Infection Prevention eBug Bytes October 2015

1. Infection PreventioneBug BytesOctober 2015

2. Drug-resistant E. coli continues to climb in community health settings • Drug-resistant E. coli infections are on the rise in community hospitals, where more than half of U.S. patients receive their healthcare, according to a new study from Duke Medicine. The study reviewed patient records at 26 hospitals in the Southeast. By examining demographic information, admission dates and tests, the researchers also found increased antibiotic-resistant infections among community members who had limited exposure to health care settings, but who may have acquired the bugs through some other environmental factors. The study data were gathered through the Duke Infection Control Network (DICON), which helps community hospitals and surgery centers across the U.S. prevent infections using education and evidence-based strategies. The data showed that between 2009 and 2014, the incidence of drug-resistant extended-spectrum beta-lactamase (ESBL)-producing E. coli doubled from a rate of 5.28 incidents per 100,000 patients to a rate of 10.5 infections per 100,000. The median age of patients infected with E. coli was 72 years. Looking at the timing of patients' infections and when they were last in contact with a healthcare setting, the researchers also discovered that people with infrequent healthcare contact were acquiring the superbug at an even faster rate than patients who have regular contact with hospitals or nursing homes. The data showed a greater than three-fold increase in community-associated infections between 2009 and 2014. • Source: Infection Control & Hospital Epidemiology October 2015 (online pub)

3. MSSA Infection in Infants • Invasive methicillin-susceptible Staphylococcus aureus (S. aureus) infection (MSSA) caused more infections and more deaths in hospitalized infants than invasive methicillin-resistant S. aureus infection (MRSA), which suggests measures to prevent S. aureus infections should include MSSA in addition to MRSA, according to an article published online by JAMA Pediatrics. Researchers coauthors compared demographics and mortality of infants with MRSA and MSSA at 348 neonatal intensive care units (NICUs) around the United States to determine the annual proportion of S. aureus infections that were MRSA and to contrast the risk of death after invasive MRSA and MSSA infections. The authors identified 3,888 of 887,910 infants (0.4 percent) with 3,978 invasive S. aureus infections. Infections were more commonly caused by MSSA (2,868 of 3,978 or 72.1 percent) than MRSA (1,110 of 3,978 or 27.9 percent). More infants with invasive MSSA infections (n=237) died before hospital discharge than infants with invasive MRSA infections (n=110). However, the proportions of infants who died after invasive MSSA and MRSA infections were similar at 237 of 2,474 (9.6 percent) and 110 of 926 (11.9 percent). The absolute numbers of infections and deaths due to MSSA exceed those due to MRSA. Consideration should be given to expanding hospital infection control efforts targeting MRSA to include MSSA as well. Future studies to better define the relationship between MSSA colonization and subsequent infection will help to clarify the importance of such interventions for preventing MSSA disease. • Source: Aaron M. Milstone, MD, MHS et al. Burden of Invasive Staphylococcus aureus Infections in Hospitalized Infants. JAMA Pediatrics, October 2015

4. Biologists discover bacteria communicate like neurons • Biologists have discovered that bacteria are actually quite sophisticated in their social interactions and communicate with one another through similar electrical signaling mechanisms as neurons in the human brain. In a study published in this week's advance online publication of Nature, the scientists detail the manner by which bacteria living in communities communicate with one another electrically through proteins called "ion channels”. All of our senses, behavior and intelligence emerge from electrical communications among neurons in the brain mediated by ion channels. Bacteria use similar ion channels to communicate and resolve metabolic stress. The discovery suggests that neurological disorders that are triggered by metabolic stress may have ancient bacterial origins, and could thus provide a new perspective on how to treat such conditions. But how bacteria use those ion channels remained a mystery until researchers embarked on an effort to examine long-range communication within biofilms--organized communities containing millions of densely packed bacterial cells. These communities of bacteria can form thin structures on surfaces--such as the tartar that develops on teeth--that are highly resistant to chemicals and antibiotics. The study found that biofilms are able to resolve social conflicts within their community of bacterial cells just like human societies. When a biofilm composed of hundreds of thousands of Bacillus subtilis bacterial cells grows to a certain size, the researchers discovered, the protective outer edge of cells, with unrestricted access to nutrients, periodically stopped growing to allow nutrients--specifically glutamate, to flow to the sheltered center of the biofilm. In this way, the protected bacteria in the colony center were kept alive and could survive attacks by chemicals and antibiotics. Source: Nature Mag

5. Nurse used same 2 syringes on 67 employees • The message said the flu shot administered two days earlier at the workplace clinic held at Otsuka Pharmaceutical in West Windsor may have exposed recipients to HIV, Hepatitis B and Hepatitis C. They needed to get tested immediately, then tested again in four to six months. The infection-control lapse occurred Sept. 30 when a nurse inoculated 67 workers using just two syringes. • "I have not slept since I have found out. I am tired beyond belief," said one of the shot recipients, who provided the email to NJ Advance Media. "At first I viewed it as not a big deal. But then it starts hitting you: HIV, Hepatitis C ... this is serious.“ • The bungled clinic came to light when someone at the company noticed something was amiss and reported it. The state Department of Health reportedly interviewed the nurse who gave the injections that night. The U.S. Centers for Disease Control and Prevention also was notified. • The Department of Health then informed the state Board of Nursing temporarily surrender the LPN license she'd held for 30 years pending further action against her. • Source: www.advisen.com

6. Lung Infection Outbreak Linked to Hospital Water Supply • A Mycobacterium abscessus outbreak among lung transplant patients at a single hospital was traced to new building construction and its tainted water supply. M. abscessus infections were confirmed in 39 recently hospitalized lung transplant patients, the source of which was traced to 12 tap water supply locations in the ward, prompting the use of sterile water and a new antibiotic prophylaxis regimen, including imipenem and inhaled amikacin, to manage the outbreak. A new medical tower that had largely ICU beds and began to serve patients in late 2013...lead to an amplification event where the concentration of M. abscessus grew past a certain threshold, but those isolates were present before the construction and opening of the building. Mycobacterium abscessus, and all rapid growing mycobacteria, can be problematic for hospitals, because they're ubiquitous in the environment. They're in the soil, they're in the water supply, and always a concern when you're building a new building -- potential contamination of the water to patients who could be at risk to acquire infections. From August 2013 through May 2014, the incidence rate was 3.9 cases per month, but that rate dropped back down to an average of 1.0 cases per month after the implementation of intervention in June 2014 through March 2015 (incidence rate ratio 0.26, 95% CI 0.13-0.51, P<0.0001). In 92% of the patients, M. abscessus was first isolated in the respiratory tract. The researchers took cultures from environmental biofilms from 73 water sources in the hospital. These included patient room faucets and shower heads, ward faucets, and ice machines. Out of those 73 source environmental cultures, 12, or 16%, grew M. abscessus. Source: Baker AW, et al "A cluster of mycobacterium abscessus among lung transplant patients: investigation and mitigation" IDWeek 2015; Abstract 627.

7. UV Light Cut C. diff Transmissions by 25 Percent on Oncology Floors • New research from Penn Medicine infection control specialists found that ultraviolet (UV) robots helped reduce the rates transmission of the common bacterial infection known as Clostridium difficile among cancer inpatients - mostly blood cancer patients, a group more vulnerable to hospital-acquired infections - by 25 percent. The interventions also saved about $150,000 in annual direct medical costs. The data was presented at the annual ID Week meeting by David Pegues, MD,, a professor of Infectious Diseases in Penn's Perelman School of Medicine and a healthcare epidemiologist in the Hospital of University of Pennsylvania's Infection Prevention and Control (Abstract #1715). UV robots flash UV lights across the room to lock onto DNA of organisms and kill them. The team found that using a ultraviolet germicidal irradiation robot after a room cleaning by EVS not only reduced the number of infections in cancer patients compared to the year prior with no robot, but did so without adversely impacting room turn around. They also report that infections increased by 16 percent on units without the robot during the study period. • C. diff aren't as deadly as other bacteria, but they are harder to clean away. They forms spores that are resistant to many disinfectants and can persist in the hospital environment for months. Approximately 500,000 people contract C. diff while in the hospital every year in the U.S., and nearly 15,000 die directly from the infection. Cancer patients, whose immune systems may be compromised from stem cell transplants and/or chemotherapy, are more susceptible to infections than other inpatients.

8. MRSA: How you can avoid NFL player Daniel Fells' plight at the gym • Daniel Fells, the 32-year-old Giants tight end, is fighting a serious MRSA type of staph infection that may lead to amputation, and will almost certainly end his career. Fells trouble began with an ankle injury, for which he received a cortisone shot. He was taken to the emergency room on October 2 with a fever of 104 degrees; he has been in the ICU since Friday (October 9), and has already had five surgeries, according to an NFL report. A number of prominent NFL players have had MRSA infections, including members of the Browns, Redskins, and Rams. The Buccaneers' had an outbreak among three players and now faces a lawsuit from former kicker Lawrence Tynes, who claims that unsanitary conditions at the team's facilities caused him to become infected with MRSA, which required multiple surgeries and six weeks of intravenous antibiotics to cure. Tynes says this infection has ended his career, costing him over $20 million in anticipated future earnings. These Staphylococcal infections occur regularly with contact sports, especially with wrestling and football, because the close, skin-to-skin contact can infect abrasions from artificial grass (turf burns) or cuts the athlete's might already have from the rough sports. • Fells' infection, reportedly occurring after a cortisone shot into the joint, is uncommon. Knees are more commonly injected with steroids than other joints; infection following knee injection ranges from 1 in 3,000 to 1 in 5,000. • Source: http://www.forbes.com/sites/judystone/2015/10/13/how-you-can-avoid-daniel-fells-mrsa-plight/

9. Methicillin-Susceptible, Vancomycin-Resistant Staphylococcus aureus (VRSA) • Acquisition of high-level vancomycin resistance by Staphylococcus aureus represents a major public health risk because this antimicrobial drug continues to be the first-line and most inexpensive therapy to treat methicillin-resistant S. aureus (MRSA) despite concerns about its clinical efficacy. • Vancomycin-resistant MRSA (VR-MRSA) was recovered from the bloodstream of a patient in Brazil . VR-MRSA belongs to sequence type (ST) 8 and is phylogenetically related to the community-associated (CA) MRSA USA300 genetic lineage that has rapidly disseminated in the United States and the northern region of South America (USA300-Latin American variant [USA300-LV]). • The vanA gene cluster in VR-MRSA was carried by a transferable staphylococcal plasmid (pBRZ01). • A clinical isolate of vancomycin-resistant, methicillin-susceptible S. aureus (VR-MSSA) exhibited the in vivo transfer of the vanA gene cluster to 2 unrelated S. aureus strains causing bacteremia within the same patient. • www.cdc.gov

10. CMS Inspectors find Mission Hospital, Orange County, CA in crisis • The Mission Hospital Regional Medical Center in Orange County, CA, experienced deadly infections after joint surgery, a federal CMS inspection report shows. The report provides a rare, unobstructed look at conditions inside the private nonprofit hospital, which risked losing its accreditation last year over a small but severe outbreak of infections related to hip and knee surgeries. Mission Hospital is one example of how hospitals, even some with shining reputations and awards and special certifications, can fail to follow protocols aimed at preventing dangerous infections that can easily start and spread inside their facilities. At some of the other big hospitals in Orange County, problems ranged from bad hand hygiene to rusty procedure tables to a dirty diaper strewn on the floor of a neonatal intensive care unit, a Register review of CMS inspection reports from the past five years has found. The Register reviewed the reports on Mission Hospital and others following the outbreak at Mission Hospital, where four patients developed serious and unusual infections following hip and knee replacement surgeries in May and June 2014. For about two weeks in October, the hospital closed operating rooms under pressure from regulators as it scrambled to find the source of that outbreak. The infection control department was short-staffed and under-funded. The hospital employed one full-time infection control doctor and a part-time consultant - not enough to "provide oversight of the infection control practices" at a hospital, which has two campuses in Mission Viejo and Laguna Beach with 533 beds and that performs about 7,000 surgeries a year. http://www.ocregister.com/articles/hospital-684860-mission-operating.html

11. Contaminated Bronchoscopes Linked in 2014 to A Potential ‘Superbug’ Outbreak • While generally not publicly known, contaminated bronchoscopes, like duodenoscopes, are also prone to transmitting deadly superbug infections. • This is a particularly troubling finding, because health officials have publicly concluded that the complexity of the duodenoscope’s design — namely, its complex forceps elevator mechanism, which is challenging to clean — is primarily responsible for the nation’s recent spate of outbreaks of CRE (and their related superbugs). • Moreover, not just duodenoscopes, but other types of GI endoscopes featuring an exposed elevator wire channel — namely, linear echo-endoscopes — might also be difficult to clean and pose an increased risk of CRE transmission. But, bronchoscopes, in contrast, do not feature a forceps elevator mechanism. Instead, they are much simpler in design and easier to clean than GI endoscopes, especially duodenoscopes. To date, health officials have not publicly cautioned the public about the risk of outbreaks of CRE following bronchoscopy. In December 2014, Olympus filed a medical device report, or MDR, documenting that contaminated bronchoscopes can transmit CRE to patients. According to this filed report, 14 patients tested “positive” for (meaning they were either infected or colonized with) a carbapenem-resistant strain of Klebsiella pneumoniae (i.e., CRE) after having undergone diagnostic bronchoscopy. • Source: http://www.latimes.com/business/la-fi-fda-scope-infections-20150917-story.html

12. Ebola Virus Disease in Health Care Workers — Guinea, 2014 • An outbreak of Ebola virus disease (Ebola) began in Guinea in December 2013 and has continued through September 2015 (1). Health care workers (HCWs) in West Africa are at high risk for Ebola infection owing to lack of appropriate triage procedures, insufficient equipment, and inadequate infection control practices (2,3). To characterize recent epidemiology of Ebola infections among HCWs in Guinea, national Viral Hemorrhagic Fever (VHF) surveillance data were analyzed for HCW cases reported during January 1–December 31, 2014. During 2014, a total of 162 (7.9%) of 2,210 laboratory-confirmed or probable Ebola cases among Guinean adults aged ≥15 years occurred among HCWs, resulting in an incidence of Ebola infection among HCWs 42.2 times higher than among non-HCWs. • The disproportionate burden of Ebola infection among HCWs taxes an already stressed health infrastructure, underscoring the need for increased understanding of transmission among HCWs and improved infection prevention and control measures to prevent Ebola infection among HCWs. Cases of Ebola infections among HCWs during this outbreak were first reported in January 2014. The highest number of Ebola case notifications in HCWs in Guinea in a single week occurred during week 51 with 15 cases. This also corresponded to the week with the highest number of total Ebola cases (HCW and non-HCW) in Guinea during 2014. • Source: MMWR October 2, 2015 / 64(38);1083-1087

13. Measles Outbreak Associated with Vaccine Failure in Adults • Beginning on February 16, 2014, several patients were evaluated at Kosrae State Hospital for acute onset of fever and rash. No history of travel or specific disease exposures was available in the hospital records. Initial clinical diagnoses were dengue fever or chikungunya. However, during the next several months, as more persons with fever and rash were examined at the hospital, measles was considered as a possible diagnosis. On May 15, serum samples collected from two persons with fever and rash had tested positive for measles-specific immunoglobulin M (IgM) antibodies. During February 16–June 10, a total of 139 measles cases were detected in Kosrae through febrile rash illness surveillance at the hospital, contact tracing, and a retrospective investigation of earlier fever and rash cases. The first measles cases in Pohnpei were detected on May 12, and during May 12–August 31, 251 cases were reported. The first case in Chuuk was detected on July 24; three cases were reported there during July 24–August 26 (rash onset date could not be confirmed for one patient). This resulted in a total of 393 measles cases from the three states. Among the 393 measles patients, 306 had vaccination records and the remaining 87 were classified as having unknown vaccination status including 74 adults. Among those with vaccination records, 216 (71%) had received at least one MCV dose before the outbreak, including 169 (96%) of adults aged >19 years. Among adult patients with vaccination records, 123 (70%) had received ≥2 doses of MCV. Among the 90 unvaccinated patients, 54 (60%) were aged <12 months and therefore ineligible for routine vaccination. Among 89 children and adolescents aged 1–19 years with measles, 29 (33%) were unvaccinated; seven (3%) adults were unvaccinated. Source: MMWR October 2, 2015 / 64(38);1088-1093

14. Autopsy shows fungal infection played role in death of UPMC patient • An autopsy of a Pittsburgh-based UPMC heart transplant patient revealed that a fungal infection played a role in her death. This contradicts UPMC's claims that the deaths of three transplant patients at UPMC Presbyterian and Montefiore hospitals could not be directly attributed to fungal infections possibly linked to mold found in the facilities. • After UPMC discovered that four transplant patients suffered fungal infections within a year span, the system temporarily closed its transplant program to seek a source of the infection. While mold was found in one of UPMC Presbyterian's intensive care units, an investigation did not yield a definitive source of the fungal infections. Pittsburgh-based UPMC resumed the transplant program at its Presbyterian and Montefiore hospitals on Sunday after voluntarily shutting down its organ transplant program last week when it linked a mold problem to four patients who developed infections, three of whom died. • The report also notes the following organizations will be monitoring UPMC's follow-up actions: The Health Resources and Services Administration, the Organ Procurement and Transplantation Network, the United Network for Organ Sharing and a division within CMS. Source: http://www.beckershospitalreview.com/quality/transplant-program-reopens-at-upmc-presbyterian-and-montefiore.html

15. New Legionnaires’ Outbreak in the Bronx Claims a Life • One of the people sickened in a new outbreak of Legionnaires’ disease in the city has died, health officials said Wednesday. The Department of Health and Mental Hygiene released few details about the person, saying only that the patient was between the ages of 40 and 49 and had “severe underlying health conditions.” The city also said the number of people sickened by the outbreak, which is centered in the Morris Park section of the Bronx, had risen to 13, including the person who died. Of those, 11 are hospitalized and one has been released. Legionnaires’ disease, a type of pneumonia, killed 12 people in the South Bronx this summer and sickened more than 100 others. City officials said they believed it spread through vapor released from a water-cooling tower atop a building there. Health officials have said the group of cases in Morris Park is unrelated to the earlier cluster. They said they began investigating the Morris Park cluster last week, sending teams of investigators to test 35 cooling towers in the area. Of the cooling towers sampled, 15 tested positive for the bacterium, all of which were ordered by the city to be disinfected. At least six of the water-cooling towers that tested positive for Legionella bacterium are associated with the Albert Einstein College of Medicine. The college issued a statement saying it had complied with the new city law. Source: http://www.wsj.com/articles/new-legionnaires-outbreak-in-the-bronx-claims-a-life-1443643340?tesla=

16. Reduction in CDI in the ICU with UV Room Decontamination • UV light for room disinfection (UVD)] has been shown to eradicate methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter, and C. difficile under the artificial conditions of inoculating surfaces with bacteria, exposing the bacteria to UV light and then culturing the surface. • The use of ultraviolet disinfection during hospital discharge could reduced the incidence of ICU-associated Clostridium difficile infection, according to recently published data. To further test UVD in a clinical setting, researchers examined its first year of implementation at Westchester Medical Center, a tertiary care hospital with 180 ICU beds in Valhalla, New York. UVD was performed after discharge with UV light after standardized procedures. For each case of C. difficile infection, data concerning the patients’ lengths of stay, the rooms they occupied and the rate of hospital- and community-associated C. difficile infection were collected. Analysis was performed, comparing the first year of UVD procedures (July 2011 through June 2012) and a similar period of time before implementation (May 2010 through April 2011). Hospital-associated C. difficile was reduced by 22% during the period of UVD implementation (RR = 0.78; 95% CI, 0.61-1.009). When examining adult ICU cases alone (n = 60), researchers observed a much more significant reduction in C. difficile infection of 70% among UVD patients (P < .001). • Source: Nagaraja A, et al. Am J Infect Control. 2015;doi:10.1016/j.ajic.2015.05.003.

17. Rare Salmonella Strain Sickens 14 Patients at Henry Ford Hospital • The “mysterious” infection that sickened 14 patients last week at a hospital in Michigan was caused by a rare bacterial strain called Salmonella Isangi. Officials of Detroit’s Henry Ford Hospital are not saying much about the outbreak, like how the patients contracted the Salmonella and whether the source of the bacteria has been identified, causing speculation to mount. • Salmonella infections are often traced to contaminated food or water. Yet, “Salmonella can be transmitted basically by anything that enters your mouth, whether it’s a dirty hand, touching something that has Salmonella and touching your mouth, or food. • Typical symptoms include nausea, vomiting, diarrhea and abdominal pain. If it gets more severe, they can develop a fever and ultimately, it can become bloody diarrhea. The hospital acted immediately by restricting the patients by identifying them, by treating them and by preventing any further spread. So they reacted to this issue as quickly as possible and as efficiently as possible. • The seven patients that have been released are not a threat to anyone around them. As for the others still in the hospital, they could still be there because of what brought them there in the first place. No publicized reports or findings suggest that Henry Ford’s outbreak last week is linked to any type of contaminated medical instrumentation. • Source: http://www.clickondetroit.com/news/14-patients-diagnosed-with-salmonella-at-henry-ford-hospital/35566506

18. A cloud of bacteria follows you around • According to a study published in PeerJ, each of us is surrounded by a cloud of bacteria every second of our lives. These microbial companions are so unique that the cloud might be as identifiable as your fingerprint. The study was relatively small - just 11 participants - but it brings evidence that our microbial footprints may be as good as an actual footprint at identifying us. Researchers put the subjects inside a sanitized chamber for 90 minutes, then tested the cloud of microbes each subject left behind. Previous research found that we put our microbial footprint into the room we've just entered relatively quickly, with your house having different mircobiomes than your office or the hotel room you spent a vacation in. The subjects left behind plenty of common, human-associated microbes, but the ratios of these microbes were unique enough that researchers were able to identify nearly all of the subjects just based on their microbial footprints. • The most interesting aspect of the study may be the implications it has on forensic evidence used in crimes. As anyone who has watched CSI knows, DNA evidence can lead to a solid guilty or innocent verdict in a crime. But sometimes there is no DNA, so with what we know about microbial footprints, forensic analysts may turn to the microbial clouds for evidence. A study last year suggested microbial footprints may be used in sexual assault cases if there is an absence of DNA. In Hawaii, a different group is trying to figure out if microbes left on or around homicide victims could tie a suspect to the crime. • Source: Meadow, J, et al. Humans differ in their personal microbial cloud. PeerJ . 2015

19. Does NICU bed configuration affect sepsis, MRSA rates? • Researchers compared rates of colonization by methicillin-resistant Staphylococcus aureus, late-onset sepsis and mortality in single-patient neonatal intensive care unit rooms and open-unit rooms in a recent study published in the journal Infection Control & Hospital Epidemiology. • The study was conducted in the NICU of a tertiary referral center which was organized into single-patient and open-unit rooms. Clinical data sets including bed location and microbiology results were then examined over the next 29 months. Of the more than 1,800 patients studied, single-patient and open-unit models had similar incidences of MRSA colonization and MRSA colonization-free survival times. Late-onset sepsis rates were also similar in single-patient and open-unit models, as were sepsis-free survival rates and the combined outcome of sepsis or death. • Ultimately, the researchers concluded single-patient rooms did not reduce the rates of MRSA colonization, late-onset sepsis or death. However, they did discover the NICU's MRSA colonization rate was impacted by hand hygiene compliance, regardless of room configuration. • Source: Infection Control and Hospital Epidemiology Oct 2015

20. FDA orders duodenoscope manufacturers to conduct postmarket surveillance studies in health care facilities • The U.S. Food and Drug Administration today ordered the three manufacturers of duodenoscopes marketed in the U.S. to conduct postmarket surveillance studies to better understand how the devices are reprocessed in real-world settings. The three manufacturers – Olympus America, Inc., Fujifilm Medical Systems, U.S.A., Inc., and Hoya Corp. (Pentax Life Care Division) – that market duodenoscopes sold in the U.S will have 30 days to submit postmarket surveillance plans to the FDA. These proposals must detail their plans to conduct studies to evaluate, among other things, how well health care personnel are following instructions to clean and disinfect duodenoscopes between patients and to better understand the rate of contamination of clinically used duodenoscopes. These studies are based on the FDA’s current understanding of factors that may be contributing to infection outbreaks following endoscopic retrograde cholangiopancreatography procedures (ERCP), as well as the information needed to help fill gaps in knowledge. The goal of these studies is to collect useful data about the effectiveness of current reprocessing instructions and practices that can provide the FDA with information necessary to protect the public health, including taking action to help reduce the risk of duodenoscope infections. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm465639.htm

21. Bubonic Plague in Michigan • A Michigan resident recently became the 14th person this year to contract the plague, the same disease that was responsible for the Black Death pandemic in Europe in the 1300s. Although the plague has never officially been eradicated, instances of infection usually remain low in the U.S., averaging around seven cases per year. The 14 reported cases have been mostly of the bubonic form of the plague, which is spread to humans through fluids from infected rodents or flea bites. The plague consists of three forms: bubonic, pneumonic and septicemic, with the bubonic plague being the cause of 80 percent of plague cases in the U.S. The Michigan resident was diagnosed with bubonic plague, which cannot be spread from person to person. The only form that can be transmitted from person to person is the pneumonic plague because it affects the lungs and can be spread through coughing. • The septicemic form of the plague is the rarest and occurs when the plague spreads to the bloodstream. This rare form was the cause of death in June for a Colorado teenager, who was believed to have been infected by a flea bite on his parent's rural ranch in Colorado. The Michigan woman who came down with the bubonic plague was also infected in Colorado during a camping trip. A possible contributing factor is the drought that is occurring throughout the West. Rodents may be flocking to campgrounds in search of food, and fleas may be biting humans more as they jump onto humans from dying animals. But those traveling out west to a rural area: hunters should use gloves when handling animals, wearing long sleeves and bug spray containing DEET for those going camping. Any animals brought along on the trip should be treated with flea control products. www.cdc.gov

22. Should Doctors Go Bare? Infection Control Debate Rages • HAIs and the rise of MDROs has put new focus on whether requiring doctors to go “bare below the elbows” (BBE) would help infection control. BBE means no long sleeves, no neckties, no wristwatches, no jewelry other than a wedding band, and generally that physicians will wear scrubs. The practice was adopted in the UK in 2008. But it appears to be a tough sell in the US. At a debate today at IDWeek 2015 in San Diego, two physicians squared off in a friendly—and highly entertaining—debate. Michael Edmond, MD, MPH, MP,of the University of Iowa Hospitals and Clinics said his hospital is going BBE January 1, 2016. He took the “yes” side of the debate. Neil Fishman, MD, of Penn Medicine in Philadelphia, PA, took the “no” side and closed his debate with a hip-hop style rap. • Edmond began by citing studies that showed how dirty and microbe-contaminated lab coats could get. Though some surveys have shown patients prefer to see their doctors in coats and ties, “Patients preferences vary” and the survey techniques may bias the answers, he said. In a straw poll after the debate, the audience sided 58% to 42% with Fishman. Edmond said he was convinced that BBE would help infection control since staph and other organisms persist on clothing, lasting over a month on white coats, particularly if they are polyester not cotton. Source: Forbes Magazine Article

23. Ebola Nurse Critical; Sneezing Every Second • A nurse who contracted Ebola while working in West Africa is now "critically ill" with complications arising from the infection. Pauline Cafferkey was readmitted to a specialist isolation unit at the Royal Free Hospital in London last week. • The hospital said in a statement that her condition had deteriorated. Ms Cafferkey, 39, from Cambuslang in South Lanarkshire, contracted Ebola while working at a treatment centre in Sierra Leone last year. She spent almost a month in isolation at the Royal Free at the beginning of the year after the virus was detected when she arrived back in the UK. She was later discharged after apparently making a full recovery, but it was discovered last week that Ebola was still present in her body. Bodily tissues can harbour the Ebola infection months after the person appears to have fully recovered. When the desperate call for health workers came at the height of the Ebola outbreak, Pauline Cafferkey stepped up to the very risky challenge. Whilst most were keen to be as far away as possible from the epidemic, Pauline ran right into the centre of it. Ms Cafferkey had initially gone to an out-of-hours doctor in Glasgow on Monday of last week, but was sent home after being told she probably had a virus. Her family has claimed doctors "missed a big opportunity" to spot she had fallen ill again. She was admitted to the city's Queen Elizabeth University Hospital the following day after continuing to feel unwell, before being transferred to the Royal Free in a military aircraft on Friday morning. She was admitted on Friday morning when her condition was serious and it is now critical. • Source: http://www.bbc.com/news/uk-scotland-34529575