Unit Based Champions Infection Prevention eBug Bytes

1. Unit Based ChampionsInfection PreventioneBug Bytes September 2012

2. New 'SARS-like' respiratory illness identified • The World Health Organization has issued an international alert after the discovery of a new respiratory illness similar to the SARS virus which swept the world in 2002. The disease was identified in a 49-year-old man in Qatar, who is now being treated in a London hospital. Another sufferer from Saudi Arabia has since died. There have been reports of a small number of other cases of serious respiratory illness in the Middle East over the past three months. The Qatari man was first reported ill on 3 September, and was transferred to the UK a week later. He had previously visited Saudi Arabia. The UK's Health Protection Agency conducted laboratory tests and has confirmed the presence of a new coronavirus. • Coronaviruses are a large family of viruses which includes those that cause the common cold and SARS. This new virus, however, is different from any previously identified in humans. Symptoms include fever, cough, shortness of breath, and breathing difficulties, and there are as yet no specific recommendations on treatment. • The HPA says that the disease is unlikely to be easily transmitted, as, if it were, more cases would have been expected. The incubation period is believed to be about seven days. • "Given that this is a novel coronavirus, WHO is currently in the process of obtaining further information to determine the public health implications of these two confirmed cases," says the WHO. It says it's not recommending any travel restrictions, although it is offering advice to Haaj pilgrims, here. • "As we are aware of only two cases worldwide and there is no specific evidence of ongoing transmission, at present there is no specific advice for the public or returning travelers to take but we will share any further advice with the public as soon as more information becomes available," says Professor John Watson, head of the respiratory diseases department at the HPA.

3. H3N2 – Cases on the Rise • SAN FRANCISCO ID News — The number of influenza H3N2 variant virus infections in the United States has reached 302, officials from the CDC reported at the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy. First reported to the public in early August, the last number of cases reported by Infectious Disease News was 145 on August 9. There has since been 1 death related to the virus, according to Lyn Finelli, DrPH, Lead of the Surveillance and Outbreak Response Team, Influenza Division, National Center for Immunization and Respiratory Diseases of the CDC. “We’re interested in these infections because sustained and efficient transmission of these viruses represents opportunities for pandemics, just like we saw with H1N1 in 2009,” Finelli said during a press briefing. Finelli said that 16 of the cases resulted in hospitalizations. The patient that died was an older adult with several underlying conditions. All of the cases reported contact with swine at local county fairs. There has been little report of human-to-human transmission, Finelli said. Children appear to be the most susceptible. The immunity profile shows no immunity to the virus in children and moderate immunity in young and older adults. • Physicians are advised to test patients that come in with influenza-like illness and to treat patients with either oseltamivir or zanamivir. Two vaccine candidates have been sent to drug manufacturers, in case cases start to escalate, Finelli said. • “It’s hard to predict what is going to happen, as fairs wind down and as cooler weather ensues,” Finelli said. “It’s possible that we’ll see local outbreaks, maybe in daycare centers and schools, in the susceptible population.”

4. Antibiotic Use Aids MRSA Spread in Hospital and Infection Control Measures Do Little to Prevent It • The use of a commonly prescribed antibiotic is a major contributor to the spread of infection in hospitals by the 'superbug' MRSA. A study also found that increasing measures to prevent infection -- such as improved hygiene and hand washing -- appeared to have only a small effect on reducing MRSA infection rates during the period studied. The researchers tracked MRSA infection over 10 years from 1999 to 2009 at St George's Hospital, London, looking at how it has adapted to survive in a hospital environment and at factors that affected its prevalence. They found that a significant drop in MRSA rates coincided with a reduction in hospital prescriptions of ciprofloxacin, the most commonly prescribed antibiotic of the fluoroquinolone family. As ciprofloxacin prescriptions fell from 70-100 daily doses for every 1000 occupied beds to about 30 doses, the number of patients identified by the laboratory to be infected with MRSA fell by half, from an average of about 120 a month to about 60. Following this, over the last two years of the study both the drug prescription level and MRSA rates remained at these reduced levels. Journal of Antimicrobial Chemotherapy, 2012; 67 (10): 2514

5. Xenex device eliminates 95% of C. diff from hospital rooms • Evidence continues to mount that hospital cleanliness plays a role in the spread of HAIs, which are caused by deadly pathogens such as C. diff, MRSA, VRE and Acinetobacter. Hospital cleaning teams are not able to disinfect all the surfaces in patient rooms in the allotted time, with research showing that more than half of the surfaces remain untouched. Additionally, "superbugs" such as C. diff are showing resistance to cleaning fluids, making them even more difficult to remove and eliminate. • Xenex Healthcare Services recently participated in a study conducted at The University of Texas MD Anderson Cancer Center to evaluate the efficacy of its pulsed xenon UV light disinfection system versus bleach in a hospital setting. Shashank Ghantoji, M.D., M.P.H., a postdoctoral fellow, presented the poster, "Comparison of Pulsed Xenon UV to Bleach for the Decontamination of C. difficile from Surfaces in the Patient Environment" at the recent ICAAC conference in San Francisco. • "The study showed a 95 percent reduction in C. diff when the rooms were cleaned with the device(s)," said Roy F. Chemaly, M.D., M.P.H., associate professor in MD Anderson's Department of Infectious Diseases, Infection Control and Employee Health. Yahoo Finance 9-18-12

6. Vaccine for MRSA being tested • Pfizer Inc. and GlaxoSmithKline Plc, are each testing novel vaccines to halt methicillin-resistant Staphylococcus aureus, or MRSA, long a dangerous infection in hospitals and nursing homes and which is now increasingly finding its way into daycare centers, schools and prisons. • The vaccines are in early studies and years away from possible approval. Two other drug companies have already tried and failed to make an effective vaccine, most recently Merck & Co. in 2011. Mostly benign Staphylococcus aureus bacteria live widely on people's skin and in their nasal passages. About 1 percent of those with the bacteria carry MRSA, a toxic form of the illness that enters the bloodstream and is resistant to most treatments. MRSA, which kills more than 11,400 Americans a year, can enter the body through a cut, a sore, a catheter or a breathing tube. • In hospitals, a vaccine would be used for patients going into surgery or those with compromised immune systems. Beyond hospitals, people could get routine vaccinations to help protect them against proliferating staph bacteria in places like daycare centers for children and gym locker rooms • www.bloomberg.com Sept 17 2012

7. Feds wrap up investigation at VA hospital • The federal government has closed its investigation of the Veterans Administration hospital in St. Louis, citing "vast improvements" in its sterilization procedures. The Department of Veterans Affairs' Office of Inspector General issued the report last week, more than two years after sterilization concerns were first raised at John Cochran VA Medical Center. • "The facility has made vast improvements in its reusable medical equipment-related policies and practices over the past 6 months and the central issue of patient safety during dental procedures has been addressed," the report's executive summary said. • In 2010, faulty sterilization at the center's dental clinic raised concerns that 1,812 veterans were potentially exposed to hepatitis and HIV. Subsequent testing found no link to hepatitis or HIV in patients. • Investigators came to the hospital in January but found that sterilization technique problems persisted. Among the problems: Contamination tests were not recorded; floors were dirty; surgical implants were not sterilized for the required 48 hours. www.columbiatribune.com Sept 14, 2012

8. CDC: Multistate E. coli O145 Outbreak Has Sickened 14 in 6 States • Today the U.S. Centers for Disease Control and Prevention announced that the E. coli O145 outbreak that killed a young girl in Louisiana has sickened at least 14 people in six states: Georgia (5 illnesses), Louisiana (4), Alabama (2), California (1), Florida (1) and Tennessee (1). Three people have been hospitalized. • The source of the contamination remains unknown. • Illness onset dates range from April 15 to May 12. Infections that began after May 12 may not have been reported yet. The most recent case was reported on June 4. • A 21-month-old girl in Louisiana died from her infection on May 31 after falling ill several weeks earlier. This outbreak has no connection to the May 26 death of a 6-year-old Massachusetts boy suffering from an E. coli O157:H7 infection.

9. Report Finds HAI Under Reported in CA • California public health authorities who reviewed 100 hospitals found that the facilities failed to report as many as a third of the infections they should have reported in 2011 under the state's public reporting law.. • The reviews, completed last year, consisted of one- to two-day examinations by public health authorities at 100 hospitals that volunteered; there are more than 400 hospitals in the state. Reviewers examined infection data that was reported in 2011 and compared that with medical lab findings and patient records. Results for individual hospitals were not tracked. Reviewers took a close look at hospital reporting practices of infections including VRE, or vancomycin-resistant enterococci, C. Dif., or Clostridium difficile, and MRSA, or methicillin-resistant Staphylococcus aureus and central lines. Reviewers found that hospitals failed to report about 150 out of 577 C. difficile infections. Among central-line infections, hospitals missed reporting 68 out of 180 verified infections. For VRE, hospitals also missed about a quarter of the 149 reportable cases, and for C. Dif, hospitals missed nearly 10 percent of 2,338 reportable cases. Underreporting was often a result of confusion about complex instructions on identifying which infections were caused by hospital practices. • Source: August 10, 2012 www.californiawatch.org

10. CDC: Cases of new swine flu strain rising • A new strain of swine flu in humans continues to spread, health officials said Thursday, with more than 100 cases reported. • The Centers for Disease Control and Prevention says 145 cases of the influenza A (H3N2) variant have been found in four states since mid-July: 113 in Indiana, 30 in Ohio, one in Illinois and one in Hawaii. • The CDC says it expects the case count to increase. Two people were hospitalized, but both have been released, officials said. The CDC says people exposed to pigs should take precautions to protect themselves from this new strain of flu, namely: • Wash your hands with soap and water before and after touching pigs. • Don't drink or eat near pigs, and don't take food into animal areas. • Avoiding contact with animals such as pigs may be the best protection • Even though the regular seasonal flu vaccine contains a strain of the A-flu virus group, it will not prevent you from getting sick if you come into contact with the new flu strain. CDC is taking preliminary steps to develop an H3N2 vaccine.

11. Wal-Mart, Indiana grower cantaloupe after outbreak • An unidentified farm in southwestern Indiana is withdrawing cantaloupe from the marketplace following a salmonella outbreak that has sickened 141 people and killed two in 20 U.S. states, federal regulators said. • Wal-Mart Stores Inc. also began contacting outlets and instructing them to withdraw cantaloupe grown in southwestern Indiana as a precaution. • . As a result of initial investigations by state health departments, a farm in southwestern Indiana has contacted distributors and is withdrawing its cantaloupe from the marketplace, the Centers for Disease Control and Prevention in Atlanta said last night. The farm has agreed to cease distributing cantaloupes for the rest of the growing season. Consumers who recently bought cantaloupes grown in southwestern Indiana are being advised not to eat them and to discard any remaining fruit, the CDC said. • Among those sickened, 31 were hospitalized, the U.S. Food and Drug Administration said yesterday in a statement. Kentucky had the most reports of illness, 50, followed by Illinois with 17 and Indiana with 13, according to the statement.

12. Daily Disinfection of High Touch Surfaces Reduces Hand Contamination • New research demonstrates that daily cleaning of high-touch surfaces in isolation rooms of patients with Clostridium difficile (C. difficile) or methicillin-resistant Staphylococcus aureus (MRSA) significantly reduces the rate of the pathogens on the hands of healthcare personnel. The findings underscore the importance of environmental cleaning for reducing the spread of difficult to treat infections. • Researchers from the Cleveland Veterans Affairs Medical Center conducted a prospective, randomized trial comparing regular cleaning protocols of housekeeping staff with daily disinfection of high-touch surfaces performed by researchers (i.e., bed rail and bedside tables, call button and phone, and toilet seat, and bathroom hand rail) in 34 C. difficile and 36 MRSA isolation rooms. The study assessed hand contamination of physicians, nurses, and research staff six to eight hours after disinfection procedures. In rooms with daily disinfection, there were significant reductions in the amount and frequency of pathogens on the hands of investigators and healthcare personnel caring for the patients (6.4 percent with daily disinfection versus 30 percent with standard cleaning). • Source: Oct 2012 issue of Infection Control and Hospital Epidemiology