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Role of Persistent Environmental Role of Persistent Environmental Contamination and Universal Glove and Gown Use in the Acquisition of Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Intensive Care Unit Patients Item Type dissertation Authors Ajao, Adebola Oluwakemi Publication Date 2011 Abstract Background: Extended-spectrum beta-lactamase (ESBL)- producing Gram-negative rods (GNR) are emerging pathogens that are associated with considerable morbidity, mortality and costs among hospitalized patients. The association between persistent environ... Keywords extended spectrum beta-lactams; patient-to-patient transmission; universal glove and gown; Cross Infection-- prevention & control; Escherichia coli; Intensive Care Units; Klebsiella pneumoniae; Universal Precautions Download date 24/09/2021 21:49:24 Link to Item http://hdl.handle.net/10713/780 CURRICULUM VITAE Name: Adebola Oluwakemi Ajao Permanent Address: 211 Riverbend Lane Nashville, TN, 37221 Degree and Date to be Conferred: Ph.D., 2011 Collegiate Institutions Attended: 2006 -2011 University of Maryland, Baltimore, MD Ph.D., Molecular Epidemiology 2000-2001 Boston University, Boston, MA M.P.H Epidemiology and Biostatistics 1997-2000 Purdue University, West Lafayette, IN B.S., Microbiology Published Manuscripts 1. Harris AD, Johnson JK, Thom KA, Morgan DJ, McGregor JC, Ajao AO, Moore AC, Comer AC, Furuno JP. Risk factors for Development of Intestinal Colonization with Imipenem-Resistant Pseudomonas aeruginosa in the Intensive Care Unit Setting. Infect Control and Hosp Epidemiol. 2011 Jul; 32(7):719-22. 2. Ajao AO, Harris AD, Roghmann MC, Johnson JK, Zhan M, McGregor JC, Furuno JP. A Systematic Review of Measurement and Adjustment for Colonization Pressure in Methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococci and Clostridium difficile Acquisition Studies. Infect Control and Hosp Epidemiol. 2011 May;32(5):481-9 3. Ajao AO, Robinson G, Lee MS, Ranke TD, Venezia RA, Furuno JP, Harris AD, Johnson JK. Comparison of Culture Media for Detection of Acinetobacter baumannii in Surveillance Cultures of Critically-ill Patients. Eur J Clin Microbiol Infect Dis. 2011 Apr 12 Abstracts 1. Ajao AO, Harris AD, Roghmann M, Perencevich EN, Schweizer ML, Chen WH, Furuno JP. Age as a Non-linear Predictor in the Progression from Methicillin- resistant Staphylococcus aureus (MRSA) Colonization to Infection. 49th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), San Francisco, CA, September 2009. 2. Furuno JP, Harris AD, Perencevich EN, Ajao AO, Schweizer ML, Andersen DA, Chan JA, Miller RR. Infection and Rapid Hospital Readmission. 49th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), San Francisco, CA, September 2009. 3. Ajao AO, Harris AD, Roghmann M, Johnson JK, Zhan M, McGregor JC, Furuno JP. Systematic Review of Measurement and Adjustment for Colonization Pressure in Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin- resistant enterococci (VRE). Society for Healthcare Epidemiology of America (SHEA) Annual Meeting, Atlanta, Georgia, March 2010. 4. Roghmann M, Ajao AO, Lydecker A, Adhikari RP, Karauzum H, Chen WH, Johnson JK, Aman MJ. Lower Antibody Levels to Staphylococcus aureus Exotoxins associated with Sepsis in Hospitalized Patients with Invasive S. aureus Infections. 50th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Boston MA, September 15, 2010 (oral presentation). 5. Ajao AO, Ranke T, Lee M, Robinson G, Furuno JP, Harris AD, Thom KA, Johnson JK. Detection of Multi-drug resistant Acinetobacter baumannii (MDR- AB) in Peri-Rectal Surveillance Cultures of Critically Ill Patients for Infection Control. 50th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Boston MA, September 15, 2010. 6. Ajao AO, Johnson JK, Harris AD, Zhan M, McGregor JC, Thom KA, Furuno JP. Risk of acquiring Extended spectrum-β-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli from prior room occupants in intensive care unit. Society for Healthcare Epidemiology of America (SHEA) Annual Meeting, Dallas, Texas, April 2011. 7. Ajao AO, Furuno JP, Harris AD, Lee M, Robinson G, Johnson JK. Prevalence and Molecular Characterization of Extended-Spectrum-β-lactamase (ESBL) and AmpC β-lactamase Genes among Klebsiella spp. and Escherichia coli Colonizing Isolates in Intensive Care Unit Patients. Society for Healthcare Epidemiology of America (SHEA) Annual Meeting, Dallas, Texas, April 2011. 8. Johnson JK, Thom KA, Harris AD, Morgan DJ, Ajao AO, Furuno JP. Carbapenem Resistance in Extended-spectrum Beta-lactamase (ESBL)-producing Klebsiella and Escherichia coli (ESBL-KE). Interscience Conference on Antimicrobial Agents and Chemotherapy 51st Meeting. September, 2011. Chicago, IL. (Abstract # K-818) Professional Society Memberships 2001-present American Public Health Association 2004 -present Society of Clinical Research Associates 2008-present American Society of Microbiology 2011 Society for Epidemiology Research Honors and Awards 2009 Recipient of ASM/ICAAC Student and Post-Doctoral Fellows Travel Grant 2011 Recipient of SHEA Travel Award Teaching Responsibilities Spring 2008 Teaching Assistant, Biostatistical Computing (PREV 619) Fall 2008 Teaching Assistant, Introduction to Biostatistics (PREV 600) ABSTRACT Title of Dissertation: The Role of Persistent Environmental Contamination and Universal Glove and Gown Use in the Acquisition of Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Intensive Care Unit Patients. Adebola O. Ajao, Doctor of Philosophy, 2011 Dissertation Directed by: Jon P. Furuno, Ph.D. Assistant Professor, Department of Epidemiology and Public Health Background: Extended-spectrum β-lactamase (ESBL)-producing Gram-negative rods (GNR) are emerging pathogens that are associated with considerable morbidity, mortality and costs among hospitalized patients. The association between persistent environmental contamination and acquisition of ESBL-GNR and the effectiveness of universal glove and gown in reducing the transmission of ESBL-GNR among Intensive care unit (ICU) patients has not been well established. Objectives: The objectives of this dissertation are to evaluate the role of persistent environmental contamination using prior room occupant as a proxy in the acquisition of ESBL-GNR and to evaluate the effectiveness of universal glove and gown use in reducing the incidence of ESBL-GNR in ICU patients. Methods: A retrospective cohort study and a quasi-experimental study were conducted using patient data obtained from the central data repository and by laboratory analysis. Peri-anal surveillance cultures were collected from all patients on ICU admission, weekly and at ICU discharge and clinical cultures were collected as medically indicated. Inclusion criteria were ICU length of stay >48 hours and a peri-anal surveillance culture negative for ESBL-GNR on ICU admission. Multivariable logistic regression and segmented linear regression were used to analyze the data. Results: The first study of 18,175 admissions to the University of Maryland Medical Center (UMMC) medical ICU (MICU) and surgical ICU (SICU) between September 1, 2001 and June 30, 2009 showed that prior room occupants’ ESBL-Klebsiella and E. coli positive status is not associated with acquiring ESBL- Klebsiella and E. coli after adjusting for potential confounders (Adjusted Odds Ratio (AOR) = 1.39, 95% Confidence Interval (CI) = 0.94 - 2.08). The second study of 6,089 admissions to the MICU between July 1, 2005 and June 30, 2009 showed that universal glove and gown did not reduce acquisition of ESBL-GNR immediately (p =0.48) or long term (p =0.34). Conclusions: Our study results suggest that environmental contamination may not play a significant role in the acquisition of ESBL-GNR at UMMC. Universal glove and gown was not effective at reducing the acquisition of ESBL-GNR immediately and long term at UMMC. The Role of Persistent Environmental Contamination and Universal Glove and Gown Use in the Acquisition of Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Intensive Care Unit Patients by Adebola O. Ajao Dissertation submitted to the faculty of the Graduate School of the University of Maryland, Baltimore in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2011 © Copyright 2011 by Adebola O. Ajao All rights Reserved DEDICATION This dissertation is dedicated to my loving husband Yomi Ajao, who supported me throughout my doctoral program. To my sweet daughter, Oluwadara Ajao, who lived with a part-time mummy for four years. To my wonderful parents, Prof. &Mrs. S.A. Olanrewaju, my siblings and in-laws who supported me throughout this journey. I am sincerely grateful for all your love and support. iii Acknowledgements I would like to express my gratitude to my primary dissertation mentor Dr. Jon P. Furuno and all my committee members, Dr. Anthony D. Harris, Dr. Jennifer K. Johnson, Dr. Jessina C. McGregor, Dr. Kerri A. Thom, and Dr. Min Zhan for their time, support and guidance throughout my dissertation process. I would like to thank the laboratory team, Gwen Robinson, Mary Lee, Tarah Ranke, Alex Perdieu, Chrisley Pickens, Angela Stancil and Katarina Lincalis for all their hard work. I would like to thank the data support team, Jingkun Zhu, Angela Comer and Joseph Rosenberg for data extraction and data validation support. I would also like to thank the entire faculty and staff of the Department of Epidemiology and Public
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