A brand new examine by researchers on the College of Utah suggests some of the frequent healthcare-associated infections (HAIs) spreads extra extensively in intensive care items (ICUs) than beforehand understood.
The findings, printed final week in JAMA Community Open, are based mostly on genomic evaluation of Clostridium difficile isolates collected from two ICUs in Utah in 2018. The researchers have been aiming to quantify charges of C issue unfold throughout the 2 ICUs and describe transmission dynamics. C issue causes extreme diarrhea and is a number one reason for HAIs around the globe, accounting for 223,000 hospitalizations and 12,800 deaths in america annually.
Whereas most genomic research of C issue transmission in hospitals analyze affected person samples, this examine additionally included sampling of healthcare supplier (HCP) fingers and the hospital atmosphere to grasp how the pathogen strikes between sufferers and hospital surfaces. What the researchers discovered was that just about 8% of admitted sufferers had C issue that was genetically linked to a different sufferers, and that motion of the pathogen was greater than threefold greater than if that they had relied on affected person sampling alone.
“There’s lots occurring beneath the hood that we’re simply not seeing,” senior examine writer Michael Rubin, MD, PhD, an epidemiologist and infectious illness specialist on the College of Utah, mentioned in a college press launch.
Expanded sampling captures extra C diff transmission
Through the 13-week examine, researchers collected every day samples from three affected person physique websites, three surfaces in affected person rooms (affected person contact surfaces, HCP contact surfaces, and bathroom surfaces), and fingers or gloves of HCPs who cared for the affected person. They then performed entire genome sequencing (WGS) on each toxigenic and nontoxigenic C issue isolates to establish transmission clusters (outlined as isolates with two or fewer single nucleotide variants between them). Nontoxigenic C issue strains are normally not related to an infection and never included in most surveillance research.
A complete of seven,000 samples have been collected throughout 278 distinctive ICU admissions over the course of the examine, with 177 sufferers consenting to body-site sampling. From these samples, researchers recovered 178 C issue isolates—46 from affected person physique websites, 87 from affected person rooms, 1 from a shared environmental floor, and 44 from HCP fingers.
There’s lots occurring beneath the hood that we’re simply not seeing.
WGS evaluation recognized seven transmission clusters involving 22 (7.7%) of 287 occupant stays. Of the clusters, two included isolates from two distinct occupants’ physique websites, suggesting patient-to-patient transmission, whereas two others included environmental or HCP hand isolates and affected person isolates, which implies a affected person acquired from or shed the pathogen into the atmosphere or the fingers of an HCP caring for one more occupant. The remaining 3 included isolates from environmental surfaces from a number of occupant stays. Solely two of the 22 clustered occupant stays concerned sequential occupants of the identical room.
“Importantly, 5 of those transmission clusters (71.4%) would have been missed with out the expanded sampling of environmental surfaces and HCP fingers as a result of they didn’t embrace affected person physique website isolates from a number of occupant stays,” the examine authors wrote.
The authors word that many of the C issue isolates have been nontoxigenic and that solely two sufferers, each in the identical hospitals, have been recognized as having C issue an infection. However the truth that so lots of the transmission clusters included isolates from environmental surfaces and HCP fingers suggests C issue transmission in ICUs has been underestimated in earlier research, and it might point out lapses in an infection prevention and management that might enable for the unfold of toxigenic It is troublesome.
“What I am hoping we get from this paper is that well being care suppliers put a better emphasis on an infection prevention measures and cling to them as a lot as they presumably can,” Rubin mentioned.
