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    The dynamics of Enterococcus transmission from bacterial reservoirs commonly encountered by anesthesia providers

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    Authors
    Loftus, Randy W.
    Koff, Matthew D.
    Brown, Jeremiah R.
    Patel, Hetal M.
    Jensen, Jens T.
    Reddy, Sundara
    Ruoff, Kathryn L.
    Heard, Stephen O.
    Yeager, Mark P.
    Dodds, Thomas M.
    UMass Chan Affiliations
    Department of Anesthesiology
    Document Type
    Journal Article
    Publication Date
    2015-04-01
    Keywords
    Adult
    Aged
    Anesthesia
    Anesthesiology
    Anti-Bacterial Agents
    Cross Infection
    Electrophoresis, Gel, Pulsed-Field
    *Enterococcus faecalis
    Equipment Contamination
    Equipment Design
    Female
    Gram-Positive Bacterial Infections
    Hand
    Hand Disinfection
    Humans
    Male
    Microbial Sensitivity Tests
    Middle Aged
    Operating Rooms
    Phenotype
    Postoperative Period
    Prospective Studies
    Time Factors
    Anesthesiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1213/ANE.0000000000000123
    Abstract
    BACKGROUND: Enterococci, the second leading cause of health care-associated infections, have evolved from commensal and harmless organisms to multidrug-resistant bacteria associated with a significant increase in patient morbidity and mortality. Prevention of ongoing spread of this organism within and between hospitals is important. In this study, we characterized Enterococcus transmission dynamics for bacterial reservoirs commonly encountered by anesthesia providers during the routine administration of general anesthesia. METHODS: Enterococcus isolates previously obtained from bacterial reservoirs frequently encountered by anesthesiologists (patient nasopharynx and axilla, anesthesia provider hands, and the adjustable pressure-limiting valve and agent dial of the anesthesia machine) at 3 major academic medical centers were identified as possible intraoperative bacterial transmission events by class of pathogen, temporal association, and phenotypic analysis (analytical profile indexing). They were then subjected to antibiotic disk diffusion sensitivity for transmission event confirmation. Isolates involved in confirmed transmission events were further analyzed to characterize the frequency, mode, origin, location of transmission events, and antibiotic susceptibility of transmitted pathogens. RESULTS: Three hundred eighty-nine anesthesia reservoir isolates were previously identified by gross morphology and simple rapid tests as Enterococcus. The combination of further analytical profile indexing analysis and temporal association implicated 43% (166/389) of those isolates in possible intraoperative bacterial transmission events. Approximately, 30% (49/166) of possible transmission events were confirmed by additional antibiotic disk diffusion analysis. Two phenotypes, E5 and E7, explained 80% (39/49) of confirmed transmission events. For both phenotypes, provider hands were a common reservoir of origin proximal to the transmission event (96% [72/75] hand origin for E7 and 89% [50/56] hand origin for E5) and site of transmission (94% [16/17] hand transmission location for E7 and 86% [19/22] hand transmission location for E5). CONCLUSIONS: Anesthesia provider hand contamination is a common proximal source and transmission location for Enterococcus transmission events in the anesthesia work area. Future work should evaluate the impact of intraoperative hand hygiene improvement strategies on the dynamics of intraoperative Enterococcus transmission.
    Source
    Anesth Analg. 2015 Apr;120(4):827-36. doi: 10.1213/ANE.0000000000000123. Link to article on publisher's site
    DOI
    10.1213/ANE.0000000000000123
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/25758
    PubMed ID
    24937346
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1213/ANE.0000000000000123
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