Rapid Response and Containment of an NDM-Producing Klebsiella Pneumoniae Outbreak in a Hematology Ward: Case Study from an Italian Hospital
Abstract
1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Outbreak Recognition
3. Results
3.1. Control of the Outbreak
- General measures for personnel management during an epidemic;
- Measures to ensure an environment conducive to IPC;
- Identification of colonized or infected patients and communication with relevant hospital committees;
- Case isolation procedures;
- Alternative measures when single-room isolation is not feasible;
- Standard precautions and pathogen-specific transmission control measures;
- Appropriate use of antimicrobials and invasive devices to optimize patient outcomes and reduce the risk of resistance.
3.2. Follow Up
4. Discussion
Limitations and Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
NDM | New Delhi metallo-beta-lactamase |
KP | Klebsiella pneumoniae |
MDRO | Multi-drug resistant organism |
IPC | Infection prevention and control |
HAI | Healthcare-associated infection |
BMTC | Bone Marrow Transplant Center |
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Patient | Admission (Date, Unit) | First Isolation of NDM-Producing KP (Date, Sample) | Subsequent Isolations (Sample) |
---|---|---|---|
1 | 5 April, Hematology 3 August, BMTC | 21 April, rectal swab | Bronchoalveolar lavage Bronchoaspirate Blood culture |
2 | 5 August, BMTC | 19 August, rectal swab | Urine culture |
3 | 23 August, BMTC | 2 September, rectal swab | — |
4 | 28 July, BMTC | 9 September, rectal and pharyngeal swabs | — |
Antibiotic | SIR |
---|---|
Amikacin | R |
Amoxicillin/Clavulanic acid | R |
Cefepime | R |
Cefotaxime | R |
Ceftazidime | R |
Ciprofloxacin | R |
Ertapenem | R |
Fosfomycin | R |
Genamicin | R |
Imipenem | R |
Piperacillin/Tazobactam | R |
Trimethoprim/Sulfamethoxazole | R |
Area/Item | Note/Action |
---|---|
General measures for personnel management during an epidemic outbreak | |
Procedure to control the risk of NDM-producing KP spread? | Present, applied |
Professional in charge of IPC measures, especially for MRDO? | Present (1 physician and 2 nurses) |
Risk assessment for the prevention and control of NDM KP infections? | Conducted |
Rectal swabs to detect MDRO performed at admission and weekly? | Yes |
Activation of disinfection and decontamination procedures? Supervision? | Yes, supervised by the hygiene service |
Staff provided with regular information, training, and supervision regarding IPC measures, standard and specific precautions? | Yes, by the hygiene service |
Protocol for sharing information about colonization/infection by NDM KP at transfer/discharge? | Present, applied |
In case of a suspected outbreak, was the unit identified as high risk and early isolation measures activated? | Yes |
NDM-producing KP-positive patient adequately informed about the modes of transmission? | Yes, by the physician in charge |
Caregiver of the NDM-producing KP-positive patient adequately informed and trained? | Yes |
Procedures for the transportation of a positive patient within the hospital applied correctly? | Yes |
Information to minimize risk provided at discharge of a positive patient? | Yes, colonization status highlighted in the discharge letter |
Operators transporting a positive patient adequately informed? | Yes |
Restrictions of access to the ward during the alarm period (e.g., limiting the presence of non-essential personnel)? | Yes, access to the ward for students was suspended |
Measures to ensure the adequacy of the hospital environment for IPC | |
Procedures for cleaning, disinfection and decontamination of equipment/objects in the event of an outbreak by NDM-producing KP? | Present, applied |
Room of the NDM-producing KP-positive patient cleaned according to the procedure? | Yes |
Bathroom of the NDM-producing KP positive patient cleaned twice a day? | Yes |
Additional cleaning procedures carried out during the hospital stay and on discharge of the positive patient? | Yes |
Environmental swabs carried out to check the effectiveness of the cleaning actions? | No |
Do hospital cleaning staff understand and correctly implement cleaning and disinfection procedures? | Yes. Inspections carried out by the hygiene service |
Cleaning procedures foreseen in case of NDM-producing KP outbreaks recorded? | Yes, cleaning interventions recorded |
Identification of positive patients and communication to the responsible committees | |
Did active contact surveillance include screening of all contacts of the source and secondary cases? | Yes |
Screening carried out according to the hospital protocol? | Yes |
Screening performed on all incoming patients? | Yes |
Screening repeated every 7 days for 3 weeks after the discharge of the last patient in the outbreak? | Yes |
In the suspect of an outbreak, were the Epidemiological Observatory, the Infection Control Officer and the Microbiology Service notified? | Yes |
Outbreak Management Team activated? | Yes |
Outbreak Management Team conducted an appropriate epidemiological investigation? | Yes |
Surveillance data collected shared with the personnel of the unit interested by the outbreak? | Yes |
Isolation of a case | |
Positive patient isolated in a single room? | Yes, single rooms were available |
Signs indicating isolation of the patient? | Yes |
Dedicated staff available for the positive patient? | Not feasible based of the unit’s staffing. Ensured continuity of specialized nursing and medical care |
In the presence of multiple cases, dedicated staff used of designed nurses identified? | Not feasible based of the unit’s staffing. Ensured continuity of specialized nursing and medical care |
Additional measures implemented to reduce the risk of pathogen transmission? | Increased awareness and training of the staff |
Procedures to follow when single-room isolation is not possible | |
Cohorting of positive patients conducted? | Yes |
Additional isolation measures activated in shared rooms (functional isolation)? | Yes |
Room shared only with positive patients or with low-risk negative patients? | Yes |
Carts with dedicated PPE and dedicated waste bin placed next to the patient’s bed? | Yes |
Medical devices/PPE removed before exiting the room? | Yes |
Standard precautions and specific measures for controlling infection transmission | |
Hand hygiene practices followed by healthcare workers? | Yes |
Adherence to hand hygiene procedure evaluated and how? | Yes, by direct observation from the Hygiene service |
Training courses on hand hygiene organized for all healthcare personnel? | Yes, training courses for healthcare staff conducted in 2021 and 2022 |
Consumption of alcohol gel evaluated? | Yes |
Healthcare workers trained on the use of PPE? | Yes, specific training received |
Correct use of PPE evaluated and how? | Yes, by direct observation from the Hygiene service |
Regular cleaning and disinfection of the environment, items and reusable medical devices (reconditioning/reprocessing) carried out? | Yes |
How were cleaning and disinfection evaluated? | By the Hygiene service |
Dedicated equipment for positive patients? (e.g., stethoscope, blood pressure cuff, glucometer, oximeter, thermometer, etc.) | Yes |
Proper management and disposal of linen and waste? | Yes |
Were contact precautions implemented as required? | Yes |
How were contact precautions evaluated? | By direct observation |
Ensuring appropriate use of antimicrobials and invasive devices to optimize patient outcome and reduce the risk of adverse events and the emergence of MDRO | |
Was antibiotic therapy evaluated with the infectious disease consultant? | Yes |
Was appropriate use of invasive devices conducted? | Yes |
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Tocco Tussardi, I.; Stevanin, G.; Montesarchio, L.; Palladini, F.; Aprili, I.; Zandonà, E.; Tecchio, C.; Tardivo, S. Rapid Response and Containment of an NDM-Producing Klebsiella Pneumoniae Outbreak in a Hematology Ward: Case Study from an Italian Hospital. Healthcare 2025, 13, 1457. https://doi.org/10.3390/healthcare13121457
Tocco Tussardi I, Stevanin G, Montesarchio L, Palladini F, Aprili I, Zandonà E, Tecchio C, Tardivo S. Rapid Response and Containment of an NDM-Producing Klebsiella Pneumoniae Outbreak in a Hematology Ward: Case Study from an Italian Hospital. Healthcare. 2025; 13(12):1457. https://doi.org/10.3390/healthcare13121457
Chicago/Turabian StyleTocco Tussardi, Ilaria, Gloria Stevanin, Livio Montesarchio, Francesca Palladini, Irene Aprili, Emanuela Zandonà, Cristina Tecchio, and Stefano Tardivo. 2025. "Rapid Response and Containment of an NDM-Producing Klebsiella Pneumoniae Outbreak in a Hematology Ward: Case Study from an Italian Hospital" Healthcare 13, no. 12: 1457. https://doi.org/10.3390/healthcare13121457
APA StyleTocco Tussardi, I., Stevanin, G., Montesarchio, L., Palladini, F., Aprili, I., Zandonà, E., Tecchio, C., & Tardivo, S. (2025). Rapid Response and Containment of an NDM-Producing Klebsiella Pneumoniae Outbreak in a Hematology Ward: Case Study from an Italian Hospital. Healthcare, 13(12), 1457. https://doi.org/10.3390/healthcare13121457