Nosocomial Infections

Elizabethkingia Infection in Healthcare Settings

Avatar photoZahra Masoud
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There are 3 important factors in the healthcare environment that can affect discrimination and, ultimately, disclosure: (1) whether staff make an effort to reduce stigma and discrimination associated with HIV; (2) the level of encouragement staff provide to promote HIV testing and disclosure, including partner and family referrals; and (3) the ability to provide or refer patients to proper counseling and offer support.14 In healthcare environments, discrimination can take subtle and dangerous forms, including avoidance of treatment by healthcare practitioners, use of excessive precautions, and the release of sensitive information to third parties, rather than encouragement of voluntary disclosure. Each of these actions undermines the patient-provider relationship and can lead to suboptimal care and avoidance of care.14

There are 3 important factors in the healthcare environment that can affect discrimination and, ultimately, disclosure: (1) whether staff make an effort to reduce stigma and discrimination associated with HIV; (2) the level of encouragement staff provide to promote HIV testing and disclosure, including partner and family referrals; and (3) the ability to provide or refer patients to proper counseling and offer support.14 In healthcare environments, discrimination can take subtle and dangerous forms, including avoidance of treatment by healthcare practitioners, use of excessive precautions, and the release of sensitive information to third parties, rather than encouragement of voluntary disclosure. Each of these actions undermines the patient-provider relationship and can lead to suboptimal care and avoidance of care.14

Study authors assessed the prevalence of Elizabethkingia, healthcare settings involved, positive culture sites, and mitigation measures to prevent outbreak.

Elizabethkingia (EK) is an emerging cause of healthcare-associated infections, particularly among chronically ventilated patients, according to a study presented at IDWeek, held virtually from October 21 to 25, 2020.

Within the species, E meningoseptica, E anopheles, and E miricola are associated with human illness. The CDC Division of Healthcare Quality Promotion reviewed consultations between January 2013 and December 2019 that involved EK species, and summarized data on healthcare settings, infection types, laboratory analysis, and control measures.

Nine consultations within 8 states and 73 patient infections were included. There was a median of 4 infections per consultation (range, 1-28), and E anopheles was the most frequently identified species from patient isolates. Of the total consultations, positive cultures were found in either respiratory only (4/9), bloodstream and respiratory (3/9), bloodstream only (1/9), or sinus only (1/9).

Long term acute care hospitals accounted for 4 consultations (44%) with 32 infections (44%) and ventilator skilled nursing facilities accounted for 2 consultations (22%) with 31 infections (42%). Other healthcare settings included acute care hospital (1 consultation; 7 infections), outpatient ear, nose, and throat clinic (1 consultation; 2 infections), and assisted living facility (1 consultation; 1 infection). Of the 6 consultations that utilized whole genome sequencing, 4 sequences were found to be closely related isolates from different patients.

Mitigation measures to reduce EK in facility water systems included the development of water management plans, consultation with water management specialists, flushing water outlets, and monitoring water quality. Mitigation measures to minimize patient exposure included the use of splash guards on sinks, cleaning of shower facilities and equipment, and storing respiratory therapy supplies away from water sources.

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Overall, the study authors conclude that, “Robust water management plans and infection control practices to minimize patient exposure to contaminated water are important measures to reduce infection risk among vulnerable patients.”

Reference:

Crist MB, McQuiston JR, Walters MS, et al. Investigations of healthcare-associated Elizabethkingia infections – United States, 2013-2019. Presented at: IDWeek 2020; October 21-25, 2020. Poster 868.

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