Unit Based Champions Infection Prevention eBug Bytes

1. Unit Based ChampionsInfection PreventioneBug Bytes January 2013

2. VA hospital under investigation fordeadly Legionnaires' disease outbreak The Veterans Affairs Inspector General is investigating a Pittsburgh VA nursing home, to determine whether hospital administrators took appropriate action to prevent a deadly outbreak of Legionnaires' disease at the facility. In November, the Pittsburgh VA acknowledged 29 diagnosed cases of Legionnaires' disease in the past two years, but claim that only five of those cases came from the hospital. Still, CBS News has learned the Pittsburgh VA called a consultant as far back as 2011 to look into its legionella problem. The company, Liquitech, told CBS News that in December of 2011, Pittsburgh VA officials informed Liquitech it had the deadly bacteria in its water system. After an inspection, Liquitech noted in an e-mail, quote "they have legionella" and "systems not being properly maintained. Four months later, the Pittsburgh VA called in Enrich, Inc., a second legionella prevention company. "The facility has worked...to formulate a plan to suppress the legionella.... Testing results indicate remediation...has been successful." The VA Inspector General is currently investigating whether the Pittsburgh VA took appropriate action to prevent the outbreak. http://www.cbsnews.com/8301-505263_162-57563464/va-hospital-under-investigation-for-deadly-legionnaires-disease-outbreak/

3. 700 at Buffalo VA hospital exposed to HIV after accidental reuse of insulin pens More than 700 patients at the Buffalo Veterans Administration Center may have been exposed to HIV, hepatitis B or hepatitis C because of accidental reuse of insulin pens, according to a hospital statement and published reports. Authorities told The Buffalo News there is a "very small risk" for the diabetic patients who may have been exposed to the reused insulin pens between Oct. 19, 2010 and November 2012. The VA memo obtained by the News said the problem was discovered by a routine pharmacy inspection last Nov. 1. In a statement to The Associated Press, VA spokeswoman Evangeline Conley said the hospital "recently discovered that in some cases, insulin pens were not labeled for individual patients." She added that "although the pen needles were always changed, an insulin pen may have been used on more than one patient.“ Conley said that once this was discovered the hospital took "immediate action" to ensure the insulin pens were being used according to pharmaceutical guidelines. Even with a fresh needle, contamination could have occurred if bodily fluid flowed back into the insulin pens. The VA said it is offering free blood tests to rule out any infections.

4. ICUs Led by Intensivists Have Decreased Sepsis Mortality Rates In October 2008, a regional medical center changed its ICU model from an open ICU, in which general physicians care for patients, to an ICU where intensivists have primary responsibility or co-management of all patients. Researchers studied 847 patients in two different time periods — one from June to September 2008, which occurred before the model changed, and one from June to September 2009, which was after the new model was implemented. Patients in the ICU after the model changed to an intensivist-led ICU had a shorter length of stay and a trend toward decreased mortality compared with patients in the open ICU. The mortality rate of sepsis patients in the intensivist-led ICU was less than the rate in the open ICU.In addition, compliance with evidence-based ICU practices, including timely initiation of deep venous thrombosis prophylaxis and timely initiation of nutritional support, was higher in the intensivist-led ICU than in the open ICU, according to the study. http://www.journalacs.org/article/S1072-7515(12)01365-8/abstract

5. Hospitals turn away visitors with flu symptoms • As public health officials struggle to contain the spread of influenza, pertussis and norovirus, a growing number of hospitals around the country are placing restrictions on visitors to protect their patients from infection. Hospitals in at least 10 states have asked visitors with flulike symptoms not to visit patients. Some are placing outright bans on children and teenagers, fearing they may be most likely to infect patients. Most hospitals, though, are also making exceptions — for instance, in cases where a loved one is critically or terminally ill. • Hospitals in Boston, the first place in the country to declare a flu emergency last week, were among the first to start asking visitors with signs of illness to wear masks and avoid certain wards. On Monday, several hospitals in Western Michigan asked anyone with a fever, cough, runny nose or other signs of the flu to refrain from visiting. Jersey City Medical Center said that any visitor under age 18 or with signs of flulike illness will not be allowed to see patients. And four hospitals in the Peoria, IL, area said that they would start enforcing new guidelines barring children and would allow staff to ask anyone who coughs or sneezes in the patient-care area to leave. • “

6. Sydney vomiting bug poses risk for cruise-line passengers A new strain of a vomiting bug first found in Australia has killed nursing home residents from California to Japan, spoiled luxury cruises and may have sickened more than 1 million Britons so far in its global sweep. The new norovirus, identified in Sydney last March, caused the worst bout of gastroenteritis in a decade in Australia's Victoria state last year. Healthcare facilities in the Northern Hemisphere should prepare for a "severe" epidemic this winter, researchers from eight countries said in a report this month. The norovirus strain is adding to a list of winter ails topped by a resurgence of flu. Gastro outbreaks have been reported in New Zealand, France, Belgium, Denmark and Scotland, and cruise ships carrying suspected patients have docked in New York and Florida the past three weeks, heralding a new wave of infections for which there is no specific treatment or vaccine. "Cruise ships are almost a sentinel sensing system for norovirus," said Peter White, professor of microbiology at the University of New South Wales in Sydney, who helped identify and characterize the new strain. "Norovirus is going to wreak havoc in their cruise industry for the next year while this new strain gets a grip." Source: Bloomberg News Jan 15 2013

7. Gut Infections Are Growing More Lethal • Deaths from the infections more than doubled from 1999 to 2007, to more than 17,000 a year from 7,000 a year, the CDC. Of those who died, 83 percent were over age 65. Two thirds of the deaths were caused by a bacterium, Clostridium difficile, which people often contract in hospitals and nursing homes, particularly when they have been taking antibiotics. The bacteria have grown increasingly virulent and resistant to treatment in recent years. • But researchers were surprised to discover that the second leading cause of death from this type of illness was the norovirus. It causes a highly contagious infection, sometimes called winter vomiting illness, that can spread rapidly on cruise ships and in prisons, dormitories and hospitals. Both diseases are spread by the fecal-oral route, meaning that people swallow germs found in feces, often spread by people who did not wash their hands after using the toilet. Problems with C. difficile are not new: Health officials first began warning in 2004 that a more virulent and drug-resistant strain had emerged. It produces high amounts of two potent toxins that can wreak havoc in cells lining the intestine. • Source: NY Times May 2012

8. Hand sanitizer spread faster than the flu • The nation's hands are saturated with the ethyl-alcohol-based bacteria beater, studies show. Hand sanitizer sales totaled $173.5 million in 2012, up less than 1% versus the year before, according to SymphonyIRI Group, a Chicago, IL-based market research firm. That figure, which accounts for purchases made at supermarkets, drug stores and mass market, hasn't budged much in several years. The big exception was 2009, when the swine-flu outbreak prompted sales to spike to $301 million. • Though it only first came onto the market in 1996, and the rows of 2-ounce plastic bottles have displaced chewing gum in many checkout aisles, sales growth appears to have stalled, according to a recent survey by Global Industry Analysts, a San Jose, CA-based market research firm. Going forward, sales are expected to increase modestly to just over $226 million by 2018, the report says. Over the weekend, New York joined Massachusetts in declaring a public health emergency after the number of patients admitted to hospitals statewide rose 55% during the preceding week. Already, there have been reported shortages in flu vaccine. • Should this flu season get much worse, experts say, there could end up being a sanitizer shortage too, as production has tapered off