Elizabeth A. Lyle

Bio: Elizabeth A. Lyle is an academic researcher from Rush University Medical Center. The author has contributed to research in topics: Intensive care unit & Terminal cleaning. The author has an hindex of 3, co-authored 3 publications receiving 696 citations.

Reduction in Acquisition of Vancomycin-Resistant Enterococcus after Enforcement of Routine Environmental Cleaning Measures

Abstract: Background The role of environmental contamination in nosocomial cross-transmission of antibiotic-resistant bacteria has been unresolved. Using vancomycin-resistant enterococci (VRE) as a marker organism, we investigated the effects of improved environmental cleaning with and without promotion of hand hygiene adherence on the spread of VRE in a medical intensive care unit. Methods The study comprised a baseline period (period 1), a period of educational intervention to improve environmental cleaning (period 2), a "washout" period without any specific intervention (period 3), and a period of multimodal hand hygiene intervention (period 4). We performed cultures for VRE of rectal swab samples obtained from patients at admission to the intensive care unit and daily thereafter, and we performed cultures of environmental samples and samples from the hands of health care workers twice weekly. We measured patient clinical and demographic variables and monitored intervention adherence frequently. Results Our study included 748 admissions to the intensive care unit over a 9-month period. VRE acquisition rates were 33.47 cases per 1000 patient-days at risk for period 1 and 16.84, 12.09, and 10.40 cases per 1000 patient-days at risk for periods 2, 3, and 4, respectively. The mean (+/-SD) weekly rate of environmental sites cleaned increased from 0.48+/-0.08 at baseline to 0.87+/-0.08 in period 2; similarly high cleaning rates persisted in periods 3 and 4. Mean (+/-SD) weekly hand hygiene adherence rate was 0.40+/-0.01 at baseline and increased to 0.57+/-0.11 in period 2, without a specific intervention to improve adherence, but decreased to 0.29+/-0.26 in period 3 and 0.43+/-0.1 in period 4. Mean proportions of positive results of cultures of environmental and hand samples decreased in period 2 and remained low thereafter. In a Cox proportional hazards model, the hazard ratio for acquiring VRE during periods 2-4 was 0.36 (95% confidence interval, 0.19-0.68); the only determinant explaining the difference in VRE acquisition was admission to the intensive care unit during period 1. Conclusions Decreasing environmental contamination may help to control the spread of some antibiotic-resistant bacteria in hospitals.

Transfer of vancomycin-resistant enterococci via health care worker hands.

Abstract: Background:Therolesofthecontaminatedhospitalenvironment and of patient skin carriage in the spread of vancomycin-resistant enterococci (VRE) are uncertain. Transfer of VRE via health care worker (HCW) hands is assumed but unproved. We sought to determine the frequency of VRE transmission from sites in the environment or on patients’ intact skin to clean environmental orskinsitesviacontaminatedhandsofHCWsduringroutine care. Methods:We cultured sites on the intact skin of 22 patients colonized by VRE, as well as sites in the patients’ rooms, before and after routine care by 98 HCWs. Observers recorded sites touched by HCWs. Cultures were obtained from HCW hands and/or gloves before and after care. All isolates underwent pulsed-field gel electrophoresis. We defined a transfer to have occurred when a culture-negative site became positive with a VRE pulsotype after being touched by an HCW who had the same pulsotypeonhisorherhandsorglovesandwhohadpre

How long do nosocomial pathogens persist on inanimate surfaces? A systematic review

Abstract: Inanimate surfaces have often been described as the source for outbreaks of nosocomial infections. The aim of this review is to summarize data on the persistence of different nosocomial pathogens on inanimate surfaces. The literature was systematically reviewed in MedLine without language restrictions. In addition, cited articles in a report were assessed and standard textbooks on the topic were reviewed. All reports with experimental evidence on the duration of persistence of a nosocomial pathogen on any type of surface were included. Most gram-positive bacteria, such as Enterococcus spp. (including VRE), Staphylococcus aureus (including MRSA), or Streptococcus pyogenes, survive for months on dry surfaces. Many gram-negative species, such as Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia marcescens, or Shigella spp., can also survive for months. A few others, such as Bordetella pertussis, Haemophilus influenzae, Proteus vulgaris, or Vibrio cholerae, however, persist only for days. Mycobacteria, including Mycobacterium tuberculosis, and spore-forming bacteria, including Clostridium difficile, can also survive for months on surfaces. Candida albicans as the most important nosocomial fungal pathogen can survive up to 4 months on surfaces. Persistence of other yeasts, such as Torulopsis glabrata, was described to be similar (5 months) or shorter (Candida parapsilosis, 14 days). Most viruses from the respiratory tract, such as corona, coxsackie, influenza, SARS or rhino virus, can persist on surfaces for a few days. Viruses from the gastrointestinal tract, such as astrovirus, HAV, polio- or rota virus, persist for approximately 2 months. Blood-borne viruses, such as HBV or HIV, can persist for more than one week. Herpes viruses, such as CMV or HSV type 1 and 2, have been shown to persist from only a few hours up to 7 days. The most common nosocomial pathogens may well survive or persist on surfaces for months and can thereby be a continuous source of transmission if no regular preventive surface disinfection is performed.

Hospital-Acquired Infections Due to Gram-Negative Bacteria

Abstract: Hospital-acquired infections are most commonly associated with mechanical ventilation, invasive medical devices, or surgical procedures. Gram-negative bacteria are responsible for more than 30% of hospital-acquired infections and predominate in hospital-acquired pneumonia. They are highly efficient at up-regulating or acquiring mechanisms of antibiotic drug resistance, especially in the presence of antibiotic selection pressure. This review updates what clinicians should know about these often life-threatening infections.

Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007.

Abstract: 146. In: 16th Annual Society for Healthcare Epidemiology of America. Chicago, Ill; 2006. 950. Harvey MA. Critical-care-unit bedside design and furnishing: impact on nosocomial infections. Infect Control Hosp Epidemiol 1998;19(8):597­ 601. 951. Srinivasan A, Beck C, Buckley T, et al. The ability of hospital ventilation systems to filter Aspergillus and other fungi following a building implosion. Infect Control Hosp Epidemiol 2002;23(9):520-4. 952. Maragakis LL, Bradley KL, Song X, et al. Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port. Infect Control Hosp Epidemiol 2006;27(1):67-70. 953. Organizations JCoAoH. Comprehensive Accredication Manual for Hospitals: The Official Handbook. Oakbrook Terrace: JCAHO; 2007. 954. Peterson LR, Noskin GA. New technology for detecting multidrug­ resistant pathogens in the clinical microbiology laboratory. Emerg Infect Dis 2001;7(2):306-11. 955. Diekema DJ, Doebbeling BN. Employee health and infection control. Infect Control Hosp Epidemiol 1995;16(5):292-301. 956. Rutala WA, Weber DJ, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Health-Care Facilities. In preparation. 957. Weems JJ, Jr. Nosocomial outbreak of Pseudomonas cepacia associated with contamination of reusable electronic ventilator temperature probes. Infect Control Hosp Epidemiol 1993;14(10):583-6. 958. Berthelot P, Grattard F, Mahul P, et al. Ventilator temperature sensors: an unusual source of Pseudomonas cepacia in nosocomial infection. J Hosp Infect 1993;25(1):33-43. 959. 959. CDC. Bronchoscopy-related infections and pseudoinfections--New York, 1996 and 1998. MMWR Morb Mortal Wkly Rep 1999;48(26):557­ 60. 960. Heeg P, Roth K, Reichl R, Cogdill CP, Bond WW. Decontaminated single-use devices: an oxymoron that may be placing patients at risk for cross-contamination. Infect Control Hosp Epidemiol 2001;22(9):542-9. 961. www.fda.gov/cdrh/reprocessing/ 962. CDC. Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbidity & Mortality Weekly Report 2003;52(RR08):1-36.