Infection Prevention eBug Bytes October 2015

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Infection PreventioneBug BytesOctober 2015
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Drug-resistant E. coli continues to climb
in community health settings

• Drug-resistant E. coli infections are on the rise
  in community hospitals, where more than half of
  U.S. patients receive their healthcare, according
  to a new study from Duke Medicine. The study
  reviewed patient records at 26 hospitals in the
  Southeast. By examining demographic information,
  admission dates and tests, the researchers also
  found increased antibiotic-resistant infections
  among community members who had limited exposure
  to health care settings, but who may have
  acquired the bugs through some other
  environmental factors. The study data were
  gathered through the Duke Infection Control
  Network (DICON), which helps community hospitals
  and surgery centers across the U.S. prevent
  infections using education and evidence-based
  strategies. The data showed that between 2009 and
  2014, the incidence of drug-resistant
  extended-spectrum beta-lactamase (ESBL)-producing
  E. coli doubled from a rate of 5.28 incidents per
  100,000 patients to a rate of 10.5 infections per
  100,000. The median age of patients infected with
  E. coli was 72 years. Looking at the timing of
  patients' infections and when they were last in
  contact with a healthcare setting, the
  researchers also discovered that people with
  infrequent healthcare contact were acquiring the
  superbug at an even faster rate than patients who
  have regular contact with hospitals or nursing
  homes. The data showed a greater than three-fold
  increase in community-associated infections
  between 2009 and 2014.
• Source Infection Control Hospital Epidemiology
  October 2015 (online pub)

3
MSSA Infection in Infants

• Invasive methicillin-susceptible Staphylococcus
  aureus (S. aureus) infection (MSSA) caused more
  infections and more deaths in hospitalized
  infants than invasive methicillin-resistant S.
  aureus infection (MRSA), which suggests measures
  to prevent S. aureus infections should include
  MSSA in addition to MRSA, according to an article
  published online by JAMA Pediatrics. Researchers
  coauthors compared demographics and mortality of
  infants with MRSA and MSSA at 348 neonatal
  intensive care units (NICUs) around the United
  States to determine the annual proportion of S.
  aureus infections that were MRSA and to contrast
  the risk of death after invasive MRSA and MSSA
  infections. The authors identified 3,888 of
  887,910 infants (0.4 percent) with 3,978 invasive
  S. aureus infections. Infections were more
  commonly caused by MSSA (2,868 of 3,978 or 72.1
  percent) than MRSA (1,110 of 3,978 or 27.9
  percent). More infants with invasive MSSA
  infections (n237) died before hospital discharge
  than infants with invasive MRSA infections
  (n110). However, the proportions of infants who
  died after invasive MSSA and MRSA infections were
  similar at 237 of 2,474 (9.6 percent) and 110 of
  926 (11.9 percent). The absolute numbers of
  infections and deaths due to MSSA exceed those
  due to MRSA. Consideration should be given to
  expanding hospital infection control efforts
  targeting MRSA to include MSSA as well. Future
  studies to better define the relationship between
  MSSA colonization and subsequent infection will
  help to clarify the importance of such
  interventions for preventing MSSA disease.
• Source Aaron M. Milstone, MD, MHS et al. Burden
  of Invasive Staphylococcus aureus Infections in
  Hospitalized Infants. JAMA Pediatrics, October
  2015

4
Biologists discover bacteria communicate like
neurons

• Biologists have discovered that bacteria are
  actually quite sophisticated in their social
  interactions and communicate with one another
  through similar electrical signaling mechanisms
  as neurons in the human brain. In a study
  published in this week's advance online
  publication of Nature, the scientists detail the
  manner by which bacteria living in communities
  communicate with one another electrically through
  proteins called "ion channels. All of our
  senses, behavior and intelligence emerge from
  electrical communications among neurons in the
  brain mediated by ion channels. Bacteria use
  similar ion channels to communicate and resolve
  metabolic stress. The discovery suggests that
  neurological disorders that are triggered by
  metabolic stress may have ancient bacterial
  origins, and could thus provide a new perspective
  on how to treat such conditions. But how bacteria
  use those ion channels remained a mystery until
  researchers embarked on an effort to examine
  long-range communication within
  biofilms--organized communities containing
  millions of densely packed bacterial cells. These
  communities of bacteria can form thin structures
  on surfaces--such as the tartar that develops on
  teeth--that are highly resistant to chemicals and
  antibiotics. The study found that biofilms are
  able to resolve social conflicts within their
  community of bacterial cells just like human
  societies. When a biofilm composed of hundreds of
  thousands of Bacillus subtilis bacterial cells
  grows to a certain size, the researchers
  discovered, the protective outer edge of cells,
  with unrestricted access to nutrients,
  periodically stopped growing to allow
  nutrients--specifically glutamate, to flow to the
  sheltered center of the biofilm. In this way, the
  protected bacteria in the colony center were kept
  alive and could survive attacks by chemicals and
  antibiotics. Source Nature Mag

5
Nurse used same 2 syringes on 67 employees

• The message said the flu shot administered two
  days earlier at the workplace clinic held at
  Otsuka Pharmaceutical in West Windsor may have
  exposed recipients to HIV, Hepatitis B and
  Hepatitis C. They needed to get tested
  immediately, then tested again in four to six
  months. The infection-control lapse occurred
  Sept. 30 when a nurse inoculated 67 workers using
  just two syringes.
• "I have not slept since I have found out. I am
  tired beyond belief," said one of the shot
  recipients, who provided the email to NJ Advance
  Media. "At first I viewed it as not a big deal.
  But then it starts hitting you HIV, Hepatitis C
  ... this is serious.
• The bungled clinic came to light when someone at
  the company noticed something was amiss and
  reported it. The state Department of Health
  reportedly interviewed the nurse who gave the
  injections that night. The U.S. Centers for
  Disease Control and Prevention also was notified.
• The Department of Health then informed the state
  Board of Nursing temporarily surrender the LPN
  license she'd held for 30 years pending further
  action against her.
• Source www.advisen.com

6
Lung Infection Outbreak Linked to Hospital Water
Supply

• A Mycobacterium abscessus outbreak among lung
  transplant patients at a single hospital was
  traced to new building construction and its
  tainted water supply. M. abscessus infections
  were confirmed in 39 recently hospitalized lung
  transplant patients, the source of which was
  traced to 12 tap water supply locations in the
  ward, prompting the use of sterile water and a
  new antibiotic prophylaxis regimen, including
  imipenem and inhaled amikacin, to manage the
  outbreak. A new medical tower that had largely
  ICU beds and began to serve patients in late
  2013...lead to an amplification event where the
  concentration of M. abscessus grew past a certain
  threshold, but those isolates were present before
  the construction and opening of the building.
  Mycobacterium abscessus, and all rapid growing
  mycobacteria, can be problematic for hospitals,
  because they're ubiquitous in the environment.
  They're in the soil, they're in the water supply,
  and always a concern when you're building a new
  building -- potential contamination of the water
  to patients who could be at risk to acquire
  infections. From August 2013 through May 2014,
  the incidence rate was 3.9 cases per month, but
  that rate dropped back down to an average of 1.0
  cases per month after the implementation of
  intervention in June 2014 through March 2015
  (incidence rate ratio 0.26, 95 CI 0.13-0.51,
  Plt0.0001). In 92 of the patients, M. abscessus
  was first isolated in the respiratory tract. The
  researchers took cultures from environmental
  biofilms from 73 water sources in the hospital.
  These included patient room faucets and shower
  heads, ward faucets, and ice machines. Out of
  those 73 source environmental cultures, 12, or
  16, grew M. abscessus. Source Baker AW, et al
  "A cluster of mycobacterium abscessus among lung
  transplant patients investigation and
  mitigation" IDWeek 2015 Abstract 627.

7
UV Light Cut C. diff Transmissions by 25 Percent
on Oncology Floors

• New research from Penn Medicine infection control
  specialists found that ultraviolet (UV) robots
  helped reduce the rates transmission of the
  common bacterial infection known as Clostridium
  difficile among cancer inpatients - mostly blood
  cancer patients, a group more vulnerable to
  hospital-acquired infections - by 25 percent. The
  interventions also saved about 150,000 in annual
  direct medical costs. The data was presented at
  the annual ID Week meeting by David Pegues, MD,,
  a professor of Infectious Diseases in Penn's
  Perelman School of Medicine and a healthcare
  epidemiologist in the Hospital of University of
  Pennsylvania's Infection Prevention and Control
  (Abstract 1715). UV robots flash UV lights
  across the room to lock onto DNA of organisms and
  kill them. The team found that using a
  ultraviolet germicidal irradiation robot after a
  room cleaning by EVS not only reduced the number
  of infections in cancer patients compared to the
  year prior with no robot, but did so without
  adversely impacting room turn around. They also
  report that infections increased by 16 percent on
  units without the robot during the study period.
• C. diff aren't as deadly as other bacteria, but
  they are harder to clean away. They forms spores
  that are resistant to many disinfectants and can
  persist in the hospital environment for months.
  Approximately 500,000 people contract C. diff
  while in the hospital every year in the U.S., and
  nearly 15,000 die directly from the infection.
  Cancer patients, whose immune systems may be
  compromised from stem cell transplants and/or
  chemotherapy, are more susceptible to infections
  than other inpatients.

8
MRSA How you can avoid NFL player Daniel Fells'
plight at the gym

• Daniel Fells, the 32-year-old Giants tight end,
  is fighting a serious MRSA type of staph
  infection that may lead to amputation, and will
  almost certainly end his career. Fells trouble
  began with an ankle injury, for which he received
  a cortisone shot. He was taken to the emergency
  room on October 2 with a fever of 104 degrees he
  has been in the ICU since Friday (October 9), and
  has already had five surgeries, according to an
  NFL report. A number of prominent NFL players
  have had MRSA infections, including members of
  the Browns, Redskins, and Rams. The Buccaneers'
  had an outbreak among three players and now faces
  a lawsuit from former kicker Lawrence Tynes, who
  claims that unsanitary conditions at the team's
  facilities caused him to become infected with
  MRSA, which required multiple surgeries and six
  weeks of intravenous antibiotics to cure. Tynes
  says this infection has ended his career, costing
  him over 20 million in anticipated future
  earnings. These Staphylococcal infections occur
  regularly with contact sports, especially with
  wrestling and football, because the close,
  skin-to-skin contact can infect abrasions from
  artificial grass (turf burns) or cuts the
  athlete's might already have from the rough
  sports.
• Fells' infection, reportedly occurring after a
  cortisone shot into the joint, is uncommon. Knees
  are more commonly injected with steroids than
  other joints infection following knee injection
  ranges from 1 in 3,000 to 1 in 5,000.
• Source http//www.forbes.com/sites/judystone/2015
  /10/13/how-you-can-avoid-daniel-fells-mrsa-plight/
  

9
Methicillin-Susceptible, Vancomycin-Resistant
Staphylococcus aureus (VRSA)

• Acquisition of high-level vancomycin resistance
  by Staphylococcus aureus represents a major
  public health risk because this antimicrobial
  drug continues to be the first-line and most
  inexpensive therapy to treat methicillin-resistant
  S. aureus (MRSA) despite concerns about its
  clinical efficacy.
• Vancomycin-resistant MRSA (VR-MRSA) was recovered
  from the bloodstream of a patient in Brazil .
  VR-MRSA belongs to sequence type (ST) 8 and is
  phylogenetically related to the
  community-associated (CA) MRSA USA300 genetic
  lineage that has rapidly disseminated in the
  United States and the northern region of South
  America (USA300-Latin American variant
  USA300-LV).
• The vanA gene cluster in VR-MRSA was carried by a
  transferable staphylococcal plasmid (pBRZ01).
• A clinical isolate of vancomycin-resistant,
  methicillin-susceptible S. aureus (VR-MSSA)
  exhibited the in vivo transfer of the vanA gene
  cluster to 2 unrelated S. aureus strains causing
  bacteremia within the same patient.
• www.cdc.gov

10
CMS Inspectors find Mission Hospital, Orange
County, CA in crisis

• The Mission Hospital Regional Medical Center in
  Orange County, CA, experienced deadly infections
  after joint surgery, a federal CMS inspection
  report shows. The report provides a rare,
  unobstructed look at conditions inside the
  private nonprofit hospital, which risked losing
  its accreditation last year over a small but
  severe outbreak of infections related to hip and
  knee surgeries. Mission Hospital is one example
  of how hospitals, even some with shining
  reputations and awards and special
  certifications, can fail to follow protocols
  aimed at preventing dangerous infections that can
  easily start and spread inside their facilities.
  At some of the other big hospitals in Orange
  County, problems ranged from bad hand hygiene to
  rusty procedure tables to a dirty diaper strewn
  on the floor of a neonatal intensive care unit, a
  Register review of CMS inspection reports from
  the past five years has found. The Register
  reviewed the reports on Mission Hospital and
  others following the outbreak at Mission
  Hospital, where four patients developed serious
  and unusual infections following hip and knee
  replacement surgeries in May and June 2014. For
  about two weeks in October, the hospital closed
  operating rooms under pressure from regulators as
  it scrambled to find the source of that outbreak.
  The infection control department was
  short-staffed and under-funded. The hospital
  employed one full-time infection control doctor
  and a part-time consultant - not enough to
  "provide oversight of the infection control
  practices" at a hospital, which has two campuses
  in Mission Viejo and Laguna Beach with 533 beds
  and that performs about 7,000 surgeries a year.
  http//www.ocregister.com/articles/hospital-684860
  -mission-operating.html

11
Contaminated Bronchoscopes Linked in 2014 to A
Potential Superbug Outbreak

• While generally not publicly known, contaminated
  bronchoscopes, like duodenoscopes, are also prone
  to transmitting deadly superbug infections.
• This is a particularly troubling finding, because
  health officials have publicly concluded that the
  complexity of the duodenoscopes design namely,
  its complex forceps elevator mechanism, which is
  challenging to clean is primarily responsible
  for the nations recent spate of outbreaks of CRE
  (and their related superbugs).
• Moreover, not just duodenoscopes, but other types
  of GI endoscopes featuring an exposed elevator
  wire channel namely, linear echo-endoscopes
  might also be difficult to clean and pose an
  increased risk of CRE transmission. But,
  bronchoscopes, in contrast, do not feature a
  forceps elevator mechanism. Instead, they are
  much simpler in design and easier to clean than
  GI endoscopes, especially duodenoscopes. To
  date, health officials have not publicly
  cautioned the public about the risk of outbreaks
  of CRE following bronchoscopy. In December 2014,
  Olympus filed a medical device report, or MDR,
  documenting that contaminated bronchoscopes can
  transmit CRE to patients. According to this filed
  report, 14 patients tested positive for
  (meaning they were either infected or colonized
  with) a carbapenem-resistant strain of Klebsiella
  pneumoniae (i.e., CRE) after having undergone
  diagnostic bronchoscopy.
• Source http//www.latimes.com/business/la-fi-fda-
  scope-infections-20150917-story.html

12
Ebola Virus Disease in Health Care Workers
Guinea, 2014

• An outbreak of Ebola virus disease (Ebola) began
  in Guinea in December 2013 and has continued
  through September 2015 (1). Health care workers
  (HCWs) in West Africa are at high risk for Ebola
  infection owing to lack of appropriate triage
  procedures, insufficient equipment, and
  inadequate infection control practices (2,3). To
  characterize recent epidemiology of Ebola
  infections among HCWs in Guinea, national Viral
  Hemorrhagic Fever (VHF) surveillance data were
  analyzed for HCW cases reported during January
  1December 31, 2014. During 2014, a total of 162
  (7.9) of 2,210 laboratory-confirmed or probable
  Ebola cases among Guinean adults aged 15 years
  occurred among HCWs, resulting in an incidence of
  Ebola infection among HCWs 42.2 times higher than
  among non-HCWs.
• The disproportionate burden of Ebola infection
  among HCWs taxes an already stressed health
  infrastructure, underscoring the need for
  increased understanding of transmission among
  HCWs and improved infection prevention and
  control measures to prevent Ebola infection among
  HCWs. Cases of Ebola infections among HCWs during
  this outbreak were first reported in January
  2014. The highest number of Ebola case
  notifications in HCWs in Guinea in a single week
  occurred during week 51 with 15 cases. This also
  corresponded to the week with the highest number
  of total Ebola cases (HCW and non-HCW) in Guinea
  during 2014.
• Source MMWR October 2, 2015 / 64(38)1083-1087

13
Measles Outbreak Associated with Vaccine Failure
in Adults

• Beginning on February 16, 2014, several patients
  were evaluated at Kosrae State Hospital for acute
  onset of fever and rash. No history of travel or
  specific disease exposures was available in the
  hospital records. Initial clinical diagnoses were
  dengue fever or chikungunya. However, during the
  next several months, as more persons with fever
  and rash were examined at the hospital, measles
  was considered as a possible diagnosis. On May
  15, serum samples collected from two persons with
  fever and rash had tested positive for
  measles-specific immunoglobulin M (IgM)
  antibodies. During February 16June 10, a total
  of 139 measles cases were detected in Kosrae
  through febrile rash illness surveillance at the
  hospital, contact tracing, and a retrospective
  investigation of earlier fever and rash cases.
  The first measles cases in Pohnpei were detected
  on May 12, and during May 12August 31, 251 cases
  were reported. The first case in Chuuk was
  detected on July 24 three cases were reported
  there during July 24August 26 (rash onset date
  could not be confirmed for one patient). This
  resulted in a total of 393 measles cases from the
  three states. Among the 393 measles patients,
  306 had vaccination records and the remaining 87
  were classified as having unknown vaccination
  status including 74 adults. Among those with
  vaccination records, 216 (71) had received at
  least one MCV dose before the outbreak, including
  169 (96) of adults aged gt19 years. Among adult
  patients with vaccination records, 123 (70) had
  received 2 doses of MCV. Among the 90
  unvaccinated patients, 54 (60) were aged lt12
  months and therefore ineligible for routine
  vaccination. Among 89 children and adolescents
  aged 119 years with measles, 29 (33) were
  unvaccinated seven (3) adults were
  unvaccinated. Source MMWR October 2, 2015 /
  64(38)1088-1093

14
Autopsy shows fungal infection played role in
death of UPMC patient

• An autopsy of a Pittsburgh-based UPMC heart
  transplant patient revealed that a fungal
  infection played a role in her death. This
  contradicts UPMC's claims that the deaths of
  three transplant patients at UPMC Presbyterian
  and Montefiore hospitals could not be directly
  attributed to fungal infections possibly linked
  to mold found in the facilities.
• After UPMC discovered that four transplant
  patients suffered fungal infections within a year
  span, the system temporarily closed its
  transplant program to seek a source of the
  infection. While mold was found in one of UPMC
  Presbyterian's intensive care units, an
  investigation did not yield a definitive source
  of the fungal infections. Pittsburgh-based UPMC
  resumed the transplant program at its
  Presbyterian and Montefiore hospitals on Sunday
  after voluntarily shutting down its organ
  transplant program last week when it linked a
  mold problem to four patients who developed
  infections, three of whom died.
• The report also notes the following organizations
  will be monitoring UPMC's follow-up actions The
  Health Resources and Services Administration, the
  Organ Procurement and Transplantation Network,
  the United Network for Organ Sharing and a
  division within CMS. Source http//www.beckersho
  spitalreview.com/quality/transplant-program-reopen
  s-at-upmc-presbyterian-and-montefiore.html

15
New Legionnaires Outbreak in the Bronx Claims
a Life

• One of the people sickened in a new outbreak of
  Legionnaires disease in the city has died,
  health officials said Wednesday. The Department
  of Health and Mental Hygiene released few details
  about the person, saying only that the patient
  was between the ages of 40 and 49 and had severe
  underlying health conditions. The city also
  said the number of people sickened by the
  outbreak, which is centered in the Morris Park
  section of the Bronx, had risen to 13, including
  the person who died. Of those, 11 are
  hospitalized and one has been released.
  Legionnaires disease, a type of pneumonia,
  killed 12 people in the South Bronx this summer
  and sickened more than 100 others. City officials
  said they believed it spread through vapor
  released from a water-cooling tower atop a
  building there. Health officials have said the
  group of cases in Morris Park is unrelated to the
  earlier cluster. They said they began
  investigating the Morris Park cluster last week,
  sending teams of investigators to test 35 cooling
  towers in the area. Of the cooling towers
  sampled, 15 tested positive for the bacterium,
  all of which were ordered by the city to be
  disinfected. At least six of the water-cooling
  towers that tested positive for Legionella
  bacterium are associated with the Albert Einstein
  College of Medicine. The college issued a
  statement saying it had complied with the new
  city law. Source http//www.wsj.com/articles/new-
  legionnaires-outbreak-in-the-bronx-claims-a-life-1
  443643340?tesla

16
Reduction in CDI in the ICU with UV Room
Decontamination

• UV light for room disinfection (UVD) has been
  shown to eradicate methicillin-resistant
  Staphylococcus aureus, vancomycin-resistant
  enterococci, Acinetobacter, and C. difficile
  under the artificial conditions of inoculating
  surfaces with bacteria, exposing the bacteria to
  UV light and then culturing the surface.
• The use of ultraviolet disinfection during
  hospital discharge could reduced the incidence of
  ICU-associated Clostridium difficile infection,
  according to recently published data. To further
  test UVD in a clinical setting, researchers
  examined its first year of implementation at
  Westchester Medical Center, a tertiary care
  hospital with 180 ICU beds in Valhalla, New York.
  UVD was performed after discharge with UV light
  after standardized procedures. For each case of
  C. difficile infection, data concerning the
  patients lengths of stay, the rooms they
  occupied and the rate of hospital- and
  community-associated C. difficile infection were
  collected. Analysis was performed, comparing the
  first year of UVD procedures (July 2011 through
  June 2012) and a similar period of time before
  implementation (May 2010 through April 2011).
  Hospital-associated C. difficile was reduced by
  22 during the period of UVD implementation (RR
  0.78 95 CI, 0.61-1.009). When examining adult
  ICU cases alone (n 60), researchers observed a
  much more significant reduction in C. difficile
  infection of 70 among UVD patients (P lt .001).
• Source Nagaraja A, et al. Am J Infect Control.
  2015doi10.1016/j.ajic.2015.05.003.

17
Rare Salmonella Strain Sickens 14 Patients at
Henry Ford Hospital

• The mysterious infection that sickened 14
  patients last week at a hospital in Michigan was
  caused by a rare bacterial strain called
  Salmonella Isangi. Officials of Detroits Henry
  Ford Hospital are not saying much about the
  outbreak, like how the patients contracted the
  Salmonella and whether the source of the bacteria
  has been identified, causing speculation to
  mount.
• Salmonella infections are often traced to
  contaminated food or water. Yet, Salmonella can
  be transmitted basically by anything that enters
  your mouth, whether its a dirty hand, touching
  something that has Salmonella and touching your
  mouth, or food.
• Typical symptoms include nausea, vomiting,
  diarrhea and abdominal pain. If it gets more
  severe, they can develop a fever and ultimately,
  it can become bloody diarrhea. The hospital acted
  immediately by restricting the patients by
  identifying them, by treating them and by
  preventing any further spread. So they reacted to
  this issue as quickly as possible and as
  efficiently as possible.
• The seven patients that have been released are
  not a threat to anyone around them. As for the
  others still in the hospital, they could still be
  there because of what brought them there in the
  first place. No publicized reports or findings
  suggest that Henry Fords outbreak last week is
  linked to any type of contaminated medical
  instrumentation.
• Source http//www.clickondetroit.com/news/14-pati
  ents-diagnosed-with-salmonella-at-henry-ford-hospi
  tal/35566506

18
A cloud of bacteria follows you around

• According to a study published in PeerJ, each of
  us is surrounded by a cloud of bacteria every
  second of our lives. These microbial companions
  are so unique that the cloud might be as
  identifiable as your fingerprint. The study was
  relatively small - just 11 participants - but it
  brings evidence that our microbial footprints may
  be as good as an actual footprint at identifying
  us. Researchers put the subjects inside a
  sanitized chamber for 90 minutes, then tested the
  cloud of microbes each subject left behind.
  Previous research found that we put our microbial
  footprint into the room we've just entered
  relatively quickly, with your house having
  different mircobiomes than your office or the
  hotel room you spent a vacation in. The subjects
  left behind plenty of common, human-associated
  microbes, but the ratios of these microbes were
  unique enough that researchers were able to
  identify nearly all of the subjects just based on
  their microbial footprints.
• The most interesting aspect of the study may be
  the implications it has on forensic evidence used
  in crimes. As anyone who has watched CSI knows,
  DNA evidence can lead to a solid guilty or
  innocent verdict in a crime. But sometimes there
  is no DNA, so with what we know about microbial
  footprints, forensic analysts may turn to the
  microbial clouds for evidence. A study last year
  suggested microbial footprints may be used in
  sexual assault cases if there is an absence of
  DNA. In Hawaii, a different group is trying to
  figure out if microbes left on or around homicide
  victims could tie a suspect to the crime.
• Source Meadow, J, et al. Humans differ in their
  personal microbial cloud. PeerJ . 2015

19
Does NICU bed configuration affect sepsis, MRSA
rates?

• Researchers compared rates of colonization by
  methicillin-resistant Staphylococcus aureus,
  late-onset sepsis and mortality in single-patient
  neonatal intensive care unit rooms and open-unit
  rooms in a recent study published in the journal
  Infection Control Hospital Epidemiology.
• The study was conducted in the NICU of a tertiary
  referral center which was organized into
  single-patient and open-unit rooms. Clinical data
  sets including bed location and microbiology
  results were then examined over the next 29
  months. Of the more than 1,800 patients studied,
  single-patient and open-unit models had similar
  incidences of MRSA colonization and MRSA
  colonization-free survival times. Late-onset
  sepsis rates were also similar in single-patient
  and open-unit models, as were sepsis-free
  survival rates and the combined outcome of sepsis
  or death.
• Ultimately, the researchers concluded
  single-patient rooms did not reduce the rates of
  MRSA colonization, late-onset sepsis or death.
  However, they did discover the NICU's MRSA
  colonization rate was impacted by hand hygiene
  compliance, regardless of room configuration.
• Source Infection Control and Hospital
  Epidemiology Oct 2015

20
FDA orders duodenoscope manufacturers to conduct
postmarket surveillance studies in health care
facilities

• The U.S. Food and Drug Administration today
  ordered the three manufacturers of duodenoscopes
  marketed in the U.S. to conduct postmarket
  surveillance studies to better understand how the
  devices are reprocessed in real-world settings.
  The three manufacturers Olympus America, Inc.,
  Fujifilm Medical Systems, U.S.A., Inc., and Hoya
  Corp. (Pentax Life Care Division) that market
  duodenoscopes sold in the U.S will have 30 days
  to submit postmarket surveillance plans to the
  FDA. These proposals must detail their plans to
  conduct studies to evaluate, among other things,
  how well health care personnel are following
  instructions to clean and disinfect duodenoscopes
  between patients and to better understand the
  rate of contamination of clinically used
  duodenoscopes. These studies are based on the
  FDAs current understanding of factors that may
  be contributing to infection outbreaks following
  endoscopic retrograde cholangiopancreatography
  procedures (ERCP), as well as the information
  needed to help fill gaps in knowledge. The goal
  of these studies is to collect useful data about
  the effectiveness of current reprocessing
  instructions and practices that can provide the
  FDA with information necessary to protect the
  public health, including taking action to help
  reduce the risk of duodenoscope infections.
  http//www.fda.gov/NewsEvents/Newsroom/PressAnnoun
  cements/ucm465639.htm

21
Bubonic Plague in Michigan

• A Michigan resident recently became the 14th
  person this year to contract the plague, the same
  disease that was responsible for the Black Death
  pandemic in Europe in the 1300s. Although the
  plague has never officially been eradicated,
  instances of infection usually remain low in the
  U.S., averaging around seven cases per year. The
  14 reported cases have been mostly of the bubonic
  form of the plague, which is spread to humans
  through fluids from infected rodents or flea
  bites. The plague consists of three forms
  bubonic, pneumonic and septicemic, with the
  bubonic plague being the cause of 80 percent of
  plague cases in the U.S. The Michigan resident
  was diagnosed with bubonic plague, which cannot
  be spread from person to person. The only form
  that can be transmitted from person to person is
  the pneumonic plague because it affects the lungs
  and can be spread through coughing.
• The septicemic form of the plague is the rarest
  and occurs when the plague spreads to the
  bloodstream. This rare form was the cause of
  death in June for a Colorado teenager, who was
  believed to have been infected by a flea bite on
  his parent's rural ranch in Colorado. The
  Michigan woman who came down with the bubonic
  plague was also infected in Colorado during a
  camping trip. A possible contributing factor is
  the drought that is occurring throughout the
  West. Rodents may be flocking to campgrounds in
  search of food, and fleas may be biting humans
  more as they jump onto humans from dying animals.
  But those traveling out west to a rural area
  hunters should use gloves when handling animals,
  wearing long sleeves and bug spray containing
  DEET for those going camping. Any animals brought
  along on the trip should be treated with flea
  control products. www.cdc.gov

22
Should Doctors Go Bare? Infection Control Debate
Rages

• HAIs and the rise of MDROs has put new focus on
  whether requiring doctors to go bare below the
  elbows (BBE) would help infection control. BBE
  means no long sleeves, no neckties, no
  wristwatches, no jewelry other than a wedding
  band, and generally that physicians will wear
  scrubs. The practice was adopted in the UK in
  2008. But it appears to be a tough sell in the
  US. At a debate today at IDWeek 2015 in San
  Diego, two physicians squared off in a
  friendlyand highly entertainingdebate.
  Michael Edmond, MD, MPH, MP,of the University of
  Iowa Hospitals and Clinics said his hospital is
  going BBE January 1, 2016. He took the yes
  side of the debate. Neil Fishman, MD, of Penn
  Medicine in Philadelphia, PA, took the no side
  and closed his debate with a hip-hop style rap.
• Edmond began by citing studies that showed how
  dirty and microbe-contaminated lab coats could
  get. Though some surveys have shown patients
  prefer to see their doctors in coats and ties,
  Patients preferences vary and the survey
  techniques may bias the answers, he said. In a
  straw poll after the debate, the audience sided
  58 to 42 with Fishman. Edmond said he was
  convinced that BBE would help infection control
  since staph and other organisms persist on
  clothing, lasting over a month on white coats,
  particularly if they are polyester not cotton.
  Source Forbes Magazine Article

23
Ebola Nurse Critical Sneezing Every Second

• A nurse who contracted Ebola while working in
  West Africa is now "critically ill" with
  complications arising from the infection. Pauline
  Cafferkey was readmitted to a specialist
  isolation unit at the Royal Free Hospital in
  London last week.
• The hospital said in a statement that her
  condition had deteriorated. Ms Cafferkey, 39,
  from Cambuslang in South Lanarkshire, contracted
  Ebola while working at a treatment centre in
  Sierra Leone last year. She spent almost a month
  in isolation at the Royal Free at the beginning
  of the year after the virus was detected when she
  arrived back in the UK. She was later discharged
  after apparently making a full recovery, but it
  was discovered last week that Ebola was still
  present in her body. Bodily tissues can harbour
  the Ebola infection months after the person
  appears to have fully recovered. When the
  desperate call for health workers came at the
  height of the Ebola outbreak, Pauline Cafferkey
  stepped up to the very risky challenge. Whilst
  most were keen to be as far away as possible from
  the epidemic, Pauline ran right into the centre
  of it. Ms Cafferkey had initially gone to an
  out-of-hours doctor in Glasgow on Monday of last
  week, but was sent home after being told she
  probably had a virus. Her family has claimed
  doctors "missed a big opportunity" to spot she
  had fallen ill again. She was admitted to the
  city's Queen Elizabeth University Hospital the
  following day after continuing to feel unwell,
  before being transferred to the Royal Free in a
  military aircraft on Friday morning. She was
  admitted on Friday morning when her condition was
  serious and it is now critical.
• Source http//www.bbc.com/news/uk-scotland-345295
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