Öz
Aim: In preventing healthcare-associated infections, it's crucial to follow basic practices like handwashing, maintaining clean environments, adhering to isolation rules, and conducting active surveillance and staff training by the Infection Control Committee. This study aimed to share the experience of managing carbapenem-resistant Enterobacteriaceae (CRE) outbreaks and evaluate the implemented measures
Materials and Methods: All patients hospitalized in the Organ Transplant Service between 05.22.20 and 06.14.20 were included in the study, and Infection Control Committee surveillance records and meeting minutes were used during data collection and retrospective evaluation.
Results: Due to an increase in the number of patients under contact isolation in the Transplant Unit because of carbapenem-resistant Enterobacteriaceae infection/colonization (5 infections, 1 colonization), it was planned to conduct rectal swab screenings among patients without infection/colonization. As a result, rectal swab cultures were obtained from 32 patients. Among the screened patients, eight (8/32 - 25%) were found to be colonized with CRE. Following the practices, observations, and training conducted by the Infection Control Committee to prevent the spread of CRE, it was observed that the number of isolated patients (two patients) had significantly decreased
Conclusion: Failure to comply with standard precautions and contact isolation may lead to increased incidence of CRE colonization and infections. In preventing the spread of CRE, basic preventive measures such as hand hygiene and contact isolation, as well as determined implementation and training of the Infection control committee, are vital.
Anahtar Kelimeler
Nosocomial infection Enterobacteriaceae Carbapenem resistance
Kaynakça
- Gozel MG, Hekimoglu CH, Gozel EY, et al. National Infection Control Program in Turkey: The healthcare associated infection rate experiences over 10 years. Am J Infect Control 2021; 49(7):885-892.
- Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE). November 2015 Update - CRE Toolkit National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion. 2015.
- Önal U, Sipahi OR, Pullukçu H, et al. Retrospective evaluation of the patients with urinary tract infections due to carbapenemase producing Enterobacteriaceae. J Chemother 2020;32(1):15–20. Sağlık hizmeti ilişkili enfeksiyonlar sürveyans ağı (USHİESA) özet raporu. 2022 [cited 2023 Dec 8th]; Available from: https://hsgm.saglik.gov.tr/depo/birimler/bulasici-hastaliklar-ve-erken-uyari db/Dokumanlar/Raporlar/USHIESA_OZET_RAPORU_2022.pdf
- European Centre for Disease Prevention and Control. Combined clonal and plasmid-mediated outbreak of carbapenemase-producing Enterobacterales in Lithuania, ECDC: Stockholm; 2020. [cited 2023 Dec 12th]; Available from: https://www.ecdc.europa.eu/en/publications-data/combined-clonal-and-plasmid-mediated outbreak-carbapenemase-producing Guidelines for the Prevention and Control of Carbapenem-Resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in Health Care Facilities. Geneva: World Health Organization. 2017 [cited 2023 Oct 3]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK493061/
- Enfield KB, Huq NN, Gosseling MF, et al. Control of simultaneous outbreaks of carbapenemase-producing enterobacteriaceae and extensively drug-resistant Acinetobacter baumannii infection in an intensive care unit using interventions promoted in the Centers for Disease Control and Prevention 2012 carbapenemase resistant Enterobacteriaceae Toolkit. Infect Control Hosp Epidemiol 2014;35(7):810-817.
- Hayden MK, Lin MY, Lolans K, et al. Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals. Clin Infect Dis 2015;60(8):1153–61.
- Implementation manual to prevent and control the spread of carbapenem-resistant organisms at the national and health care facility level. Geneva: World Health Organization. 2019;(6)
- Sönmezer MÇ, Tezer H, Parlakay A, et al. Control of a nosocomial outbreak due to multi drug resistant Pseudomonas aeruginosa in a pediatric intensive care unit. Turk J Pediatr Dis 2014;8(3), 124-128.
Öz
Amaç: Sağlık bakımı ile ilişkili enfeksiyonların önlenmesinde el yıkama, çevre temizliği, izolasyon kurallarına uyum gibi temel uygulamalar ile birlikte Enfeksiyon kontrol komitesinin yürüttüğü aktif sürveyans ve personel eğitimi büyük önem taşımaktadır. Bu çalışmada karbapenem dirençli Enterobacteriaceae (KDE) salgın yönetim tecrübesinin aktarılması ve yapılan uygulamaların değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Organ Nakli Servis’inde 22.05.20 ile 14.06.20 tarihleri arasında yatan tüm hastalar çalışmaya dahil edilerek, verilerin toplanması ve geriye dönük değerlendirilmesi sırasında Enfeksiyon Kontrol Komitesi sürveyans kayıtları ve toplantı tutanakları kullanılmıştır.
Bulgular: Organ Nakli Ünitesi’nde karbapenem dirençli Enterobacteriaceae enfeksiyonu/kolonizasyonu (5 enfeksiyon, 1 kolonizasyon) nedeniyle temas izolasyonunda izlenen hasta sayısının artması nedeniyle, enfeksiyon/kolonizasyonu olmayan hastalardan rektal sürüntü taraması yapılması planlanlanarak, 32 hastadan rektal sürüntü kültürü gönderildi. Tarama yapılan hastalardan sekizinde (8/32-%25) KDE kolonizasyonu saptandı. Enfeksiyon Kontrol Komitesi tarafından KDE yayılımının engellenmesi amacıyla yapılan uygulamalar, gözlemler ve eğitimler sonucunda izolasyondaki hasta sayısının (iki hasta) belirgin derecede azalmış olduğu gözlenmiştir.
Sonuç: Standart önlemler ve temas izolasyonuna uyumsuzluk KDE kolonizasyonu ve ardından enfeksiyonların daha sık görülmesine neden olabilir. KDE’lerin yayılımının önlenmesinde el hijyeni ve temas izolasyon gibi temel önleyici tedbirleri birlikte Enfeksiyon kontrol komitesinin kararlı uygulama ve eğitimleri büyük önem taşımaktadır.
Anahtar Kelimeler
Kaynakça
- Gozel MG, Hekimoglu CH, Gozel EY, et al. National Infection Control Program in Turkey: The healthcare associated infection rate experiences over 10 years. Am J Infect Control 2021; 49(7):885-892.
- Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE). November 2015 Update - CRE Toolkit National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion. 2015.
- Önal U, Sipahi OR, Pullukçu H, et al. Retrospective evaluation of the patients with urinary tract infections due to carbapenemase producing Enterobacteriaceae. J Chemother 2020;32(1):15–20. Sağlık hizmeti ilişkili enfeksiyonlar sürveyans ağı (USHİESA) özet raporu. 2022 [cited 2023 Dec 8th]; Available from: https://hsgm.saglik.gov.tr/depo/birimler/bulasici-hastaliklar-ve-erken-uyari db/Dokumanlar/Raporlar/USHIESA_OZET_RAPORU_2022.pdf
- European Centre for Disease Prevention and Control. Combined clonal and plasmid-mediated outbreak of carbapenemase-producing Enterobacterales in Lithuania, ECDC: Stockholm; 2020. [cited 2023 Dec 12th]; Available from: https://www.ecdc.europa.eu/en/publications-data/combined-clonal-and-plasmid-mediated outbreak-carbapenemase-producing Guidelines for the Prevention and Control of Carbapenem-Resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in Health Care Facilities. Geneva: World Health Organization. 2017 [cited 2023 Oct 3]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK493061/
- Enfield KB, Huq NN, Gosseling MF, et al. Control of simultaneous outbreaks of carbapenemase-producing enterobacteriaceae and extensively drug-resistant Acinetobacter baumannii infection in an intensive care unit using interventions promoted in the Centers for Disease Control and Prevention 2012 carbapenemase resistant Enterobacteriaceae Toolkit. Infect Control Hosp Epidemiol 2014;35(7):810-817.
- Hayden MK, Lin MY, Lolans K, et al. Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals. Clin Infect Dis 2015;60(8):1153–61.
- Implementation manual to prevent and control the spread of carbapenem-resistant organisms at the national and health care facility level. Geneva: World Health Organization. 2019;(6)
- Sönmezer MÇ, Tezer H, Parlakay A, et al. Control of a nosocomial outbreak due to multi drug resistant Pseudomonas aeruginosa in a pediatric intensive care unit. Turk J Pediatr Dis 2014;8(3), 124-128.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Bulaşıcı Hastalıklar |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Haziran 2024 |
| Gönderilme Tarihi | 6 Ekim 2023 |
| Yayımlandığı Sayı | Yıl 2024 |