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Endemic cross-infection in an acute medical ward
S S Bukhari1, P J Sanderson, D M Richardson
1Department of Microbiology, Edgware General Hospital, Middlesex, UK.
Abstract:
Urine samples from patients on an acute medical ward were examined each week over a three-month period in order to detect endemic cross colonization or infection. The bed positions for each patient in the ward were recorded continuously and the patients cared for by each different nurse team noted. We found an outbreak of urinary colonization/infection with a strain of Klebsiella K8 in nine patients. Two groups of two patients probably suffered cross colonization/infection with different strains of Escherichia coli. These episodes were not detected by our routine laboratory ward liaison surveillance, but by the weekly samples and molecular typing methods applied to these relatively common strains. This survey demonstrates that cross colonization/infection may occur more widely than is normally detected. The implications of these findings to surveillance audit programmes are discussed.
Insights
Routine surveillance missed hospital-acquired urinary tract infections and colonizations. Weekly sampling and molecular methods detected outbreaks of Klebsiella and Escherichia coli, highlighting gaps in current infection control practices.
Area of Science:
- Infectious Diseases
- Microbiology
- Hospital Epidemiology
Background:
- Hospital-acquired infections (HAIs) pose a significant threat to patient safety.
- Cross-colonization and infection between patients are common transmission routes.
- Current surveillance methods may not adequately detect endemic or low-level outbreaks.
Purpose of the Study:
- To investigate the incidence of endemic cross-colonization and infection in an acute medical ward.
- To evaluate the effectiveness of routine laboratory surveillance versus weekly sampling for early detection.
- To identify specific pathogens and transmission patterns within the ward.
Main Methods:
- Weekly collection and analysis of urine samples from all patients over a three-month period.
- Continuous recording of patient bed positions and nursing staff assignments.
- Molecular typing techniques (e.g., strain identification) applied to isolated pathogens.
Main Results:
- An outbreak of urinary colonization/infection involving nine patients with Klebsiella K8 was identified.
- Two separate groups of two patients each showed probable cross-colonization/infection with different Escherichia coli strains.
- These episodes were undetected by routine laboratory ward liaison surveillance.
Conclusions:
- Cross-colonization and infection in hospital settings may be more prevalent than typically detected.
- Weekly sampling combined with molecular typing offers enhanced sensitivity for detecting outbreaks.
- Findings necessitate a review and potential enhancement of hospital surveillance and audit programs for infection control.
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