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Title: Unit Based Champions Infection Prevention eBug Bytes

Unit Based ChampionsInfection PreventioneBug
  • March 2013

Thousands of Oklahoma dental patients urged to
get tested for HIV
  • Thousands of patients of an Oklahoma dentist are
    being urged to get tested for HIV and hepatitis
    after public health officials found evidence of
    practices that could have exposed patients to the
    viruses.  The Oklahoma and Tulsa health
    departments said Thursday approximately 7,000
    people who were treated at clinics operated by
    Dr. W. Scott Harrington could have been exposed
    to Hepatitis B, hepatitis C, and HIV, the virus
    that causes AIDS, calling the dentist "a menace
    to public health. State and county health
    inspectors went to Harrington's practice after a
    patient with no known risk factors tested
    positive for both hepatitis C and the virus that
    causes AIDS. 
  • The agencies found "major violations - employees
    using dirty equipment, reusing needles and
    administering drugs without a license, multiple
    sterilization issue, the use of a separate,
    rusty, set of instruments for patients who were
    known to carry infectious diseases. Rusted
    instruments are porous and cannot be properly
    sterilized," the board said in a 17-count
    complaint against the dentist.
  • Source Fox News March 29 2013

Ottawa Hospital C. difficile outbreak blamed on
clutter, poor cleaning
  • C. difficile is an antibiotic-resistant infection
    that colonizes in a persons bowels. It is common
    in hospitals where it can spread easily on
    surfaces that require intensive cleaning to
    remove it and is more severe in elderly patients
    and those with compromised immune systems.
    Infection rates first spiked last spring at The
    Ottawa Hospital and have remained stubbornly
    high. The General campus then saw historically
    high rates in January with 15 new C. difficile
    infections, matching the number from December.
    While infections fell to six new cases in
    February, the Civic campus saw a jump from eight
    infections in January to 14 in February.
  • In response, the hospital introduced the SWAT
    teams, which are made up of clinic, housekeeping
    and infection control staff and are designed to
    provide quick responses to outbreaks. The
    hospital has also introduced new cleaning
    inspection practices by using ultraviolet lights
    to detect areas that have been missed.
    Worthington recognized that overcrowding was also
    a factor in the battle against C. difficile, and
    nurses at the hospital say the problem is not
    getting better. Patients regularly stay on beds
    in hallways and patients have been kept
    overnight in recovery rooms because there is
    nowhere else to put them. www.ottawacitizen.com

C. diff prevention activities fail to halt
  • According to the new survey, 70 percent of
    infection preventionists have adopted additional
    interventions in their healthcare facilities to
    address C. difficile infection (CDI) since March
    of 2010, but only 42 percent have seen a decline
    in their healthcare facility-associated CDI rates
    during that time period 43 percent have not seen
    a decline. While CDI rates have climbed to
    all-time highs in recent years, few facilities
    (21 percent of respondents) have added more
    infection prevention staff to address the
    problem. APIC conducted the 2013 CDI Pace of
    Progress survey in January 2013 to assess
    activities that have been implemented in U.S.
    healthcare facilities in the last three years to
    prevent and control CDI, a healthcare-associated
    infection that kills 14,000 Americans each year.
  • Survey also noted an inconsistency between
    cleaning efforts and monitoring. More than nine
    in 10 respondents (92 percent) have increased the
    emphasis on environmental cleaning and equipment
    decontamination practices since March 2010, but
    64 percent said they rely on observation, versus
    more accurate and reliable monitoring
    technologies to assess cleaning effectiveness.
    Fourteen percent said that nothing was being done
    to monitor room cleaning.
  • Sixty percent of respondents have antimicrobial
    stewardship programs at their facilities,
    compared with 52 percent in 2010. Because
    antimicrobial use is one of the most important
    risk factors for CDI, stewardship programs that
    promote judicious use of antimicrobials should be

Antibiotic-Resistant Strain of E. Coli Increasing
Among Older Adults and Residents of Nursing Homes
  • Antibiotic-resistant Escherichia coli (E. coli)
    continues to proliferate, driven largely by
    expansion of a strain of E. coli know as sequence
    type ST131. A new study points to hospitals and
    long-term care facilities (LTCF) as settings in
    which this antibiotic-resistant strain is
    increasingly found. E. coli is the most common
    gram-negative pathogen, causing both
    gastrointestinal disease and extraintestinal
    infections such as pneumonia, meningitis, and
    bloodstream, urinary tract, abdominal, and wound
    infections. Strains of E. coli that are resistant
    to single or multiple classes of antibiotics are
    becoming more prevalent. E. coli ST131 is
    commonly associated with fluoroquinolone
    resistance. In this retrospective study,
    investigators evaluated nearly 300 consecutive
    patients in Olmsted County, Minnesota with
    extraintestinal E. coli infections and found
    ST131 to be a dominant, antimicrobial-resistant
    clonal group associated with older age, long-term
    care facility residence, complicated infections,
    history of urinary tract infection, and prior
    antimicrobial use. Patients with ST131 isolates
    were often treated with ineffective antibiotics
    at first and as a result they had recurrent or
    persistent symptoms. Reference ICHE, March

Nurse Shortage, NICU Infection Rates Linked
  • Neonatal intensive care units (NICUs) are widely
    understaffed, potentially increasing the risk of
    infection in critically ill babies, researchers
  • In a retrospective study, hospitals understaffed
    nearly one-third of their NICU infants and more
    than 90 of their high-acuity NICU infants in
    2009, relative to staffing guidelines, Jeannette
    Rogowski, PhD, of the University of Medicine and
    Dentistry of New Jersey in Piscataway, and
    colleagues reported online in JAMA Pediatrics. In
    addition, infection rates for very low birth
    weight infants were 16.5 in 2008 and 13.9 in
    2009, with higher levels of nurse understaffing
    associated with 40 higher odds of infant
    infection. National guidelines specify
    nurse-to-patient staffing levels that are
    typically based on acuity. For instance, the
    lowest-acuity infants have a recommended
    nurse-to-patient ratio of 1 to 3 or 4, but the
    highest-acuity infants have ratios of greater
    than one nurse per patient. But studies have
    shown shortfalls in NICU nurse staffing, which
    have been associated with higher rates of
    nosocomial infections, particularly among infants
    with very low birth weights. The researchers
    conducted a retrospective cohort study using 67
    NICUs from the Vermont Oxford Network, with data
    on 5,771 very low birth weight babies from 2008
    and 5,630 very low weight babies from 2009.
    Reference JAMA Pediatrics March 2013
  • Nurse understaffing was assessed based on survey
    data in 3008 (4,046 nurses and 10,394 infant
    assignments) and 2009 (3,645 nurses and 8,804
    infant assignments).
  • Overall, they found widespread understaffing of
    NICUs across the U.S. compared with national
    guidelines, with about a third of NICU infants
    being understaffed, and each infant had about 0.4
    nurses on average.

Drug-Resistant MRSA Bacteria Here to Stay in
Hospital and Community Settings
  • Researchers at Princeton University used
    mathematical models to explore what will happen
    to community and hospital MRSA strains, which
    differ genetically. Originally methicillin-resista
    nt Staphylococcus aureus (MRSA) was confined to
    hospitals. However, community-associated strains
    emerged in the past decade and can spread widely
    from person to person in schools, athletic
    facilities and homes.
  • Both community and hospital strains cause
    diseases ranging from skin and soft-tissue
    infections to pneumonia and septicemia. Hospital
    MRSA is resistant to numerous antibiotics and is
    very difficult to treat, while community MRSA is
    resistant to fewer antibiotics.
  • The new study found that these differences in
    antibiotic resistance, combined with more
    aggressive antibiotic usage patterns in hospitals
    versus the community setting, over time will
    permit hospital strains to survive despite the
    competition from community strains.
    Hospital-based antibiotic usage is likely to
    successfully treat patients infected with
    community strains, preventing the newcomer
    strains from spreading to new patients and
    gaining the foothold they need to out-compete the
    hospital strains. www.infectioncontroltoday.com

Tamiflu Resistance May Be Rising
The pandemic H1N1 influenza A strain -- now
circulating as seasonal flu -- appears to be
developing resistance to oseltamivir (Tamiflu) in
Australia, a researcher is reporting there. And
increasingly the resistance is being seen among
patients never treated with the drug, according
to Aeron Hurt, PhD, of the World Health
Organization's Collaborating Centre for Reference
and Research on Influenza in Melbourne,
Australia. That finding, Hurt is scheduled to
tell attendees at the annual meeting of the
Australasian Society for Infectious Diseases,
which begins Wednesday, suggests that strains
resistant to oseltamivir might be fit enough to
spread widely in the community. The fear is not
without precedent -- an oseltamivir-resistant
seasonal influenza A strain (also H1N1) spread
globally in 2008, which reduced the effectiveness
of the drug. Oseltamivir is prescribed to prevent
complications of the flu. And Hurt and colleagues
reported in 2011 that the pandemic strain showed
oseltamivir resistance in a cluster of cases in
the Australian state of New South Wales. In that
cluster, 29 of 182 patients -- or 15.9 -- had
virus that was resistant to the drug.
Source referenceHurt AC, et al. "Antiviral
resistance in influenza The current situation
and future risks" ASID 2013.
New Heart Warning for PopularZ-Pak Antibiotics
  • An antibiotic used to treat common infections may
    carry serious heart risks, according to a new
    warning from the U.S. Food and Drug
    Administration. The drug, called azithromycin but
    sold under the brand names Zithromax and Zmax as
    Z-Pak capsules, is prescribed for infections of
    the ears, lungs, sinuses, skin, throat, and
    reproductive organs, according to the FDA. But
    the antibiotic can interfere with the hearts
    electrical activity, disturbing its rhythm with
    potentially fatal consequences. Health care
    professionals should consider the risk of fatal
    heart rhythms with azithromycin when considering
    treatment options for patients who are already at
    risk for cardiovascular events, the FDA said in
    a statement. Elderly people and those with
    irregular heart rates, arrhythmias, and low blood
    levels of potassium or magnesium are at a
    particularly high risk for the deadly heart
    condition, according to the FDA. The warning
    comes 10 months after a study published in the
    New England Journal of Medicine found a small
    increase in cardiovascular deaths among people
    treated with Zithromax compared to those given
    the antibiotics amoxicillin or ciprofloxacin or
    no treatment at all. Source NEJM

FDA alert Compounding pharmacy recall
A New Jersey compounding pharmacy is voluntarily
recalling a number of antibiotics and
anesthetic/analgesic solutions due to mold
contamination, according to an FDA alert. Med
Prep Consulting, Inc. in Tinton Falls, N.J., was
notified by a Connecticut hospital that found
visible particulate contaminants in 50 ml bags of
magnesium sulfate 2gm in dextrose 5 in water, 50
ml for injection intravenous solution confirmed
to be mold. Administration of an intravenous
product that is contaminated with mold could
result in a fatal infection in a broad array of
patients. To date, no injuries or illnesses have
been reported, according to the alert. (UHS does
not use this compounding company)
ACIP considers revising Tdap revaccination
The Advisory Committee on Immunization Practices
(ACIP) is considering an alternative
revaccination schedule for the tetanus-diptheria-
acellular pertussis (Tdap) vaccine to improve the
vaccines coverage of pertussis The occurrence
of pertussis in the United States has drastically
reduced since the vaccines inception and the
overall burden has been reduced, but in recent
years there have been increases in pertussis with
notable epidemic years. National overall
pertussis incidence in 2012 was 13.4 cases per
100,000 with the rate reaching as high as 100
cases per 100,00 in some states, according to
preliminary data cited by Thomas Clark, MD,
medical epidemiologist for the CDC. A group is
considering data to assess the safety and
cost-effectiveness of shortening the intervals
between revaccination with the Tdap vaccine to
combat waning immunity to pertussis, and it hopes
to have recommendations for the ACIP meeting in
Trends in Tuberculosis United States, 2012
In 2012, a total of 9,951 new tuberculosis (TB)
cases were reported in the United States, an
incidence of 3.2 cases per 100,000 population.
This represents a decrease of 6.1 from the
incidence reported in 2011 and is the 20th
consecutive year of declining rates. Of the 3,143
counties in the United States, 1,388 (44.2) did
not report a new TB case during 20102012. The TB
rate in foreign-born persons in the United States
was 11.5 times as high as in U.S.-born persons.
In comparison with non-Hispanic whites, TB rates
among non- Hispanic Asians, Hispanics, and
non-Hispanic blacks were 25.0, 6.6, and 7.3 times
as high, respectively. Although the number of
cases dropped below 10,000 for the first time
since standardized national reporting of TB began
in 1953, a number of challenges remain that slow
progress toward the goal of TB elimination in the
United States. Initiatives to increase TB
awareness and testing and treatment of latent
infection and disease will be critical to TB
elimination efforts, especially among
foreign-born populations, racial/ethnic
minorities, and other groups that are
disproportionately affected. MMWR / Vol. 62 /
No. 11
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