Unit Based Champions Infection Prevention eBug Bytes

1
Unit Based ChampionsInfection PreventioneBug
Bytes

• March 2013

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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

3
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

4
C. diff prevention activities fail to halt
spread

• 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
  encouraged.

5
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
  2013

6
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
  reported.
• 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.

7
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

8
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.
9
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

10
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)
11
ACIP considers revising Tdap revaccination
recommendations
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
June.
12
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