The healthcare environment serves as a reservoir or a source for outbreaks. Single outbreaks via an environmental reservoir have often been described in healthcare settings, while the trend of these multiple outbreaks has not been understood well. Here, we investigated the epidemiologic features of outbreaks associated with the healthcare environment.
Structured data on environmental sources from Outbreak Database based on information from articles published worldwide were extracted. A total of 317 articles of outbreaks associated with the healthcare environment (e.g., environmental surfaces, patent care items, water and water-related appliances, and air and ventilation systems) in 48 countries during 1965-2016 were analyzed.
Of the 317 outbreaks reviewed, 295 (93%) were monophasic. 161 outbreaks (51%) occurred in an ICU setting. The 6,317 infected patients and 338 healthcare personnel were involved in 317 healthcare-associated outbreaks via the environment. 251 patients (4%) died of an infection. 265 outbreaks (84%) caused at least one infection among patients involved, including 112 pneumonias (35%) and 104 bloodstream infections (33%) (Fig. 1). Bacteria (N=244, 77%) were the most frequent pathogen, followed by fungi (N=49, 15%) and mycobacteria (N=15, 5%) (Fig. 2). Of the bacteria, non-fermenting Gram-negative bacilli (N=100, 41%) was the most common, followed by Legionella (N=56, 23%), Enterobacteriaceae (N=35, 14%), and multidrug-resistant organisms (N=31, 13%). 136 outbreaks (43%) were obviously transmitted by contact, followed by inhalation and invasive technique. Genotyping was performed in 66% of outbreaks (N=209). Key control measures included modification of care/equipment (N=181, 57%) and improved disinfection/sterilization (N=170, 54%). 47 (15%) and 5 (2%) outbreaks led to closure of the affected location and restriction of workload, respectively (Fig. 3).
This study characterized epidemiologically outbreaks associated with healthcare environment, demonstrating the environmental role in healthcare-associated outbreaks. Analysis of structured data on multiple outbreaks can help develop infection prevention strategies in healthcare facilities.
W. Rutala, PDI: Consultant and Speaker's Bureau , Consulting fee and Speaker honorarium .
M. Kaku, None
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