Hospital outbreak control requires joint efforts from hospital management, microbiology and infection control

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Antimicrobial Resistance

Background:

• An outbreak of multidrug-resistant Klebsiella pneumoniae (MDR-Kp) producing CTX-M15 occurred in a large Swedish teaching hospital.
• The outbreak involved 247 patients across numerous wards over a 27-month period (May 2005–August 2007).
• Elderly patients were disproportionately affected, highlighting a vulnerable population.

Purpose of the Study:

• To investigate the transmission dynamics of an MDR-Kp outbreak.
• To identify contributing factors to the spread of infection.
• To evaluate the effectiveness and cost of implemented control measures.

Main Methods:

• Manual review of hospital administrative records to map transmission chains.
• Faecal screening and clinical cultures for case identification.
• Analysis of patient movement and ward contact patterns.
• Assessment of implemented infection control interventions.

Main Results:

• Faecal screening detected twice as many cases as clinical cultures, indicating a significant subclinical reservoir.
• Transmission was complex, involving direct/indirect patient-to-patient contact, exacerbated by patient overcrowding.
• Interventions included enhanced hygiene, increased bed capacity, improved cleaning, and staff/patient education.
• The total cost of interventions was estimated at €3 million.

Conclusions:

• Effective control required resources to enforce existing infection control policies and improve compliance, rather than novel strategies.
• Addressing patient overcrowding and enhancing hand hygiene were crucial for mitigating transmission.
• Investment in resources and education proved effective in managing the MDR-Kp outbreak.