Infection Prevention eBug Bytes March 2014

1. Infection PreventioneBug BytesMarch 2014

2. Physicians' stethoscopes more contaminated than palms of their hands In this study, 71 patients were examined by one of three physicians using sterile gloves and a sterile stethoscope. After they completed the examination, two parts of the stethoscope (the tube and diaphragm) and four regions of the physician's hands (back, fingertips, and thenar and hypothenar eminences) were measured for the total number of bacteria present. The stethoscope's diaphragm was more contaminated than all regions of the physician's hand except the fingertips. Further, the tube of the stethoscope was more heavily contaminated than the back of the physician's hand. Similar results were observed when contamination was due to methicillin-resistant S.aureus (MRSA) after examining MRSA-colonized patients. This work is the first to compare directly the level of contamination of physicians' hands and stethoscopes. Stethoscope contamination is not trivial and is comparable to the contamination of healthcare workers' fingertips, the hand region most implicated in microbial cross-transmission. Physicians must be aware of the need to disinfect their stethoscope after each use. Reference: Yves Longtin, Alexis Schneider, Clément Tschopp, Gesuèle Renzi, Angèle Gayet-Ageron, Jacques Schrenzel, Didier Pittet. Contamination of Stethoscopes and Physicians' Hands After a Physical Examination. Mayo Clinic Proceedings, 2014; 89 (3): 291

3.  A new study found more than 80 percent of raw chicken used in hospitals in food for patients and staff was contaminated with a form of antibiotic resistant bacteria called extended-spectrum beta-lactamase producing E. coli. While sufficient preparation eliminated the presence of bacteria, poultry meat delivered to hospital kitchens remains a potential point of entry for these dangerous bacteria into the hospital. Researchers from the University Hospital of Geneva in Switzerland collaborated with the Food Control Authority of Geneva to test raw chicken delivered to the central hospital kitchen that prepares more than 8,000 meals daily. They compared the hospital samples to food in local supermarkets for the presence of ESBLs finding that most (86%) chicken meat samples were positive. E. coli is a normal part of healthy human gut flora but can also cause urinary tract infections and occasionally more serious invasive infections. The researchers also looked at how food, as a potential source of multi-resistant bacteria, impacts the health of food handlers, healthcare workers and patients. They found six of 93 food handlers were ESBL carriers, but overall were no more likely to be colonized by ESBL-producing bacteria than the Swiss population. Source: Infection Control and Hospital Epidemiology April 2014 Hospital food safety measures reduce risk of contaminated hospital food

4. New study shows flu vaccine reduced children's risk of intensive care unit flu admission by three-fourths Getting a flu vaccine reduces a child's risk of flu-related intensive care hospitalization by 74 percent, according to a CDC study published in the Journal of Infectious Diseases. The study is the first to estimate vaccine effectiveness (VE) against flu admissions to pediatric intensive care units (PICU). It illustrates the important protection flu vaccine can provide to children against more serious flu outcomes. CDC recommends annual flu vaccination for everyone 6 months and older and especially for children at high risk of serious flu-related complications. Flu causes hospitalizations in children each season, but how many children are affected varies, depending on the severity of the season. CDC estimates that 20,000 children younger than 5 years are hospitalized on average each year. For children younger than 18 years, published studies suggest an annual range of flu-related hospitalization rates of between one child and seven children per 10,000 children. Between 4 percent and 24 percent of hospitalized children require PICU admission. www.cdc.gov/flu

5. CDC reports more cases of Heartland virus disease The CDC in collaboration with health officials in Missouri and Tennessee have identified six new cases of people sick with Heartland virus: five in Missouri and one in Tennessee. The new cases, discovered in 2012 and 2013, are in addition to two discovered in 2009. Heartland virus was first reported in two northwestern Missouri farmers who were hospitalized in 2009 with what was thought to be ehrlichiosis, a tick-borne disease. However, the patients failed to improve with treatment and testing failed to confirm ehlrlichiosis. Working with state and local partners, CDC eventually identified the cause of the men’s illness: a previously unknown virus in the phlebovirus family now dubbed Heartland virus. Ongoing investigations have yielded six more cases bringing to eight the total number of known cases. All of the case-patients were white men over the age of 50. Their symptoms included fever, fatigue, loss of appetite, headache, nausea, or muscle pain. Four of the six new cases were hospitalized and one died. Five of the six new cases reported tick bites in the days or weeks before they fell ill. CDC studies to date have shown Heartland virus is carried by Lone Star ticks, which are primarily found in the southeastern and eastern United States. www.cdc.gov

6. Shingles is a painful viral infection that affects almost one million people worldwide and 30 percent of Americans every year. Known as herpes zoster, it’s caused by the same virus that causes chicken pox, the varicella-zoster virus. The outbreak occurs mostly in people older than 50 because the virus can lay dormant in the nerve tissue of the body for many years then become activated and cause shingles later in life. If you are diagnosed with shingles, you are contagious as long as you have blisters and ulcers. Since it can be spread from person to person it is important to cover your rash and wash your hands frequently. It also is important to avoid people who have not received the chicken pox vaccine, pregnant women and anyone with a weak immune system.A shingles outbreak can last several weeks. Even before the rash appears the following symptoms may occur: Fatigue, Headache, Tingling, Itching, Burning Pain. After a few days a blistering rash in clusters appears. The shingles rash is always located along the involved nerve pattern called a dermatome, typically in a band on one side of the body. If the rash crosses the midline of the body, it is not shingles. Most commonly the rash is on the chest and/or back. However, it can occur on other body parts.You can decrease your risk of developing shingles and its complications with the shingles vaccine known as Zostavax. This vaccine is available to people 50 years and older. www.sciencedaily.com/releases/2014/02/140226132752.htm Shingles: A common and painful condition caused by Varicella Zoster

7. Camels may be source of MERS virus in Middle East A new study suggests that camels may be the source of the mysterious new MERS virus infecting people in the Middle East. Three-quarters of camels tested in Saudi Arabia show evidence of infection with the virus. Camels have long been prime suspects in the outbreak of MERS, a respiratory virus that's killed at least 79 people and infected 182 in several Middle Eastern countries. But because so many animals have it, the study also suggests strongly that MERS has been around for a while, and authorities are only recently noticing it because of sensitive new tests.Middle East Respiratory virus or MERS first showed up in 2012, when it killed an elderly Saudi man. It worries health experts because it's related to severe acute respiratory syndrome, or SARS, which swept around the world in 2003, infecting around 8,000 people and killing close to 800 before it was stopped. Both conditions are caused by coronaviruses, members of a family of viruses that usually cause common cold symptoms and that infect a wide range of mammals. Both also have been carried around the world by travelers, who have gone on to infect others. The United Nations says it could cause a pandemic. SARS came from an animal called a civet and scientists have also found evidence that MERS might infect bats.

8. Antibiotic-resistant infections onthe Rise in Rhode Island Hospitals ri The emergence of community-acquired infections, such as urinary tract infections (UTI), due to strains resistant to common antibiotics are on the rise, according to Rhode Island Hospital researchers. The incidence of infections due to these microorganisms is increasing, which creates a challenge regarding appropriate antimicrobial therapy, especially in a community or outpatient setting where oral antibiotics are used. The study noted the emergence of community-acquired infections due to ESBL-producing bacteria, a significant increase in healthcare-associated infections, as well as E. coli becoming the predominant pathogen in all three acquisition groups (community-acquired, healthcare-associated, and hospital-acquired). The researchers found high levels of resistance to the antibiotics Ciprofloxacin and Trimethoprim-Sulfamethoxazole (TMP-SMZ), which could lead to poor outcomes in the community as these are the commonly used antibiotics in outpatient settings for urinary tract infections. Source: Steven Z Kassakian, Leonard A Mermel. Changing epidemiology of infections due to extended spectrum beta-lactamase producing bacteria. Antimicrobial Resistance and Infection Control, 2014; 3 (1): 9 DOI: 10.1186/2047-2994-3-9 --------------------------------------------------------------------------------