Unit Based Champions Infection Prevention eBug Bytes July/August 2013

1
Unit Based ChampionsInfection PreventioneBug
BytesJuly/August 2013
2
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.

http//www.shea-online.org/View/ArticleId/219/Cont
aminated-Ultrasound-Gel-Tied-to-Outbreak-of-Health
care-Associated-Infections.aspx
3
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

4
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
  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 gt50. Most patients with
  primary septicemia report recent consumption of
  raw oysters, usually from the Gulf of Mexico

5
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

6
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

7
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
  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
  MERS-CoV as advised in the current surveillance
  recommendations.
• Source World Health Organization

8
PICCs 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, 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
  2013).

9
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/130
  729709

10
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