Unit Based Champions Infection Prevention eBug Bytes

1. Unit Based ChampionsInfection PreventioneBug Bytes December 2012

2. Investigators Conduct Meta-Analysis of Antimicrobial CVCs Antimicrobial catheters have been utilized to reduce risk of catheter colonization and infection. Researchers sought to determine if there is a greater than expected risk of microorganism-specific colonization associated with the use of antimicrobial central venous catheters (CVCs). The researchers performed a meta-analysis of 21 randomized, controlled trials comparing the incidence of specific bacterial and fungal species colonizing antimicrobial CVCs and standard CVCs in hospitalized patients. The proportion of minocycline-rifampin colonized CVCs that were colonized with Candida species was greater than the proportion associated with standard colonized CVCs. In comparison, the proportion of colonized chlorhexidine-silver sulfadiazine CVCs specifically colonized with Acinetobacter species or diphtheroids was less than the proportion of similarly colonized standard CVCs. No such differences were found with CVCs colonized with staphylococci. Reference: Novikov A, et al. Impact of catheter antimicrobial coating on species-specific risk of catheter colonization: a meta-analysis. Antimicrobial Resistance and Infection Control 2012, 1:40 doi:10.1186/2047-2994-1-40

3. Flesh-Eating Fungus Responsible for Five Deaths in Wake of Massive Tornado • A fast growing, flesh-eating fungus killed 5 people following a massive tornado that devastated Joplin, Mo., according to the Centers for Disease Control and Prevention (CDC). Health officials should be aware of infections caused by the fungus Apophysomyces, according to the studies, which tracked 13 people infected by the pathogen during the Class EF-5 tornado -- the most powerful category -- whose 200-plus mph winds plowed through Joplin on May 22, 2011, initially killing 160 and injuring more than 1,000. • The common fungus -- which lives in soil, wood or water -- usually has no effect on people. But once it is introduced deep into the body through a blunt trauma puncture wound, it can grow quickly if the proper medical response is not immediate, the studies said. Five of the 13 people infected through injuries suffered during the Joplin tornado died within two weeks. • Dr. Benjamin Park, chief of the Epidemiology Team at the CDC's Mycotic Diseases Branch, said the victims were infected when their injuries from the tornado were contaminated with debris from the storm, including gravel, wood and soil, as well as the aerosolized fungus. • Sources: New England Journal of Medicine, 2012; 367 (23): 2194

4. 'Sticky' Stomach Flu Virus Stands Up to Typical Restaurant Dishwashing Measures • Restaurant dishes and silverware may be an overlooked place where people can catch stomach viruses. Norovirus is the leading cause of epidemic gastroenteritis and the major cause of foodborne illness worldwide, responsible for at least 50% of all gastroenteritis outbreaks in the United States. • To carry out the experiment, the research team infused cream cheese and reduced fat milk -- two foods that are known for being difficult to clean off -- with murine norovirus (MNV-1), Escherichia coli (E. coli K-12) or Listeria innocua (L. innocua). The scientists then applied the dairy products to stainless steel utensils, ceramic plates and glassware, and put the tableware through a variety of chlorine and quaternary ammonium compound (QAC)-based sanitary protocols delivered via a commercial dishwasher or hand washing. The team found that while both the commercial dishwasher and manual washing reduced bacterial loads of E. coli K-12 and L. innocua enough to meet safety standards, neither technique was able to significantly reduce the presence of MNV-1. Reference: Lizanel Feliciano, Jianrong Li, Jaesung Lee, Melvin A. Pascall. Efficacies of Sodium Hypochlorite and Quaternary Ammonium Sanitizers for Reduction of Norovirus and Selected Bacteria during Ware-Washing Operations. • PLoS ONE, 2012; 7 (12):

5. Surgeon infected 5 patients atCedars-Sinai, hospital reports • Cedars-Sinai Medical Center, LA said Friday that a heart surgeon unwittingly infected five patients during valve replacement surgeries, due to tiny tears in his latex surgical glove, earlier this year. The infections caused four of the patients to need a second operation, officials said. • The infections occurred after the tears in the latex surgical gloves routinely worn by the doctor allowed bacteria from a skin inflammation on his hand to pass into the patients' hearts, according to the hospital. The patients survived the second operations and are still recovering, hospital officials said. Hospital officials called it a "very unusual occurrence" probably caused by an unfortunate confluence of events: the nature of the surgery, the microscopic rips in the gloves and the surgeon's skin condition. Valve replacement requires the surgeon to use thick sutures and tie more than 100 knots, which can cause extra stress on the gloves. • The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation

6. FDA to Hold Public Hearing on Antiseptic Patient Preoperative Skin Preparation Products • The Food and Drug Administration (FDA) is holding a public hearing Dec. 12-13, 2012 to obtain input on how to address microbial contamination of patient preoperative skin preparation drug products. Currently, patient preoperative skin preparations are not required to be sterile. Bacteria can contaminate these products at the time of manufacture or during product use. Contaminated patient preoperative skin preparations have been associated with clinical infections and adverse outcomes. At this public hearing, the FDA is interested in obtaining public comment about certain scientific and product use issues related to patient preoperative skin preparations. • Patient preoperative skin preparations are over-the-counter (OTC) topical antiseptic drug products used to reduce the number of bacteria on the skin prior to medical procedures or injections. Although they are marketed predominantly to healthcare facilities, the use of these products extends beyond the healthcare facility setting. For example, consumers with medical conditions requiring regular injections (e.g., of insulin or heparin) may use these products at home.

7. Bed Bugs Not Repelled by Commercial Ultrasonic Frequency Devices • According to an article in the Journal of Economic Entomology, commercial devices that produce ultrasound frequencies are NOT promising tools for repelling bed bugs. In "Efficacy of Commercially Available Ultrasonic Pest Repellent Devices to Affect Behavior of Bed Bugs (Hemiptera: Cimicidae)," authors K. M. Yturralde and R. W. Hofstetter report the results of their tests of four commercially available electronic pest repellent devices designed to repel insect and mammalian pests by using sound. The devices, which were purchased online, were used according to manufacturers' instructions. A sound arena was created for each ultrasonic device, in addition to a control arena which featured no sound. However, the authors found that there were no significant differences in the number of bed bugs observed in the control (no sound) and sound arenas, and that bed bugs were neither deterred nor attracted to the arena with the sound device. • Bed bugs are commonly exposed to frequencies made by their host species (humans) and by appliances and machines found in homes. Therefore, it may be possible that bed bugs also would exploit sounds made by their human hosts, such as breathing or snoring.

8. Vaccine rule is said to hurt health efforts • Representatives from governments around the world will meet in Geneva next month in a session convened by the United Nations Environmental Program to prepare a global treaty to reduce health hazards by banning certain products and processes that release mercury into the environment. But a proposal that the ban include thimerosal, which has been used since the 1930s to prevent bacterial and fungal contamination in multidose vials of vaccines, has drawn strong criticism from pediatricians. • In the United States, thimerosal has not been used in children's vaccines since the early 2000s after the Food and Drug Administration and public health groups came under pressure from advocacy groups that believed there was an association between the compound and autism in children. • Since then, however, there has been a lot of research, and the evidence is overwhelming that thimerosal is not harmful. Science clearly documented no hazards from thimerosal in vaccines. The preservative plays a critical role in distribution of vaccine to the global community. • Source: NY Times Dec 17 2012

9. Beagle sniffs out bacterial infection • A 2-year-old beagle in the Netherlands has been trained to sniff out Clostridium difficile, a skill that could help doctors catch the deadly infection days before laboratory tests. Clostridium difficile infections often occur in people who are already taking antibiotics, causing symptoms that range from mild diarrhea to severe inflammation of the colon. And to make matters worse, the bug is particularly adept at spreading through hospitals, uncontrolled by the usual surface cleansers. • The clever canine, called Cliff, correctly identified 50 stool samples containing the bacterium, which kills 14,000 Americans each year, according to the U.S. Centers for Disease Control and Prevention. Cliff also identified 47 of 50 stool samples that were Clostridium difficile-free (he couldn't make up his mind about the last three). • Laboratory tests for Clostridium difficile - dubbed C. diff - can take up to 48 hours. But Cliff gives his answer immediately by sitting or lying down. Stool from patients with the C. diff has a characteristic smell, often likened to horse manure, which Cliff learned to identify over two months of training. Now he can smell the bug even without the stool, correctly identifying 25 of 30 patients with the infection and 265 of 270 without

10. Hospital super-bug strains traced back to US, Canada • Researchers have now shown that the gastrointestinal illness that spread to various hospitals across the world was caused by two different but related strains of Clostridium difficile. One of the strains originated in the U.S. while the other came from Canada. The outbreak occurred between 2002 and 2006 in hospitals across UK, U.S.A., Canada and Europe. Researchers were able to determine the source as well as track its spread across the countries. "We found that this outbreak came from two separate epidemic strains or lineages of C. difficile, FQR1 and FQR2, both emerging from North America over a very short period and rapidly spread between hospitals around the world.” C. difficile produces highly resistant spores. These spores help the organism survive harsh conditions and spread to other geographical areas. The strains of C. difficile infection linked with the outbreak had developed resistance to a commonly used drug, fluoroquinolone. It was an effective treatment for C. difficile infection but these strains acquired resistance to this frontline antibiotic. It is now virtually useless against this organism, but resistance seems to have been a major factor in the continued evolution and persistence of these strains in hospitals and clinical settings. • Source: Nature Genetics