Example No. 1

The problem
Two patients from the same long term care facility were admitted to the same intensive care unit (ICU) of a New Jersey hospital and were found to be infected with the same Gram negative bacteria. Two additional cases were discovered in the hospital's ICU.

Actions taken
Isolates from all four patients were sent to PHRI to determine if they shared the same DNA fingerprint. PHRI's analysis showed that the two patients from the long term care facility had transmitted the organism to the other patients in the ICU. The hospital then instituted numerous changes in their isolation practice in the ICU's and in the long term care facility, including placement of patients infected with drug-resistant bacteria on contact precautions, and the cohorting of such patients in a designated area of the unit.

Outcome
In the past three months, there has been no recurrence of this organism in the ICU.




Example No. 2

The problem
In the neonatal intensive care unit (NICU) of another New Jersey hospital, an infant was found to be colonized with a Gram negative bacterium. The hospital conducted a routine surveillance to determine if other infants were also colonized with this organism and found nine (9) additional infected babies. The organism was also found in cultures taken from air vents, respiratory equipment, sinks, faucets, and scales.

Actions taken
PHRI's DNA fingerprinting demonstrated that the strains were genetically related to each other. The hospital initiated the following interventions: additional hand washing stations were added in the NICU; staff monitoring procedures were augmented to assure that proper techniques were followed for hand sterilization by all staff members; a more aggressive cleaning procedure, along with more staff to achieve the cleaning, was implemented; more frequent decontamination of common use equipment was scheduled.

Outcome
The interventions were effective in stopping the spread of the cluster within two weeks of implementation.




Example No. 3

The problem
Four patients attending the same hemodialysis unit were found to have the blood stream infections with the same Gram negative bacteria. The hospital collected extensive environmental samples from water inflow and outflow ports, dialysis stations, air vents, and dialyzers to try to identify the reservoir for the bacteria. Sixteen positive samples were found.

Actions taken
PHRI's DNA fingerprinting revealed that strains from two of the patients were the same, but that the other two were different, and only one of the four had a strain that was the same as the environmental samples. After consultation, additional samples were sent to PHRI for typing, yet none correlated to any patient. All of the environmental samples were reevaluated and differences classified. Based on these results, the hospital staff instituted multiple interventions: they re-educated staff on appropriate infection control protocols, performed aggressive cleaning of machines and furniture, changed curtains, and decontaminated air vents.

Outcome
The infection control efforts were successful, and no additional cases have been reported.