Download 1. Animal-human interface - Working Toward Zero HAIs

INFECTION PREVENTION
EBUG BYTES
Maureen Spencer, M.Ed, RN, CIC
Director, Clinical Implementation
Accelerate Diagnostics
New lawsuit alleges mold killed 2 more
patients at third UPMC hospital
The family of a patient at UPMC Shadyside hospital in Pittsburgh who contracted a fungal infection and
later died has filed a lawsuit against UPMC and its laundry provider alleging negligence. This is the first
time UPMC Shadyside has been implicated in the mold outbreak that briefly shut down UPMC's
transplant program in 2015 and was blamed for five patient deaths — the previous five patients were
in UPMC Montefiore and UPMC Presbyterian. The lawsuit also mentions another unnamed patient who
allegedly died at Shadyside in 2015 after getting a fungal infection, bringing the total number of patients
who died at UPMC hospitals during the mold outbreak to seven. The family of John R. Haines filed the
lawsuit on Tuesday. Mr. Haines was being treated for leukemia at UPMC Shadyside in September
when he contracted a rhizopus-positive pneumonia infection. He died in the hospital in October,
according to the report. The lawsuit is also against Dubois, Pa.-based Paris Cleaners, which handles
the laundry for UPMC hospitals. An internal report from UPMC made public in January as part of
another lawsuit found the laundry facility's ventilation system blew fungus onto linens later delivered to
UPMC hospitals, which could have caused the fungal infections. UPMC maintains that the two new
patients mentioned in the new lawsuit did not acquire their fungal infections inside UPMC Shadyside,
even though the hospital sent a letter to Mr. Haines before he died acknowledging the rhizopus mold
infection developed while he was at Shadyside.
Source: http://www.post-gazette.com/news/health/2017/02/14/Lawsuit-says-mold-killed-patient-at-thirdUPMC-hospital/stories/201702140117
Fresno nursing home reports Legionnaires'
death
A resident of NorthPointe Health Centre in Fresno, Calif., recently died of
Legionnaires' disease. The Fresno County Public Health Department is investigating
the death. The resident's name, age and date of death have not been released due
to patient confidentiality laws. Health officials have not detected Legionnaires' among
any other patients at the facility. County health officials recommended point-of-use
filters for showers, prohibited use of ice machines and recommended the use of
bottled water for drinking to protect patients at NorthPointe. The recommendations
are to remain in effect until an infection control remediation plan is in place. The
investigation marks the second time Fresno health officials have launched a
response to a Legionnaires' death in a local nursing home in the last two months. In
January, health officials identified the condition in a patient at Horizon Health &
Subacute Center. Legionnaires' disease is a type of pneumonia caused by
Legionella bacteria. It is not spread via person-to-person contact or by drinking
water, but can be contracted by inhaling mist from infected water sources, such as
cooling misters and plumbing systems.
Source: http://www.fresnobee.com/news/local/article132519589.html
4 things to know about the infection
prevention profession
Infection preventionists play a critically important role in healthcare, but their profession is
somewhat of a mystery to most.
The Association for Professionals in Infection Control (APIC) surveyed 4,078 APIC members
in 2015 and published preliminary results from the survey in the American Journal of
Infection Control in February.
Here are four things to know about infection preventionists, pulled from the APIC survey.
1. Most (66.2 percent) infection preventionists work in acute care hospitals. The rest work in
long-term care facilities, outpatient settings, ambulatory care or other settings.
2. Surveillance and investigation account for 25.4 percent of infection preventionists' time.
IPs also spend time on prevention and control of transmission (15.6 percent), identification
of infection (14.2 percent) and management and communication (12.2 percent), among
other activities.
3. Nearly half of survey participants (43 percent) were certified in infection prevention and
control. Several other participants (37.7 percent) said they were not currently certified but
plan to sit for certification in the future.
4. Respondents with current infection prevention and control certification made more money
than those without ($85,911 versus $68,817).
Source: http://www.ajicjournal.org/article/S0196-6553(16)31152-X/pdf
11 key infectious disease terms to know
1. Animal-human interface: When humans and animals interact after people set up dwellings on land stripped of
trees and other flora, but where forest animals remain prevalent. Diseases can be spread from animals to humans
in this manner.
2. Emerging disease: A disease that infects a particular regional population for the first time, or a disease that's
been present at low levels in a region but then rapidly becomes more prevalent.
3. Epidemic: An increase in the number of cases of a disease in a particular geographic region exceeding the
number typically experienced.
4. Index case: The first person infected with a pathogen known to health officials — often referred to as "patient
zero."
5. Microbe: A living thing that is invisible to the human eye like bacteria, fungi or viruses.
6. One Health: A phrase that expresses the inherent linkage between the health of humans, animals and the
environment.
7. Pandemic: An epidemic spanning many countries, regions or continents. The parameters of this definition are a
bit amorphous and largely depend on the opinions of scientists and health officials using the term.
8. Reservoir: An animal, plant or environment in which a disease can subsist for extended periods of time.
9. Spillover: The transmission of disease from one species to another.
10. Vector: A living creature that passes a disease to another living creature.
11. Zoonotic: Any disease that spreads from animals — including insects — to people.
Source: Becker’s Healthcare News
Rare, deadly strep bacteria continues to
spread in Alaska's homeless population
Public health officials are still battling to confine a strain of group A Streptococcus bacteria
that has been spreading throughout Alaska's homeless population since October. There have
been seven to 10 severe strep cases per month since October and 90 percent of them were in
homeless people. Four people have died. State epidemiologist Joe McLaughlin said the bacteria
is fairly common. Most healthy people don’t show any symptoms or just have mild skin or throat
infections. But if a person’s immune system is already compromised, then the bacteria can enter
into a small cut and lead to major infections, toxic shock syndrome, or amputations. The
outbreak started in Fairbanks over the summer then died down. It spread to Anchorage in the
fall. There have been seven to 10 severe cases per month since October. Ninety percent of the
patients were homeless. Four people have died. Epidemic Intelligence Service Officer Emily
Mosites, who is with the Center for Disease Control in Anchorage, said this outbreak has been
hard to stop. The bacteria spreads through human contact, like coughing near someone or
touching, and it’s impacting a very mobile population. But she stressed that most people should
not worry.
Source: http://www.alaskapublic.org/2017/02/13/health-workers-trying-to-control-rare-strepoutbreak-in-homeless-population/
Drug-resistant superbug might be more
widespread than previously known
Over a 16-month period, the Harvard-MIT research team examined genetic
sequences from about 250 samples of patients who had CRE in four hospitals in
Boston and Irvine, Calif. Hanage and his colleagues were aiming instead to get a
“population snapshot” of CRE, to define how frequently these infections occurred
and to understand which bacterial strains were causing infections within hospitals.
First, the researchers found very little evidence of direct transmission between
patients who became sick. Hanage and his colleagues believe transmission may
be occurring without causing symptoms. In other words, people colonized with
these germs may spread them, a la Typhoid Mary, without ever becoming sick
themselves. Most patients will not have any symptoms of CRE, which lives in the
gastrointestinal tract. The study also documented “the identical gene in different
species. The extent to which this has happened is really quite surprising. They
found two cases of high-level resistance they could not explain. This he compared
to “dark matter: We know it’s there because we can see its effects, but what’s
actually making it happen at the moment is unknown.”
Source: http://kdvr.com/2017/01/17/drug-resistant-superbug-may-be-morewidespread-than-previously-known/
Common weed could help fight MRSA
The red berries of a weed found in the southern United States contain an compound that can
disarm a deadly superbug, according to research published Friday.
Researchers from Emory University and the University of Iowa found that extracts from the
Brazilian peppertree, which traditional healers in the Amazon have used for hundreds of years to
treat skin and soft-tissue infections, have the power to stop methicillin-resistant Staphylococcus
aureus (MRSA) infections in mice. The study was published in Nature's Scientific Reports.
Cassandra Quave, an Emory University scientist who studies how indigenous people use plants
in healing practices, said researchers pulled apart the chemical ingredients of the berries and
tested them in mice infected with these superbug strains. The mice got injections containing the
bacteria with or without the plant extracts. Those that didn't receive the extracts developed skin
lesions. But in the other mice, the extracts -- a mixture of 27 chemicals -- prevented skin lesions
from forming.
Instead of destroying the bacteria, the ingredients in the fruit weakened the bacteria by
preventing them from producing the toxins it uses as weapons to damage tissue. The extracts
from the fruit repress a gene that allows the bacterial cells to communicate with one another.
Source: http://www.nature.com/articles/srep42275
Septic shock surveillance should be based
on clinical data, not billing codes
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• In the February issue of CHEST, investigators compared the effectiveness of claims-based
surveillance using ICD-9 codes with clinical-based data and specific diagnostic parameters.
Their findings suggest that surveillance based on clinical criteria is a more reliable way to track
cases of septic shock. Researchers examined data from 27 academic hospitals between 20052014 and looked for cases of septic shock using two different methods: claims data and clinical
data. For claims-based surveillance, they located cases with septic shock-related ICD-9 billing
codes.
• For clinical surveillance, they looked for patients who received concurrent vasopressors, blood
culture orders, and antibiotics. When compared, they showed the sensitivity was higher for the
clinical criteria than for the claims (74.8 percent versus 48.3 percent) relative to medical record
reviews, but positive predictive value was comparable (83 percent versus 89 percent).
Investigators found that with clinical data, septic shock cases rose from 12.8 to 18.6 per 1,000
hospitalizations, while mortality declined from 54.9 percent to 50.7 percent.
• Meanwhile, the results from ICD-9 codes show a much larger jump, from 6.7 to 19.3 cases per
1,000 hospitalizations, while mortality decreased from 48.3 percent to 39.3 percent.
• Source: https://www.eurekalert.org/pub_releases/2017-02/ehs-sss021317.php
7 pediatric flu deaths, 1,300+ flu hospitalizations
reported in one week
Seven influenza-associated pediatric deaths were reported in the week ending Jan. 28,
bringing the total number of pediatric flu deaths to 15 for the season, according to the CDC's
latest FluView update.
Additionally, from Jan. 21 to Jan. 28, there were 1,366 new confirmed flu-associated
hospitalizations, bringing the total number of people hospitalized with the flu to 5,683. The
overall flu hospitalization rate was 20.3 per 100,000 people as of Jan. 28.
Outpatient visits for influenza-like illness also continue to rise as the season progresses. During
the week ending Jan. 28, 3.9 percent of outpatient visits were due to influenza-like illness,
above the baseline of 2.2 percent and up 0.5 percentage points from the week prior.
Some states are seeing more outpatient visits for flu than others — 15 states experienced high
influenza-like illness activity during the week ending Jan. 28. Those states are: Alabama,
Arkansas, Georgia, Indiana, Kansas, Kentucky, Louisiana, Missouri, New Jersey, New York,
Oklahoma, Pennsylvania, South Carolina, Tennessee and Wyoming. The week prior, just 10
states reported high flu-like illness activity.
Source: https://www.cdc.gov/flu/weekly/
THANK YOU
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