Download File - Working Toward Zero HAIs

Unit Based Champions
Infection Prevention
eBug Bytes
July/August 2013
Contaminated Ultrasound Gel
In December 2011, researchers uncovered an unusual cluster of P.aeruginosa in the
cardiovascular surgery intensive care unit during routine infection control surveillance. The
bug is known to increase the risk of bloodstream and respiratory infections in immunecompromised individuals. Sixteen patients became colonized or infected with the bacteria,
with all cases occurring in the respiratory tract. The outbreak was found to have stemmed
from bottles of ultrasound transmission gel used during cardiovascular surgery. Following
replacement of this gel with a sterile product, no further cases occurred. Cultures of gel from
a bottle in use in the operating room grew P.aeruginosa that was identical to the outbreak
strain. It was originally thought that the gel had likely become contaminated during use.
However, sealed bottles of gel grew the same P.aeruginosa strain, proving that the product
was contaminated during the manufacturing process at the plant of Pharmaceutical
Innovations. As a result of this investigation, the FDA issued a warning about the gel, alerting
the risk of infection posed by the product and instructing healthcare providers and systems
not to use the infected products. The Beaumont Health System investigators also recently
published proposed guidelines in Infection Control and Hospital Epidemiology for the use of
sterile versus nonsterile ultrasound gel. These guidelines include the need for sterile, singledose ultrasound gel to be used for all invasive procedures and give appropriate storage and
warming methods for the gel. Prior to this, no such guidelines existed in the US.
http://www.shea-online.org/View/ArticleId/219/Contaminated-Ultrasound-Gel-Tied-to-Outbreak-of-Healthcare-AssociatedInfections.aspx
U.S. FDA probes multi-state
outbreak of intestinal bug
• The FDA said on Monday it is investigating a multi-state outbreak of an
intestinal infection called cyclosporiasis, whose cause has not yet been
determined.
• As of July 18, 2013, more than 200 cases of cyclospora infection in
residents of multiple states, including Iowa, Nebraska, Texas, and
Wisconsin
• Cyclosporiasis is caused by ingesting food or water containing a one-celled
parasite that is too small to be detected without a microscope. Symptoms
include watery diarrhea, vomiting and body ache. Untreated, the illness
can last from a few days to a month or more. Other symptoms may
include headache, fever, weight loss and fatigue
• Most people with healthy immune systems recover from the infection
without treatment. Older people and those with weakened immune
systems might be at higher risk for prolonged illness. The condition is
typically treated with the antibiotics Bactrim, Septra and Cotrim,
according to the CDC
•
http://www.chicagotribune.com/health/sns-rt-us-fda-infection-20130722,0,6075330.story
Raw Oyster–associated Vibrio vulnificus
Illnesses and Deaths, California
• A recent review of surveillance data indicated that rates of Vibrio spp.
infections in the United States increased from 1996 to 2010, and, of the 3 most
commonly reported species, V. vulnificus caused the most hospitalizations and
deaths.
• V. vulnificus is a gram-negative, halophilic bacterium that occurs naturally in
marine and estuarine waters. Human infection usually results from exposure to
the organism by consumption of raw or undercooked shellfish, usually oysters,
or by a wound coming into contact with seawater. Illness typically is manifest
as primary septicemia (following ingestion) or as wound infection with or
without septicemia (following wound exposure).
• Persons at risk for severe V. vulnificus disease are those with preexisting liver
disease, alcoholism, diabetes, hemochromatosis, or an immunocompromising
condition. Patients with primary septicemia often are in shock when they come
to medical attention, and the fatality rate has been reported to be >50%. Most
patients with primary septicemia report recent consumption of raw oysters,
usually from the Gulf of Mexico
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Researchers Examine HCW Ring
Wearing and Potential for HAI
Transmission
Tens of thousands of healthcare workers worldwide can only wear a plain wedding ring at
work, if any at all. This arose from policies citing early laboratory evidence that rings can
carry clinically relevant bacteria, but with little supporting clinical data.
A systematic literature review was performed of studies investigating the infection risk of
ring wearing by healthcare workers. PubMed, Cochrane Library and clinical trials registries
were searched. Data was extracted on study design and quality, and the following
outcomes: healthcare-acquired infection (HAI) rates, bacterial transmission, and bacterial
contamination of healthcare workers’ hands.
The researchers conclude that no direct evidence was found that healthcare workers
wearing rings results in higher HAI or bacterial transmission rates. Most studies did not
identify higher contamination associated with ring wearing; furthermore, the clinical
significance of a statistical difference in the number of colony forming units is unclear.
They add that guidelines could benefit from reconsidering ring wearing guidance, and
focusing on interventions with a more defined evidence base; fewer intrusions into
healthcare workers’ personal autonomy may increase willingness to participate in other
important interventions.
Reference: Dyar A and Dyar OJ. Poster presentation P156 at the 2nd International Conference on Prevention and
Infection Control (ICPIC 2013): Ring wearing in healthcare settings: an evidence-based update. Antimicrobial
Resistance and Infection Control 2013, 2(Suppl 1):P156 doi:10.1186/2047-2994-2-S1-P156
Mycoplasma pneumoniae Outbreak at a
University — Georgia, 2012
• Georgia Institute of Technology, was experiencing a pneumonia outbreak among
students.
• Respiratory swabs collected from students with pneumonia and tested at CDC using
a quantitative real-time polymerase chain reaction (qPCR) assay were positive for
Mycoplasma pneumoniae. The university alerted students, faculty, and staff
members to the outbreak and recommended prevention measures by e-mail, social
media, and posters. A survey administered to students assessed illness prevention
behaviors, outbreak awareness, and communication preferences.
• Eighty-three cases were diagnosed among students during September 1–December
4, 2012, making this outbreak the largest reported at a U.S. university in 35 years.
• Because M. pneumoniae infection most commonly causes upper respiratory illness
(only an estimated 3%–10% of persons with infection experience pneumonia,
infected persons often go about their normal activities and infect others, as in this
outbreak. No cases were identified among faculty or staff members, perhaps in
part because they generally do not use university health services.
• Source: August 2, 2013 / 62(30);603-606
New MERS-CoV Case
• The World Health Organization (WHO) has been informed of an additional
laboratory-confirmed case of Middle East respiratory syndrome coronavirus
(MERS-CoV) infection in Saudi Arabia.
• The patient is an 83-year-old man from Assir region who became ill on 17 July
2013 and is currently hospitalized. Additionally, a previously laboratoryconfirmed case, also from Assir region, has died.
• Globally, from September 2012 to date, WHO has been informed of a total of
91 laboratory-confirmed cases of infection with MERS-CoV, including 46 deaths.
• Based on the current situation and available information, WHO encourages all
Member States to continue their surveillance for severe acute respiratory
infections (SARI) and to carefully review any unusual patterns.
• Healthcare providers are advised to maintain vigilance. Recent travelers
returning from the Middle East who develop SARI should be tested for MERSCoV as advised in the current surveillance recommendations.
•Source: World Health Organization
PICC’s Safety Tied to
Patient Population
• A new study reports that peripherally inserted central catheters (PICCs) do not reduce
the risk of central line-associated bloodstream infections (CLABSIs) in hospitalized
patients.
• PICCs have become one of the most commonly used central venous catheters (CVCs) in
healthcare settings since they are considered easier and safer to use, with less risk of
CLABSIs. The study, published in the September issue of Infection Control and Hospital
Epidemiology, demonstrates that the risk of CLABSI with PICCs is based more on patient
factors, rather than the device. A systematic review and meta-analysis of 23 studies of
PICCs to compare the risk of CLABSIs between PICCs and other non-cuffed, non-tunneled
central venous catheters (CVCs).
• The analysis involved 57,250 patients and revealed that hospitalized patients with PICCs
were just as likely to develop bloodstream infection when compared with patients with
other types of CVCs; however, non-hospitalized patients in outpatient settings appeared to
fare better with PICCs than other devices.
•Source: Chopra V, O’Horo JC, et al. The Risk of Bloodstream Infection Associated with
Peripherally Inserted Central Catheters Compared with Central Venous Catheters in Adults:
A Systematic Review and Meta-Analysis. Infection Control and Hospital Epidemiology 34:9
(September 2013).
Outbreak of Acinetobacter
infected eight in burn unit
• A bacterial outbreak that struck the UF Health Shands Hospital's burn unit in
March ultimately infected eight patients with one patient still in an isolation unit
created in the outbreak's aftermath.
• The bacteria, called acinetobacter baumannii, typically affect very sick patients
and live on surfaces and in soil.
• The hospital's infection control department is checking for contamination in
other areas of the hospital. While most patients can resist the bacteria, which
cause potentially fatal infections such as ventilator-associated pneumonia and
urinary tract infections, patients who are highly immunocompromised, such as
burn patients, are especially vulnerable.
• The outbreak of acinetobacter baumannii at Shands mirrors a growing trend
across the country and world of antibiotic-resistant bacteria causing deadly
infections in hospitals' sickest patients. Dr. Brad Spellberg, an infectious disease
expert at UCLA, estimates there are roughly 50,000 cases of this bacteria
annually in the U.S., and 20 times that in the world. It is also common in
returning troops from Afghanistan and Iraq, many of whom were contaminated
through soil. http://www.ocala.com/article/20130729/ARTICLES/130729709
H7N9 bird flu transmits from
person to person
• The deadly H7N9 bird flu can spread from person to person and may be a
serious threat to humans, Chinese health officials report.
• The virus, which has killed one-third of the patients hospitalized with it,
attaches itself to cells in the windpipe and lungs, infecting even cells
lodged deep in the respiratory system, said researchers who analyzed the
biological features of the virus. This dual-target binding may make the
virus better able to jump from birds to humans, according to their report,
which was published July 3 in the journal Nature.
• "The new virus has a unique binding property," said lead researcher
Yuelong Shu, director of the Chinese National Influenza Center at the
China CDC in Beijing.
• There is no need for widespread alarm, however, another expert said. The
same aspects of the H7N9 flu that make it so severe -- its location in the
lower respiratory system, for example -- also make it harder to transmit
from person to person.
• http://www.nlm.nih.gov/medlineplus/news/fullstory_138402.html