Infection Prevention eBug Bytes October 2014

1. Infection PreventioneBug BytesOctober 2014

2. E. coli Outbreak at Hospital Associated With Contaminated Specialized Gastrointestinal Endoscopes • In March 2013, NDM-producing Escherichia coli was identified from a patient at a teaching hospital in Illinois. Between March 2013 and July 2013, six additional patients with a history of admission to this hospital had positive clinical cultures for NDM-producing E. coli. In August 2013, CDC launched an investigation to identify the source. A medical record review revealed that a history of ERCP procedures involving the use of a duodenoscope was common among initial cases. In this outbreak, 39 patients with NDM-producing CRE were identified from January 2013 through December 2013, 35 with duodenoscope exposure in one hospital. Some of those patients had positive blood cultures, often an indication of infection and others were found to be colonized with CRE but did not have a CRE nfection.  NDM-producing E coli was recovered from a reprocessed duodenoscope and shared similarity to all case patient isolates. Based on a case-control study, case patients had significantly higher odds of being exposed to a duodenoscope. An infection prevention assessment that focused on duodenoscope reprocessing (such as cleaning) was conducted, and it was found that the hospital followed all manufacturer-recommended procedures. After the hospital changed its duodenoscope reprocessing to a gas sterilization procedure, no additional case patients were identified. Source: JAMA October 8 2014

3. 700+ babies exposed to TB at Providence Memorial Hospital, El Paso, Tx • At Providence Memorial Hospital in El Paso, Texas, an employee with an active case of tuberculosis exposed more than 700 patients and more than 40 employees to the infection, according to the City of El Paso Department of Public Health. • The employee worked in the post-partum and newborn nursery at the hospital, meaning the patients exposed to TB were newborns. The exposure took place between September 2013 and August 2014. • As of Sept. 19, 706 patients and 43 exposed employees have been indentified. The hospital has worked with the Department of Public Health to review employment and medical records to determine who was exposed. Families of every exposed patient have been contacted via telephone and with a letter that provides screening instructions. • A person with active TB spreads the disease through coughs and sneezes, but close contact over an extended period of time is usually necessary to spread the disease, according to the Department of Public Health. • According to an El Paso Times report, Providence Memorial screens employees for TB annually, but the employee in this case exhibited symptoms after the screening.

4. White House escalates fight against antibiotic resistance • President Barack Obama ordered federal agencies to launch a concerted effort to combat the growing "urgent health threat" from bacteria that is resistant to antibiotic treatment, a problem that kills 23,000 people each year. • An executive order signed by Obama calls for a five-year plan to implement a newly announced national strategy for tackling the problem to be submitted to him by mid-February. It also posts a $20 million prize for the development of a rapid test that can be used to identify and track the spread of highly resistant bacterial infections. • Thursday's order establishes a task force to be co-chaired by the secretaries of Defense, Agriculture and Health and Human Services, as well as a presidential advisory council made up of top nongovernmental experts. • At the same time Thursday, Obama's Council of Advisors on Science and Technology called for doubling the current investment in antibiotic surveillance, stewardship and research and development to $900 million annually, and spurring commercial development of new antibiotics with another $800 million in federal spending each year • Source:

5. 4th Patient Dies, 15 Infected at Greenville Memorial Hospital Linked to Contaminated Tap Water • An “unusual” infection at Greenville Memorial Hospital in South Carolina that could have national implications likely caused a number of deaths in the OR, according to hospital officials. In total, 15 patients have tested positive for the infection linked to surgical procedures performed in an operating room earlier this year. • Preliminary findings show that the infection, Mycobacterium abscessus, could not be traced to one piece of equipment or process as originally thought, officials said. But tests show that water in various locations inside the hospital contained the bacterium. But just how the patients were infected by the tap water remains a mystery, he said. "Short of the association with tap water, we do not have a definitive causation," he said. "CDC told us in the beginning that we may never know the exact reason for this.“ The infection came to light in March, when the first patient was diagnosed after a health care provider suspected something unusual and ordered a special test. Another case was identified in April with the rest discovered over the next month and a half. Three of the cases date to 2013 before the outbreak was identified. While most of the patients had undergone cardiac surgery, two had abdominal surgery and one a neurological operation. • Source: http://www.greenvilleonline.com/story/news/local/2014/07/21/fourth-patient-dies-hospital-infection-water-identified-source/12958379/

6. Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children • The CDPHE, Children’s Hospital Colorado, and CDC are investigating nine cases of acute neurologic illness among pediatric patients. The cases were identified during August 9–September 17, 2014 among children aged 1–18 years (median age 10 years). Most of the children were from the Denver metropolitan area. All were hospitalized. Common features included acute focal limb weakness and specific findings on magnetic resonance imaging (MRI) of the spinal cord consisting of non-enhancing lesions largely restricted to the gray matter. In most cases, these lesions spanned more than one level of the spinal cord. Some also had acute cranial nerve dysfunction with correlating non-enhancing brainstem lesions on MRI. None of the children experienced altered mental status or seizures. None had any cortical, subcortical, basal ganglia, or thalamic lesions on MRI. Most children reported a febrile respiratory illness in the two weeks preceding development of neurologic symptoms. In most cases, cerebrospinal fluid (CSF) analyses demonstrated mild-moderate pleocytosis (increased cell count in the CSF) consistent with an inflammatory or infectious process. CSF testing to date has been negative for West Nile virus and enteroviruses, including poliovirus. Nasopharyngeal specimens were positive for rhinovirus/enterovirus in six out of eight patients that were tested. Of the six positive specimens, four were typed as EV-D68, and the other two are pending typing results. Testing of other specimens is still in process. Eight out of nine children have been confirmed to be up to date on polio vaccinations. Epidemiologic and laboratory investigations of these cases are ongoing. www.cdc.gov

7. Hepatitis C outbreaks at three Toronto colonoscopy clinics kept secret • Three Toronto colonoscopy clinics have had hepatitis C outbreaks since 2011. Toronto Public Health says 11 patients were infected and that tainted sedative injections were the “possible” cause in all cases. The authorities responsible for investigating the spread of infection and inspecting the clinics — TPH and the College of Physicians and Surgeons of Ontario, respectively — kept the outbreaks secret. 11 patients contracted the liver-damaging virus during three outbreaks over the last three years: three were infected at the Downsview Endoscopy Clinic on Dec. 7, 2011, three at the North Scarborough Endoscopy Clinic on Oct. 17, 2012, and five at the Finch Ave. W. site of the Ontario Endoscopy Clinic on March 15, 2013. • Nine of the 11 infected patients have gone on to develop chronic hepatitis C, meaning the virus has remained in their bodies, placing them at risk of serious, long-term problems, including cirrhosis of the liver and liver cancer. • None of the clinics offered up anyone to be interviewed, but all three provided written statements. They all expressed concern for the health and recovery of the patients, said they co-operated fully with investigations and emphasized that they are committed to ensuring outbreaks never occur again. The Downsview Endoscopy Clinic also said it no longer uses multi-dose vials. http://www.thestar.com/life/health_wellness/2014/09/27/hepatitis_c_outbreaks_at_three_toronto_colonoscopy_clinics_kept_secret.html

8. Bio-inspired coating for medical devices repels blood, bacteria • Medical devices implanted in the body or in contact with flowing blood present two critical, life-threatening challenges for doctors treating their patients: blood clotting and bacterial infection. A team of scientists and engineers has developed a new surface coating for medical devices using FDA-approved materials. The coating repelled blood from more than 20 medically relevant substrates the team tested -- made of plastic to glass and metal -- and also suppressed biofilm formation. The team implanted medical-grade tubing and catheters coated with the material in large blood vessels in pigs, and it prevented blood from clotting for at least eight hours without the use of blood thinners such as heparin. Heparin is notorious for causing potentially lethal side-effects like excessive bleeding but is often a necessary evil in medical treatments where clotting is a risk. The Wyss team developed a super-repellent coating that can be adhered to existing, approved medical devices. In a two-step surface-coating process, they chemically attached a monolayer of perfluorocarbon, which is similar to Teflon. Then they added a layer of liquid perfluorocarbon, which is widely used in medicine for applications such as liquid ventilation for infants with breathing challenges, blood substitution, eye surgery, and more. The team calls the tethered perfluorocarbon plus the liquid layer a Tethered-Liquid Perfluorocarbon surface, or TLP for short. • Source: Nature Biotechnology, 2014; DOI: 10.1038/nbt.3020