Unit Based Champions Infection Prevention eBug Bytes November 2013

1. Unit Based ChampionsInfection PreventioneBug BytesNovember 2013

2. MERS-COV – More Cases • The World Health Organization (WHO) has been informed of an additional four laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV). These include the first laboratory-confirmed case from Oman and three additional laboratory-confirmed cases from Saudi Arabia. • The patient in Oman is a 68-year-old man from Al Dahkliya region who became ill on Oct. 26, 2013 and was hospitalized on Oct. 28, 2013. Preliminary epidemiological investigations revealed that he did not recently travel outside the country. However, investigations are currently ongoing to determine what exposures might be responsible for his infection. Of the three patients including one death reported from the Eastern Region in Saudi Arabia, one is a woman and two are men. The three patients, one of whom is a healthcare worker, had underlying medical conditions. Their ages range from 49 to 83 years old. All three patients reported having no contact with animals prior to their illness, while one patient was reported to have been in contact with a previously laboratory-confirmed case. Globally, from September 2012 to date, WHO has been informed of a total of 149 laboratory-confirmed cases of infection with MERS-CoV, including 63 deaths.

3. Location of Alcohol Sanitizer in ICUs • The introduction of alcohol-based handrub dispensers has had a positive influence on compliance of healthcare workers with the recommended guidelines for hand hygiene. However, establishing the best location for these dispensers remains a problem. The workflow observations revealed that the activities of patient care were most often at the entrance and near the computer at the right side of the test room. Healthcare workers stated that the location of the dispenser should meet several requirements. Measurements of the frequency of use showed that the dispenser located near the computer, at the back of the room, was used less frequently than the dispenser located near the sink and the dispenser located at the entrance to the room.  Workflow observations and the expressed preferences of healthcare workers guide the choice for the location of alcohol-based handrub dispensers and these choices may be optimized based on measurement of the frequency of use of the dispensers. • Reference: Boog MC, Erasmus V, de Graaf JM,  van Beeck E, Melles M and van Beeck EF. Assessing the optimal location for alcohol-based hand rub dispensers in a patient room in an intensive care unit. BMC Infectious Diseases 2013, 13:510  doi:10.1186/1471-2334-13-510

4. MRSA on the decline across VA hospitals • The MRSA Prevention Initiative, implemented in 2007, resulted in significant decreases in both the transmission (colonization with the organism) of MRSA (17 percent for intensive care units [ICUs] and 21 percent for non-ICUs) and healthcare-associated infection (HAI) rates within the hospitals (62 percent for ICUs, 45 percent for non-ICUs). In the two-year period following the first wave of the initiative (data previously published[i]), both MRSA transmissions and HAIs continued to decrease in non-ICU settings (declining an additional 13.7 percent and 44.8 percent, respectively), while holding steady in ICUs.  • The MRSA Prevention Initiative utilizes a bundled approach that includes screening every patient for MRSA, use of gowns and gloves when caring for patients colonized or infected with MRSA, hand hygiene, and an institutional culture change focusing on individual responsibility for infection control. It also created the new position of MRSA Prevention Coordinator at each medical center. Source: AJIC Nov 2013

5. FDA Seeks Changes to OTC Antiseptics to Prevent Infection • An ongoing evaluation of "infrequent but continuing" reports of infections resulting from over-the-counter (OTC) antiseptic products used prior to surgery or injections has prompted the US Food and Drug Administration (FDA) to request label and packaging changes to enhance safety, the agency said yesterday. • The FDA is requesting that manufacturers voluntarily package OTC antiseptics indicated for preoperative or preinjection skin preparation in single-use containers and to label their products as sterile or nonsterile. • The FDA says infections tied to the use of contaminated topical antiseptics have been reported in the medical literature and to the Centers for Disease Control and Prevention (CDC) and to the FDA. Reported infections have ranged from localized infections at injection sites to systemic infections that resulted in death. The FDA says it has reviewed reports of 4 deaths, 5 cases of wound infection, 7 cases of peritonitis, 10 cases of septic arthritis, 14 cases of indwelling catheters requiring replacement, 16 cases of injection site infection, and 32 cases of bacteremia. • Source: Medscape Nov 14 2013

6. Hospitals Try Yogurt to Prevent Infections in Patients • At Holy Redeemer Hospital in Meadowbrook, Pa., a worrisome trend emerged in 2011: an uptick in cases of one of the most virulent hospital infections, despite measures to battle the bug by scrubbing surfaces with bleach and isolating affected patients. But the hospital was able to drive down cases last year after adding a new weapon to its arsenal: probiotics, the small organisms that help maintain the natural balance of bacteria in the intestines. Contained in supplements and foods such as yogurt, probiotics are of growing interest in health care for their potential in helping to treat a number of conditions, including irritable bowel syndrome, tooth decay and chronic fatigue syndrome. Now, Holy Redeemer and other hospitals are experimenting with probiotics as a preventive measure for patients who are on antibiotics. For all their infection-fighting power, antibiotics kill the good bugs along with the bad in the intestine. The result is an imbalance in the gut that can lead a bacterium known as Clostridium difficile—C. diff for short—to colonize and produce a toxin that can cause diarrhea, dehydration and fever. In severe cases, C. diff infections can lead to kidney failure, recurrent infection and death. Source: Wall Street Journal, Nov 17 2013

7. FDA Warns of Infection Risk With Topical Antiseptics • The FDA has recommended that antiseptic products-- available as single- or multiple-use -- be sold only as single-use preparations. In addition, the antiseptics should not be diluted after opening and any leftover solution should be discarded. The FDA also has requested that manufacturers voluntarily revise the product labels for topical antiseptics to indicate whether the drug is manufactured as a sterile or nonsterile product. However, it cautioned that even products manufactured as sterile can become contaminated during use and that the term "nonsterile" does not mean the product contains harmful bacteria. The FDA said it has reviewed reports of four deaths, five cases of wound infection, seven cases of peritonitis, 10 cases of septic arthritis, 14 cases of indwelling catheters requiring replacement, 16 cases of injection site infection, and 32 cases of bacteremia -- all confirmed to have been caused by contaminated antiseptic products. The infectious organisms implicated in the outbreaks included Bacillus cereus, Burkholderia cepacia, Pseudomonas aeruginosa, Achromobacter xylosoxidans, Ralstonia pickettii, Serratia marcescens, and Mycobacterium abscessus, the agency said. Commonly used products contain isopropyl or ethyl alcohol, povidone iodine, poloxamer iodine, benzalkonium chloride, benzethonium chloride, or chlorhexidine gluconate. • Source: http://www.fda.gov/Drugs/DrugSafety/ucm374711.htm