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Unit Based Champions Infection Prevention eBug Bytes July/August 2013

Unit Based Champions Infection Prevention eBug Bytes July/August 2013. Contaminated Ultrasound Gel.

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Unit Based Champions Infection Prevention eBug Bytes July/August 2013

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  1. Unit Based ChampionsInfection PreventioneBug BytesJuly/August 2013

  2. Contaminated Ultrasound Gel In December 2011, researchers uncovered an unusual cluster of P.aeruginosa in the cardiovascular surgery intensive care unit during routine infection control surveillance. The bug is known to increase the risk of bloodstream and respiratory infections in immune-compromised individuals. Sixteen patients became colonized or infected with the bacteria, with all cases occurring in the respiratory tract. The outbreak was found to have stemmed from bottles of ultrasound transmission gel used during cardiovascular surgery. Following replacement of this gel with a sterile product, no further cases occurred. Cultures of gel from a bottle in use in the operating room grew P.aeruginosa that was identical to the outbreak strain. It was originally thought that the gel had likely become contaminated during use. However, sealed bottles of gel grew the same P.aeruginosa strain, proving that the product was contaminated during the manufacturing process at the plant of Pharmaceutical Innovations. As a result of this investigation, the FDA issued a warning about the gel, alerting the risk of infection posed by the product and instructing healthcare providers and systems not to use the infected products. The Beaumont Health System investigators also recently published proposed guidelines in Infection Control and Hospital Epidemiology for the use of sterile versus nonsterile ultrasound gel. These guidelines include the need for sterile, single-dose ultrasound gel to be used for all invasive procedures and give appropriate storage and warming methods for the gel. Prior to this, no such guidelines existed in the US. http://www.shea-online.org/View/ArticleId/219/Contaminated-Ultrasound-Gel-Tied-to-Outbreak-of-Healthcare-Associated-Infections.aspx

  3. U.S. FDA probes multi-state outbreak of intestinal bug • The FDA said on Monday it is investigating a multi-state outbreak of an intestinal infection called cyclosporiasis, whose cause has not yet been determined. • As of July 18, 2013, more than 200 cases of cyclospora infection in residents of multiple states, including Iowa, Nebraska, Texas, and Wisconsin • Cyclosporiasis is caused by ingesting food or water containing a one-celled parasite that is too small to be detected without a microscope. Symptoms include watery diarrhea, vomiting and body ache. Untreated, the illness can last from a few days to a month or more. Other symptoms may include headache, fever, weight loss and fatigue • Most people with healthy immune systems recover from the infection without treatment. Older people and those with weakened immune systems might be at higher risk for prolonged illness. The condition is typically treated with the antibiotics Bactrim, Septra and Cotrim, according to the CDC • http://www.chicagotribune.com/health/sns-rt-us-fda-infection-20130722,0,6075330.story

  4. Raw Oyster–associated Vibrio vulnificus Illnesses and Deaths, California • A recent review of surveillance data indicated that rates of Vibrio spp. infections in the United States increased from 1996 to 2010, and, of the 3 most commonly reported species, V. vulnificus caused the most hospitalizations and deaths. • V. vulnificus is a gram-negative, halophilic bacterium that occurs naturally in marine and estuarine waters. Human infection usually results from exposure to the organism by consumption of raw or undercooked shellfish, usually oysters, or by a wound coming into contact with seawater. Illness typically is manifest as primary septicemia (following ingestion) or as wound infection with or without septicemia (following wound exposure). • Persons at risk for severe V. vulnificus disease are those with preexisting liver disease, alcoholism, diabetes, hemochromatosis, or an immunocompromising condition. Patients with primary septicemia often are in shock when they come to medical attention, and the fatality rate has been reported to be >50%. Most patients with primary septicemia report recent consumption of raw oysters, usually from the Gulf of Mexico

  5. Researchers Examine HCW Ring Wearing and Potential for HAI Transmission • Tens of thousands of healthcare workers worldwide can only wear a plain wedding ring at work, if any at all. This arose from policies citing early laboratory evidence that rings can carry clinically relevant bacteria, but with little supporting clinical data. • A systematic literature review was performed of studies investigating the infection risk of ring wearing by healthcare workers. PubMed, Cochrane Library and clinical trials registries were searched. Data was extracted on study design and quality, and the following outcomes: healthcare-acquired infection (HAI) rates, bacterial transmission, and bacterial contamination of healthcare workers’ hands. • The researchers conclude that no direct evidence was found that healthcare workers wearing rings results in higher HAI or bacterial transmission rates. Most studies did not identify higher contamination associated with ring wearing; furthermore, the clinical significance of a statistical difference in the number of colony forming units is unclear. They add that guidelines could benefit from reconsidering ring wearing guidance, and focusing on interventions with a more defined evidence base; fewer intrusions into healthcare workers’ personal autonomy may increase willingness to participate in other important interventions. • Reference: Dyar A and Dyar OJ. Poster presentation P156 at the 2nd International Conference on Prevention and Infection Control (ICPIC 2013): Ring wearing in healthcare settings: an evidence-based update. Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P156 doi:10.1186/2047-2994-2-S1-P156

  6. Mycoplasma pneumoniae Outbreak at a University — Georgia, 2012 • Georgia Institute of Technology, was experiencing a pneumonia outbreak among students. • Respiratory swabs collected from students with pneumonia and tested at CDC using a quantitative real-time polymerase chain reaction (qPCR) assay were positive for Mycoplasma pneumoniae. The university alerted students, faculty, and staff members to the outbreak and recommended prevention measures by e-mail, social media, and posters. A survey administered to students assessed illness prevention behaviors, outbreak awareness, and communication preferences. • Eighty-three cases were diagnosed among students during September 1–December 4, 2012, making this outbreak the largest reported at a U.S. university in 35 years. • Because M. pneumoniae infection most commonly causes upper respiratory illness (only an estimated 3%–10% of persons with infection experience pneumonia, infected persons often go about their normal activities and infect others, as in this outbreak. No cases were identified among faculty or staff members, perhaps in part because they generally do not use university health services. • Source: August 2, 2013 / 62(30);603-606

  7. New MERS-CoV Case • The World Health Organization (WHO) has been informed of an additional laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia. • The patient is an 83-year-old man from Assir region who became ill on 17 July 2013 and is currently hospitalized. Additionally, a previously laboratory-confirmed case, also from Assir region, has died. • Globally, from September 2012 to date, WHO has been informed of a total of 91 laboratory-confirmed cases of infection with MERS-CoV, including 46 deaths. • Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. • Healthcare providers are advised to maintain vigilance. Recent travelers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. • Source: World Health Organization

  8. PICC’s Safety Tied to Patient Population • A new study reports that peripherally inserted central catheters (PICCs) do not reduce the risk of central line-associated bloodstream infections (CLABSIs) in hospitalized patients. • PICCs have become one of the most commonly used central venous catheters (CVCs) in healthcare settings since they are considered easier and safer to use, with less risk of CLABSIs. The study, published in the September issue of Infection Control and Hospital Epidemiology, demonstrates that the risk of CLABSI with PICCs is based more on patient factors, rather than the device. A systematic review and meta-analysis of 23 studies of PICCs to compare the risk of CLABSIs between PICCs and other non-cuffed, non-tunneled central venous catheters (CVCs). • The analysis involved 57,250 patients and revealed that hospitalized patients with PICCs were just as likely to develop bloodstream infection when compared with patients with other types of CVCs; however, non-hospitalized patients in outpatient settings appeared to fare better with PICCs than other devices. • Source: Chopra V, O’Horo JC, et al. The Risk of Bloodstream Infection Associated with Peripherally Inserted Central Catheters Compared with Central Venous Catheters in Adults: A Systematic Review and Meta-Analysis. Infection Control and Hospital Epidemiology 34:9 (September 2013).

  9. Outbreak of Acinetobacter infected eight in burn unit • A bacterial outbreak that struck the UF Health Shands Hospital's burn unit in March ultimately infected eight patients with one patient still in an isolation unit created in the outbreak's aftermath. • The bacteria, called acinetobacter baumannii, typically affect very sick patients and live on surfaces and in soil. • The hospital's infection control department is checking for contamination in other areas of the hospital. While most patients can resist the bacteria, which cause potentially fatal infections such as ventilator-associated pneumonia and urinary tract infections, patients who are highly immunocompromised, such as burn patients, are especially vulnerable. • The outbreak of acinetobacter baumannii at Shands mirrors a growing trend across the country and world of antibiotic-resistant bacteria causing deadly infections in hospitals' sickest patients. Dr. Brad Spellberg, an infectious disease expert at UCLA, estimates there are roughly 50,000 cases of this bacteria annually in the U.S., and 20 times that in the world. It is also common in returning troops from Afghanistan and Iraq, many of whom were contaminated through soil. http://www.ocala.com/article/20130729/ARTICLES/130729709

  10. H7N9 bird flu transmits from person to person • The deadly H7N9 bird flu can spread from person to person and may be a serious threat to humans, Chinese health officials report. • The virus, which has killed one-third of the patients hospitalized with it, attaches itself to cells in the windpipe and lungs, infecting even cells lodged deep in the respiratory system, said researchers who analyzed the biological features of the virus. This dual-target binding may make the virus better able to jump from birds to humans, according to their report, which was published July 3 in the journal Nature. • "The new virus has a unique binding property," said lead researcher Yuelong Shu, director of the Chinese National Influenza Center at the China CDC in Beijing. • There is no need for widespread alarm, however, another expert said. The same aspects of the H7N9 flu that make it so severe -- its location in the lower respiratory system, for example -- also make it harder to transmit from person to person. • http://www.nlm.nih.gov/medlineplus/news/fullstory_138402.html

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