2021 Volume 46 Issue 3 Pages 385-391
Infection control in facilities for patients with severe motor and intellectual disabilities (SMID) can be challenging due to the special circumstances of the care environment and clinical condition of SMID patients that limits the applicability of existing textbooks and guidelines on nosocomial infection control measures. Recently, we experienced an outbreak of infection with bacteria producing extended-spectrum beta-lactamase (ESBL) in the hospital ward for SMID patients. The total number of inpatients in this ward was 42 at that time, with the average age being 46 years. Twenty-one of the inpatients received tube feeding, and the remaining 21 were capable of oral food intake. We suspected an outbreak and ordered a stool culture for all patients hospitalized in the ward. The results obtained revealed 60% (25/42) of the patients to be carriers of ESBL-producing bacteria. The carriage rate was 90% in a group or patients receiving tube feeding, and 29% in the oral food intake group (p < 0.001). The environmental swabbing of the tube feeding preparation room located in the ward detected intestinal bacteria, which suggests that the contaminated hands of our staff and contaminated tube feeding equipment could be responsible for the outbreak of bacterial infection. Our review of the equipment cleaning/disinfection procedure revealed inadequate disinfection of the equipment. For example, tubes used for feeding were replaced only once a week, which actually need to be replaced after each use. Careful cleaning and disinfection of tube feeding equipment and replacement of tubes after each use are demanding on both human and financial resources, which is a major issue in infection control.
