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Infection Prevention
eBug Bytes
June 2015
New strategies for stopping
spread of Staph and MRSA
• Staphylococcus aureus -- better known as Staph -- is a common inhabitant of the human
nose, and people who carry it are at increased risk for dangerous Staph infections.
• However, it may be possible to exclude these unwelcome guests using other more benign
bacteria, according to a new study led by scientists representing the Translational Genomics
Research Institute (TGen), the Statens Serum Institut, and Milken Institute School of Public
Health (SPH) at the George Washington University.
• The study, published in the AAAS journal Science Advances, suggests that a person's
environment is more important than their genes in determining the bacteria that inhabit
their noses. The study also suggests that some common nasal bacteria may prevent Staph
colonization. The multi-center research team looked at data taken from 46 identical twins
and 43 fraternal twins in the Danish Twin Registry, one of the oldest registries of twins in the
world. It showed that there is no genetically inherent cause for specific bacteria in the nasal
microbiome. The so-called nasal microbiome is the collection of microbes living deep within
the nasal cavity. This research might ultimately lead to interventions that could route Staph
from the nose and thus prevent dangerous infections, including those caused by antibiotic
resistant Staph, the authors say. Studies suggest drug-resistant Staph infections kill more than
18,000 people in the United States every year. The researchers also looked for possible
gender differences and found that contrary to past studies there is no difference between
men and woman in the likelihood of nasal colonization by Staph.
•
Source: Liu C et al. Staphylococcus aureus and the ecology of the nasal microbiome. Science Advances, 2015; 1 (5)
Toothbrush contamination in
communal bathrooms
• Data confirms that there is transmission of fecal coliforms in communal bathrooms
can serve as a vector for transmission of potentially pathogenic organisms. Enteric
bacteria are a family of bacteria, Enterobacteriaceae, they are known to be normal
flora found in the gut. Pseudomonas group of bacteria are gram-negative aerobic
rods commonly found in soil, water, plants and animals. They are part of the
normal flora of the gut and also on the skin of humans.
• All toothbrushes were collected from participants using communal bathrooms,
with an average of 9.4 occupants per bathroom. Regardless of the storage method,
at least 60% of the toothbrushes were contamination with fecal coliforms. There
were no differences seen with the effectiveness of the decontamination methods
between cold water, hot water or rinsing with mouthwash and 100% of
toothbrushes regularly rinsed with mouthwash had growth on MacConkey agar
indicating fecal contamination (n=2). Fecal coliforms were seen on 54.85% of
toothbrushes, which has been seen in previous studies. There is an 80% chance
that the fecal coliforms seen on the toothbrushes came from another person using
the same bathroom.
• Source: American Society for Microbiology. "Toothbrush contamination in
communal bathrooms." ScienceDaily. ScienceDaily, 2 June 2015
MERS Virus’s Path: One Man, Many
South Korean Hospitals
•
At first, doctors thought the 68-year-old man might have simple pneumonia. He coughed
and wheezed his way through four hospitals before officials figured out, nine days later, that
he had something far more serious and contagious. Along the way the man infected dozens
who then became potential carriers themselves and infected dozens more and counting.
The original diagnosis that missed what became South Korea’s first case of Middle East
respiratory syndrome, or MERS, was possibly caused by incomplete information from the
patient about his travels. And the WHO acknowledged that MERS was not an easy virus to
identify early because its symptoms are similar to other respiratory infections, like a
common cold. But it was especially problematic in South Korea because of peculiarities in
the hospital system. Patients jostle, cajole and name-drop to get referrals to the biggest
hospitals, which they believe attract the best doctors. Family members and outside
caregivers commingle with the sick in crowded emergency wards. They often stay with the
patients in their rooms and do much of the nursing work — wiping sweat, emptying
bedpans, changing sheets and exposing themselves to infections. As of Tuesday – June 8th,
the South Korean authorities had confirmed at least 95 MERS cases and were monitoring
more than 2,500 people under quarantine for symptoms. At least seven patients have died.
There has been no sign of a panic among the wider public. But fears of the virus have led to
the closings of nearly 2,000 kindergartens and schools and the cancellation of concerts and
religious and social gatherings. Sales of face masks and hand sanitizer have soared.
http://www.nytimes.com/2015/06/09/world/asia/mers-viruss-path-one-man-many-southkorean-hospitals.html?&_r=1
Researchers Map Where Hospital
Pathogens Are Lurking
•
•
•
In a new approach to reducing the scourge of hospital-acquired infections, a team of scientists has been
testing thousands of microbe samples from a Chicago hospital to learn how a medical building might
make patients sicker. Data from the three-year Hospital Microbiome Project are still being analyzed. So
far the team has found factors including ventilation and humidity, and design features such as
furnishings and fixtures, affect the kinds of bacteria people encounter inside a hospital in ways that
impact their health. The scientists aim one day to slow the rise of antibiotic-resistant bacteria in hospital
settings by manipulating conditions from room to room to keep pathogens in check.
A person typically sheds some 37 million bacteria every hour into the surrounding air or onto surfaces
touched. Every building appears to have its own unique microbiome, depending on how it is built and
operated, who uses it and what they do there. In hospitals, for example, the air that many patients
breathe, recycled through heating and air-conditioning systems, concentrates human-related bacteria
and potential pathogens, compared with patient rooms with open windows where outdoor air can
circulate. Other recent studies discovered that moisture-loving bacteria living in showerheads include
distinct populations of potential pathogens quite different from microbes on shower curtains a few feet
away. Drug-resistant staph germs can live for up to a week on some common furniture fabrics. Strep
germs can survive for months on a dry surface. Typically, people came in and out of each room 100
times a day, trailing invisible plumes of bacteria, the researchers found. Some room surfaces had
thousands of types of bacteria; others had only a few hundred. Within hours of arrival of a new patient,
however, his or her personal collection of microbes spread throughout the room, mingling with
microbes already present and making the microbiome of each room unique. Researchers hope the
project will inspire a new generation of infection-control practices. Dr. Green, of the University of
Oregon, believes the technology will begin showing up in hospitals within five years.
Source: http://fpn.advisen.com/?resource_id=2378153821162460763#top
Health officials tracing path of
woman with rare TB
• Health officials are trying to track down people who may have been in contact with
a woman with a rare and deadly form of hard-to-treat tuberculosis.
• The woman has an extremely drug-resistant form of the disease, which is
impervious to most TB drugs. Three to four cases are reported each year in the
United States, on average.
• Health officials in Illinois are working with the Centers for Disease Control and
Prevention to find people with whom the woman may have had prolonged direct
contact, in close quarters, CDC spokesman Tom Skinner said.
• TB is not as easily spread as diseases like the flu or measles. But it is a dangerous
illness, especially for people with weakened immune systems, and health officials
are taking the situation seriously, Skinner said. In April, the woman traveled from
India to the United States, arriving at Chicago's O'Hare International Airport. She
spent time in Missouri, Tennessee and Illinois before growing sick and being
admitted to an isolation unit at a suburban Chicago hospital. She is now being cared
for at a National Institutes of Health hospital in Bethesda, MD, where she is in
stable condition. The CDC did not release other details.
• Source: http://abcnews.go.com/Health/wireStory/health-officials-tracing-pathwoman-rare-tb-31624273
CDC updates guidelines for prevention and
control of MERS-CoV in light of new outbreak
• The recommendations were informed by evidence-based infection prevention
and control guidelines CDC published previously in July 2014. Among the
guidelines, the CDC recommends minimizing the chance of exposure by:
•Taking steps to ensure all persons with symptoms of a respiratory
infection adhere to hygiene and cough etiquette, as well as hand hygiene.
•Designating waiting area spaces for patients who may have symptoms of
respiratory infection away from other patients.
•Ensuring quick triage and isolation of patients who may have MERS-CoV.
•Properly training and demonstrating how to use personal protective
equipment, such as gloves, gowns, and respiratory and eye protection.
• According to the CDC, the Republic of Korea has been investigating an outbreak
of MERS since May. It is the largest outbreak of MERS outside the Arabian
Peninsula. Only two patients in the United States have tested positive for the
MERS-CoV infection - both in May 2014 - while more than 500 have tested
negative. CDC has provided information for travelers and is working with health
departments, hospitals and other partners to prepare for this. To stay up to date
on the situation, visit the CDC's MERS home page. www.cdc.gov
Measles Transmission in an International Airport
at a Domestic Terminal Gate — April–May 2014
•
•
On April 22, 2014, the Minnesota Department of Health notified CDC of a case of measles in a child
aged 19 months who had documentation of receiving 1 dose of measles, mumps, and rubella
vaccine at age 12 months. The child's illness was clinically compatible with measles, which was
confirmed by polymerase chain reaction and immunoglobulin M serology at the Minnesota
Department of Health Public Health Laboratory. The child was febrile and developed a rash on
April 17 while on an international flight from India to the United States before taking a connecting
flight from Chicago to Minneapolis. Persons with measles are infectious from 4 days before to 4
days after rash onset. Therefore, travelers were exposed on both the international and domestic
flights. CDC's Division of Global Migration and Quarantine was contacted and provided information
on potentially exposed persons to relevant health departments for follow-up. No documented
transmission was reported as a result of the two flight exposures.
On May 5, the Massachusetts Department of Public Health contacted the Minnesota Department
of Health to report a case of measles in a Minnesota resident aged 46 years with unknown
vaccination status, who was traveling in Massachusetts for business when a rash was observed.
The case was confirmed by polymerase chain reaction and immunoglobulin M serology at the
Massachusetts Department of Public Health Laboratory. This person had no known exposures or
international travel, and did not fly on the same aircraft as the child from Minnesota on April 17.
However, investigation revealed that both patients had traveled through a Chicago airport and
used the same gate for their respective flights. Measles is a highly communicable disease, and
infectious droplets can remain suspended in the air for up to 2 hours after an infected person
leaves the area. MMWR June 26, 2015 / 64(24);679
Financial Penalties Reduce
Hospital-Acquired Infections
• After Medicare's Hospital-Acquired Conditions Payment Policy came into effect,
infections, such as central-line-associated bloodstream infections, decreased in
hospitals with low operating margins. In fact, it was in the hospitals with the least
amount of money at their disposal that the improvement in infection rates was
best. In the first year of the policy, there was a 3% decline in bloodstream
infections per quarter, according to new research. However, although the policy
ended reimbursement for infections that were acquired in the hospital, infection
rates in American hospitals as a whole were unchanged. "In previous work, we
found no impact of the policy on rates of targeted hospital-acquired infections
reported to the NHSN, but we were worried that the policy might have unintended
consequences, particularly in hospitals that were already resource-constrained,"
investigator Grace Lee, MD, from Boston Children's Hospital and Harvard Medical
School, told Medscape Medical News.. According to the research the pair
presented at the APIC 2015 Annual Meeting in Nashville, Tennessee, resourceconstrained hospitals actually reduced their infection rates after the policy was
implemented.
• Source: Medscape Medical News – June 30 2015
IPs spend more time in collecting and reporting
hospital infection data than protecting patients
•
Collecting and reporting hospital infection data to federal health agencies takes more than
5 hours each day, at the expense of time needed to ensure that frontline healthcare
personnel are adhering to basic infection prevention practices such as hand hygiene,
according to a recent case study, to be presented on Saturday, June 27 at the 42nd Annual
Conference of the Association for Professionals in Infection Control and Epidemiology
(APIC). Infection preventionists (IPs) play a critical role in the effort to eliminate healthcareassociated infections (HAIs), which strike one in 25 U.S. hospital patients. But many IPs,
especially those in community hospitals, feel burdened by the time necessary to comply
with the Centers for Medicare & Medicaid Services (CMS) reporting requirements--so
much so that one IP decided to find out just how much time it takes. The answer: five
hours and eight minutes a day of IP time, based on a five-day work week. That leaves little
time to observe practices, go on rounds, lead safety drills, or answer questions about how
to keep patients safe. IPs at Robert Wood Johnson University Hospital Somerset tabulated
the amount of time necessary to review lab data and complete reports for bloodstream
infections, urinary tract infections, surgical site infections, MRSA infections, and
Clostridium difficile infections to the Centers for Disease Control and Prevention's National
Healthcare Safety Network (NHSN). IPs at hospitals across the country are responsible for
analyzing lab reports and reporting infection data to the NHSN database, which is used for
Medicare payment determination by CMS. Source: Association for Professionals in
Infection Control Conference – abstract presentations.