"An exhaustive epidemiological investigation ensued, including evaluation of a possible environmental source," Wallace said.
An infection prevention and control team collected cultures of "numerous high-touch surfaces" in two patient rooms, in hand washing sinks, a blood glucose monitor, a supply room entry keypad, a computer used for charting, the room where clean ventilators were stored, a return air vent and a clean ventilator."
Also, the hospital launched environmental disinfection with complete cleaning of all involved rooms and units. The effort included removing and thoroughly cleaning ventilation ducts in each room, especially because one of the environmental cultures indicated presence of the strain from a return air vent specimen.
Hospital epidemiologist Zakir Shaikh, MD, Wallace and Methodist's quality vice president Virginia Davis said the hospital was able to arrest the outbreak in a much shorter time-frame compared with most other reported outbreaks of this bacterium, which can persist for months or years, because they enlisted every part of the hospital in the effort.
The three lab cultures came back early one afternoon, and "within a couple of hours we had the team assembled to decide how we were going to monitor this over time to make sure we could contain it," says Davis.
"As soon as we identified that initial cluster of three, it raised red flags for us and we instituted a team response," Wallace says. "The prevention department got hold of Dr. Shaikh immediately, and we called in all of the players, involving nursing, physicians, administration, the lab, environmental services and the physical plant—every department that directs patient care or does behind-the-scenes work."
Shaikh says that Methodist, a 515-bed tertiary hospital in the middle of downtown Dallas, is relatively unusual in its vigilance to culturing patients, a practice it engages during the admissions process. It spends more than $500,000 a year on gowns, gloves and cultures.
They started the practice started five years ago when the hospital started seeing an influx of patients coming in from long-term care facilities and nursing homes who had antibiotic resistant infections.
"As a preventive strategy, we put criteria together to do cultures on patients who were coming in from hospitals or nursing homes or who had draining wounds," in order to prevent the spread of multi-drug resistant organisms, he says.