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Infection Prevention eBug Bytes July 2015


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Title: Infection Prevention eBug Bytes July 2015

Infection PreventioneBug BytesJuly 2015
The U.S. just recorded its first confirmed
measles death in 12 years
  • Health officials on Thursday confirmed the
    country's first measles death since 2003, and
    they believe the victim was most likely exposed
    to the virus in a health facility in Washington
    state during an outbreak there. The woman died in
    the spring a later autopsy confirmed that she
    had an undetected measles infection, the
    Washington State Department of Health said in a
    statement. The official cause of death was
    announced as "pneumonia due to measles. The
    woman was at a Clallam County health facility "at
    the same time as a person who later developed a
    rash and was contagious for measles," the health
    department statement read. "The woman had several
    other health conditions and was on medications
    that contributed to a suppressed immune system.
    She didnt have some of the common symptoms of
    measles such as a rash, so the infection wasnt
    discovered until after her death. According to
    the U.S. Centers for Disease Control and
    Prevention, 178 people from 24 states and the
    District were reported to have measles from Jan.
    1 through June 26 of this year. Two-thirds of the
    cases, the CDC noted, were "part of a large
    multi-state outbreak linked to an amusement park
    in California. This newly confirmed case marks
    Washington's 11th reported instance of measles
    this year, and state health officials urged
    people to vaccinate against the virus.
    Source http//

Greenville Health System Settles a Lawsuit
Claiming Negligence Caused a Patients
Infection, Death
  • Greenville Health System has settled a wrongful
    death lawsuit with the beneficiaries of a
    surgical patient who died after contracting an
    infection, court documents show.mmGHS offered
    600,000 for full settlement of claims arising
    from the hospital's medical treatment of Ella Mae
    Mattison, according to a court order approving
    the settlement in late June.
  • Mattison, 59, was admitted to Greenville Memorial
    Hospital on Aug. 28, 2013, for coronary artery
    disease, according to court documents. She
    underwent coronary artery bypass surgery on Sept.
    2, 2013, and was diagnosed with Mycobacterium
    abscessus on March 10, 2014, according to the
    court records. She died June 23, 2014.m The
    lawsuit alleged employees of GHS were negligent
    in their care of Mattison, resulting in her
    death. GHS denied any and all liability,
    according to the court document.
  • Fifteen patients were infected and four died
    after contracting the Mycobacterium abscessus
    infection at Greenville Memorial Hospital,
    officials said last year.

Your mobile phone may be 'patient zero' for
hospital infections
  • In a paper published in the Journal of
    Occupational and Environmental Hygiene,
    Australian researchers sought to investigate the
    potential role mobile phones play as reservoirs
    for infection and bacterial colonization in the
    hospital setting.
  • The researchers screened a group of 226 staff
    members comprising 146 physicians and 80 medical
    students at a regional Australian hospital
    between January 2013 and March 2014.
  • They concluded that 74 percent of staff members'
    mobile phones were contaminated with bacteria, of
    which 5 percent was deemed potentially harmful.
  • Similar organisms were found on the dominant
    hands of staff members.
  • Junior medical staff members were found to be at
    greater risk for heavy microbial growth.
  • Of the 226 participants, 31 percent reported
    cleaning their phones routinely.
  • Of those who cleaned their phones, only 21
    percent reported using alcohol containing wipes.
  • The researchers concluded that disinfection
    guidelines for cell phone use in hospitals should
    be developed and implemented.
  • Source Journal of Occupational and Environmental
    Hygiene June 2015

Reconsidering Contact Precautions for Endemic
BACKGROUND Whether contact precautions (CP) are
required to control the endemic transmission of
methicillin-resistant Staphylococcus aureus
(MRSA) or vancomycin-resistant Enterococcus (VRE)
in acute care hospitals is controversial in light
of improvements in hand hygiene, MRSA
decolonization, environmental cleaning and
disinfection, fomite elimination, and
chlorhexidine bathing. OBJECTIVE To provide a
framework for decision making around use of CP
for endemic MRSA and VRE based on a summary of
evidence related to use of CP, including impact
on patients and patient care processes, and
current practices in use of CP for MRSA and VRE
in US hospitals. DESIGN A literature review, a
survey of Society for Healthcare Epidemiology of
America Research Network members on use of CP,
and a detailed examination of the experience of a
convenience sample of hospitals not using CP for
epidemiologists and infection prevention
experts. RESULTS No high quality data support or
reject use of CP for endemic MRSA or VRE. Our
survey found more than 90 of responding
hospitals currently use CP for MRSA and VRE, but
approximately 60 are interested in using CP in a
different manner. More than 30 US hospitals do
not use CP for control of endemic MRSA or
VRE. CONCLUSIONS Higher quality research on the
benefits and harms of CP in the control of
endemic MRSA and VRE is needed. Until more
definitive data are available, the use of CP for
endemic MRSA or VRE in acute care hospitals
should be guided by local needs and
resources. Source Infect Control Hosp Epidemiol
OSHA Issues New Guidance for Healthcare Entities
  • According to the Occupational Health and Safety
    Administration (OSHA), 2013 statistics
    demonstrate that healthcare workers have a rate
    of work-related illness and injury that is nearly
    twice as high as the overall rate seen in private
    industry.1 In the last five years, OSHA has
    issued a number of guidance documents on topics
    ranging from prevention of workplace violence
    against healthcare workers to safer patient
    handling methods intended to protect both
    patients and healthcare workers. Now, OSHA has
    issued Inspection Guidance for inspections to be
    conducted in inpatient healthcare settings with
    North American Industry Classification System
    (NAICS) Major Group codes 622 (hospitals) and 623
    (nursing and residential care facilities). All
    inspections of hospitals, nursing facilities, and
    residential care facilities conducted after June
    25, 2015, will include inspections related to the
    following hazards, in addition to whatever
    triggered the inspection in the first
  • Musculoskeletal Disorders (MSDs) related to
    patient or resident handling Workplace Violence
  • Bloodborne Pathogens Tuberculosis and Slips,
    trips, and falls.
  • In addition to these hazards, OSHA inspections of
    affected healthcare facilities may also include
    inspections to ascertain whether there is any
    exposure to multi-drug resistant organisms
    (MDROs), such as Methicillin-resistant
    Staphylococcus aureus (MRSA) and to hazardous
    chemicals, such as sanitizers, disinfectants,
    anesthetic gases, and hazardous drugs.
  • OSHA claims the rate of work-related illness and
    injury in healthcare was 6.4 incidents per 100
    employees in 2013. Source https//

Variation In Antibiotic Prescribing Among VA
  • A previous study estimated that antibiotics were
    prescribed in 10 of 95 million office visits. By
    1999, 22 of adult and 14 of pediatric
    prescriptions for broad-spectrum antibiotics were
    for URIs, conditions which are largely viral.
    Similarly, a 2007-9 survey showed that more than
    25 of prescriptions were for conditions not
    warranting antibiotics.
  • There are large geographic differences in
    prescribing not readily explained by patterns of
    disease. While some inappropriate antibiotic use
    has declined, sites with high-prescription rates
    had a higher proportion of antibiotic-resistant
    invasive pneumococcal infections, which are life
    threatening as well as far more costly to treat.
    This was especially true for overuse of
    cephalosporins and macrolides (e.g., azithromycin
    or clarithromycin). In this study, researchers
    looked at differences in individual prescribing
    patterns, examining all VA outpatient records
    from 2005-12 for patients seen for ARIs.
    Importantly, they excluded patients who had
    underlying conditions (comorbidities) like
    diabetes or COPD that might have put them at
    higher risk for a serious bacterial infection.
    They also looked only at providers who had seen
    at least 100 patients with this condition.
  • Disappointingly, despite educational efforts to
    reduce antibiotic use over the past decade, the
    proportion of the 1 million ARI visits examined
    that led to antibiotic prescription increased
    from 67.5 to 69.2. Macrolide prescriptions
    alone increased from 36.8 to 47. The most
    interesting finding was the huge variation in
    prescribing patterns. Lead author Barbara Jones,
    M.D., M.S., assistant professor of internal
    medicine at the University of Utah and clinician
    at the VA Salt Lake City Health Care System,
    commented that she expected prescriptions in
    10-40 of visits. Yet they found a higher
    ratemore than 20 higherand this was driven by
    individual practitioners habits, rather than by
    differences in patients illness or underlying
  • Source Annals of Internal Medicine 21 July 2015,
    Vol. 163. No. 2

Healthcare Workers are Not Removing PPE Correctly
  • Fewer than 1 in 6 healthcare workers (HCW)
    followed all Centers for Disease Control and
    Prevention (CDC) recommendations for the removal
    of personal protective equipment (PPE) after
    patient care, according to a brief report
    published in the July issue of the American
    Journal of Infection Control.
  • In this study undertaken by researchers from the
    University of Wisconsin, a trained observer
    watched healthcare personnel entering and exiting
    patient rooms specified as following isolation
    precautions on various units of the hospital.
    Isolation precautions are used to help stop the
    spread of germs from one person to another and
    may require use of gowns, gloves, and face
    protection. Observations took place Oct. 13-31,
  • The CDC recommends that gloves should be removed
    first, followed by the gentle removal of the gown
    from the back while still in the patient's
    isolation room. Of the 30 HCWs observed removing
    PPE, 17 removed the gown out of order, 16 wore
    their PPE out into the hallway, and 15 removed
    their gown in a manner that was not gentle, which
    could cause pathogens from the gown to transfer
    to their clothes. "As a result of the current
    Ebola outbreak, the critical issue of proper PPE
    removal has come front and center," the authors
    state. "Healthcare facilities should use this
    opportunity of heightened interest to undertake
    practice improvement focused on PPE removal
    protocol, including technique, for all
    healthcare-associated conditions that require the
    donning and doffing of PPE." Source Variation
    in health care worker removal of personal
    protective equipment by Caroline Zellmer, Sarah
    Van Hoof, and Nadia Safdar appears in the
    American Journal of Infection Control, Volume 43,
    Issue 7 (July 2015).

Rapid Ebola test could play key role in efforts
to end lingering outbreak
  • More than 11,000 people have died since the Ebola
    epidemic began in March 2014, and though cases
    have been declining, the international emergency
    response that the outbreak prompted has not been
    able to drive the virus back underground. The
    fight against the disease achieved a significant
    victory in May, when Liberia -- one of the
    nations hardest hit by the virus -- was declared
    Ebola-free by WHO. Less than 2 months after this
    win, however, new cases of the disease were
    discovered in the country. The first of these was
    a 17-year-old boy who was misdiagnosed with
    malaria and who, before passing away, came into
    contact with at least 102 people who may have
    caught the disease from him. This case tragically
    illustrates the need for a fast way to accurately
    identify Ebola cases so that patients get the
    care they need and transmission can be halted.
  • ReEBOV Antigen Rapid Test Kit uses a few drops of
    blood and the same technology used in at-home
    pregnancy tests to provide results in 15 minutes.
    In comparison, the current gold standard test for
    Ebola, qRT-PCR, can take up to a day to return a
    diagnosis. The WHO study, conducted in
    Ebola-hotspot Sierra Leone, compares ReEBOV's
    performance with that of qRT-PCR. By testing 292
    stored patient samples with both methods,
    researchers found that ReEBOV performed nearly as
    well as the gold standard, and agreed with
    qRT-PCR on 91.8 of infected samples and 84.6 of
    non-infected samples.
  • Source American Association for Clinical
    Chemistry (AACC). "Rapid Ebola test could play
    key role in efforts to end lingering outbreak."
    ScienceDaily 27 July 2015

Breath of Fresh Air An Observational Study of
Factors That Compromise Operating Room Air Quality
  • BACKGROUND Understanding what leads to high
    airborne particulate levels in the operating room
    (OR) is crucial for improving patient safety and
    surgical outcomes. This study examined whether
    the number of times OR doors are opened affects
    airborne particulate counts.
  • METHODS Particulate levels and observations were
    recorded from a single location in a modern,
    positive pressure OR approximately every ?ve
    minutes during eight surgical procedures over ?ve
    days. Observations recorded which OR door was
    opened (whether to the sterile core or to the
    outer corridor) the number of times the door was
    opened the job title of the person opening it
    and the reason for opening it. Baseline data was
    collected in the morning before any activity.
    Reference samples were taken in the OR, sterile
    core, outer corridor and surgical wing front
  • RESULTS One or more OR doors were open during
    48 of all readings (333/697). Overall airborne
    particulate count increased when either door was
    open (plt0.1950). For particles larger than 0.5
    microns, there was a signi?cant increase in
    particulate counts when either door was open
    (plt0.0001). Particulate levels were higher during
    cases than between cases (plt0.0286). The most
    common reasons for opening either door were for
    case equipment (29, 95 CI 25, 34), status
    updates (12) and work-related conversations
  • CONCLUSIONS Each time an OR door is opened, the
    number of airborne particulates increases this
    increases the risk of airborne particulates
    entering the sterile ?eld. This data supports
    interventions aimed at increasing the use of
    intercoms/viewing monitors, equipment bundling,
    kit review, and maximizing teamwork. These
    strategies will minimize unnecessary door
    openings and help prevent surgical site
    infections. Although unanticipated circumstances
    are a fact of life in academic hospitals, medical
    institutions must develop best practices that
    maximize patient safety without compromising the
    pedagogic mission. Source Oral Abstracts /
    American Journal of Infection Control 43 (2015)

Pay Attention to the Microbe Behind the Curtain
  • A total of 35 patient, privacy curtains were hung
    in several different units of the hospital. The
    curtains were identical in appearance and touch
    and were swabbed twice weekly for four weeks and
    then once a week for eight weeks. The hand grip
    area on each curtain was sampled using
    saline-soaked swabs and plated onto blood agar.
    Colony counts were plotted by time and compared
    to occupancy levels for each unit. In total, 582
    swabs were collected during the trial.
  • Contamination was rapid. Twenty-eight curtains
    demonstrated contamination on the first swab all
    curtains were contaminated by week two.
    Contamination levels increased substantially at
    week five, followed by steady increases each week
    thereafter. 52. Methicillin-resistant
    Staphylococcus aureus (MRSA) was found on 12
    (34) of the curtains. Vancomycin
    resistant-enterococci (VRE) were identified on
    1/12 of Unit 4 curtains.No Carbapenem-resistantEnt
    erobacteriaceae (CRE) were detected.
  • Patient, privacy curtains are a source of
    microbial contamination. Results suggest
    increased contamination rates with higher room
    occupancy and that curtains should be removed,
    cleaned and sanitized after approximately five
    weeks of use.
  • Source Michelle M. Bushey, et al. APIC 2015

Evaluating the Efficacy of UVTechnology in Acute
  • Sampling was carried out on 28 types of surfaces
    present in 21 rooms in two hospitals. The total
    bacterial load was determined by swabbing each
    surface in triplicate, then plating and
    incubating on Rodac (contact) plates for 48 hours
    at 37 C. Each surface was swabbed after manual
    disinfection but prior to treatment with an
    automated UV-C device, and then again following
    UV-C treatment.
  • Treatment of 21 hospital rooms with an automated
    UV-C device following manual disinfection
    procedures resulted in complete or near complete
    bacteria kill for the 28 surface types tested.
    Although the distance between each surface and
    the UV-C device varied, the mean plate count
    after UV-C treatment was zero or near zero in all
    cases (Figure 1). The difference between mean
    plate count before and after treatment was
    statistically significant for all but two of the
    rooms examined.
  • Treating hospital rooms with an automated UV-C
    device may be a safe and effective way to reduce
    or eliminate microorganism presence that remains
    after manual disinfection, particularly for
    high-touch or vertical surfaces that are
    incompatible with solution-based methods.
  • Source Maurice E. Croteau,, et al. APIC 2015

Implementation of an Operating Room Management
Plan for the Prevention of Perioperative
  • A multidisciplinary workgroup determined the most
    common co-morbidities in patients undergoing
    those speci?c surgeries, cross referenced with
    those that place patients at higher risk of
    perioperative hypothermia (PH). The risk
    assessment was then constructed for various
    temperature ranges, and risk assigned according
    to probability, patient effect and our
    preparedness to re-establish normothermia.
    Patients who undergo bariatric, spine, pediatric
    and total joint procedures are at a high risk of
    PH in operating rooms with temperatures less than
    62F. As a result, a new process was created that
    required intraoperative warming of all patients
    in this risk category, as well as frequent,
    documented temperature checks, and possible room
    temperature adjustment. A brief evaluation of the
    new process demonstrated a lack of signi?cant
    temperature changes between patients in the
    higher and lower risk categories. Though surgeons
    have varying temperature preferences for
    operating rooms, it is important to protect our
    patients from the complications associated with
    PH, while remaining ?exible. The risk assessment
    allowed us to customize our processes to best
    accomplish this task. We have seen success n the
    prevention of perioperative hypothermia among our
    patients. Source APIC 2015 abstract
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