Infection prevention and control interventions in the first outbreak of methicillin-resistant Staphylococcus aureus infections in an equine hospital in Sweden

<p>Abstract</p> <p>Background</p> <p>The first outbreak of methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) infection in horses in Sweden occurred in 2008 at the University Animal Hospital and highlighted the need for improved infection prevention and control. The present study describes interventions and infection prevention control in an equine hospital setting July 2008 - April 2010.</p> <p>Method</p> <p>This descriptive study of interventions is based on examination of policy documents, medical records, notes from meetings and cost estimates. MRSA cases were identified through clinical sampling and telephone enquiries about horses post-surgery. Prospective sampling in the hospital environment with culture for MRSA and genotyping of isolates by <it>spa</it>-typing and pulsed-field gel electrophoresis (PFGE) were performed.</p> <p>Results</p> <p>Interventions focused on interruption of indirect contact spread of MRSA between horses via staff and equipment and included: Temporary suspension of elective surgery; and identification and isolation of MRSA-infected horses; collaboration was initiated between authorities in animal and human public health, human medicine infection control and the veterinary hospital; extensive cleaning and disinfection was performed; basic hygiene and cleaning policies, staff training, equipment modification and interior renovation were implemented over seven months.</p> <p>Ten (11%) of 92 surfaces sampled between July 2008 and April 2010 tested positive for MRSA <it>spa</it>-type 011, seven of which were from the first of nine sampling occasions. PFGE typing showed the isolates to be the outbreak strain (9 of 10) or a closely related strain. Two new cases of MRSA infection occurred 14 and 19 months later, but had no proven connections to the outbreak cases.</p> <p>Conclusions</p> <p>Collaboration between relevant authorities and the veterinary hospital and formation of an infection control committee with an executive working group were required to move the intervention process forward. Support from hospital management and the dedication of staff were essential for the development and implementation of new, improved routines. Demonstration of the outbreak strain in the environment was useful for interventions such as improvement of cleaning routines and interior design, and increased compliance with basic hygienic precautions. The interventions led to a reduction in MRSA-positive samples and the outbreak was considered curbed as no new cases occurred for over a year.</p

Decision-support tools to build climate resilience against emerging infectious diseases in Europe and beyond

Climate change is one of several drivers of recurrent outbreaks and geographical range expansion of infectious diseases in Europe. We propose a framework for the co-production of policy-relevant indicators and decision-support tools that track past, present, and future climate-induced disease risks across hazard, exposure, and vulnerability domains at the animal, human, and environmental interface. This entails the co-development of early warning and response systems and tools to assess the costs and benefits of climate change adaptation and mitigation measures across sectors, to increase health system resilience at regional and local levels and reveal novel policy entry points and opportunities. Our approach involves multi-level engagement, innovative methodologies, and novel data streams. We take advantage of intelligence generated locally and empirically to quantify effects in areas experiencing rapid urban transformation and heterogeneous climate-induced disease threats. Our goal is to reduce the knowledge-to-action gap by developing an integrated One Health—Climate Risk framework

Colonic pericryptal fibroblasts - Differentiation pattern in embryogenesis and phenotypic modulation in epithelial proliferative lesions

Experimental evidence has shown that fetal gut mesenchymal cells can modulate epithelial cell differentiation. It is postulated that reciprocal stromal-epithelial interactions in the digestive tract are maintained beyond embryonic life. The mature colonic mucosa contains pericryptal fibroblasts (PCF), a stromal cell type exhibiting smooth muscle morphological features, which are thought to regulate the growth and differentiation of adjacent epithelial cells. Using an antibody directed at α-smooth muscle actin, which is constantly expressed in smooth muscle cells, we performed an immunohistochemical study on human embryonic tissues to assess PCF differentiation during development. PCF expressing ct-smooth muscle actin were first detected around the 21st week of gestation, at the bases of the crypts; the number of differentiated PCF increased then progressively, in synchrony with epithelial proliferation, to achieve at birth the characteristic distribution found in adults. We analyzed a series of non-malignant and malignant epithelial proliferative lesions of the adult colon by the same technique. Only sparse immunoreactive PCF were observed in 10/10 pure tubular adenomas, whereas in 11/11 villous adenomas immunoreactive PCF were consistently found bordering proliferative epithelia. Interestingly, 3/5 papillary adenomas, associated with areas of moderate to marked dysplasia, demonstrated foci of multi-layered immunoreactive PCF. In 14/14 carcinomas examined, PCF were no longer recognizable; stromal cells expressing variable amounts of β-smooth muscle actin, constituting the desmoplastic reaction, were constantly present. These observations establish immunohistochemically a smooth muscle phenotypic feature of PCF, which is acquired at mid-gestation, and the ability of PCF to proliferate in conjunction with some epithelial neoplasias. These findings might help to clarify the histogenesis of PCF and to improve our understanding of the mesenchymal-epithelial interactions suspected to operate during organogenesis as well as benign and malignant neoplastic conditions. © 1989 Springer-Verlag