We describe bundle measures implemented to overcome a protracted carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak in an 18-bed trauma Intensive Care Unit (ICU) at Strasbourg University Hospital, a tertiary referral center in France. Outbreak cases were defined by a positive CRAB sample with OXA-23 profile during or after ICU say. To sustain the capacity of the busy trauma ICU, infection control bundles were purposely selected to control the outbreak without closing the ICU. During the outbreak, from May 2015 to January 2019, 141 patients were contaminated by CRAB, including 91 colonized and 50 infected patients. The conventional infection and prevention control (IPC) measures implemented included weekly active surveillance of patients’ samples, enhancement of environmental cleaning, interventions to improve hand hygiene compliance and antibiotic stewardship with audits. Supplemental measures were needed, including environmental samplings, health care workers’ (HCWs) hand sampling, chlorhexidine body-washing, relocation of the service to implement Airborne Disinfection System (ADS), replication of crisis cells, replacement of big environmental elements and improvement of HCW organization at the patient’s bedside. The final measure was the cohorting of both CRAB patients and HCW caring for them. Only the simultaneous implementation of aggressive and complementary measures made it possible to overcome this long-lasting CRAB epidemic. Facing many CRAB cases during a rapidly spreading outbreak, combining simultaneous aggressive and complementary measures (including strict patients and HCW cohorting), was the only way to curb the epidemic while maintaining ICU capacity.

An Undiagnosed Index Case Leading to a Nosocomial Scabies Outbreak: How Mass Single-Dose Ivermectin Treatment Can Help Control a Nosocomial Epidemic To the Editor-Scabies prevalence is increasing in France, particularly in nosocomial settings. 1 A scabies outbreak was reported in the Oncology and Hematology Department (OHD) of Strasbourg University Hospital following scabies diagnoses in 4 healthcare workers. Initial management was remarkable because no index case was identified. This epidemic lasted 9 weeks from January to April 2015; consequences could have been serious in view of the patients' comorbidities. Here, we describe this outbreak, its course, as well as the containment measures implemented to stop it. A retrospective and descriptive study of this epidemic was performed. The OHD can accommodate up to 76 inpatients and 47 outpatients in a day hospital. People involved in the epidemic were classified into 2 categories: cases and contacts. Cases were patients or members of the OHD medical team with scabies symptoms who were epidemiologically linked to the index case or to another case. Cases were confirmed by dermatologists or other hospital physicians trained by dermatologists or by a general practitioner. Contacts were either patients cared for by the same medical team as the index case or were members of this medical staff. The epidemic was managed by a crisis team (CT) composed of members of the OHD, hospital administrators, occupational doctors, and hospital hygienists. Three weeks after the beginning of the epidemic, hospital hygienists were warned that 4 members of the OHD medical staff were suspected of having scabies. From then on, other cases were thoroughly searched for. No index case was identified until 10 days later, when OHD physicians, interrogated by the hospital hygienists, mentioned the case of patient X, a 42-year-old man hospitalized on January 27, 2015, in the OHD for new progression of graft versus host disease (GvH) after regular visits at the day hospital during January. His illness was considered a serious grade IV mucocutaneous GvH at admission, and he died 9 days after admission. No cutaneous sample was taken to support the scabies diagnosis, but patient X was the only patient with a clinical profile that could mask crusted scabies. Importantly, his family was found to be chronically infected for 1 year before his admission. Overall, 35 patients and healthcare professionals were considered secondary cases. Among them, 17 (49%) were patients, of whom 6 were hospitalized at the same time as patient X; 2 were hospitalized between the time of patient X's death and the outbreak of the epidemic; 6 were outpatients in

Objective: Despite the existence of various levels of infection prevention and control (IPC) measures aimed at limiting the transmission of vancomycin-resistant enterococci (VRE) in hospitals, these measures are sometimes difficult to implement. Using an agent-based model (ABM), we simulated the transmission of VRE within and between 3 care units according to different IPC measures. Methods: The ABM was modelled on short-stay medical wards, represented by 2 conventional care units and 1 intensive care unit. The scenarios consisted of the simulation of various compliance rates of caregivers with regard to hand hygiene (HH) in different contexts of IPC measures: (1) standard precautions for all patients, (2) additional contact precautions for VRE-carrier patients, (3) geographical cohorting of carrier patients, and (4) creation of an isolation unit with dedicated staff. Results: With <50% HH compliance, the dissemination of VRE was not adequately controlled. With 80% compliance for all patients (ie, standard precautions scenario), there were no secondary VRE cases in 50% of the simulations, which represented the best scenario. A more realistic rate, 60% HH compliance for all patients, revealed interesting results. Implementing an isolation unit was effective only if the level of HH compliance was low. Patient cohorting was less effective. Conclusions: The present ABM showed that while contact precautions, geographic cohorting, and an isolation unit may represent good complements to standard precautions, they may theoretically not be necessary if HH is followed at a high level of compliance.

Mobile dental delivery systems (MDDSs) are receiving growing interest for reaching isolated patients, as well as in dental care for fragile and hospitalized patients, with the advantage of being able to be used from room to room or during general anesthesia (GA) in an operating room. Therefore, ensuring the care safety is crucial. The aim of this study was to elaborate and assess an MDDS maintenance protocol, containing the management of dental unit waterlines and adapted to specific conditions such as dental care under GA. A step-by-step protocol was established and implemented for an MDDS used during dental care under GA in children. Samples of the output water were collected at J0, J+1, 3, 6, 12, and 24 months, and cultured to observe the microbiological quality of the water. All the results (heterotrophic plate count at 22 °C, at 37 °C, and specific pathogenic germs sought) showed an absence of contamination. The protocol presented was effective over time and allowed ensuring the safety of care to be ensured when using MDDS, even during dental procedures under GA. As a result, it could be implemented by any dental care delivery structure wanting to reinforce the safety of its practice.