Multidrug‐resistant NDM‐1 Klebsiella outbreak and infection control in endoscopic urology
What's known on the subject? and What does the study add? Since the first case of multidrug‐resistant New Delhi metallo‐β‐lactamase (NDM‐1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these o...
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| Published in | BJU international Vol. 110; no. 11c; pp. E922 - E926 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.12.2012
Wiley Subscription Services, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1464-4096 1464-410X 1464-410X |
| DOI | 10.1111/j.1464-410X.2012.11556.x |
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| Abstract | What's known on the subject? and What does the study add?
Since the first case of multidrug‐resistant New Delhi metallo‐β‐lactamase (NDM‐1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these organisms because the NDM‐1 carriers tend to be the common UTI‐causing organisms. Further, the nature of the procedures involved in endoscopy in the urinary tract confers the potential for direct exposure and transmission of the organisms that commonly cause UTI. Although decontamination by sterilization of urological endoscopes and surgical instruments is well established in the operating theatre suite, there were no national standardized guidelines for infection control measures with respect to the video camera head in endoscopic urology in the UK.
This paper reports the first UK outbreak of NDM‐1 Klebsiella UTI, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where single‐use sterile disposable plastic camera sheaths were not routinely used and the camera head was regularly cleaned with detergent wipes. We found that infection control practices vary across UK urology units. In the context of infection control, we highlight a need for standardized practice in the use of camera sheaths and in the decontamination process for endoscopic video camera heads. Either sterilization or use of single‐use sterile disposable plastic camera sheaths with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended.
OBJECTIVES
•
To report the first UK outbreak of NDM‐1 Klebsiella, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where camera sheathing was not routinely used and the camera head was regularly cleaned with detergent wipes.
•
To survey the use of camera sheath and infection control practices in endoscopy in urology in the UK.
PATIENTS AND METHODS
•
A structured questionnaire was conducted via telephone interview with urological theatre sisters/charge nurses from all urological units across the UK.
•
Data on the use of camera sheath, cleaning practices, type of disinfectant used and choice of prophylactic antibiotics were obtained.
RESULTS
•
Out of 206 NHS urology units, 158 (77%) units across the UK were surveyed. Forty‐one (25.9%) do not use camera sheaths, 16 (10.1%) were used dependent on the consultant's preference, and the remaining 101 (63.9%) routinely used camera sheath.
•
Twenty‐one (13.3%) units clean the camera head only at the end of the operating list and the remainder clean after every case.
•
The choice of cleaning agent/disinfectant used varied considerably. They are broadly categorised as alcoholic wipes 90 (57%), detergent wipes 46 (29.1%) and soapy water 21 (13.3%).
•
The choice of prophylactic antibiotic includes gentamicin alone (96.3%), augmentin alone (1.4%), gentamicin/amoxicillin (0.7%) and cefuroxime alone (0.7%).
CONCLUSIONS
•
In the context of infection control, we highlight the need for a standardized practice in the use of camera sheaths and the process of decontamination of the endoscopic camera head.
•
Either sterilization or use of single‐use sterile disposable plastic camera sheath with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. |
|---|---|
| AbstractList | What's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo-[beta]-lactamase (NDM-1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these organisms because the NDM-1 carriers tend to be the common UTI-causing organisms. Further, the nature of the procedures involved in endoscopy in the urinary tract confers the potential for direct exposure and transmission of the organisms that commonly cause UTI. Although decontamination by sterilization of urological endoscopes and surgical instruments is well established in the operating theatre suite, there were no national standardized guidelines for infection control measures with respect to the video camera head in endoscopic urology in the UK. This paper reports the first UK outbreak of NDM-1 Klebsiella UTI, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where single-use sterile disposable plastic camera sheaths were not routinely used and the camera head was regularly cleaned with detergent wipes. We found that infection control practices vary across UK urology units. In the context of infection control, we highlight a need for standardized practice in the use of camera sheaths and in the decontamination process for endoscopic video camera heads. Either sterilization or use of single-use sterile disposable plastic camera sheaths with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. OBJECTIVES * To report the first UK outbreak of NDM-1 Klebsiella, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where camera sheathing was not routinely used and the camera head was regularly cleaned with detergent wipes. * To survey the use of camera sheath and infection control practices in endoscopy in urology in the UK. PATIENTS AND METHODS * A structured questionnaire was conducted via telephone interview with urological theatre sisters/charge nurses from all urological units across the UK. * Data on the use of camera sheath, cleaning practices, type of disinfectant used and choice of prophylactic antibiotics were obtained. RESULTS * Out of 206 NHS urology units, 158 (77%) units across the UK were surveyed. Forty-one (25.9%) do not use camera sheaths, 16 (10.1%) were used dependent on the consultant's preference, and the remaining 101 (63.9%) routinely used camera sheath. * Twenty-one (13.3%) units clean the camera head only at the end of the operating list and the remainder clean after every case. * The choice of cleaning agent/disinfectant used varied considerably. They are broadly categorised as alcoholic wipes 90 (57%), detergent wipes 46 (29.1%) and soapy water 21 (13.3%). * The choice of prophylactic antibiotic includes gentamicin alone (96.3%), augmentin alone (1.4%), gentamicin/amoxicillin (0.7%) and cefuroxime alone (0.7%). CONCLUSIONS * In the context of infection control, we highlight the need for a standardized practice in the use of camera sheaths and the process of decontamination of the endoscopic camera head. * Either sterilization or use of single-use sterile disposable plastic camera sheath with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. What's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo- beta -lactamase (NDM-1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these organisms because the NDM-1 carriers tend to be the common UTI-causing organisms. Further, the nature of the procedures involved in endoscopy in the urinary tract confers the potential for direct exposure and transmission of the organisms that commonly cause UTI. Although decontamination by sterilization of urological endoscopes and surgical instruments is well established in the operating theatre suite, there were no national standardized guidelines for infection control measures with respect to the video camera head in endoscopic urology in the UK. This paper reports the first UK outbreak of NDM-1 Klebsiella UTI, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where single-use sterile disposable plastic camera sheaths were not routinely used and the camera head was regularly cleaned with detergent wipes. We found that infection control practices vary across UK urology units. In the context of infection control, we highlight a need for standardized practice in the use of camera sheaths and in the decontamination process for endoscopic video camera heads. Either sterilization or use of single-use sterile disposable plastic camera sheaths with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. times To report the first UK outbreak of NDM-1 Klebsiella, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where camera sheathing was not routinely used and the camera head was regularly cleaned with detergent wipes. times A structured questionnaire was conducted via telephone interview with urological theatre sisters/charge nurses from all urological units across the UK. times Out of 206 NHS urology units, 158 (77%) units across the UK were surveyed. Forty-one (25.9%) do not use camera sheaths, 16 (10.1%) were used dependent on the consultant's preference, and the remaining 101 (63.9%) routinely used camera sheath. times In the context of infection control, we highlight the need for a standardized practice in the use of camera sheaths and the process of decontamination of the endoscopic camera head. What's known on the subject? and What does the study add? Since the first case of multidrug‐resistant New Delhi metallo‐β‐lactamase (NDM‐1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these organisms because the NDM‐1 carriers tend to be the common UTI‐causing organisms. Further, the nature of the procedures involved in endoscopy in the urinary tract confers the potential for direct exposure and transmission of the organisms that commonly cause UTI. Although decontamination by sterilization of urological endoscopes and surgical instruments is well established in the operating theatre suite, there were no national standardized guidelines for infection control measures with respect to the video camera head in endoscopic urology in the UK. This paper reports the first UK outbreak of NDM‐1 Klebsiella UTI, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where single‐use sterile disposable plastic camera sheaths were not routinely used and the camera head was regularly cleaned with detergent wipes. We found that infection control practices vary across UK urology units. In the context of infection control, we highlight a need for standardized practice in the use of camera sheaths and in the decontamination process for endoscopic video camera heads. Either sterilization or use of single‐use sterile disposable plastic camera sheaths with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. OBJECTIVES • To report the first UK outbreak of NDM‐1 Klebsiella, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where camera sheathing was not routinely used and the camera head was regularly cleaned with detergent wipes. • To survey the use of camera sheath and infection control practices in endoscopy in urology in the UK. PATIENTS AND METHODS • A structured questionnaire was conducted via telephone interview with urological theatre sisters/charge nurses from all urological units across the UK. • Data on the use of camera sheath, cleaning practices, type of disinfectant used and choice of prophylactic antibiotics were obtained. RESULTS • Out of 206 NHS urology units, 158 (77%) units across the UK were surveyed. Forty‐one (25.9%) do not use camera sheaths, 16 (10.1%) were used dependent on the consultant's preference, and the remaining 101 (63.9%) routinely used camera sheath. • Twenty‐one (13.3%) units clean the camera head only at the end of the operating list and the remainder clean after every case. • The choice of cleaning agent/disinfectant used varied considerably. They are broadly categorised as alcoholic wipes 90 (57%), detergent wipes 46 (29.1%) and soapy water 21 (13.3%). • The choice of prophylactic antibiotic includes gentamicin alone (96.3%), augmentin alone (1.4%), gentamicin/amoxicillin (0.7%) and cefuroxime alone (0.7%). CONCLUSIONS • In the context of infection control, we highlight the need for a standardized practice in the use of camera sheaths and the process of decontamination of the endoscopic camera head. • Either sterilization or use of single‐use sterile disposable plastic camera sheath with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. What's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo-β-lactamase (NDM-1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these organisms because the NDM-1 carriers tend to be the common UTI-causing organisms. Further, the nature of the procedures involved in endoscopy in the urinary tract confers the potential for direct exposure and transmission of the organisms that commonly cause UTI. Although decontamination by sterilization of urological endoscopes and surgical instruments is well established in the operating theatre suite, there were no national standardized guidelines for infection control measures with respect to the video camera head in endoscopic urology in the UK. This paper reports the first UK outbreak of NDM-1 Klebsiella UTI, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where single-use sterile disposable plastic camera sheaths were not routinely used and the camera head was regularly cleaned with detergent wipes. We found that infection control practices vary across UK urology units. In the context of infection control, we highlight a need for standardized practice in the use of camera sheaths and in the decontamination process for endoscopic video camera heads. Either sterilization or use of single-use sterile disposable plastic camera sheaths with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. • To report the first UK outbreak of NDM-1 Klebsiella, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where camera sheathing was not routinely used and the camera head was regularly cleaned with detergent wipes. • To survey the use of camera sheath and infection control practices in endoscopy in urology in the UK. • A structured questionnaire was conducted via telephone interview with urological theatre sisters/charge nurses from all urological units across the UK. • Data on the use of camera sheath, cleaning practices, type of disinfectant used and choice of prophylactic antibiotics were obtained. • Out of 206 NHS urology units, 158 (77%) units across the UK were surveyed. Forty-one (25.9%) do not use camera sheaths, 16 (10.1%) were used dependent on the consultant's preference, and the remaining 101 (63.9%) routinely used camera sheath. • Twenty-one (13.3%) units clean the camera head only at the end of the operating list and the remainder clean after every case. • The choice of cleaning agent/disinfectant used varied considerably. They are broadly categorised as alcoholic wipes 90 (57%), detergent wipes 46 (29.1%) and soapy water 21 (13.3%). • The choice of prophylactic antibiotic includes gentamicin alone (96.3%), augmentin alone (1.4%), gentamicin/amoxicillin (0.7%) and cefuroxime alone (0.7%). • In the context of infection control, we highlight the need for a standardized practice in the use of camera sheaths and the process of decontamination of the endoscopic camera head. • Either sterilization or use of single-use sterile disposable plastic camera sheath with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. What's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo-β-lactamase (NDM-1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these organisms because the NDM-1 carriers tend to be the common UTI-causing organisms. Further, the nature of the procedures involved in endoscopy in the urinary tract confers the potential for direct exposure and transmission of the organisms that commonly cause UTI. Although decontamination by sterilization of urological endoscopes and surgical instruments is well established in the operating theatre suite, there were no national standardized guidelines for infection control measures with respect to the video camera head in endoscopic urology in the UK. This paper reports the first UK outbreak of NDM-1 Klebsiella UTI, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where single-use sterile disposable plastic camera sheaths were not routinely used and the camera head was regularly cleaned with detergent wipes. We found that infection control practices vary across UK urology units. In the context of infection control, we highlight a need for standardized practice in the use of camera sheaths and in the decontamination process for endoscopic video camera heads. Either sterilization or use of single-use sterile disposable plastic camera sheaths with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended.UNLABELLEDWhat's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo-β-lactamase (NDM-1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these organisms because the NDM-1 carriers tend to be the common UTI-causing organisms. Further, the nature of the procedures involved in endoscopy in the urinary tract confers the potential for direct exposure and transmission of the organisms that commonly cause UTI. Although decontamination by sterilization of urological endoscopes and surgical instruments is well established in the operating theatre suite, there were no national standardized guidelines for infection control measures with respect to the video camera head in endoscopic urology in the UK. This paper reports the first UK outbreak of NDM-1 Klebsiella UTI, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where single-use sterile disposable plastic camera sheaths were not routinely used and the camera head was regularly cleaned with detergent wipes. We found that infection control practices vary across UK urology units. In the context of infection control, we highlight a need for standardized practice in the use of camera sheaths and in the decontamination process for endoscopic video camera heads. Either sterilization or use of single-use sterile disposable plastic camera sheaths with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended.• To report the first UK outbreak of NDM-1 Klebsiella, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where camera sheathing was not routinely used and the camera head was regularly cleaned with detergent wipes. • To survey the use of camera sheath and infection control practices in endoscopy in urology in the UK.OBJECTIVES• To report the first UK outbreak of NDM-1 Klebsiella, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where camera sheathing was not routinely used and the camera head was regularly cleaned with detergent wipes. • To survey the use of camera sheath and infection control practices in endoscopy in urology in the UK.• A structured questionnaire was conducted via telephone interview with urological theatre sisters/charge nurses from all urological units across the UK. • Data on the use of camera sheath, cleaning practices, type of disinfectant used and choice of prophylactic antibiotics were obtained.PATIENTS AND METHODS• A structured questionnaire was conducted via telephone interview with urological theatre sisters/charge nurses from all urological units across the UK. • Data on the use of camera sheath, cleaning practices, type of disinfectant used and choice of prophylactic antibiotics were obtained.• Out of 206 NHS urology units, 158 (77%) units across the UK were surveyed. Forty-one (25.9%) do not use camera sheaths, 16 (10.1%) were used dependent on the consultant's preference, and the remaining 101 (63.9%) routinely used camera sheath. • Twenty-one (13.3%) units clean the camera head only at the end of the operating list and the remainder clean after every case. • The choice of cleaning agent/disinfectant used varied considerably. They are broadly categorised as alcoholic wipes 90 (57%), detergent wipes 46 (29.1%) and soapy water 21 (13.3%). • The choice of prophylactic antibiotic includes gentamicin alone (96.3%), augmentin alone (1.4%), gentamicin/amoxicillin (0.7%) and cefuroxime alone (0.7%).RESULTS• Out of 206 NHS urology units, 158 (77%) units across the UK were surveyed. Forty-one (25.9%) do not use camera sheaths, 16 (10.1%) were used dependent on the consultant's preference, and the remaining 101 (63.9%) routinely used camera sheath. • Twenty-one (13.3%) units clean the camera head only at the end of the operating list and the remainder clean after every case. • The choice of cleaning agent/disinfectant used varied considerably. They are broadly categorised as alcoholic wipes 90 (57%), detergent wipes 46 (29.1%) and soapy water 21 (13.3%). • The choice of prophylactic antibiotic includes gentamicin alone (96.3%), augmentin alone (1.4%), gentamicin/amoxicillin (0.7%) and cefuroxime alone (0.7%).• In the context of infection control, we highlight the need for a standardized practice in the use of camera sheaths and the process of decontamination of the endoscopic camera head. • Either sterilization or use of single-use sterile disposable plastic camera sheath with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended.CONCLUSIONS• In the context of infection control, we highlight the need for a standardized practice in the use of camera sheaths and the process of decontamination of the endoscopic camera head. • Either sterilization or use of single-use sterile disposable plastic camera sheath with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. |
| Author | O'Neill, Patricia Elves, Andrew Koo, Vincent S.W. |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23107243$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1086/596734 10.1016/S1473-3099(10)70143-2 10.1016/j.jhin.2003.12.037 10.1111/j.1469-0691.2010.03385.x 10.1128/AAC.00774-09 |
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| References | 2010; 10 2007 2010; 16 2009; 30 2009; 53 2009; 15 2004; 56 e_1_2_8_2_2 e_1_2_8_3_2 e_1_2_8_6_2 e_1_2_8_5_2 e_1_2_8_7_2 MacPherson DW (e_1_2_8_4_2) 2009; 15 e_1_2_8_9_2 Parsons DW (e_1_2_8_8_2) 2007 e_1_2_8_10_2 e_1_2_8_11_2 |
| References_xml | – volume: 30 start-page: 447 year: 2009 end-page: 52 article-title: Success of an infection control program to reduce the spread of carbapenem‐resistant publication-title: Infect Control Hosp Epidemiol – volume: 53 start-page: 5046 year: 2009 end-page: 54 article-title: Characterization of a new metallo‐β‐lactamase gene, bla(NDM‐1), and a novel erythromycin esterase gene carried on a unique genetic structure in sequence type 14 from India publication-title: Antimicrob Agents Chemother – volume: 15 start-page: 1727 year: 2009 end-page: 32 article-title: Population mobility, globalization, and antimicrobial drug resistance publication-title: Emerg Infect Dis – start-page: 9 year: 2007 – volume: 10 start-page: 597 year: 2010 end-page: 602 article-title: Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study publication-title: Lancet Infect Dis – volume: 16 start-page: 1699 year: 2010 end-page: 701 article-title: New Delhi metallo‐β‐lactamase (NDM‐1): towards a new pandemia? publication-title: Clin Microbiol Infect – volume: 56 start-page: S70 issue: 2 year: 2004 end-page: 5 article-title: Household cleaning andsurface disinfection: new insights and strategies publication-title: J Hosp Infect – ident: e_1_2_8_11_2 doi: 10.1086/596734 – ident: e_1_2_8_5_2 – ident: e_1_2_8_7_2 – ident: e_1_2_8_3_2 doi: 10.1016/S1473-3099(10)70143-2 – ident: e_1_2_8_6_2 – volume: 15 start-page: 1727 year: 2009 ident: e_1_2_8_4_2 article-title: Population mobility, globalization, and antimicrobial drug resistance publication-title: Emerg Infect Dis – ident: e_1_2_8_10_2 doi: 10.1016/j.jhin.2003.12.037 – start-page: 9 volume-title: Smith's Textbook of Endourology year: 2007 ident: e_1_2_8_8_2 – ident: e_1_2_8_9_2 doi: 10.1111/j.1469-0691.2010.03385.x – ident: e_1_2_8_2_2 doi: 10.1128/AAC.00774-09 |
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| Snippet | What's known on the subject? and What does the study add?
Since the first case of multidrug‐resistant New Delhi metallo‐β‐lactamase (NDM‐1) Klebsiella and... What's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo-β-lactamase (NDM-1) Klebsiella and... What's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo-[beta]-lactamase (NDM-1) Klebsiella and... What's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo- beta -lactamase (NDM-1) Klebsiella and... |
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| SubjectTerms | beta-Lactamases - pharmacology camera sheath Cameras Decontamination Detergents Disease Outbreaks Disease transmission Disinfectants Disinfection - methods Drug resistance Drug Resistance, Multiple Endoscopes Endoscopes - microbiology Endoscopy Endoscopy - adverse effects Escherichia coli Head Humans Infection infection control Infection Control - methods Infections Inventories Klebsiella Klebsiella - drug effects Klebsiella - isolation & purification Klebsiella outbreak Metallo- beta -lactamase NDM‐1 Plastics Sheaths Sterilization Sterilization - methods Theater United Kingdom - epidemiology Urinary tract Urinary Tract Infections - epidemiology Urinary Tract Infections - microbiology Urinary Tract Infections - prevention & control Urology |
| Title | Multidrug‐resistant NDM‐1 Klebsiella outbreak and infection control in endoscopic urology |
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