Infection Prevention eBug Bytes June 2016

1. Infection PreventioneBug BytesJune 2016 Zika Virus

2. A New Way to Clean GI Scopes • Some are now calling for a radical shift in scope reprocessing from high-level disinfection to steam sterilization. A leading proponent of this shift is infection prevention expert William Rutala, PhD, MPH. "Sterilization is the only way to unify reprocessing and reduce the infection risk," says Dr. Rutala, a professor in the division of infectious diseases at the University of North Carolina's School of Medicine. “ • Although the incidence of post-procedure infection remains very low, endoscopes represent a significant risk of disease transmission."Dr. Rutala will recommend to the FDA that it mandate that all GI scopes be sterilizable by 2018. A scope you could steam sterilize would be a "game-changer," says Donna Nucci, RN, BSN, CIC, an infection preventionist at Yale New Haven (Conn.) Hospital. "Nobody is going to get to zero microbial contamination all the time. Even if you're following the new CDC guidelines, that might not be enough. "Based on outbreak data, Dr. Rutala estimates that you can eliminate about 85% of outbreaks if you curb deficiencies associated with what takes place in the soiled utility room: cleaning, disinfection, automated endoscope reprocessors (AERs), contaminated water and drying. • http://www.outpatientsurgery.net/surgical-facility-administration/infection-control/a-new-way-to-clean-gi-scopes--11-15

3. New case of Elizabethkingia confirmed in Wisconsin • The Wisconsin Department of Health Services have confirmed another case of Elizabethkingia, bringing the total number of confirmed cases in the state to 61. A total of 18 Wisconsin residents with confirmed infections have died, though it is not clear if the infections were directly attributable to the deaths due to the fact that the majority of those infected were over the age of 65 and had preexisting comorbidities. There are also four suspected cases of infection in the state with one associated death among those cases. These cases cannot be confirmed because there are no longer specimens available for testing Both a Michigan resident and a resident from Illinois with confirmed infections related to the Wisconsin outbreak have also died. A cluster of ten infections in Illinois were found to belong to a strain of Elizabethkingia not associated with the outbreak in Wisconsin. Recently, Elizabethkingia was detected in a Wisconsin infant — this too was found to be a strain unrelated to the outbreak. • Disease detectives from the WDHS and the CDC are conducting an ongoing investigation into the outbreak. The source of the infection remains unknown. • https://www.dhs.wisconsin.gov/disease/elizabethkingia.htm

4. First Discovery in U.S. of Colistin Resistance in an E. coli Infection • The Multidrug Resistant Organism Repository and Surveillance Network (MRSN) at the Walter Reed Army Institute of Research (WRAIR) characterized a transferrable gene for colistin resistance in the US that may herald the emergence of truly pan-drug resistant bacteria. Colistin is the last agent used to combat bacteria that are resistant to the strongest antibiotics. Colistin has remained the best tool available to treat MDROs because bacteria were not exchanging genes for its resistance. This latest discovery shows that bacteria may be exchanging resistance genes for colistin. This colistin-resistance gene has been reported in China, Europe and Canada and, as of now, is reported in the U.S. A clinical sample from a urinary tract infection was collected from a patient in a military treatment facility in Pennsylvania. The sample was sent to the Walter Reed National Military Medical Center (WRNMMC) where colistin susceptibility was tested. The results showed that no safe dosage of colistin would be effective to treat such a bacterial infection. WRNMMC recognized colistin-resistance and sent a sample to WRAIR's MRSN for sequencing, which identified the colistin-resistant gene, mcr-1. • Source: Antimicrobial Agents and Chemotherapy (AAC) of the American Society for Microbiology (ASM

5. Lyme discovery: Borrelia bacteria hides inside parasitic worms, causing chronic brain diseases • The examination of autopsied brain tissues from patients who died of neurological conditions has revealed that many tick-borne infections, such as Lyme disease, go undiagnosed and untreated. Alan B. MacDonald, MD, presented research that found three Borrelia pathogens, including B. burgdorferi the causative agent of Lyme disease, thriving inside parasitic nematode worms, worm eggs or larvae in the brain tissue of nineteen deceased patients. These microscopic worms are endosymbionts, meaning the Borrelia bacteria dwell inside the worms. A tick bite delivers the nematode into the human body. Current tests, like the ELISA and Western blot, do not adequately detect the presence of Borrelia bacteria.” MacDonald says his discovery also shows “while patients are wrongly declared free of Lyme and other tick-borne infections, in reality, too often they contract serious neurodegenerative diseases which can kill them.” The Rocky Mountain Multiple Sclerosis Center Tissue Bank provided MacDonald with ten specimens from deceased MS patients; all ten specimens showed evidence of Borrelia infected nematodes. Infected worms were also found in five tissue specimens from patients who succumbed to the highly malignant brain tumor Glioblastoma multiforme, the same cancer which took the life of Senator Edward Kennedy (D-MA). Ironically, in 1993, Senator Kennedy chaired a hearing of the Labor and Human Resources committee titled: Lyme disease: A Diagnostic and Treatment Dilemma. Finally, four specimens from patients who died from Lewy Body dementia, the same illness which afflicted comedian Robin Williams, also showed the presence of infected nematodes. Source: http://outbreaknewstoday.com/lyme-discovery-borrelia-bacteria-hides-inside-parasitic-worms-causing-chronic-brain-diseases-13216/

6. Gold Medal, Gold Medal Wondra, and Signature Kitchens Flour Recalled Due to Possible E. coli O121 Contamination • General Mills is collaborating with health officials to investigate an ongoing, multistate outbreak of E. coli O121 that may be potentially linked to Gold Medal flour, Wondra flour, and Signature Kitchens flour (sold in Safeway, Albertsons, Jewel, Shaws, Vons, United, Randalls, and Acme). Out of an abundance of caution, a voluntary recall is being made. To date, E. coli O121 has not been found in any General Mills flour products or in the flour manufacturing facility and the company has not been contacted directly by any consumer reporting confirmed illnesses related to these products. State and federal authorities have been researching 38 occurrences of illnesses across 20 states related to a specific type of E. coli (E. coli O121), between December 21, 2015, and May 3, 2016. While attempting to track the cause of the illness, CDC found that approximately half of the individuals reported making something homemade with flour at some point prior to becoming ill. Some reported using a General Mills brand of flour. Based on the information that has been shared with General Mills, some of the ill consumers may have also consumed raw dough or batter. Consumers are reminded to not consume any raw products made with flour.

7. 11 deaths at Pasadena's Huntington Hospital may be linked to dirty scopes • Pasadena health officials said June 1st that 16 patients were infected by dangerous bacteria from medical scopes at Huntington Hospital from January 2013 to August 2015, including 11 who have died. It is not clear how many of those patients died from their infections. The hospital had previously said just three patients were infected in the outbreak that officials said was limited to the middle of 2015. The infections were detailed in an investigation into the outbreak, which blamed both the design of the scope and also problems by the hospital in disinfecting them. For example, the hospital had been using canned compressed air from Office Depot to dry the scopes. Huntington hospital officials had confirmed last August that three patients were sickened the previous month but declined to say more about their condition. They later told Olympus Corp of at least three deaths, according to the company's report to federal regulators. When the regulatory reports were discovered, hospital officials said that they believed patient privacy laws prevented them from telling the public that the unnamed patients had died. In January, Olympus recalled one model of its duodenoscopes because of the possibility of infections. The reusable scope suspected of causing the Pasadena outbreak had a different, older design from the one that Olympus recalled. http://www.latimes.com/business/la-fi-huntington-hospital-scopes-20160601-snap-story.html

8. UPMC settles one mold infection lawsuit for $1.35M • After four patients contracted mold infections in two UPMC hospitals in Pittsburgh, the system faced two lawsuits from patients' family members. One such case was recently settled for $1.35 million, according to the Pittsburgh Post-Gazette. The daughter of Tracy Fischer, who was the first of the four transplant patients to die after contracting the mold infection, settled her suit following a month of mediation. The settlement was made official by Allegheny County Common Pleas Judge Ronald Folino on Wednesday. In the settlement, UPMC agreed to pay the family $850,000 now and $500,000 in one year. "We again extend our sympathy to the family of Ms. Fischer and appreciate their graciousness," UPMC said in a statement emailed to the Post-Gazette. UPMC still faces a suit from the family of Che DuVall, who died nearly a year after Ms. Fischer. The family's attorney, Brendan Lupetin, said this case is different because Mr. DuVall's death happened so long after Ms. Fischer's. "The conditions were more aggravated because there were things that should have been looked into," he told the Post-Gazette. In May, the CDC pointed to the improper use of negative-pressure rooms as a possible source of the mold infections. http://www.post-gazette.com/news/health/2016/05/26/UPMC-settles-with-family-of-woman-that-contracted-mold-infection/stories/201605260191

9. Memphis VA cited by OSHA after body tissue found in drain • Memphis VA Medical Center is under investigation by the Occupational Safety and Health Administration upon discovery that human body tissue is not being properly disposed of at the facility. • According to OSHA's complaint, an engineer pipe-fitter was exposed to body tissue in March while unclogging a drain at Memphis VA Medical Center. The sink, in a housekeeping closet of the third-floor surgical unit, was full of brown water. As the pipe-fitter cleared the drain, body tissue floated to the top. He collected the tissue in a bucket and placed it outside of a building on the hospital's campus without a biohazard label, according to OSHA. • The pipe-fitter's exposure to the body tissue was deemed a "serious" violation by OSHA. According to the complaint, the pipe-fitter had not been provided the hepatitis B vaccine and was not trained in blood borne pathogens.

10. Infant with Zika-related microcephaly born in New Jersey • On Tuesday, a baby girl was born in a New Jersey hospital with severe Zika-related microcephaly, according to The New York Times. The mother is 31 years old and reportedly contracted the virus in her home country of Honduras. Manny Alvarez, MD, chairman of the Department of Obstetrics, Gynecology and Reproductive Science at Hackensack (N.J) University Medical Center, told the Times the mother knew she had the virus before coming to the U.S. to visit relatives. Physicians at the Donna A. Sanzari Women's Hospital in Hackensack opted to deliver the baby via caesarean section after scans revealed the infant was underweight for her gestational age. According to ABC News, this is the first infant born in the continental U.S. with Zika-related microcephaly — a baby was born in Hawaii in January with microcephaly related to the virus. Microcephaly is a neurologically debilitating birth defect in which babies are born with abnormally small heads. The infant is also suffering from intestine and vision issues. Regarding the birth, Dr. Alvarez told the Times, "It tells you that Zika is real...there is still a lot of work to be done insofar as controlling the virus.“ • http://www.nytimes.com/2016/06/01/nyregion/girl-with-zika-virus-is-born-at-a-new-jersey-hospital.html?_r=2

11. Investigation of Hep C Transmission with Injection Therapy for Chronic Pain • On November 26, 2014, the California DPH contacted CDC concerning a report from the Santa Barbara DPH regarding acute hepatitis C virus (HCV) infection in a repeat blood donor. The patient, who was asymptomatic, was first alerted of the infection by the blood bank and had no traditional risk factors for HCV infection. One such exposure occurred at a doctor’s office (clinic A) where the blood donor received an injection procedure as part of prolotherapy. Prolotherapy, also known as regenerative injection therapy, is an increasingly popular, injection-based complementary and alternative medical therapy used to treat chronic musculoskeletal pain . In addition, some patients also received platelet rich plasma therapy, that involves injection of autologous blood with a high platelet-to-plasma ratio. The initial investigation into clinic A revealed infection control breaches that included reentering multidose medication vials with a used syringe, use of single-dose medication vials for multiple patients, poor hand hygiene and inconsistent glove use, and lack of aseptic technique when handling injection equipment and medication. Clinic A was advised to stop these practices, and staff members were educated on blood borne pathogen transmission. Six other patients were determined to have HCV infection. Among these six patients, five were unaware of their HCV infection status. Four of the patients without a prior HCV diagnosis or risk factors for HCV had injection procedures performed in clinic A on the same day as the index patient. A common injected substance used in all the infected patients was not identified through medical chart review. MMWR June 3, 2016 / 65(21);547–549

12. Needle stealing case highlights issue with tracking health workers • Authorities say an HIV-positive surgical tech stole syringes with fentanyl and endangered patients at a suburban Denver hospital -- the third incident of this type in the state in less than a decade. Colorado lawmakers are trying to tighten regulations but experts say it is a national concern. Surgery technician Rocky Allen, who jumped from hospital to hospital before he was caught, was taking a syringe filled with painkillers from an operating room in January. The hospital and state health officials issued a public call for the approximately 2,900 patients who had surgery during Allen's time at the hospital to be tested for hepatitis and HIV. No reported cases of HIV have been detected but about 1,000 people still either need to be tested or get follow up tests. Allen, who has pleaded not guilty to federal charges, had a long history of problems. The former Navy medic was court martialed for stealing fentanyl at a military hospital in Kandahar in 2011 and received a general discharge after agreeing to a plea deal. The current law only requires techs such as Allen to self-disclose any civil, criminal or administrative action related to their job duties and to provide their employment history over the previous five years. But Allen, who was fired from at least five hospitals in Colorado and other states, left off some hospitals where he worked from his resume, making it more difficult to vet his background. Under a bill awaiting Colorado Gov. John Hickenlooper's signature, surgical technicians would have to pass a fingerprint-based criminal background check and a drug test before being allowed to work in the state.

13. Researchers: Drop the No-EatingRule Before Colonoscopy • There may be a better way to get stubborn or procrastinating patients to sign up for potentially life-saving colonoscopies: Let 'em eat macaroni and cheese. Researchers speculate that a 1-day, low-residue diet — which could include such foods as scrambled eggs, white bread, butter, chicken breasts, pretzels and good old mac-and-cheese — as opposed to the traditional all-liquid prep, may, in addition to making patients a lot happier, actually do a better job with bowel preparation. They studied 83 patients who were randomly assigned to one group or the other. All patients were also given a split-dose polyethylene glycol electrolyte lavage solution. The low-residue group not only scored higher on the Boston Bowel Preparation Scale (a mean of 7.98 vs. a mean of 7.54), they were also much less hungry in the evening, much less tired in the morning and much happier with their diets — reporting a 97% satisfaction rate versus 46%. • "In the U.S., we've been over-restrictive with the diet with clear liquids," says lead author Jason B. Samarasena, MD. "This is another study that adds to that data pool showing that [a low-residue diet] is as good as, and potentially even better than, clear liquids. Hopefully, that will encourage patients to have colonoscopies and repeat their colonoscopies if they have to." • http://www.mdlinx.com/gastroenterology/conference-interview/article/401

14. Zika virus could spread through oral sex and kissing, scientists warn • Dr. John T. Brooks, an epidemiologist at the Centers for Disease Control and Prevention, told The New York Times it's not out of the question that Zika could be transmitted by oral sex. But he also said he thought it was unlikely that the virus could be transmitted through kissing. Although Zika has been detected in saliva samples, so far, there have been no documented cases of the virus being transmitted by saliva, according to scientists. Zika transmission via sexual contact has been reported in the U.S., Canada, France, Italy and several other countries. Public health officials warn that mosquitos carrying the Zika virus could start infecting Americans as soon as this month. Preventing mosquito bites at home should be at the top of every summer to-do list. • According to new research from Consumer Reports, most "natural" bug sprays won't effectively ward off the mosquitos that carry the virus known to cause birth defects. Although products derived from oils might smell better, they don't last nearly as long as synthetic chemical-based repellants like picaridin and DEET. If used as directed, products containing picaridin and DEET are safe for use by pregnant and even breast-feeding women, according to the U.S. Centers for Disease Control and Prevention. Here are the top three picks for warding off the zika-spreading Aedes mosquitos, according to Consumer Reports: Sawyer Picaridin, Ben's 30% Deet Tick & Insect Wilderness Formula, and Repel Lemon Eucalyptus. • http://www.people.com/article/zika-orally-transmitted-olympics

15. 141 Allina patients possibly exposed to TB • Some patients of Allina Health may have been exposed to TB by two workers who helped deliver care at two major hospitals. In late May, Allina Health, Minneapolis, began notifying 141 patients--warning them of the possible exposure. The patients were treated at either Abbott Northwestern Hospital or Mercy Hospital earlier this year. Allina learned that a worker in each location, who helped deliver care, had active TB. • According to the CDC, the number of TB cases in the United States rose last year for the first time in a quarter-century. In Minnesota, the CDC reported 147 cases in 2014 and 150 in 2015. • Allina Health's statement went on to say, "All of these patients have or will receive a telephone call and letter notifying them of the exposure and advising them to seek medical attention if they have experienced any symptoms of TB, or to schedule a free blood test for TB at one of our clinics. Allina Health will pay for all testing and any necessary follow up treatment related to the potential exposure.“ • http://www.kare11.com/news/health/141-allina-patients-possibly-exposed-to-tb/234445183

16. Mumps moves across Nebraska: 21 confirmed cases • A mumps outbreak that began at Midland University in Fremont, Neb., has spread to new areas of the state as most students have returned home for the summer. The number of confirmed cases in the state recently jumped from 10 to 21, according to the Nebraska Department of Health and Human Services. • "Mumps is an illness caused by a highly contagious virus and this outbreak is ongoing with potential for further spread," said Tom Safranek, MD, an epidemiologist with DHHS. "If people start experiencing mumps-like symptoms, they should contact their healthcare provider, and healthcare providers should be on the lookout for mumps cases.“ • The mumps made a resurgence on college campuses in the spring semester of 2016, most prominently at Harvard University in Cambridge, Mass., where nearly 60 confirmed cases threatened to impede commencement ceremonies. • http://www.beckershospitalreview.com/quality/mumps-moves-across-nebraska-21-confirmed-cases.html

17. Hospital worker cellphones are hotbeds for fungus • The Candida fungus was found on the majority of cellphones belonging to employees at a hospital in Poland. Candida can live on the skin and mucous membranes without causing an infection, but, according to the CDC, "overgrowth of these organisms can cause symptoms to develop." Candida can cause thrush, yeast infections and bloodstream infections. • Researchers tested 175 mobile phones and the hands of staff members at University Hospital in Bialystock, Poland. They found 131, or 74.9 percent, of the tested phones were colonized with the fungus. The dominant species identified were Candida albicans, C. glabrata and C. krusei. • Further, just 19.4 percent of participants reported cleaning the surface of their phones. The prevalence of mobile phone contamination by Candida is high in the University Hospital in Białystok, Poland. Candida albicans, C. glabrata, and C. krusei were the dominant species in the samples collected from mobile phones and hands. These results pose the need to develop guidelines for mobile phone disinfection. "These results pose the need to develop guidelines for mobile phone disinfection," the study authors concluded. • http://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1577-0

18. Ditch the flowers and balloons: Leave gifts at home • Here are five items increasingly banned in some healthcare facilities: • 1. Flowers and plants are restricted in some hospitals based on recommendations from the CDC to protect immunosuppressive patients, given plants' potential to grow mold. CDC arecommends healthcare workers administering patient care refrain from handling flowers. Pollen can stick to a healthcare worker's clothes and be transferred to patients who are allergic to it • 2. Balloons, especially those made of latex, can trigger allergic reactions. • 3. Cell phones are restricted for many reasons, including fear of electromagnetic wave interference with medical equipment. However, there is little evidence of this threat. Cell phones are sometimes banned to prevent noisiness, tripping hazards when attached to chargers. Cell phones also carry 10 times more bacteria than what is found on most toilet seats, according to a 2012 University of Arizona study. • 4. Stuffed animals can cause harm if their attached eyes, noses, beads or buttons fall off and get into the hands of young patients, who may swallow them. • 5. Food can be banned from facilities in an effort to keep patients who suffer from food allergies and dietary restricts safe. Children's hospitals are especially unlikely to allow food unless a nursing supervisor has approved. • http://www.wsj.com/articles/why-many-hospitals-are-banning-flowers-and-stuffed-animals-1465234611