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Unit Based Champions Infection Prevention eBug Bytes October 2013

Unit Based Champions Infection Prevention eBug Bytes October 2013. Universal Gown, Glove Use by Employees in ICU Reduces MRSA 40%.

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Unit Based Champions Infection Prevention eBug Bytes October 2013

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  1. Unit Based ChampionsInfection PreventioneBug BytesOctober 2013

  2. Universal Gown, Glove Use by Employees in ICU Reduces MRSA 40% • The study involved 20 medical and surgical ICUs across 15 states, and examined nearly 92,000 cultures from more than 26,000 patients over a nine-month period in 2012. Participating ICUs were randomly assigned to either the intervention or control group. Healthcare workers in the intervention group were required to wear gloves and gowns for all patient contact when entering any patient room. Healthcare workers in the control group followed CDC guidelines for patient contact, and only wore gloves and gowns for contact with patients with known antibiotic-resistant bacteria. • While researchers did not find a decrease in VRE, the reduction in MRSA was notable, as was an increase in handwashing by the healthcare workers upon leaving patient rooms. "Based on the results of this study, it would be prudent for ICUs to consider adoption of universal gowning and gloving policies on intensive care units at highest risk for MRSA infections, regardless of whether patients have been positively cultured. Concerns about healthcare personnel acceptance of and compliance with universal gowning and gloving can be overcome with creative efforts focused on early engagement and positive reinforcement.“ Source: Anthony D. Harris. Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant Bacteria in the ICU. JAMA, 2013

  3. Drop in C.diff and VRE infection rates when Xenex UV room disinfection utilized as alternative to bleach • The University of Texas MD Anderson Cancer Center recently conducted two studies to evaluate the efficacy of pulsed xenon UV light room disinfection on C.diff and VRE infection rates. In both studies, use of the Xenex UV room disinfection system (instead of bleach for rooms that housed patients with C. diff infections) resulted in a reduction in the number of patients contracting these infections. The current standard for C. diff surface decontamination in the healthcare setting is a bleach solution, which may damage hospital materials and may create a toxic environment for hospital workers. Xenex's pulsed xenon UV light room disinfection system was proven effective against C. diff in the laboratory and in patient outcome results at hospitals utilizing Xenex devices. In the VRE study, the Xenex room disinfection device was implemented as part of a routine disinfection protocol of VRE isolation rooms after terminal cleaning on the Leukemia and Stem Cell Transplant (SCT) units in January 2013. Patients that occupy a room after a VRE patient are more likely to develop VRE than other patients. MD Anderson showed that the Xenex UV disinfection device was superior to manual cleaning at eliminating environmental VRE contamination. • Source: Implementing a Novel Pulsed-Xenon Ultraviolet Disinfection System in the Hospital Setting" in September 2013 at the Infection Prevention Society's "Infection Prevention 2013" conference in London

  4. 'PPMOs' offer new approach to bacterial infection: Molecular Medicine • The new PPMOs offer a fundamentally different attack on bacterial infection. They specifically target the underlying genes of a bacterium, whereas conventional antibiotics just disrupt its cellular function and often have broader, unwanted impacts. PPMOs should offer a completely different and more precise approach to managing bacterial infection, or conceptually almost any disease that has an underlying genetic component. • PPMO stands for a peptide-conjugated phosphorodiamidate morpholino oligomer - a synthetic analog of DNA or RNA that has the ability to silence the expression of specific genes. Compared to conventional antibiotics, which are often found in nature, PPMOs are completely synthesized in the laboratory with a specific genetic target in mind. In animal laboratory tests against A. baumannii, PPMOs were far more powerful than some conventional antibiotics like ampicillin. They were also effective in cases where the bacteria were resistant to antibiotics. • PPMOs have not yet been tested in humans. • Source: Journal of Infectious Diseases October 28 2013

  5. Tainted steroid shots led to varying ailments • Patients made sick by contaminated steroid injections had a "broad spectrum of disease," ranging from stroke to abscess. The pattern of disease varied over time, with meningitis dominating early in the outbreak and non-central nervous system (CNS) disease showing up later. And illnesses varied in severity from mild to life threatening to fatal. The outbreak included 751 cases and 64 deaths in 20 states -- all linked to epidural, paraspinal, or joint injections of contaminated methylprednisolone acetate from a single compounding pharmacy. The most commonly identified contaminant was a black mold, Exserohilum rostratum, which only rarely causes human disease. This has been the largest outbreak of healthcare-associated infections ever reported in the United States. Since the outbreak began, additional outbreaks have been identified and linked to contaminated products from other compounding pharmacies. These outbreaks show the urgent need to address shortfalls in the oversight and safety of compounded drugs to reduce the inherent risks associated with these products, which have not undergone review and approval by the Food and Drug Administration.  Source: NEJM Oct 24, 2013

  6. Obesity May Increase Risk of Clostridium Difficile Infection • Researchers from Boston Medical Center (BMC) and Boston University School of Medicine (BUSM) have identified obesity as a possible risk factor for clostridium difficile infection (CDI). These findings, which appear online in Emerging Infectious Diseases, may contribute to improved clinical surveillance of those at highest risk of disease. The researchers examined three groups of patients with CDI--those who were admitted from the community with no risk factors, those who had prior exposure to hospitals or clinics, and those who had onset of disease in the hospital. The researchers found that cases with community onset infection were four times more likely to be obese compared to those who had prior known exposure to a healthcare facility. These patients were also five times more likely to have inflammatory bowel disease (IBD). "We were also surprised to note that our patients who were presenting from the community were almost twice as likely to be obese as the general population in Massachusetts (34 percent compared to 23 percent). Hence, like IBD, obesity may be associated with higher risk of CDI," added Bhadelia. • Journal Reference: Florence F. et al: Possible Association between Obesity and Clostridium difficile Infection. Emerging Infectious Diseases, October 2013

  7. Communion May Have Exposed North Dakota Parishioners to Hepatitis A Virus The North Dakota Department of Health has determined through a case investigation that people who attended the following Catholic churches in North Dakota and had communion on the following dates may have been exposed to hepatitis A virus, which causes an infection of the liver: Sept. 27, 2013: Holy Spirit Church in Fargo, N.D. (school mass)Sept. 29 – Oct. 2, 2013: St. James Basilica in Jamestown, N.D. (priest convention)Oct. 6, 2013: Cathedral of St. Mary in Fargo, N.D.Oct. 7, 2013: St. Paul’s Catholic Newman Center in Fargo, N.D. Exposed individuals are encouraged to consult their healthcare provider if they develop symptoms. Symptoms of hepatitis A include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, pale stools, or jaundice. It can take about 15 to 50 days (average is one month) after being exposed to hepatitis A to develop symptoms. Hepatitis A symptoms generally last about two months. If hepatitis A symptoms develop, individuals should exclude themselves from activities for one week after onset of symptoms. The risk of people getting hepatitis A in this situation is low, but the Department of Health felt it was important for people to know about the possible exposure.

  8. MRSA Cases Continue to Decline in Veterans Hospitals Nationwide Five years after implementing a national initiative to reduce methicillin-resistant Staphylococcus aureus (MRSA) rates in Veterans Affairs (VA) medical centers, MRSA cases have continued to decline, according to a study in the November issue of the American Journal of Infection Control, the The MRSA Prevention Initiative, implemented in 2007, resulted in significant decreases in both the transmission (colonization with the organism) of MRSA (17 percent for intensive care units [ICUs] and 21 percent for non-ICUs) and healthcare-associated infection (HAI) rates within the hospitals (62 percent for ICUs, 45 percent for non-ICUs). In the two-year period following the first wave of the initiative (data previously published), both MRSA transmissions and HAIs continued to decrease in non-ICU settings (declining an additional 13.7 percent and 44.8 percent, respectively), while holding steady in ICUs. The MRSA Prevention Initiative utilizes a bundled approach that includes screening every patient for MRSA, use of gowns and gloves when caring for patients colonized or infected with MRSA, hand hygiene, and an institutional culture change focusing on individual responsibility for infection control. It also created the new position of MRSA Prevention Coordinator at each medical center. AJIC November 2013

  9. Outbreaks of Cyclospora cayetanensis • During June–August 2013, Clocal public health officials, and the Food and Drug Administration (FDA) investigated an unusually large DC, state and number of reports of cyclosporiasis (compared with annual reports to the National Notifiable Disease Surveillance System [e.g., 123 cases in 2012]), an intestinal infection caused by the parasite Cyclospora cayetanensis (1). By September 20, CDC had been notified of 643 cases from 25 states, primarily Texas (278 cases), Iowa (153), and Nebraska (86). Investigations in Iowa and Nebraska showed that restaurant-associated cases in these two states were linked to a salad mix that contained iceberg lettuce, romaine lettuce, red cabbage, and carrots (2). Most patients in Iowa and Nebraska became ill during June 15–29; cases reported during July and August were primarily from Texas. • CDC collaborated with Texas and the FDA to investigate a cluster of illnesses among patrons of a Mexican-style restaurant in Fort Bend County, Texas (restaurant A). A case of restaurant A–associated gastroenteritis was defined as gastrointestinal illness in a person who had eaten at restaurant A after June 1, 2013. Of 30 persons who ate at restaurant A, 22 had laboratory-confirmed C. cayetanensis infections, and eight had no laboratory confirmation. MMWR: Vol 62, No 43 Nov 1 2013

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