently cultured on selective chromogenic agar (Colorex™ ESBL). Culture plates were incubated aerobically at 37˚C for 24 hours. Results Of 195 samples processed, 58% (n=112) were from females. The median patient age was 62.4 years (range 20-94 years). 186 samples (95%) originated from general practitioner clinics. During the study period, only nine eligible stool samples were received from LTCF (6 public). From 195 Colorex™ ESBL chromogenic agar plates cultured, no ESBL-producing organisms were detected. Conclusions This community point prevalence study did not identify ESBL-colonisation despite high numbers of patients with invasive ESBL bloodstream infections presenting for admission in our institution. We believe this may be because of our small sample size. Data regarding antimicrobial exposure and other risk factors for ESBL-colonisation was also not available. We remain vigilant for ESBL-producing organisms., ACCEPTED, peer-reviewed

peer-reviewed, Rapid detection of patients with carbapenem-producing Enterobacteriaceae (CPE) is essential for the prevention of nosocomial cross-transmission, allocation of isolation facilities and to protect patient safety. Here, we aimed to design a new laboratory work-flow, utilising existing laboratory resources, in order to reduce time-to-diagnosis of CPE. A review of the current CPE testing processes and of the literature was performed to identify a real-time commercial polymerase chain reaction (PCR) assay that could facilitate batch testing of CPE clinical specimens, with adequate CPE gene coverage. Stool specimens (210) were collected; CPE-positive inpatients (n=10) and anonymised community stool specimens (n=200). Rectal swabs (eSwab™) were inoculated from collected stool specimens and a manual DNA extraction method (QIAamp® DNA Stool Mini Kit) was employed. Extracted DNA was then processed on the Check-Direct CPE® assay. The three step process of making the eSwab™, extracting DNA manually and running the Check-Direct CPE® assay, took <5 minutes, 1 hour 30 minutes and 1 hour 50 minutes, respectively. It was time efficient with a result available in under 4 hours, comparing favourably with the existing method of CPE screening; average time-to-diagnosis of 48/72 hours. Utilising this CPE work-flow would allow a ‘same-day’ result. Antimicrobial susceptibility testing results, as is current practice, would remain a ‘next-day’ result. In conclusion, the Check-Direct CPE® assay was easily integrated into a local laboratory work-flow and could facilitate a large volume of CPE screening specimens in a single batch, making it cost-effective and convenient for daily CPE testing., ACCEPTED, peer-reviewed

peer-reviewed, Contaminated blood cultures represent challenges regarding diagnosis, duration of hospitalization, antimicrobial use, pharmacy and laboratory costs. Facing problematic neonatal blood culture contamination (3.8%), we instigated a successful intervention combining skin antisepsis using sterile applicators with 2% chlorhexidine gluconate in 70% isopropanol prior to phlebotomy (replacing 70% isopropanol) and staff education. In the six months prior to intervention, 364 neonatal peripheral blood samples were collected. Fourteen (3.8%) were contaminated. In the post-intervention six months, 314 samples were collected. Three (0.96%) were contaminated, representing significant improvement (Fisher’s exact test: P= 0.0259). No dermatological sequelae were observed. The improvement has been sustained., ACCEPTED, peer-reviewed

non-peer-reviewed, Full text of this available at http://hdl.handle.net/10344/4486, no abstract available, PUBLISHED, Not peer reviewed

non-peer-reviewed, Full text available at http://hdl.handle.net/10344/4519, no abstract available, PUBLISHED, Not peer reviewed

peer-reviewed, Background: Burkholderia contaminans is an emerging pathogen in the cystic fibrosis (CF) setting. Included in the Burkholderia cepacia complex (Bcc), B. contaminans is a Gram negative, motile, obligate aerobe previously classified as a pseudomonad. Previous reports have described B. contaminans isolation from patients in Portugal, Switzerland, Spain, Argentina and the USA. This, however, is the first report relating to B. contaminans affecting Irish patients with CF, initially detected in a paediatric setting. Case presentation: Burkholderia contaminans was identified in the routine analysis of sputum from a fourteen year old boy, at his annual review and subsequently from the sputum from his 19 year old brother. RecA gene sequencing and pulsed field gel electrophoresis (PFGE) were unable to distinguish between the isolates, which demonstrated with susceptibility to ciprofloxacin, cotrimoxazole, meropenem, pipercillin/tazobactam and ceftazidime. Both isolates were resistant to aztreonam, with reduced susceptibility to tobramycin. Following treatment with intravenous meropenem and ceftazidime, oral ciprofloxacin and nebulised tobramycin for 6 weeks, sputum specimens from both patients were negative for B. contaminans. No other member of the local CF cohort proved positive. Conclusions: Bcc bacteria are associated with poor prognosis in CF and decreased life expectancy, specifically leading to a more rapid decline in lung function and, in some cases, to a fatal necrotizing pneumonia known as the “cepacia syndrome”. Some species exhibit innate resistance to multiple antimicrobial agents and their transmission rate can be high in susceptible patients. In that context, we describe the first incidence of CF-related B. contaminans in Ireland and its successful eradication from two patients, one paediatric, using an aggressive antimicrobial regimen., PUBLISHED, peer-reviewed