Unit Based Champions Infection Prevention eBug Bytes

1. Unit Based ChampionsInfection PreventioneBug Bytes February 2012

2. High Levels of MRSA Bacteria in U.S. Retail Meat Products, Study Suggests • Retail pork products in the U.S. have a higher prevalence of methicillin-resistant Staphylococcus aureus bacteria (MRSA) than previously identified, according to new research by the University of Iowa College of Public Health and the Institute for Agriculture and Trade Policy. • The study, published Jan. 19 in the online science journal PLoS ONE, represents the largest sampling of raw meat products for MRSA contamination to date in the U.S. The researchers collected 395 raw pork samples from 36 stores in Iowa, Minnesota and New Jersey. Of these samples, 26 -- or about 7 percent -- carried MRSA • Reference: • Ashley M. O'Brien, Blake M. Hanson, Sarah A. Farina, James Y. Wu, Jacob E. Simmering, Shylo E. Wardyn, Brett M. Forshey, Marie E. Kulick, David B. Wallinga, Tara C. Smith. MRSA in Conventional and Alternative Retail Pork Products. PLoS ONE, 2012; 7 (1): e30092 DOI: 10.1371/journal.pone.0030092

3. Study Suggests Use of Antimicrobial Scrubs May Reduce Bacterial Burden on Healthcare Worker Apparel • 32 healthcare workers wore four pairs of identically appearing control scrubs and study scrubs impregnated with an antimicrobial, or germ-killing, compound over the course of four months, washing them regularly. Participants also received identical hand hygiene educational sessions every four weeks, and researchers assessed compliance with hand hygiene practices. Researchers conducted once weekly, unannounced, garment and hand cultures of participants at the start and end of each shift where they obtained two samples from the garment’s abdominal area and cargo pant pocket – two areas of high-touch and high bacterial colonization. • According to Bearman, although the scrubs did not impact the degree of MRSA on the healthcare workers’ hands, the antimicrobial scrubs were effective in reducing the burden of MRSA on healthcare worker apparel. • The scrubs tested in the study were manufactured by Vestagen Technical Textiles. • Bearman collaborated with VCU researchers Kakotan Sanogo, Michael P. Stevens, MD, Curtis Sessler, MD, Richard Wenzel, MD, along with Adriana Rosato, PhD, Methodist Hospital Research Institute and Kara Elam, doctoral student, University of Mississippi.

4. Pairing Masks and Handwashing Could Drastically Slow Spread of Pandemic Flu • The University of Michigen “M-Flu study” was the first of its kind and received international exposure when launched in 2006. The team of M-Flu researchers recruited more than 1,000 students in U-M residence halls. The students were assigned to groups who wore masks, wore masks and practiced hand hygiene, or did neither. They were monitored for the presence of flu symptoms or the flu. A new report shows the second-year results (2007-2008) of up to a 75 percent reduction in flu-like illness over the study period when using hand hygiene and wearing surgical masks in residence hallsThe goal of M-Flu was to estimate the reduction in rate of flu infection and illness attributed to masks and hand sanitizers, and masks alone during two flu seasons. Students in both studies were asked to wear masks in the residence halls for six hours per day and clean their hands with an alcohol based hand sanitizer in addition to soap and water hand washing. • The M-Flu study was a collaboration among the School of Public Health, University of Michigan Housing and the University Health Service. In addition to Aiello and Monto, authors include current students or graduates of the U-M SPH: Rebecca Coulborn, Brian Davis, and Vanessa Perez; and a colleague at Wayne State University, Monica Uddin. The paper, "Facemasks hand hygiene and influenza among young adults: A randomized intervention trial" was scheduled to appear in PLoS ONE on Jan. 25, 2012.

5. Legionella Found in Water at Las Vegas Resort • The Southern Nevada Health District has received reports that three guests who stayed at the Luxor Resort were diagnosed with Legionnaires’ disease. The first two cases were reported in the spring of 2011. At that time the health district conducted an environmental assessment and collected bulk water samples from the Luxor. Results of the water samples did not detect Legionella bacteria and the environmental assessment indicated guests were not at increased risk of contracting Legionnaire’s disease at that time. Both patients have recovered from their illness. • The third case was reported to the health district in January 2012. At the time of the report, the patient was deceased. Based on this latest report the health district initiated a new epidemiological and environmental investigation. At this time environmental sampling was positive for Legionella bacteria. The Luxor has been working cooperatively with the health district to implement and complete a comprehensive remediation process in accordance with recommended guidelines. To date, no additional cases of disease have been reported. Legionella bacteria exist in fresh water and are commonly found throughout the environment. Symptoms include high fever, chills, cough, and some people may also suffer from muscle aches and headaches.

6. Norovirus Is the Leading Cause of Infection Outbreaks in U.S. Hospitals • The study was conducted to determine how often outbreak investigations are initiated in U.S. hospitals, as well as the triggers for investigations, types of organisms, and control measures including unit closures. Thirty-five percent of the 822 hospitals responding had investigated at least one outbreak in the previous two years. Four organisms caused nearly 60 percent of the outbreaks: norovirus (18.2 percent), Staphylococcus aureus (17.5 percent), Acinetobacter spp (13.7 percent), and Clostridium difficile (10.3 percent). These results reflect 386 outbreak investigations reported by 289 hospitals over a 24-month period. • Medical/surgical units were the most common location of outbreak investigations (25.7 percent), followed by surgical units (13.9 percent). Nearly one-third (29.2 percent) of outbreaks were reported in a category that included emergency departments, rehabilitation units, long-term acute care hospitals, psychiatric/behavioral health units, and skilled nursing facilities. According to the results, the average number of confirmed cases per outbreak was 10.1 and the average duration was 58.4 days. Unit closures were reported in 22.6 percent of the cases, causing an average 16.7 bed closures for 8.3 days. Source: AJICFebruary 2012, Volume 40, Issue 1

7. Playing Chicken With UTIs • Contaminated chicken meat may cause some human urinary tract infections, researchers suggested. The majority of such infections are caused by extraintestinal pathogenic Escherichia coli – dubbed ExPEC, for short -- but physicians and researchers have long assumed the bacteria involved always originated in the patient's own body, according to Amee Manges, PhD, of McGill University in Montreal, and colleagues. • But ExPEC outbreaks in several countries in recent years hint at an external source, the researchers reported in the March issue of Emerging Infectious Diseases. The source is probably retail meat, they argue, and the reservoir is most probably chicken. That conclusion is based on genetic analysis comparing E. coli from samples of beef, pork, and chicken with strains obtained from humans seeking treatment for a urinary tract infection. • "We suspect that the transmission is occurring the same way other foodborne agents are transferred,”– such things as poor food handling or preparation, kitchen cross-contamination, and undercooking. • Primary source: Emerging Infectious DiseasesBergeron CR, et al "Chicken as reservoir for human extraintestinal pathogenic escherichia coli" Emerg Infect Dis 2012; DOI: 10.3201/eid1803.111099.

8. More Doctors 'Fire' Families for Vaccine Refusers • Pediatricians fed up with parents who refuse to vaccinate their children out of concern it can cause autism or other problems increasingly are "firing" such families from their practices, raising questions about a doctor's responsibility to these patients. • Medical associations don't recommend such patient bans, but the practice appears to be growing, according to vaccine researchers. • In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason. • By comparison, in 2001 and 2006 about 6% of physicians said they "routinely" stopped working with families due to parents' continued vaccine refusal and 16% "sometimes" dismissed them, according to surveys conducted then by the American Academy of Pediatrics. • Source: Wall Street Journal Feb 15 2012

9. Hepatitis C deaths up, baby boomers most at risk • Deaths from liver-destroying hepatitis C are on the rise, and new data shows baby boomers . One of every 33 baby boomers are living with hepatitis C infection. Federal health officials are considering whether anyone born between 1945 and 1965 should get a one-time blood test to check if their livers harbor this ticking time bomb. The reason: Two-thirds of people with hepatitis C are in this age group, most unaware that a virus that takes a few decades to do its damage has festered since their younger days. • The issue has taken new urgency since two drugs hit the market last summer that promise to cure many more people than ever was possible. And research published Monday says testing millions of the middle-aged to find those who need the pricey treatment would be worth the cost, saving thousands of lives. Sharing a needle while injecting illegal drugs is the biggest risk factor for becoming infected with this blood-borne virus. But before 1992, when widespread testing of the blood supply began, hepatitis C commonly was spread through blood transfusions. Plus, a one-time experiment with drugs way back in high school or college could have been enough. A CDC study published Monday analyzed a decade of death records and found an increase in death rates from hepatitis C. In fact, in 2007 there were 15,000 deaths related to hepatitis C, higher than previous estimates — and surpassing the nearly 13,000 deaths caused by the better-known AIDS virus. • Source: Infectious Diseases MSNBC News – and www.cdc.gov