After identifying
CHB as a source of CPSM , a widespread annual CHB cleaning intervention involving manual scrubbing of sink drains and the proximal pipes was implemented , as well as performance of pre- and postintervention point prevalence surveys ( PPS ) of CHB drains to assess for CPSM colonization . that multiple aggressively implemented infection control interventions targeting CDI “ demonstrated a disappointing impact on endemic CDI rates over six years .” They add that their study contributes to existing data that outside of an outbreak situation , traditional infection control guidance for CDI prevention has little impact on endemic rates .
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Kwong , et al . ( 2020 ) report on a prolonged outbreak of carbapenemase-producing Serratia marcescens ( CPSM ) in their healthcare center over a two-year period . A reservoir of IMP-4 – producing S . marcescens in sink drains of clinical hand basins ( CHB ) was implicated in propagating transmission , supported by evidence from whole-genome sequencing ( WGS ). The researchers assessed the impact of manual bioburden reduction intervention on further transmission of CPSM . Environmental sampling of frequently touched wet and dry areas around CPSM clinical cases was undertaken to identify potential reservoirs and transmission pathways . After identifying CHB as a source of CPSM , a widespread annual CHB cleaning intervention involving manual scrubbing of sink drains and the proximal pipes was implemented , as well as performance of pre- and postintervention point prevalence surveys ( PPS ) of CHB drains to assess for CPSM colonization . Surveillance for subsequent transmission was conducted through weekly screening of patients and annual screening of CHB in transmission areas , and six-monthly whole-hospital PPS of patients . All CPSM isolates were assessed by WGS . In total , 6 patients were newly identified with CPSM from 2015 to 2017 ( 4.3 transmission events per 100,000 surveillance bed days [ SBD ]). All clinical CPSM isolates were linked to CHB isolates by WGS . The CHB cleaning intervention resulted in a reduction in CHB colonization with CPSM in transmission areas from 72 percent colonization to 28 percent . A single further clinical case of CPSM linked to the CHB isolates was detected over two years of surveillance following the implementation of the annual CHB cleaning program ( 0.7 transmissions per 100,000 SBD ). No transmissions were linked to undertaking the cleaning intervention . The researchers concluded that , “ A simple intervention targeted at reducing the biological burden of CPSM in CHB drains at regular intervals was effective in preventing transmission of carbapenemase-producing Enterobacterales from the hospital environment to patients over a prolonged period of intensive surveillance . These findings highlight the importance of detailed cleaning for controlling the spread of multidrug-resistant organisms from healthcare environments .”
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