Unit Based Champions Infection Prevention eBug Bytes

1. Unit Based ChampionsInfection PreventioneBug Bytes May 2012

2. Investigators Trace of Role Reusable Grocery Bag in Norovirus Outbreak • In the study, Kimberly K. Repp, PhD, MPH, of Oregon Health and Sciences University, and William E. Keene, PhD, MPH, of the Oregon Public Health Division in Portland, investigated an outbreak in a group of 17 Oregon girls, 13-14 years old, and their four adult chaperones attending a soccer tournament in Washington state. All had traveled in private automobiles, shared hotel rooms, and eaten at local restaurants. Eight cases were identified, including the index patient who was presumably infected prior to the trip. There was no direct contact between the original patient and her teammates after her symptoms began; before her overt symptoms began she left her room and moved in with a chaperone. The girl subsequently began vomiting and having diarrhea in the chaperone's bathroom. The outbreak affecting the rest of the team began several days later; they were exposed by handling a bag of snacks that unfortunately had been stored in the hotel bathroom. Virus aerosolized within the bathroom likely settled onto the grocery bag and its contents. Matching viruses were found on the reusable shopping bag two weeks later. • The investigation confirmed the great potential for contamination of surfaces. Source:

3. Whooping cough epidemic declared in Washington state Washington state's worst outbreak of whooping cough in decades has prompted health officials to declare an epidemic, seek help from federal experts and urge residents to get vaccinated amid worry that cases of the highly contagious disease could spike much higher. It's the first state to declare a whooping cough, or pertussis, epidemic since 2010, when California had more than 9,000 cases, including 10 deaths. Washington has had 10 times the cases reported in 2011, and so has Wisconsin with nearly 2,000 cases this year, though that state has not declared an epidemic. In Washington, about 1,280 cases have been reported in 2012, and officials believe the state could see as many as 3,000 cases by year's end. State officials have asked hospitals to vaccinate every adult who goes home with a new baby, and urged businesses to encourage their employees to get the adult booster shot. Washington already requires a booster shot for middle- and high-school students.

4. Superbug Spreads from Big City Hospitals to Regional Health Centers, Study Suggests • Hospitals in large cities act as breeding grounds for the superbug MRSA prior to it spreading to smaller hospitals, a study suggests. Researchers found evidence that shows for the first time how the superbug spreads between different hospitals throughout the country. • The University of Edinburgh study involved looking at the genetic make-up of more than 80 variants of a major clone of MRSA found in hospitals . Scientists were able to determine the entire genetic code of MRSA bacteria taken from infected patients. They then identified mutations in the bug which led to their emergence of new MRSA variants and traced their spread around the country. • "We found that variants of MRSA circulating in regional hospitals probably originated in large city hospitals. The high levels of patient traffic in large hospitals means they act as a hub for transmission between patients, who may then be transferred or treated in regional hospitals. “ MRSA -- methicillin-resistant Staphylococcus aureus -- first started to appear around 50 years ago following the introduction of antibiotics, to which the bacteria has become increasingly resistant. • Journal Reference: • P. R. McAdam, K. E. Templeton, G. F. Edwards, M. T. G. Holden, E. J. Feil, D. M. Aanensen, H. J. A. Bargawi, B. G. Spratt, S. D. Bentley, J. Parkhill, M. C. Enright, A. Holmes, E. K. Girvan, P. A. Godfrey, M. Feldgarden, A. M. Kearns, A. Rambaut, D. A. Robinson, J. R. Fitzgerald. Molecular tracing of the emergence, adaptation, and transmission of hospital-associated methicillin-resistant Staphylococcus aureus. Proceedings of the National Academy of Sciences, 2012; DOI: 10.1073/pnas.1202869109

5. C. difficile Infections Pose Big Risks in ICUs • In March, the Centers for Disease Control and Prevention reported that “the incidence, deaths, and excess health-care costs resulting from C. difficile infections in hospitalized patients are all at historic highs. • Prevention is the cornerstone of any effort to stem infections. Most important is to limit antibiotic exposure for patients, both in terms of the numbers of antibiotics they receive, as well as the spectrum and duration of exposure. Patients who have contracted or are suspected of having the bacterial infection should be isolated promptly. Thorough environmental cleaning and hand washing among health care workers also are important components of prevention. The presence of a C. difficile outbreak, disinfecting gels containing alcohol should not be used. Soap and water is the best and only way to get rid of C. difficile spores on people’s hands. • Hospital-wide antibiotic stewardship programs to address the spread of C. difficile and other emerging infections, and to stem antimicrobial resistance. It’s not an inexpensive disease – the infection costs the country $1 billion to $3 billion annually, and each case costs about $6,000 and three additional days of hospitalization.

6. Superbugs spread to 40 nations threatening India medical tourism • A new type of superbug (NMD-1)is spreading faster, further and in more alarming ways than any they've encountered. Researchers say the epicenter is India, where drugs created to fight disease have taken a perverse turn by making many ailments harder to treat. India's $12.4 billion pharmaceutical industry manufactures almost a third of the world's antibiotics, and people use them so liberally that relatively benign and beneficial bacteria are becoming drug immune in a pool of resistance that thwarts even high-powered antibiotics, the so-called remedies of last resort. • Poor hygiene has spread resistant germs into India's drains, sewers and drinking water, putting millions at risk of drug-defying infections. Antibiotic residues from drug manufacturing, livestock treatment and medical waste have entered water and sanitation systems, exacerbating the problem. As the super bacteria take up residence in hospitals, they're compromising patient care and tarnishing India's image as a medical tourism destination. The new superbugs are multiplying so successfully because of a gene dubbed NDM-1. That's short for New Delhi metallo-beta-lactamase-1, a reference to the city where a Swedish man was hospitalized in 2007 with an infection that resisted standard antibiotic treatments.

7. Researchers Compare Hydrogen Peroxide Vapor to Tru-D Smart UVC Disinfection in Patient Rooms • John M. Boyce, MD, et al conducted an observational study to compare the microbiological efficacy of automated "no-touch" decontamination systems: an HPV system with that of an automated UVC system (Tru-D Total Room Ultraviolet Disinfection) for room decontamination. • The study recorded before-and-after aerobic colony counts for five high-touch sites in 15 patient rooms: the bedside rail, over-bed table, TV remote, bathroom grab bar and toilet seat. Earlier published research indicates that frequently touched environmental surfaces can be contaminated with epidemiologically important microbes (such as C. diff, VRE and MRSA) that contribute to cross-transmission of patients by contaminating the hands of healthcare workers. • For this comparison, HPV and UVC processes were performed using Clostridium difficile carrier disks. The researchers concluded, "We found that both HPV and UVC decontamination reduce bacterial contamination in patient rooms ... Of the two technologies, UVC decontamination was easier to use and had significantly shorter cycle times, can be administered by personnel with only limited training, and does not require monitoring by personnel during the process.” • Reference: 1. Havill NL, Moore BA, Boyce JM; Comparison of Microbiological Efficacy of Hydrogen Peroxide Vapor and Ultraviolet Light Processes for Room Decontamination. Infect Control Hosp Epidem. 2012;33.

8. Where the Germs Are: New Study Finds Office Kitchens, Break Rooms are Crawling with Bacteria • According to the study, which was carried out in consultation with Charles Gerba, PhD, professor of microbiology at the University of Arizona, the percentage of the office surfaces tested and found to have high levels of contamination (an ATP count of 300 or higher), includes: • - 75 percent of break room sink faucet handles • - 48 percent of microwave door handles • - 27 percent of keyboards • - 26 percent of refrigerator door handles • - 23 percent of water fountain buttons • - 21 percent of vending machine buttons • . The results reinforce the crucial role of contract cleaners, whose services go a long way in successfully disinfecting office common areas at the end of every day. However, because kitchens and personal work spaces can become instantly re-contaminated, employers need to arm their employees with the knowledge and tools necessary to reduce the spread of germs. • For more information on Kimberly-Clark Professional and The Healthy Workplace Project, visit: www.healthyworkplaceproject.com