Infection Prevention eBug Bytes July 2015

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Infection PreventioneBug BytesJuly 2015
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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//www.washingtonpost.com/news/to-your
  -health/wp/2015/07/02/the-u-s-just-recorded-its-fi
  rst-confirmed-measles-death-in-12-years/

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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.

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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

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Reconsidering Contact Precautions for Endemic
MRSA and VRE
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
MRSA or VRE. PARTICIPANTS Hospital
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
201500(0)110
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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//www.osha.gov/
  dsg/hospitals/

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Variation In Antibiotic Prescribing Among VA
Physicians

• 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
  characteristics.
• Source Annals of Internal Medicine 21 July 2015,
  Vol. 163. No. 2

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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,
  2014.
• 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).

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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

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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
  desk.
• 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
  (8).
• 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)
  S3-S17

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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
  abstract

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Evaluating the Efficacy of UVTechnology in Acute
Care

• 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
  abstract

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Implementation of an Operating Room Management
Plan for the Prevention of Perioperative
Hypothermia

• 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