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Unit Based Champions Infection Prevention eBug Bytes July/August 2013


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Title: Unit Based Champions Infection Prevention eBug Bytes July/August 2013

Unit Based ChampionsInfection PreventioneBug
BytesJuly/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 immune-compromised
    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, single-dose 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.

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
  • 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

Raw Oysterassociated 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
  • 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 gt50. Most patients with
    primary septicemia report recent consumption of
    raw oysters, usually from the Gulf of Mexico

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 doi10.1186/2047-2994-2-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 1December 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 310 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 laboratory-confirmed case, also from
    Assir region, has died.
  • Globally, from September 2012 to date, WHO has
    been informed of a total of 91 laboratory-confirme
    d cases of infection with MERS-CoV, including 46
  • 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
    MERS-CoV as advised in the current surveillance
  • Source World Health Organization

PICCs Safety Tied to Patient
  • 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, OHoro 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 349 (September

Outbreak of Acinetobacter infected eight in burn
  • 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
  • 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.

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_
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