Download File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
May 2014
CRE - Klebsiella
A Deadly HAI Fungus in Children and
Questions at a Hospital
• The deaths of at least four children from a flesh-eating infection contracted from
improperly disinfected linens has raised concerns about patient safety at Children’s
Hospital in New Orleans. The outbreak of mucormycosis, which occurred between
August 2008 and July 2009, is suspected to have spread partly because of lapses in
the hospital’s infection controls and sloppy handling of contaminated linens. Among
other things, the report alleges that workers unloaded clean linens on the same
dock where medical waste was removed, moved clean and soiled linens on the
same carts, and stored linens in hospital hallways covered in dust from a nearby
construction site.
• The first victim was a premature boy in the intensive care unit whose mother
noticed a mysterious irritation in his groin; it grew into an open wound burrowing
into the baby's abdomen. The last patient to die was a 10-year-old girl, whose face
was ravaged. Three other patients at Children's Hospital here were also stricken,
including a 13-year-old boy who his parents said endured over 20 surgical
procedures in 54 days in a futile effort to save him. The children arrived at Children's
Hospital battling a serious illness before being overwhelmed by an infection.
Source: http://www.nytimes.com/2014/04/29/us/a-deadly-fungus-and-questionsat-a-hospital.html?&_r=0
Outbreak of Campylobacteriosis Associated
with a Long-Distance Obstacle Adventure Race
— Nevada, October 2012
• Campylobacter is one of the most common causes of diarrheal illness in the United
States. Most persons who become ill with campylobacteriosis get diarrhea,
cramping, abdominal pain, and fever within 2–5 days after exposure to the
organism. The diarrhea can be bloody and can be accompanied by nausea and
vomiting. The illness typically lasts about 1 week. Most cases occur as isolated,
sporadic events and are usually associated with eating raw or undercooked poultry
or from cross-contamination of other foods by these items.
• Inadvertent ingestion of muddy surface water contaminated with cattle or swine
feces during a long-distance obstacle adventure course competition likely resulted
in an outbreak of campylobacteriosis in 22 participants. A case-control study was
conducted to identify the source of infection. Twenty-four healthy controls
consisting of both military personnel and civilians who had been race participants
were identified through contact investigation of the 22 case-patients. Analysis of
the case-control study identified a statistically significant association with
"inadvertent swallowing of muddy water while competing" and Campylobacter
infection (odds ratio = 19.4; p<0.001). Source: MMWR May 2, 2014 / 63(17);375-378
MERS: CDC confirms first U.S. case of
Middle East respiratory syndrome
A case of the sometimes fatal Middle East respiratory syndrome, or MERS, has been
reported in Indiana, officials from the Centers for Disease Control and Prevention. The
patient is a healthcare provider who had been working in Riyadh, the capital of Saudi
Arabia, before boarding a plane to London on April 24, then flying to Chicago and taking a
bus to Indiana.
On April 27, the patient began to experience shortness of breath, coughing and fever,
common symptoms of the MERS coronavirus. The patient went to an emergency
department at an Indiana hospital the next day and, based on his symptoms and travel
history, was tested for the MERS coronavirus, or MERS-CoV. He has been isolated and is in
stable condition.
The high-profile MERS has emerged only in the last two years: The first case cropped up in
Saudia Arabia in 2012 and may have originated in camels before jumping to humans. Since
then, the disease has infected 262 people in 12 countries; of those, 93 have died, according
to the World Health Organization. More than 100 more cases have been reported by
various nations’ health departments but are not yet included in the WHO total count.
Source: CDC News – May 5 2014
WHO: Spread of polio now a
world health emergency
• For the first time ever, the World Health Organization on Monday declared the
spread of polio an international public health emergency that could grow in the next
few months and unravel the nearly three-decade effort to eradicate the crippling
disease. The agency identified Pakistan, Syria and Cameroon as having allowed the
virus to spread beyond their borders, and recommended that those three
governments require citizens to obtain a certificate proving they have been
vaccinated for polio before traveling abroad. At the end of last month, there were
68 confirmed polio cases worldwide, compared with just 24 at the same time last
year. In 2013, polio reappeared in Syria, sparking fears the civil war there could
ignite a wider outbreak as refugees flee to other countries across the region. The
virus has also been identified in the sewage system in Israel, the West Bank and
Gaza, although no cases have been spotted.In February, the WHO found that polio
had also returned to Iraq, where it spread from neighboring Syria. It is also
circulating in Afghanistan (where it spread from Pakistan) and Equatorial Guinea
(from neighboring Cameroon) as well as Nigeria, Ethiopia, Somalia and Kenya.
Officials also worry countries torn by conflict, such as Ukraine, Sudan and the
Central African Republic, are rife for polio reinfection. Source:
http://www.washingtonpost.com/world/middle_east/un-spread-of-polio-now-an-world-health-emergency/2014/05/05/5c0aa5a2-d44711e3-8f7d-7786660fff7c_story.html
Saudi hospital head sacked as
MERS death toll hits 117
• Saudi Arabia's acting health minister has announced the sacking of the head of a
Jeddah hospital where a spike in MERS infections among medical staff sparked
panic among the public. And as two more deaths were announced from the Middle
East Respiratory Syndrome coronavirus, which some researchers think may
originate in camels, Adel Fakieh also announced an awareness campaign to help
stop the disease's spread. The campaign urges people not only to follow strict
measures of hygiene, but specifically to avoid sick camels and refrain from eating
raw camel meat or drinking unboiled camel milk. Fakieh had already made such a
recommendation last week. The Jeddah hospital was temporarily shut last month
after several medics were infected by MERS. And panic there prompted at least
four doctors to resign in mid-April after they refused to treat MERS patients for fear
of infection. On Wednesday, health officials announced two more deaths from
MERS, bringing the toll to 117. Saudi Arabia has reported 431 infections since MERS
first appeared in its eastern region in September 2012 before spreading across the
kingdom. The majority of human-to-human infections occurred in healthcare
facilities," it said, adding that "one quarter of all cases have been healthcare
workers." The team called for improving "knowledge and attitudes" of healthcare
workers about MERS. http://www.ndtv.com/article/world/saudi-hospital-head-sacked-as-mers-death-toll-
Harmful bacteria can linger on airplane
seat-back pockets, armrests for days
• In order for disease-causing bacteria to be transmitted from a cabin surface to a
person, it must survive the environmental conditions in the airplane. In the study
Vaglenov and his colleagues tested the ability of two pathogens, methicillinresistant Staphylococcus aureus (MRSA) and E. coli O157:H7 to survive on surfaces
commonly found in airplanes. They obtained six different types of material from a
major airline carrier (armrest, plastic tray table, metal toilet button, window
shade, seat pocket cloth, and leather), inoculated them with the bacteria and
exposed them to typical airplane conditions.
• MRSA lasted longest (168 hours) on material from the seat-back pocket while E.
coli O157:H7 survived longest (96 hours) on the material from the armrest. The
researchers future plans include the exploration of effective cleaning and
disinfection strategies, as well as testing surfaces that have natural antimicrobial
properties to determine whether these surfaces help reduce the persistence of
disease-causing bacteria in the passenger aircraft cabin
• American Society for Microbiology. "Harmful bacteria can linger on airplane seatback pockets, armrests for days." ScienceDaily. ScienceDaily, 20 May 2014
Minnesota bans common anti-bacterial
chemical from soaps as pressure on
industry grows
• MINNEAPOLIS —Gov. Mark Dayton on Friday signed a bill to make Minnesota the
first state to prohibit the use of triclosan in most retail consumer hygiene
products. The Minnesota House and Senate passed it earlier last week because of
health and environmental concerns about the chemical. The ban isn't due to take
effect until Jan. 1, 2017. The Roseville Democrat said other states and the federal
government are likely to act, too. And he said come companies are already
catching on that there's no marketing advantage to keeping triclosan in its
products. He noted that Procter & Gamble's Crest toothpaste is now marketing
itself as triclosan-free.
• Triclosan is used in an estimated 75 percent of anti-bacterial liquid soaps and
body washes sold across the United States, according to the Food and Drug
Administration. The federal agency announced last year that it would revisit the
safety of triclosan and other germ-killing ingredients used in personal cleaning
products. While triclosan hasn't been shown to be hazardous to humans, studies
have raised concerns that it can disrupt hormones critical for reproduction and
development, at least in lab animals, and contribute to the development of
resistant bacteria.
Urinary tract infections: what you
need to know to reduce your risk
The Centers for Disease Control and Prevention recently reported that UTIs are the third most
common healthcare-associated infection, accounting for more than 93,000 infections in
hospitals alone.
The urinary catheter may be necessary if the person:
 Has urinary retention – this is when a person cannot urinate on their own
 Is critically ill and the amount of fluid intake and output is important
 Has a large sacral pressure ulcer that is not healing and the person is incontinent
 Undergoes certain abdominal or pelvic surgeries
The staff caring for a person with a urinary catheter is taking measures to reduce risk of CAUTI:
 The catheter should only be used when absolutely necessary!
 Anyone handling the catheter and tubing, including you, should cleanse their hands before
and after touching it.
 The catheter and drainage tubing should remain connected—no separating the device to
put on clothes or collect specimens or bladder irrigations.
 Urine should flow freely; this means that there should be no kinks in the tubing and the
bag should not be placed on the bed.
 The bag should be below the bladder (but not on the floor).
 The catheter should be secured to the person’s leg to reduce friction on the urethra.
 Simple cleaning of the area where the catheter enters the body should be done with soap
and water. www.apic.org