Unit Based Champions Infection Prevention eBug Bytes May 2013

1. Unit Based ChampionsInfection PreventioneBug BytesMay 2013

2. Targeted Screening for C. difficile Upon Admission Could Potentially Identify Most Colonized Patients • Testing patients with just three risk factors upon hospital admission has potential to identify nearly 3 out of 4 asymptomatic carriers of C. difficile, according to a new study published in the May issue of the American Journal of Infection Control. • Researchers analyzed stool samples from 320 patients showing no symptoms of C. difficile at hospital admission using a real-time polymerase chain reaction (PCR) assay. Samples from 31 of 320 patients tested positive for C. difficile, resulting in a colonization rate of 9.7 percent. The authors wanted to estimate the reservoir of colonized patients as a source of potential transmission because despite rigorous infection control measures, C. difficile infection was increasing at their institution. • In this study, independent predictors of C. difficile colonization were found to be recent hospitalization, chronic dialysis and corticosteroid use. According to the authors, one or more of the three independent risk factors were present in 155 (48 percent) of study participants, and screening only those with one or more of these factors would have identified 23 C. difficile carriers (74%).

3. ICU infections plunge 60% with copper surfaces • Copper surfaces in intensive care unit hospital rooms reduced healthcare-acquired infections by more than half, according to a study published in the May issue of Infection Control and Hospital Epidemiology. The results were surprising even to the researchers from the Medical University of South Carolina (MUSC). Microbiologist Michael Schmidt, Ph.D., said he anticipated a 10 percent reduction in infections, but the study found infections were slashed by 60 percent, according to an announcement from MUSC. Cleaning practices didn't change, but patients at three test hospitals were randomly assigned to ICU rooms with copper-coated bed rails, tables, IV poles and nurse call buttons over the 11-month test, according to the announcement. The electrical conductivity of copper "literally steals the electricity inside the microbes, rendering them inactive," Schmidt said in the announcement. "They literally die because they run out of juice." • The study also found copper surfaces could reduce colonization of multidrug-resistant microbes, such as methicillin-resistant Staphylococcus aureus (MRSA), otherwise known as superbugs, said lead author Cassandra D. Salgado, M.D., associate professor of infectious disease http://www.wpri.com/dpps/health/copper-in-hospital-rooms-may-stop-infections_6116906

4. Hospitals See Rapid Progress in Reducing Infections, Other Preventable Problems • New Jersey hospitals are celebrating a major drop in hospital infections and other preventable problems last year, due to a federally funded initiative that’s part of the Affordable Care Act. • The effort, led by the New Jersey Hospital Association, is aimed at improving the quality of care offered at hospitals by reducing preventable illnesses that originate in healthcare facilities. These problems are a major cause of concern at hospitals and reducing their occurrence is a goal of federal health reform. • The association has been holding face-to-face learning sessions in which doctors and nurses share their experiences in reducing the spread of infections, readmission rates, and other preventable problems. • Along with seeing drops in infections from colon surgeries, hysterectomies, and knee replacement surgeries, the hospitals improved in areas ranging from hospital readmissions, which fell by 6.4 percent, to pressure ulcers, which fell by 65.2 percent.

5. Carbapenem-Resistant Enterobacteriaceae • The term "CRE" was barely a blip on most hospitals' radar before the CDC highlighted the emerging infection, carbapenem-resistant enterobacteriaceae. Of 3,918 acute care facilities performing surveillance for CRE, only 145 short-stay and 36 long-term hospitals had reported cases as of last June. But though the bug has been uncommon in hospital settings so far, four factors make it extremely worrisome, CDC experts say: • 1. It kills half of patients whose bloodstreams become infected. • 2. It is resistant to nearly all antibiotics. • 3. It is increasingly seen in acute care settings. • 4. It spreads quickly within and across healthcare settings through central line associated bloodstream or catheter associated urinary tract infections. CRE was found in 1.2% hospitals in the country in 2001, but in 2011 and the first six months of 2012, it was in 4.6% of acute care hospitals. It is now in 18% of long-term care hospitals, and has been detected in hospitals in 42 states. http://www.healthleadersmedia.com/content/QUA-291756/Deadly-CRE-Infection-Spreading-Fast-in-Hospitals.html##

6. New Coronavirus Infections • Two hospital employees have been infected with a new coronavirus they likely got from caring for patients who were sick with the deadly respiratory disease. One of the healthcare workers was a 45-year-old man who got sick on May 2, and is currently in critical condition. The other employee is a 43-year-old woman who got ill on May 8, and is listed in stable condition. The latest confirmed cases provide more evidence of human-to-human transmission of the infection that's tied to the Middle East. This is the first time that healthcare workers have been diagnosed with the new coronavirus after exposure to infected patients. The WHO is calling on healthcare facilities treating patients with the virus of unknown origin to take appropriate measures to reduce risk for disease transmission. The novel coronavirus, which presents as a severe respiratory infection, has killed at least 20 people since September 2012. Since then, WHO has been informed of 40 laboratory-confirmed cases of the disease, which comes from the same family of viruses as the common cold and SARS. Since May 2013, 21 patients -- including nine that died -- have been reportedly linked to a healthcare facility in the Eastern part of Saudi Arabia. http://www.cbsnews.com/8301-204_162-57584713/two-hospital-workers-infected-with-coronavirus-after-caring-for-sick-patient/

7. Progress in Reducing National Burden of Invasive MRSA — United States, 2005–2010 • Population-based surveillance for invasive MRSA in 9 metropolitan areas with approximately 19 million persons was performed from 2005 through 2010. A case was defined as MRSA cultured from a normally sterile body site without MRSA culture in the prior 30 days, and further classified as hospital-onset (HO, cultured >3 days after admission), health care-associated community-onset (HACO, cultured ≤3 days after admission and/or either dialysis, hospitalization, surgery, long-term care residence in the prior year, or presence of a central vascular catheter within 2 days prior to MRSA culture), or community associated (CA) if none of the previous criteria were met. • An estimated 82,042 invasive MRSA infections occurred nationally in 2010 (compared to 111,345 in 2005); of these, 13,799 were CA, 51,290 were hospital HACO, and 15,744 were hospital onset HO. Adjusted national estimated incidence rates have decreased since 2005: CA by 20.3%, HACO by 22.7% and HO by 48.3%. • An estimated 29,300 fewer invasive MRSA infections occurred in the United States in 2010 compared to 2005, with greatest declines in hospital-onset infections. Effective strategies for preventing infections outside acute care settings will have the greatest impact on reducing the US national burden of invasive MRSA infections. CDC EIS Conference 2013 April 22-26, 2013