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Infection Prevention eBug Bytes July 2014 TB Transmission Study Examines Rate of HIV Diagnosis in U.S. • The annual HIV diagnosis rate in the U.S. decreased more than 30 percent from 2002-2011, with declines observed in several key populations, although increases were found among certain age groups of men who have sex with men, especially young men. There has been increasing emphasis on care and treatment for persons with human immunodeficiency virus (HIV) in the United States during the past decade, including the use of antiretroviral therapy for increasing survival and decreasing transmission. Accurate HIV diagnosis data recently became available for all states, allowing for the first time an examination of long-term national trends. • During 2002-2011, 493,372 persons were diagnosed with HIV in the United States. The annual diagnosis rate decreased by 33.2 percent, from 24.1 per 100,000 population in 2002 to 16.1 in 2011. Statistically significant decreases in diagnosis rates over time were found in nearly every demographic population with the largest changes observed in women, persons 35-44 years of age, and persons of multiple races. Changes were not evident for Asians or Native Hawaiians/other Pacific Islanders. The annual number of HIV diagnoses decreased in persons with infection attributed to injection drug use or to heterosexual contact. • Source: July 23/30 issue of JAMA, a theme issue on HIV/AIDS Low-cost TB test means quicker, more reliable diagnosis for patients • A new test for tuberculosis could dramatically improve the speed and accuracy of diagnosis for one of the world's deadliest diseases. Although preventable, TB claims three lives every minute, making it the second leading cause of mortality from an infectious disease in the world. Findings show the test can determine that a patient has tuberculosis with 86 percent sensitivity and 73 percent specificity. Smear microscopy, the most widely used test in the world, has a significantly lower ability to detect TB, ranging between 50 to 60 percent sensitivity. Spread through the air when an individual with active TB infection coughs or sneezes, reports show that if left untreated, a person with active TB infects an average of 10 to 15 people each year, leaving a great need for faster, more reliable testing. • Once sputum samples are combined with the reactive substance, a batterypowered, portable tabletop device, the TB REaD™, is then used to detect any fluorescence and deliver the diagnosis in as little as 10 minutes. The device significantly undercuts current diagnostic methods, important, given the staggering statistic that if left untreated -- a common scenario in countries lacking infrastructure or resources to efficiently screen and follow up with infected patients -- a person with active TB has only a 50 percent chance of survival. Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center • Background • Four patients were hospitalized July 2011 with Pseudomonas aeruginosa bloodstream infection (BSI), 2 of whom also had Klebsiella pneumoniae BSI. All 4 patients had an indwelling port and received infusion services at the same outpatient oncology center. • Methods • Cases were defined by blood or port cultures positive for K pneumoniae or P aeruginosa among patients receiving infusion services at the oncology clinic during July 5-20, 2011. Pulsed-field gel electrophoresis (PFGE) was performed on available isolates. Interviews with staff and onsite investigations identified lapses of infection control practices. Owing to concerns over long-standing deficits, living patients who had been seen at the clinic between January 2008 and July 2011 were notified for viral blood-borne pathogen (BBP) testing; genetic relatedness was determined by molecular testing. • Continued……… Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center • Results • Fourteen cases (17%) were identified among 84 active clinic patients, 12 of which involved symptoms of a BSI. One other patient had a respiratory culture positive for P aeruginosa but died before blood cultures were obtained. Available isolates were indistinguishable by PFGE. Multiple injection safety lapses were identified, including overt syringe reuse among patients and reuse of syringes to access shared medications. Available BBP results did not demonstrate iatrogenic viral infection in 331 of 623 notified patients (53%). • Conclusions • Improper preparation and handling of injectable medications likely caused the outbreak. Increased infection control oversight of oncology clinics is critical to prevent similar outbreaks. • Source: AJIC Volume 42, Issue 7 , Pages 731-734, July 2014 Sustained reduction of central line–associated bloodstream infections outside the intensive care unit with a multimodal intervention focusing on central line maintenance Background • Central venous catheter use is common outside the intensive care units (ICUs), but prevention in this setting is not well studied. We initiated surveillance for central line–associated bloodstream infections (CLABSIs) outside the ICU setting and studied the impact of a multimodal intervention on the incidence of CLABSIs across multiple hospitals. • Methods • This project was constructed as a prospective preintervention-postintervention design. The project comprised 3 phases (preintervention [baseline], intervention, and postintervention) over a 4.5-year period (2008-2012) and was implemented through a collaborative of 37 adult non-ICU wards at 6 hospitals in the Rochester, NY area. The intervention focused on engagement of nursing staff and leadership, nursing education on line care maintenance, competence evaluation, audits of line care, and regular feedback on CLABSI rates. Quarterly rates were compared over time in relation to intervention implementation. Sustained reduction of central line–associated bloodstream infections outside the intensive care unit with a multimodal intervention focusing on central line maintenance • Results • The overall CLABSI rate for all participating units decreased from 2.6/1000 line-days preintervention to 2.1/1,000 linedays during the intervention and to 1.3/1,000 line-days postintervention, a 50% reduction (95% confidence interval, .40-.59) compared with the preintervention period (P .0179). • Conclusion • A multipronged approach blending both the adaptive and technical aspects of care including front line engagement, education, execution of best practices, and evaluation of both process and outcome measures may provide an effective strategy for reducing CLABSI rates outside the ICU. • Source: Volume 42, Issue 7 , Pages 723-730, July 2014 Video observation to map hand contact and bacterial transmission in operating rooms • Background • Hand hygiene (HH) is considered a primary intervention to avoid transmission of bacteria in health care settings and to prevent health care-associated infections. Despite efforts to decrease the incidence of health care-associated infections by improving HH, HH compliance rates vary widely depending on the hospital environment. • Methods • We used intraoperative video observation to map temporal patterns of anesthesia provider hand contact with anesthesia work environment (AWE) surfaces and to assess HH compliance. Serial bacterial cultures of high contact objects were subsequently used to characterize bacterial transmission over time. • Continued…….. Video observation to map hand contact and bacterial transmission in OR • Results • Using World Health Organization criteria, we found a large number of HH opportunities and a low rate of HH compliance by anesthesia providers (mean, 2.9%). We observed an inverse correlation between provider hand hygiene compliance during induction and emergence from anesthesia (3.2% and 4.1%, respectively) and the magnitude of AWE surface contamination (103 and 147 CFU, respectively) at these time points. We found no correlation between frequency of hand contact with the AWE and bacterial contamination. • Conclusions • Compliance with current HH recommendations by anesthesia providers is not feasible. However, there does appear to be a correlation between HH compliance rates and bacterial contamination of the AWE, an observation that should stimulate further work to design new methods for control of bacterial transmission in operating rooms • Source: Volume 42, Issue 7 , Pages 698-701, July 2014 Hospital elevator buttons carry more bacteria than toilet surfaces Researchers swabbed 120 elevator buttons and 96 toilet surfaces over separate intervals at three large, urban teaching hospitals on weekends and weekdays in Toronto, Ontario. They swabbed the up and down buttons on the outside of the elevator, along with the ground floor and a randomly selected upper-level floor button, while they swabbed the handles of the bathroom door, the privacy latch on the door and the toilet flusher. There was a 61 percent prevalence of colonization on elevator buttons, which didn't vary based on location of the buttons, day of the week or panel position within the elevator, according to the study. Coagulase-negative staphylococci were the most common organism cultured, while Enterococcus and Pseudomonas species were infrequent. Toilet surfaces, on the other hand, only had a 43 percent prevalence of colonization. Although absence of pathogenic organisms reflects good hand hygiene and staff cleaning, the prevalence of colonization shows patients remain at risk for cross contamination because of the frequent use of elevator buttons, according to the study. Researcher noted that they took the samples during flu season, which could have influenced the bacteria count because of the increased use of hand sanitizer, or conversely, may have increased hospital traffic and generalized exposures. Source: Open Medicine, Vol 8, No 3 (2014) Safety of fecal transplant to treat C. difficile examined in study Researchers have found that fecal transplantation is effective and safe for treating C. difficile in immunocompromised patients. The study and its findings have been published online in advance of print in the American Journal of Gastroenterology. Increased lengths of stay in hospitals and extended-care facilities, in addition to broad-spectrum antibiotics, increase C. diff infection risk among immunocompromised patients. The infection is responsible for 15 to 25 percent of hospital acquired antibiotic-associated diarrhea and has increased rapidly over the past 10 years to an incidence of 10.4 cases per 1,000 patient admissions. Recurrence is common and occurs in up to 20 percent of patients after initial treatment for C. diff infection. Researchers reviewed the records of 75 adult and five pediatric patients with fecal transplant for C. diff infection. Reasons for being immunocompromised included: HIV/AIDS, solid organ transplant, an oncologic condition, immunosuppressive therapy for inflammatory bowel disease, and other medical conditions/medications, such as cirrhosis and end stage kidney disease. Analysis found an overall cure rate of 89 percent. While not directly related to fecal transplant, 12 patients had serious adverse effects (such as hospitalization) within 12 weeks of the procedure. Among these were two deaths -- one resulted from aspiration during sedation for the colonoscopy used to administer fecal transplant; the other was unrelated to fecal transplant. Some patients with inflammatory bowel disease experienced disease flares after transplant, but no patient suffered infections related to fecal transplant. Source: Fecal Microbiota Transplant for Treatment of Clostridium difficile Infection in Immunocompromised Patients. The American Journal of Gastroenterology, 2014; 109 (7): 1065 DOI: 10.1038/ajg.2014.133 Deadliest, rarest form of plague contracted near Denver • A Colorado man is infected with the rarest and most fatal form of plague, an airborne version that can be spread through coughing and sneezing. It is the first case of pneumonic plague seen in the state since 2004. The may have been exposed in Adams County near Denver. He may have contracted the illness from his dog, which died suddenly and has also been found to carry the disease. • Plague in all of its forms infects only about seven people yearly in the U.S. The disease occurs when a bacterium named Yersinia pestis infects the body, according to the U.S. Centers for Disease Control and Prevention. The difference between the pneumonic and bubonic varieties is that the bacteria take hold in the lungs in the first case, rather than underneath the skin through insect bites. Both types are treated with antibiotics. The state is working to investigate the source of exposure and to identify those who may have been exposed through close contact with the individual. Any individuals exposed will be recommended for antibiotic treatment. Colorado has had 60 cases of all types of plague since 1957, and nine people have died. Colorado officials recommend that residents keep pets away from wildlife, especially dead rodents. The plague can spread from animals after a large die-off of prairie dogs, when fleas with the bacteria seek new hosts. Source: http://www.bloomberg.com/news/2014-07-11/deadliest-rarest-form-of-plague-contracted-near-denver.html Voluntary Nationwide Recall of Tattoo Ink, Tattoo Needles, Tattoo kits Due to Microbial Contamination • July 11, 2014 - July 11, 2014- White & Blue Lion, Inc. in the City of Industry, CA is recalling all lots of tattoo Inks and tattoo needles due to pathogenic bacterial contamination. Use of these products may cause bacterial infection and can lead to sepsis, a potentially life-threatening complication of an infection. The recall includes all tattoo inks, tattoo needles, and tattoo kits distributed by White & Blue Lion. • The inks and needles are sold in tattoo kits and the inks are also sold separately by 8Decades and White & Blue Lion, Inc. through www.amazon.com. • There was a report of one illness as of today’s date. FDA Laboratory testing has found microbial bacterial contamination in both the inks and needles. • This recall is being made with the knowledge of the US Food and Drug Administration. Consumers with any questions should contact us at 1-626-5863485 from Monday to Friday between the hours of 9am to 6pm PST. It's here: Local Chikungunya cases in Florida Chikungunya has been reported in a Florida man and woman who had not recently traveled, health officials said Thursday - the first indication that the painful virus has taken up residence in the United States. Health experts had said it was only a matter of time before the virus, carried by mosquitoes, made its way to the U.S. It's been spreading rapidly in the Caribbean and Central America. It's infected 350,000 and killed 21. There have been other U.S. cases but all have been among people who had recently traveled to affected regions. Florida health officials later said there were two cases: a 41-year-old woman in Miami-Dade County and a 50-year-old man in Palm Beach County. Since 2006, the United States has averaged 28 imported cases of chikungunya (chik-un-GUHNya) per year in travelers returning from countries where the virus is common. To date this year, 243 travel-associated cases have been reported in 31 states and two territories," CDC said. However, the newly reported case represents the first time that mosquitoes in the continental United States are thought to have spread the virus to a non-traveler. This year, Puerto Rico and the U.S. Virgin Islands reported 121 and two cases of locally acquired chikungunya respectively. Chikungunya is not usually deadly, but it can cause a very bad headache, joint pain, rash and fever. The Aedes aegypti and Aedes albopictus mosquitoes that spread chikungunya are found across the southern United States and as far north as New York. http://www.nbcnews.com/health/health-news/its-here-first-local-chikungunya-casesflorida-n158746 West Virginia clinic reused needles • Health officials on Monday advised patients of a West Virginia pain management clinic to be tested for blood-borne infectious diseases after an investigation found that needles had been reused. • The investigation by West Virginia health officials found that, prior to November 2013, needles and syringes were reused at Valley Pain Management in McMechen to administer pain medications and saline solutions. They said the same pain medication vial was used for more than one patient. • These injection practices potentially exposed patients to diseases such as hepatitis B, hepatitis C and HIV, according to health department officials in West Virginia and Ohio. Health officials urged patients from both states to be tested. Health officials from both states advised patients to be tested for blood-borne infections if they had an injection between the clinic's 2010 opening and Nov. 1, 2013. Both agencies said the clinic has not cooperated with their requests for a patient list, which they are seeking so patients can be notified of their potential risk of exposure and testing options. Sierra Leone's chief Ebola doctor contracts the virus • The head doctor fighting the deadly tropical virus Ebola in Sierra Leone has himself caught the disease, the government said. The 39-year-old Sheik Umar Khan, hailed as a "national hero" by the health ministry, was leading the fight to control an outbreak that has killed 206 people in the West African country. Across Guinea, Liberia and Sierra Leone, more than 600 people have died from the illness, according to the World Health Organization, placing great strain on the health systems of some of Africa's poorest countries. • Khan, a Sierra Leonean virologist credited with treating more than 100 Ebola victims, has been transferred to a treatment ward run by medical charity Medecins Sans Frontieres, according to the statement released late on Tuesday by the president's office. • Three days ago, three nurses working in the same Ebola treatment center alongside Khan died from the disease. • http://news.msn.com/world/sierra-leones-chief-ebola-doctor-contracts-thevirus •