Unit Based Champions Infection Prevention eBug Bytes

1. Unit Based ChampionsInfection PreventioneBug Bytes March 2012

2. Double Gloving by Surgeons Study - AORN • The Association of periOperative Registered Nurses (AORN) has published the results of a 24-month study examining the effect of double-gloving with inner indicator gloves on the durability of inner gloves and the detection of glove tears or perforations during surgery. • The study results appear in the article, "Exploring the Benefits of Double Gloving During Surgery," published in the March issue of AORN Journal. In an article inset, called the Plain Language Summary, the study authors, Denise Korniewicz, PhD, RN, FAAN, and Maher El-Masri, PhD, RN, write, "double-gloving by itself may protect the wearer’s skin from needle sticks because breaches are more likely to occur to the outer gloves than the inner gloves." Their study found that healthcare providers observed blood on their hands after surgery more frequently when they wore a single pair of gloves than when they wore two pairs of gloves. The study also found that "the frequency of changing gloves during surgery was significantly higher among those healthcare providers who wore dark-colored gloves under light-colored gloves than those who wore two pairs of gloves that were the same color." The majority of healthcare providers in the authors’ study expressed favorable views about double-gloving.

3. Low Levels of Resistant Bacteria Found in Chicago-Area Ambulances A team of researchers from Lewis University in Romeoville, Ill took samples from 26 areas inside of 71 ambulances from 34 different Chicago-area municipalities. The team recovered 100 S. aureus isolates from more than 1,800 sites that were sampled (less than six percent). At least one S. aureus sample was found in 69 percent of ambulances tested. Of all isolates detected, 77 percent showed resistance to at least one commonly used antibiotic, and 12 percent were identified as the “superbug” known as methicillin-resistant S. aureus (MRSA). The authors state, “Of interest, only 5 of 71 ambulances tested positive for MRSA in at least one location (yielding the 12 MRSA isolates studied). Although there have been few previous studies of front-line advanced life support ambulances, a higher frequency of suspected MRSA in ambulance fleets has been reported previously.” “Given the ease with which S. aureus can survive on inanimate surfaces and exchange antibiotic resistance elements, a conscientious approach to the application of existing cleaning techniques, especially in key ambulance sites, needs to continue.”

4. Virginia Hospitals Reduce Infections by 41 Percent, Save $1.2 Million • VHHA Services, a subsidiary of the Virginia Hospital & Healthcare Association, coordinated a study among the four hospitals to determine if adding a persistent hand sanitizing lotion and a persistent surface disinfectant to current practices reduces HAI rates. The products, developed by Germ Pro Products, Inc., offer continual, persistent effects that kill germs on hands for four hours and on surfaces for up to 28 days. Healthcare workers at the four hospitals were instructed to apply Germ Pro Hand Sanitizing Lotion at the start of their workday and reapply every four hours. They were told to continue washing their hands or using an alcohol sanitizer as recommended in the Centers for Disease Control and Prevention (CDC) hand hygiene guidelines. Environmental services employees were instructed to apply the surface disinfectant to "touch points" only. Rooms were disinfected after patient discharges and common hospital areas were treated monthly. No capital investment was required by the participating hospitals. The study ran three months and compared HAI rates during the study to the three months prior to the study period. After the three-month trial period, results showed an average of 41.5 percent fewer infections per 1,000 patient days. Individual hospitals reduced infections 29.4 percent, 32.4 percent, 50 percent and 54.2 percent respectively. The CDC estimates the average cost of an HAI is $20,549, which results in a cost savings estimate of $1.2 million for the 59 HAIs prevented. The cost to implement both products is less than $15,000 for three months.

5. Methodist Willowbrook Hospital Achieves Zero Infection Rate • The 251-bed hospital, part of the Methodist Hospital System, achieved a zero infection rate in ventilator associated pneumonias, central line bloodstream infections, and urinary catheter infections. Hospitals nationwide have been charged with reducing the number of hospital-acquired infections and other preventable injuries as a result of the Institute of Medicine’s patient safety initiatives. Published studies show that there are 1.7 million infections in hospitals annually, resulting in almost 100,000 deaths a year—most in the above three categories. Some of the things Willowbrook did to lower infection rates include working collaboratively with its nursing staff to develop an electronic tool within the electronic medical record that alerts nurses when specific patient care tasks should be performed. For example, it alerts the nurse on the number of days a urinary catheter has been in place and to review for continued need. The removal of a simple catheter could easily be overlooked, and early removal is key to reducing the chance of a urinary tract infection. Having a committed and talented staff assisted by technology has been a key to success at Methodist Willowbrook Hospital.

6. Policy Statement on Antimicrobial Stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) • Antimicrobial resistance has emerged as a significant healthcare quality and patient safety issue in the twenty-first century that, combined with a rapidly dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health of the United States. Antimicrobial stewardship programs optimize antimicrobial use to achieve the best clinical outcomes while minimizing adverse events and limiting selective pressures that drive the emergence of resistance and may also reduce excessive costs attributable to suboptimal antimicrobial use. Therefore, antimicrobial stewardship must be a fiduciary responsibility for all healthcare institutions across the continuum of care. This position statement of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society of America outlines recommendations for the mandatory implementation of antimicrobial stewardship throughout health care, suggests process and outcome measures to monitor these interventions, and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the United States. • Source: Infection Control and Hospital Epidemiol...> Vol. 33, No. 4, April 2012

7. The Role of Suboptimal Bronchoscope Repair Practices by a Third-Party Vendor in a Pseudo-Outbreak of Pseudomonas in Bronchoalveolar Lavage Specimens • An epidemiologic investigation was conducted to determine the cause of Pseudomonas putida growth in 4 bronchoalveolar lavage (BAL) specimens within a 3-day period in May 2008. All bronchoscopes were inspected, and cultures were obtained from bronchoscopes and the environment. Bronchoscope cleaning and maintenance practices were reviewed. Microbiologic results from BAL specimens and medical records were reviewed to find additional cases. • Results. All 4 case patients had undergone bronchoscopy with one of 2 bronchoscopes, both of which had loose biopsy ports. Bronchoscope cultures grew P. putida, Pseudomonas aeruginosa, and Stenotrophomonas. The P. putida strains from the bronchoscopes matched those from the patients. Specimens from 12 additional patients who underwent bronchoscopy with these bronchoscopes grew P. putida, P. aeruginosa, or Stenotrophomonas. No patients developed clinical signs or symptoms of infection, but 7 were treated with antibiotics. Investigation revealed that the implicated bronchoscopes had been sent to an external vendor for repair; examination by the manufacturer revealed irregularities in repairs and nonstandard part replacements. • Conclusions.Third-party vendors without access to proprietary information may contribute to mechanical malfunction of medical devices, which can lead to contamination and incomplete disinfection. Infection Control and Hospital Epidemiol.. >Vol. 33, No. 3, March 2012

8. Norovirus • Norovirus is a highly contagious illness caused by infection with a virus called norovirus. • It is often called by other names, such as viral gastroenteritis or stomach flu. It is also called food poisoning, although it may not always be related to food. Norovirus is not related to the flu (influenza) which is a respiratory illness caused by the influenza virus. • Norovirus causes acute gastroenteritis which is an inflammation of the stomach and intestines • Symptoms of norovirus include diarrhea, vomiting, nausea, and stomach pain • Anyone can get norovirus, and they can have the illness multiple times during their lifetime. • Norovirus illness can be serious • Norovirus can make people feel extremely ill and vomit or have diarrhea many times a day. • Most people get better within one to two days. • Norovirus can be very serious among young children, the elderly, and people with other illnesses, and can lead to severe dehydration, hospitalization and even death. • Norovirus is highly contagious • Noroviruses spread quickly from person to person. • Outbreaks of infection are common in crowded, closed places such as hospitals or long-term care facilities, daycare centers, schools, hotels, and cruise ships. • People with norovirus are contagious from the moment they begin feeling ill to at least three days and perhaps for as long as two weeks after recovery.

9. Norovirus – Prevent Spread Wash your hands often and well: Wash your hands carefully with soap and water, especially before preparing or eating food, using the restroom or changing diapers. Alcohol-based hand sanitizers are not a substitute for washing with soap and water. • Precautions in the kitchen: Always wash fruits and vegetables, and cook oysters and other shellfish thoroughly before eating them. • Do not prepare food if you are sick: People who are infected with norovirus should not prepare food for others while they have symptoms and for three days after they recover from their illness. • Clean and disinfect contaminated surfaces thoroughly: After an episode of illness, such as vomiting or diarrhea, immediately clean and disinfect contaminated surfaces by using a bleach-based household cleaner as directed on the product label or a 1:10 solution by mixing 1/4 cup of bleach to 2 1/4 cups of water. Bleach is very caustic and emits potentially lethal fumes, so it should never be used full strength; mix in a well-ventilated area and use caution to prevent splashing. • Wash laundry thoroughly: Immediately remove and wash clothing or items that may be contaminated with vomit or fecal matter. Handle soiled items carefully. Wash laundry with detergent for the longest cycle time available and then machine dry.

10. Prevent Infections by Keeping Your Environment Clean • The Environmental Services (ES) staff plays an important part in keeping your hospital room and other areas of the hospital environment clean. But in addition to the work they do, patients also play a role. • Survey your room – does it look clean? Your hospital room should be cleaned daily and look and smell clean. If you have concerns, tell the ES staff so they can be addressed immediately. • Don’t contribute to the clutter; clutter makes it hard for the ES staff to do their job. Limit personal items, keep items off the floor and away from waste containers, have a waste container near your bed, and use it for disposal of personal items (e.g., tissues, pizza boxes, etc.). • Keep your bed and bed linens clean: • Visitors should not sit on your bed. • Take off your slippers, socks and footies before putting your feet on or in your bed. • Never use a dirty pillow – do not store them on the floor; if your pillow falls on the floor or becomes soiled in any way, ask to have it replaced. • Don’t let visitors use your bathroom – bathrooms in patient rooms are for patients. Visitors should use the public restrooms. Acknowledge the role of the ES staff every day. Thank them for their work.