Table 4 Recommendations for infection control and diagnostics to prevent and control E. anophelis outbreaks

Infection prevention

Involve infection control staff in the early planning stages of designing patient rooms and wards, especially within critical care settings

[32, 38, 39, 55, 56]

Establish a water management program

[55,56,57,58,59]

Aim for water-free patient rooms in high-risk populations

[60] [This study]

Use tap outlets without aerators

[34]

Flush taps at least daily (automatically)

[6, 50, 55]

Implement surveillance on water contamination on a periodic basis

[4, 8, 27, 28, 40, 54, 55, 61,62,63,64,65]

Implement an antibiotic stewardship program

[66,67,68,69]

Implement a national AMR surveillance program

[37, 57, 70]

Screen high-risk patients and donor tissues for multidrug resistant gram-negative bacilli

[71] [This study]

Continuously educate and monitor care providers on hand hygiene, disinfection practices and aseptic technique

[6, 27, 32, 34, 42, 54, 55, 58, 59, 61, 63, 66, 68, 69, 72,73,74,75,76,77,78,79]

Use alcohol-based hand rub instead of water and soap based hand hygiene

[6, 34, 50, 60]

Discard baby pacifiers (dummies) every 24 h

[80,81,82]

Avoid contact between clean water points and body fluids and body fluid-contaminated items

[34, 38, 39, 51, 75, 83]

Use sterile water for patient bathing and cleaning of medical equipment and patient-care items

[2, 6, 34, 38, 39, 42, 62, 72, 75, 76, 83, 84]

Outbreak control

Isolate patients with positive Elizabethkingia cultures

[4, 8, 58, 61, 79, 85,86,87] [This study]

Conduct source investigation and contact tracing, including environmental cultures, water samples and testing of close contacts

[4, 8, 42, 51, 58, 59, 66, 79, 88,89,90,91] [This study]

Use selective media such as Burkholderia Cepacia Selective Agar or combined disc tests for screening purposes

[33] [This study]

Enhance disinfection of surfaces and equipment during an outbreak

[4, 6, 8, 32, 34, 35, 40, 50, 51, 61, 63, 64, 66, 68, 72, 74, 79, 87,88,89, 92]

Restrict staff exchange during an outbreak until source is found

[61, 92]

Remove or replace contaminated water sources

[6, 32, 38, 39, 50, 63, 66, 83]

Identify clusters through whole genome sequencing

[2, 3, 5, 17, 93,94,95]