Nosocomial transmission

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Nosocomial transmission of chickenpox and varicella zoster virus seroprevalence rate amongst healthcare workers in a teaching hospital in China

Nosocomial transmission of chickenpox and varicella zoster virus seroprevalence rate amongst healthcare workers in a teaching hospital in China

In order to investigate whether self-reported history could replace serum VZV IgG screening in HCWs, self- reported history of varicella in HCWs was compared with the serum VZV IgG result to assess the reliability of self-reported history. Our study suggested that a posi- tive history of varicella provided by HCWs is not a good predictor of positive serum VZV IgG, as our study dem- onstrated a false positive rate of 19.2%. On the other hand, 89.4% of HCWs with a negative history of varicella turned out to be seropositive, suggesting negative self- reported history could not rule out existing immunity towards VZV. Review of literature from different coun- tries suggested a self-reported history of varicella has a positive predictive value of 92.5 – 99.5% and a negative predictive value of 2.5–14.4% [24–27]. Comparison of the above data suggested that the negative predictive value from our study is similar to that reported in the literature. However, the positive predictive value is only 80.8% in our study. As natural varicella usually occurred during childhood, healthcare workers could only rely on their parents for the history of varicella. One possible postulation for the above discrepancy could be due to the lower level of education in the past in China, as it may be difficult for parents to distinguish between vari- cella and other febrile exanthematous diseases, leading to lower positive predictive value in this case. Hence, self-reported history of varicella is not a reliable pre- dictor of VZV immunity in our locality, therefore screening of serum VZV IgG for all HCWs is indicated, and susceptible workers should be vaccinated so as to prevent nosocomial transmission of varicella.
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Nonperinatal Nosocomial Transmission ofCandida albicans in a Neonatal Intensive Care Unit: Prospective Study

Nonperinatal Nosocomial Transmission ofCandida albicans in a Neonatal Intensive Care Unit: Prospective Study

Nosocomial Candida albicans infections have become a major cause of morbidity and mortality in neonates in neonatal intensive care units (NICUs). To determine the possible modes of acquisition of C. albicans in hospitalized neonates, we conducted a prospective study at Grady Memorial Hospital, Atlanta, Ga. Clinical samples for fungal surveillance cultures were obtained at birth from infants (mouth, umbilicus, and groin) and their mothers (mouth and vagina) and were obtained from infants weekly until they were discharged. All infants were culture negative for C. albicans at birth. Six infants acquired C. albicans during their NICU stay. Thirty-four (53%) of 64 mothers were C. albicans positive (positive at the mouth, n 5 26; positive at the vagina, n 5 18; positive at both sites, n 5 10) at the time of the infant’s delivery. A total of 49 C. albicans isolates were analyzed by restriction endonuclease analysis and restriction fragment length polymorphism analysis by using genomic blots hybridized with the CARE-2 probe. Of the mothers positive for C. albicans, 3 of 10 were colonized with identical strains at two different body sites, whereas 7 of 10 harbored nonidentical strains at the two different body sites. Four of six infants who acquired C. albicans colonization in the NICU had C. albicans- positive mothers; specimens from all mother-infant pairs had different restriction endonuclease and CARE-2 hybridization profiles. One C. albicans-colonized infant developed candidemia; the colonizing and infecting strains had identical banding patterns. Our study indicates that nonperinatal nosocomial transmission of C. albicans is the predominant mode of acquisition by neonates in NICUs at this hospital; mothers may be colonized with multiple strains of C. albicans simultaneously; colonizing C. albicans strains can cause invasive disease in neonates; and molecular biology-based techniques are necessary to determine the epidemiologic relatedness of maternal and infant C. albicans isolates and to facilitate determination of the mode of transmission.
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No nosocomial transmission under standard hygiene precautions in short term contact patients in case of an unexpected ESBL or Q&A E. coli positive patient: a one-year prospective cohort study within three regional hospitals

No nosocomial transmission under standard hygiene precautions in short term contact patients in case of an unexpected ESBL or Q&A E. coli positive patient: a one-year prospective cohort study within three regional hospitals

During a study period of 1 year, a nosocomial transmis- sion rate of 0% from unexpected HR-GNR positive patients to contact patients was found. Out of 152 unex- pected HR-GNR positive patients, 35 patients met our inclusion criteria for index patients. Around these 35 index patients, 69 contact patients were sampled, accounting for a total of 178 contact days. Although no nosocomial transmission had occurred, five contact patients were HR-GNR positive (7.2%) and four of these were ESBL E. coli positive (5.8%), which corresponds with earlier reported prevalence rates in Dutch hospitals [6, 27]. As expected, ESBL positive patients were found most frequently among all HR-GNR positive patients (68.6%) and index patients (68.6%). From a micro- organism perspective, 85.7% of the index patients were positive for an HR-GNR E. coli. MRSA, VRE (Vancomycin- resistant Enterococcus) and PRSP (Penicillin-resistant Streptococcus pneumoniae) were not included in the present study.
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Ruling out nosocomial transmission of Cryptosporidium in a renal transplantation unit: case report

Ruling out nosocomial transmission of Cryptosporidium in a renal transplantation unit: case report

As our report demonstrates, the detection of three different Cryptosporidium species in three cryptospor- idiosis patients excluded the possibility of nosocomial transmission in the Nephrology unit, where renal trans- plant patients frequently consult and come into contact with each other. Our findings highlight the risk of symptomatic cryptosporidiosis in immunosuppressed renal transplant patients. In 2014, nine out of ten pa- tients with cryptosporidiosis diagnosed by the medical Parasitology and Mycology laboratory of the Strasbourg University Hospital were renal transplant patients (un- published data). In a pediatric renal transplantation unit, Cryptosporidium spp. was confirmed as the princi- pal cause of diarrhea in patients between 6 months and 12 years of age following transplantation. In Poland and India, the prevalence of Cryptosporidium spp. in renal transplant patients was reported to be 18.8 and 20 %, respectively [21, 22]. Cryptosporidium spp. infections were more commonly associated with profuse watery diarrhea in solid-organ recipients than in immunocom- petent patients [21, 23, 24]. Our patients undergoing combined immunosuppressive therapies exhibited watery diarrhea for several weeks before consulting, suggesting that the prevalence of Cryptosporidium spp. infections is probably underestimated in renal transplant units where screening of patients with diarrhea is not rou- tinely performed. In all three of our patients, the symp- toms completely resolved within 8 days to 1 month, in line with previous reports of slower recovery duration compared to immunocompetent patients in whom diarrhea symptoms usually cease after 10 to 15 days without treatment [3, 16]. Considering the role of im- munosuppression in the appearance and persistence of cryptosporidiosis, we opted to reduce the immunosup- pressive regimen in two of our patients, which, in asso- ciation with the anticryptosporidial agent, could prove
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Evidence for nosocomial transmission of Candida albicans obtained by Ca3 fingerprinting

Evidence for nosocomial transmission of Candida albicans obtained by Ca3 fingerprinting

The fact that our evidence indicates transmission of groups of similar strains rather than of a single strain allows some conclusions to be drawn regarding the possible scenario un- derlying these transmissions. It seems likely that the progeni- tors of the two groups of strains transmitted became estab- lished in the hospital in the past and that their progeny have since evolved while spreading throughout the hospital environ- ment; such spread may involve not only contact between hu- man hosts but also inanimate surfaces and food (21). We are now in the process of identifying the reservoirs of these strains and vehicles of their transmission in the hospital environment. Our findings also suggest one reason why previous attempts to demonstrate nosocomial transmission of C. albicans have yielded inconclusive results (5). Since the methods employed lacked the capability to group strains according to their simi- larity, they could have detected only single-strain transmission and not transmission of groups of genetically similar strains.
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Nosocomial Transmission of Group B Streptococci

Nosocomial Transmission of Group B Streptococci

Wilkinson HW, Facklam RR, Wortham EC: Distribu- tion by serological type of group B streptococci isolated from a variety of clinical material over a five-year period (with special refere[r]

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A nosocomial transmission of crimean congo hemorrhagic fever to an attending physician in north kordufan, Sudan

A nosocomial transmission of crimean congo hemorrhagic fever to an attending physician in north kordufan, Sudan

Nos.GQ862371-2) were identified as etiologic agents of the nosocomial outbreak [4]. We have also reported on an outbreak in Donkup village, Abyei District, South Kordufan [5]. Despite the fact that the Alfulah and Abyei strains belong to group III genetic lineage of CCHFV they are genetically distinct from each other and were identified as unique strains of the Sudanese CCHFV. Abyei and Alfulah virus strains are considered to be responsible for the emergence of the disease in Western and Southern region of Kordufan [4,5]. How- ever, CCHF has never been reported in North Kordufan. In February, 2010, an index patient from Lagawa Dis- trict, Southern Kordufan, Sudan, was admitted to Lagawa Rural Hospital, with an acute hemorrhagic ill- ness. Lagawa District is approximately 50 Kilometers from Alfulah, the origin of the first CCHF outbreak in Sudan. The index patient is a 60-years-old male who was admitted with clinical presentation of an acute feb- rile hemorrhagic illness. The symptoms included rapid onset of fever, headache, nausea, vomiting of blood, and bloody diarrhea. The source of infection was suspected to have been the result of consumption of raw liver of an infected sheep. He complained of high grade fever, chills, headache, epistaxis, vomiting of blood and bloody diarrhea. He had taken anti-malarial medication at home without improvement. The patient was then transferred to Kadogli Hospital, the referral hospital for the State of Southern Kordufan, approximately 200 kilo- meters from Lagawa District. As the medical facilities in Kadogli Hospital are limited, his health condition dete- riorated very rapidly and thus the patient sought addi- tional health care at Elobied Hospital, the capital of North Kordufan State. At Elobied Hospital, the patient was subjected to medical examination by the attending physician on Saturday, 20/02/2010 and was provided medical care by nurse. Clinical investigations were con- ducted and blood samples were collected after which the patient was referred to Khartoum for further medi- cal care. The patient was taken care of at the hospital and he survived the infection and discharged from the hospital in a good health.
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Nosocomial Transmission of CTX M 2 β Lactamase Producing Acinetobacter baumannii in a Neurosurgery Ward

Nosocomial Transmission of CTX M 2 β Lactamase Producing Acinetobacter baumannii in a Neurosurgery Ward

A. baumannii strains which produce plasmid-mediated CTX- M-type ␤-lactamases or TEM- and SHV-derived ESBLs are still very rare. The class A ␤-lactamases PER-1 and VEB-1, which are genetically distant from the predominant TEM- and SHV-derived ESBLs and CTX-M-type enzymes, were first re- ported among nosocomial A. baumannii isolates in Turkish and French hospitals (41, 52). Similar strains have subse- quently been isolated in France (40) and Korea (26). Among the CTX-M-type ␤-lactamases, the CTX-M-5 gene has been found in A. baumannii (GenBank accession number AF462635); however, no details have been published to date. A. baumannii usually produces a chromosomally encoded AmpC cephalosporinase, but this kind of enzyme generally cannot hydrolyze oxyiminocephalosporins, cephamycins, or carbapenems. Therefore, acquisition of plasmid-mediated en- zymes with broad- and extended-spectrum substrate specifici- ties could well allow this bacterial species to survive in present clinical environments. A. baumannii has become one of the major groups of bacteria that causes respiratory infections, especially among patients in intensive care units. Thus, the emergence of CTX-M-2-producing A. baumannii strains could become a serious clinical problem in Japan, because CTX-M- 2-producing as well as CTX-M-1-producing microorganisms have already been frequently found among clinical isolates from humans (5, 25, 55) and cattle (47).
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Nosocomial transmission of respiratory syncytial virus in immunocompromised adults

Nosocomial transmission of respiratory syncytial virus in immunocompromised adults

Respiratory syncytial virus RSV isolates obtained from nine infected immunocompromised adult patients hospitalized during two consecutive winters January through April 1987 and 1988 were[r]

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Nosocomial Transmission of Group B Streptococci in a Newborn Nursery

Nosocomial Transmission of Group B Streptococci in a Newborn Nursery

were no significant changes in colonization rates of either n#{236}others or infants l)etween the time of hospital discharge amid follow-tip evaluation four to eight weeks later. The vag[r]

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Case-fatality Ratio Due to Ebola Virus Disease in North-eastern Democratic Republic of the Congo in 2019

Case-fatality Ratio Due to Ebola Virus Disease in North-eastern Democratic Republic of the Congo in 2019

Health workers involved in the fight against the tenth EVD outbreak are accounting for an important death toll while working to protect the community. EVD among HWs is a challenge to control the current outbreak in DRC. Given the persistence of nosocomial transmission of Ebola virus disease among health care workers, it is important to question the effectiveness of the surveillance and communication system with not only the general population but also providers care. it is therefore urgent to strengthen the surveillance system and to implement strategies to overcome misconception about this outbreak and to really support behavioural change for HWs in order to reduce transmission in this population. The knowledge of the providers of care on the EVD must be reinforced in the areas at risk currently affected and not-affected.
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A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study

A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study

In conclusion, a nationwide study of all hemodialysis cen- ters in Kosovo showed an extremely high prevalence of HCV infection in hemodialysis patients. The relatively low prevalence of HCV infection in the general Kosovar popula- tion, the significant increase in the anti-HCV prevalence among hemodialysis patients in recent years, the predomin- ance of two otherwise rare HCV genotypes in the region, HCV infection associated with a longer duration of hemodialysis, and hemodialysis at more than one center in- dicate nosocomial transmission due to inappropriate infec- tion control practices as the main HCV transmission route. In most European countries, consistent reinforcement of hygienic precautions and/or isolation strategies in hemodialysis units has resulted in a substantial decrease of both the incidence and prevalence of HCV infection in hemodialysis units [35]. It seems that the WHO goal of eliminating HCV by 2030 might be difficult to achieve in settings similar to Kosovo if more rigorous measures are not implemented for effective control of HCV infection in the hemodialysis environment [36].
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A discrete events delay differential system model for transmission of vancomycin-resistant enterocuccus (VRE) in hospitals

A discrete events delay differential system model for transmission of vancomycin-resistant enterocuccus (VRE) in hospitals

Surveillance data from an oncology hospital unit on Vancomycin-resistant En- terococcus (VRE), one of the most prevalent and dangerous pathogens involved in hospital infections, is used to motivate possibilities of modeling nosocomial infec- tion dynamics. This is done in the context of hospital monitoring and isolation procedures as a prelude to the evaluation and improved design of control measures. A discrete event delay differential equation model in conjunction with statistical computational methods is formulated to estimate key population-level nosocomial transmission parameters and isolation procedures. This framework is used to test the surveillance data’s usefulness in model validation. In the process of model cal- ibration we discovered significant irregularities in the available surveillance data; these irregularities are most likely the result of the data observational recording- process as well as those in the isolation procedures. Efforts to fit data within our highly flexible dynamic-modeling framework suggest that clinical-trial level surveil- lance data is needed if one is to successfully develop quantitative models for disease transmission and intervention. It is concluded that typical “cold” data sets typ- ically encountered in biological/sociological quantitative modeling efforts may be inadequate for support of serious model development.
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Decision Making Amplification Under Uncertainty: An Exploratory Study of Behavioral Similarity and Intelligent Decision Support Systems

Decision Making Amplification Under Uncertainty: An Exploratory Study of Behavioral Similarity and Intelligent Decision Support Systems

8 Some populations are of increased risk to nosocomial transmission of drug-resistant TB such as patients with HIV infection and healthcare workers. HIV-positive status is related to higher risk of exposure to MDR-TB patients, due to increased hospitalizations in healthcare settings with inadequate infection control (WHO, 2010). Nosocomial transmission among healthcare workers (HCWs) is of particular concern because of the documented increase in rates of TB in this population: higher attributable risk of TB in this group compared to the general population (ranged from 25 to 5,361 per 100,000 per year), high prevalence of TB (on average 54% (range 33% to 79%)), and increased risk of developing latent tuberculosis (from 0.5% to 14.3%) (Joshi, Reingold, Menzies, & Pai, 2006). HCWs are a valuable and often scarce
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Molecular Evidence of Nosocomial Pneumocystis jirovecii Transmission among 16 Patients after Kidney Transplantation

Molecular Evidence of Nosocomial Pneumocystis jirovecii Transmission among 16 Patients after Kidney Transplantation

(12). Interestingly, renal transplant recipients seem to be at especially high risk of getting both a symptomatic or an asymp- tomatic Pneumocystis infection. The risk of developing PCP for patients after renal transplantation who are not receiving pro- phylaxis is approximately 5%, and in recent years, six case reports of renal transplant recipient clusters have been pub- lished (3, 4, 6, 10, 11, 20, 22). In three of these studies, P. jirovecii DNA was analyzed by molecular typing and identical P. jirovecii genotypes were found among several patients, indi- cating an interhuman, nosocomial transmission of P. jirovecii. In our study, P. jirovecii DNA obtained from respiratory secretions of 14 out of 16 renal transplantation recipients was MLST typed and compared to that of a control patient group of four immunocompromised patients. The different MLST types within the control patients and the unique MLST type of the transplantation cluster indicate that this is a suitable method of discriminating P. jirovecii clones. Moreover, se- quencing of the mt26S region was the most discriminative due to its variability compared to sequencing of the other genes. In contrast, ␤ -tub showed no variation between the different P. jirovecii sequences. This finding further demonstrates that each control patient was infected by an individual P. jirovecii clone and that the patients from the transplantation cluster were all infected by a single, undistinguishable clone. Whether patients 2 and 9 also belong to this cluster could not be determined by MLST because BAL specimens were not available, this but is likely because they were also visiting clinic 1, ward A, when PCP occurred. The fact that patients 1 to 7 and patients 9 to 16 were treated in the same inpatient and outpatient wards sug- gests close person-to-person contacts, which could support nosocomial transmission of P. jirovecii. Patients 2 to 7 and 9 to
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Clinical Profile and associations of tuberculosis among health care workers in South India

Clinical Profile and associations of tuberculosis among health care workers in South India

Every year 1.8 million people in India develop tuberculosis (TB). India accounts for one-fifth of the global TB incidence and is estimated to have the highest number of active TB cases amongst the countries of the world. Many hospitals in India handle large number of tuberculosis cases. The emergence of multidrug resistant tuberculosis has been reported to have caused outbreaks among health care workers in many hospitals. Various authorities have recommended measures to prevent the nosocomial transmission of tuberculosis. However scientific data demonstrating the efficacy of these measures is lacking. Delayed diagnosis of active pulmonary TB among hospitalized patients is common and believed to contribute significantly to nosocomial transmission. Various studies reported a risk of infection among workers exposed to patients with tuberculosis that was four to six times higher than the risk among unexposed workers. However the risk of tuberculosis among health care workers varies considerably among and within hospitals.
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Using Molecular Epidemiology To Trace Transmission of Nosocomial Norovirus Infection

Using Molecular Epidemiology To Trace Transmission of Nosocomial Norovirus Infection

Data collection and fecal specimens. Data on norovirus-positive cases diag- nosed between 2002 and 2007 were retrieved from the database of the hospital laboratory and grouped as nosocomial cases, outpatient cases, and community- acquired cases (1). We used a conservative estimate to ensure high specificity by considering the possibility of nosocomial transmission only if a patient was diagnosed with NoV infection for the first time ⬎4 days after admission. Patients who tested positive for NoV 0 to 1 day after admission were defined as having community-acquired cases. Patients with NoV-positive stools diagnosed 2 to 4 days after hospitalization were classified as indeterminate. On the basis of the ⬎4-day cutoff, 22 nosocomial clusters had previously been obtained using epi- demiological criteria (defined as ⱖ2 patients with nosocomial infection with NoV on the same ward within 5 days) (1). Background data listing the age of the patient, sex of the patient, ward where the patient was hospitalized, date of hospitalization, and date of onset of diarrhea were drawn from the hospital database. This extraction was done by an authorized person who also made the records anonymous prior to use by the research team, in compliance with reg- ulations on use of patient data.
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Epidemiological approach to nosocomial infection surveillance data: the Japanese Nosocomial Infection Surveillance System

Epidemiological approach to nosocomial infection surveillance data: the Japanese Nosocomial Infection Surveillance System

by APACHE II, operation and ventilator, and then obtains a SIR adjusted for these three factors. A SIR value of more than one indicates that the incidence of nosocomial infec- tions in the ICU is higher than the benchmark. Figure 3 shows SIRs of eight Japanese ICUs. For example, ICU5, ICU6 and ICU7 had a SIR of more than one in 2001. The SIR of ICU5 was gradually decreasing in 2002 and 2003, while, in contrast, those of ICU6 and ICU7 were increas- ing. One interpretation of these results is that ICU5 was successful in preventing infection while ICU6 and ICU7 had a potential problem in the infection control program and, therefore, should at the very least investigate the cause of the increasing incidence of nosocomial infection. The spreadsheet is simple and easy enough to be used by all infection control professionals, and it can reveal relative merits and secular changes in the incidence of nosocomial infections in the ICU. The use of the spreadsheet is expected to promote timely feedback of nosocomial infection surveillance data, which would allow infection control professionals to take prompt and efficient measures to prevent infection.
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Insufficient translation of knowledge among nurses towards management of nosocomial infections at Vihiga county Referral Hospital, Western Kenya

Insufficient translation of knowledge among nurses towards management of nosocomial infections at Vihiga county Referral Hospital, Western Kenya

Knowledge level on the nosocomial infections: Nosocomial infection are a public health concern as they diminish the quality of the healthcare delivered to patients. The risk of nosocomial infection has been reported to be the highest in developing countries including Kenya (Biberaj et al., 2014). The present study found out the participants had sufficient knowledge and attitude towards nosocomial infections despite them having acquire diploma level of education. However, their knowledge was lacking on certain areas, especially on nosocomial infection control. This was confirmed by the key informant interviews which revealed an uneven level of understanding of NIs among healthcare workers, particularly due to differences in predominant areas of deployment within the health facility, as well as the duration of service. The findings in this study are similar to that reported in a study carried out in University Clinical Center of Kosovo reported good knowledge and practice on the prevention of nosocomial infection (Gruda and Sopjani, 2017). Some research studies have reported nurses’ and physicians’ knowledge of the standard and isolation precautions to be insufficient, and impaired the control and prevention of nosocomial infections.
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Resource allocation: the main problem in infection control in intensive care units of hospitals

Resource allocation: the main problem in infection control in intensive care units of hospitals

Background and Purpose: Nosocomial infections, especially those occurring in intensive care units (ICUs), are one of the major health problems in every community. Nosocomial infections are associated with increased mortality rate and high treatment costs. Effective control of these infections essentially depends on the knowledge of healthcare providers regarding the detection and eradication of the associated causes. This study aimed to investigate the main challenges involved in the prevention and control of nosocomial infections in hospital ICUs.

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