Carbapenemase-producing Enterobacterales (CPE) are associated with poor clinical outcomes and can spread rapidly in healthcare settings. Environmental reservoirs are increasingly recognized as playing an important part in some nosocomial outbreaks. To describe the investigation and control of a CPE outbreak, lasting several years, across two separate hospital sites within one organization. Investigation of multiple ward-level CPE cross-transmissions with a number of sporadic cases. Environmental sampling of ward environments, catering facilities and electric floor scrubbers was undertaken. Eleven patients over a 19-month period were identified as carrying healthcare-associated New Delhi metallo-beta-lactamase (NDM)-producing , and a further patient carried NDM . . isolates were indistinguishable on pulsed-field gel electrophoresis typing, supporting acquisition with a single point source. Environmental sampling found contamination of the electric floor scrubbers used for cleaning the hospital catering facilities and in the associated toilets. Standard outbreak response measures achieved control of ward outbreaks. Sporadic cases and hospital-wide cross-transmission were controlled after interventions on the central food-handling unit and by decommissioning affected floor scrubbers. Electric floor scrubbers were found to have the potential to disperse Gram-negative bacteria into the surrounding environment under experimental conditions. This outbreak report demonstrates that catering facilities and kitchens can be involved in widespread healthcare outbreaks of enteric organisms. This is also the first report of the potential role of electric floor scrubbers in causing significant environmental contamination with CPE which may indicate a role in nosocomial transmission.

中文翻译：

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医院范围内与医疗保健相关的产碳青霉烯酶肠杆菌爆发：餐饮设施和厨房电动洗地机的风险

产生碳青霉烯酶的肠杆菌 (CPE) 与不良的临床结果相关，并且可以在医疗机构中迅速传播。人们越来越认识到环境储存库在一些医院内疫情暴发中发挥着重要作用。描述对一个组织内两个不同医院站点持续数年的 CPE 爆发的调查和控制。多间病区级CPE交叉传播及多例散发病例的调查对病房环境、餐饮设施和电动洗地机进行了环境采样。在 19 个月的时间里，有 11 名患者被确定携带与医疗保健相关的新德里金属-β-内酰胺酶 (NDM) 产生物，还有一名患者携带 NDM。 。脉冲场凝胶电泳分型无法区分分离株，支持单点源采集。环境采样发现用于清洁医院餐饮设施和相关厕所的电动地板洗涤器受到污染。规范的疫情应对措施实现了病区疫情的控制。对中央食品处理单元进行干预并停用受影响的地板洗涤器后，零星病例和全院范围内的交叉传播得到了控制。在实验条件下，电动地板洗涤器被发现有可能将革兰氏阴性细菌分散到周围环境中。这份疫情报告表明，餐饮设施和厨房可能涉及肠道微生物的广泛医疗保健疫情。这也是第一份关于电动洗地机可能导致 CPE 严重环境污染的报告，这可能表明其在医院传播中发挥作用。