Download File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
April 2014
Scientists are discovering a surprising
number of microbes living on cash
• In the first comprehensive study of the DNA on dollar bills, researchers at New York
University's Dirty Money Project found that currency is a medium of exchange for
hundreds of different kinds of bacteria as bank notes pass from hand to hand.
• By analyzing genetic material on $1 bills, the NYU researchers identified 3,000
types of bacteria in all—many times more than in previous studies that examined
samples under a microscope. Even so, they could identify only about 20% of the
non-human DNA they found because so many microorganisms haven't yet been
cataloged in genetic data banks. Their unpublished research offers a glimpse into
the international problem of dirty money. From rupees to euros, paper money is
one of the most frequently passed items in the world. Hygienists have long worried
that it could become a source of contagion. To make cash more durable, countries
from Canada to the Kingdom of Bhutan are printing bank notes on sheets of flexible
plastic polymer film, with implications for the microbiology of money.
• The bacteria found in a study of DNA on money included Staphylococcus aureus,
Escherichia coli, Helicobacter pylori and Corynebacterium diphtheriae. A chart in
an earlier version of this article misspelled the bacteria as Staphyloccus aureus,
Eschera coli, Heliobacter pylori and Coroynebactrium diptheriae.
Using video surveillance to measure
peoples' hand washing habits
The study was carried out using video cameras installed in the washing areas outside
latrines of four public schools in the sprawling Kibera slum of Nairobi, Kenya. Parents
and administrators gave permission for the study, and teachers were informed in
advance. A new study finds that video surveillance can provide insights into hand
washing behavior. When another person is present, for example, hand washing rates
increase 23 percent. Both methods of observation found the hand cleaning rate after
toileting was higher among girls -- a 4 percent difference, according to video
surveillance, and a 3 percent difference, according to in-person observation. Both
video observation and in-person observation demonstrated longer hand cleaning
times for hand washing with soap as compared to rubbing with sanitizer. Students at
schools equipped with soap and water, instead of sanitizer, were 1.3 times more likely
to wash their hands during simultaneous video surveillance and in-persono
bservation when compared with periods of in-person observation alone. Overall,
when students were alone at a hand cleaning station, hand cleaning rates averaged
48 percent, compared to 71 percent when at least one other student was present.
Hand cleaning rates showed an overall trend of increasing as the number of other
people present at hand cleaning stations increased. Amy J. Pickering, Annalise G. Blum, Robert F. Breiman, Pavani
K. Ram, Jennifer Davis. Video Surveillance Captures Student Hand Hygiene Behavior, Reactivity to Observation, and Peer Influence in Kenyan Primary
Schools. PLoS ONE, 2014; 9 (3): e92571
Overuse of blood transfusions
increases infection risk
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Blood transfusions are one of the most common procedures patients receive in the
hospital but the more red blood cells they receive, the greater their risk of infection,
says a new study led by the University of Michigan Heath System and VA Ann Arbor
Healthcare System. Elderly patients undergoing hip or knee surgeries were most
susceptible, with a 30 percent lower risk of infection when fewer transfusions were
used. Overall, for every 38 hospitalized patients considered for a red blood cell
transfusion (RBC), one patient would be spared a serious infection if fewer
transfusions were used.
Transfusions are often used for anemia or during surgery to make up for blood loss.
The authors evaluated all health care-associated infections that were reported after
receiving donor blood in the randomized trials. These included serious infections
such as pneumonia, bloodstream infections and wound infections. This is most likely
due to the patient’s immune system reacting to donor blood (known as transfusionassociated immunomodulation or TRIM). Transfusions may benefit patients with
severe anemia or blood loss; however, for patients with higher red blood cell levels,
the risks may outweigh the benefits.
Reference: “Healthcare-associated infection after red blood cell transfusion: A
systematic review and meta-analysis,” JAMA, doi: 10:1001/jama.2014.2726
State: RI Hospital botched
possible measles case
• State health officials have ordered Rhode Island Hospital to retrain
its emergency department staff on infection control after they
botched the handling of a potential measles case.
• The state Health Department investigated the Feb. 28 incident and
found that hospital staff violated infection control policies when
they allowed a patient with measles symptoms to sit in a public
waiting area for more than two hours. Health officials say the
patient was wearing a mask, but should have confined in a private
room under hospital policy. Tests later showed the person did not
have measles, which is highly contagious.
• Health Director Michael Fine says the hospital won't be fined for
the incident.
• Hospital officials say they take patient safety seriously and will reeducate staff about the hospital's comprehensive infection control
policies.
CDC remains concerned about C.diff but
hospitals using UV room disinfection
system are reporting fewer infections
• According to the CDC, approximately one in 25 U.S. patients contract at least
one infection during the course of their hospital care and every day, more than
more than 200 Americans with healthcare-associated infections (HAIs) will die
during their hospital stay. The CDC's HAI Progress Report showed minimal
decreases for both hospital-onset Clostridium difficile (C.diff) infections and
hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bloodstream
infections. A study published in the American Journal of Infection Control
(August 2013) reported that Cooley Dickinson Hospital (an affiliate of
Massachusetts General Hospital) experienced a 53 percent decrease in the rate
of hospital-acquired C.diff infections after implementing the Xenex system. A
study published in Journal of Infection Prevention in 2013 reported that Cone
Health experienced a 56 percent reduction in its rate of hospital acquired MRSA
infections after implementing an infection prevention program that included
Xenex's room disinfection system.
• http://www.xenex.com/article/cdc-remains-concerned-c-diff-hospitals-usingxenex-uv-room-disinfection-system-reporting-fewer-infections/
Peer reviewed article puts the
focus on infections from
conventional endoscopes
Reprocessing conventional flexible endoscopes is "time consuming, labor intensive,
expensive and, most importantly, susceptible to failure."
Due to "limited surveillance, limited reporting, and lack of immediate clinical
symptoms of patients," experts agree that cross-contamination is significantly
under-reported.
Infections "resulting from scope contamination breaks the trust between patients
and doctors and places a financial burden on healthcare institutions."
Research shows that using EndoSheath Technology and its simplified cleaning and
disinfection procedure offers "a vast improvement over current decontamination
procedures."
EndoSheath Technology eliminates "unreliable and cumbersome reprocessing" of
conventional endoscopes by condensing the protocol into just a few steps, and
"reduces reprocessing time by up to 31 minutes."
Due to its design, EndoSheath Technology is "more cost effective, reduces repair
costs, and decreases investment in multiple scopes that are out of operation while
being cleaned." BMJ 2014;348:g2047
Newly identified C. difficile strain
highly virulent
Researchers from Monash University in Australia have found that the RT244
Clostridium difficile strain, which was associated with severe disease and a high
mortality rate, has significant pathogenic potential. They found that the patients
with the RT244 strain had more severe disease, renal impairment and
hypoalbuminemia compared with non-RT244 patients. These patients also were
more likely to die: They had a 30-day mortality of 42% and four of the five deaths
were attributed to CDI. There were no deaths among patients with non-RT244
strains. Patients with the RT244 strain were 13 times more likely to die compared
with those with non-RT244 strains. “The overall clinical significance of RT244
cannot be clearly determined at present,” the researchers wrote in Clinical
Infectious Diseases. “At our laboratory, C. difficile RT244 has spontaneously
declined and the epidemiological data available to us provided no clear evidence
for the source of the strain, how it disseminated in our community or why its
incidence has declined. Further studies are required to answer these questions,
and to better understand the virulence of the strain, and its potential to become
endemic and to cause further outbreaks.”
http://www.healio.com/infectious-disease/gastrointestinal-infections/news/online/%7Baded8e63618e-4300-a1ad-f8402cbfd011%7D/newly-identified-c-difficile-strain-highly-virulent
SoClean CPAP sanitizing machine
uses activated oxygen to eliminate
any mold, bacteria, and viruses
• A study conducted by Dr. Sandra Horowitz of Brigham Women's Hospital
concluded that CPAP masks are a source of microbial contamination.
Researchers reported that a variety of bacteria were found inside CPAP masks,
even the pathogen Staph aureus.
• CPAP equipment, should be cleaned daily but is often neglected either
resulting in someone not using their CPAP machine or possibly contracting an
illness from a germ-ridden environment because the user allowed bacteria and
fungus to compound inside. Most users hand wash their equipment with soap
and water, but many others simply forget.
• The SoClean 2 destroys 99.9% of mold, bacteria, and viruses it comes in
contact with-without chemicals, soap or water with a seven minute procedure
and two hour wait time. It is FDA registered and independent lab test info is
available. Mike Schmidt, President of BRS. "The CPAP cleaning chore with the
SoClean 2; encourages users to maintain clean and sanitized CPAP equipment
to help keep them healthier and living longer as well.“
• http://www.betterrestsolutions.com/soclean/
Epidemic of Mumps among Vaccinated
Persons, the Netherlands, 2009–2012
• Mumps is an acute illness caused by mumps virus (family Paramyxoviridae) and
characterized by fever, swelling, and tenderness of >1 salivary gland, usually the
parotid gland. Complications associated with mumps include orchitis (inflammation
of the testes), meningitis, pancreatitis, and deafness. Mumps virus is spread in
respiratory droplets, and the incubation period is 15–24 days (median 19). The
Netherlands began mumps vaccination in 1987, using the measles, mumps, and
rubella combination vaccine (MMR). The vaccine is administered in a 2-dose
schedule at 14 months and 9 years of age.
• During September 1, 2009–August 31, 2012, a total of 1,557 cases of mumps were
reported in the Netherlands 1,254 (80.5%) of these were laboratory confirmed.
Most case-patients were male (59%) and 18–25 years of age (67.9%). The average
annual incidence per 100,000 population was 0.5 for the 0–3-year age group, 0.8
for the 4–14-year age group, 4.5 for the 13–17-year age group, 21.4 for the 18–25year age group, and 0.9 for the >25-year age group. Of the 1,474 cases for which
patient vaccination status was reported, 998 (67.7%) case-patients had received 2
doses of MMR; 157 (10.6%) had received 1 dose, and 242 (16.4%) were
unvaccinated. A total of 31 patients (2.1% of 1,436 patients with known
hospitalization status) were hospitalized. http://wwwnc.cdc.gov/eid/article/20/4/13-1681_article.htm
Deadly virus's spread raises
alarms in Mideast
• The United Arab Emirates over the weekend separately announced six confirmed
cases of Middle East Respiratory Syndrome, or MERS, among paramedics there,
one of whom died of the illness. The high number of cases among medical workers
raised questions about how effective Arab Gulf governments have been in
controlling the 1½-year-old outbreak. King Fahd General Hospital, the large public
hospital in Jeddah that has been hardest hit by a spike in the city this month.
• The hospital reopened its emergency room on Friday after shutting it briefly for
what authorities said was disinfection measures against MERS. But patients were
avoiding the hospital, and health workers were "very worried" after the MERS
death of one colleague and sickness in another.
• About 50 of the overall cases have been in healthcare workers, a strong warning
sign about measures being taken to control the outbreak. MERS-CoV does not
spread easily from person-to-person, so these clusters suggest a breakdown in
infection prevention and control.
• http://online.wsj.com/news/article_email/SB100014240527023038878045794998
31393801054-lMyQjAxMTA0MDEwMzExNDMyWj#printMode
Deadly H5N1 bird flu needs just 5
mutations to spread easily in people
• It's a flu virus so deadly that scientists once halted research on the disease
because governments feared it might be used by terrorists to stage a biological
attack. H5N1 avian influenza has killed 60% of the 650 humans known to be
infected since it was identified in Hong Kong 17 years ago, yet the "bird flu" virus
has yet to evolve a means of spreading easily among people.
• Now Dutch researchers have found that the virus needs only five favorable gene
mutations to become transmissible through coughing or sneezing, like regular flu
viruses. Researchers set out to determine the minimum number of mutations
necessary for airborne infection. To do this, the researchers took a strain of the
virus that had previously infected a human and altered its genes in the lab. Then
they sprayed the altered version of the virus into a ferret's nose and placed the
animal in a specially constructed cage with a second ferret who had not been
exposed to the virus. The layout of the cages prevented direct contact between
the animals, but allowed them to share airflow. When the healthy ferret
developed flu symptoms researchers knew the virus had spread through the air. By
exposing ferrets and human tissue samples to a variety of genetically altered
viruses, study authors identified five key gene mutations.
http://www.latimes.com/science/sciencenow/la-sci-sn-bird-flu-five-mutations-20140410,0,6818032.story