Infection Prevention eBug Bytes March 2015

1. Infection PreventioneBug BytesMarch 2015

2. Common bacteria on verge of becoming antibiotic-resistant superbugs • Antibiotic resistance is poised to spread globally among bacteria frequently implicated in respiratory and urinary infections in hospital settings. Two genes that confer resistance against a particularly strong class of antibiotics can be shared easily among a family of bacteria responsible for a significant portion of hospital-associated infections. bacteria recently infected several patients at two Los Angeles hospitals. The infections have been linked to medical scopes believed to have been contaminated with bacteria that can resist carbapenems, Experts recommend strictly limiting the usage of carbapenems to cases in which no other treatments can help. The researchers studied a family of bacteria called Enterobacteriaceae, which includes E. coli, Klebsiella pneumoniae and Enterobacter. CDC named carbapenem-resistant Enterobacteriaceae as one of the three most urgent threats among emerging forms of antibiotic-resistant disease. Studies have shown the fatality rate for these infections is above 50 percent in patients with weakened immune systems. • Mitchell W. Pesesky, Tahir Hussain, Meghan Wallace, Bin Wang, Saadia Andleeb, Carey-Ann D. Burnham, Gautam Dantas. KPC and NDM-1 Genes in RelatedEnterobacteriaceaeStrains and Plasmids from Pakistan and the United States. Emerging Infectious Diseases, 2015; 21 (6)

3. Indiana is battling the worst HIV outbreak in its history • HIV epidemic that now grips Austin, IN, seemed to come out of nowhere. Since the first diagnosis in mid-December, the number of infected there and in the surrounding region has skyrocketed - 26 by the beginning of March, 72 as of this Wednesday. It's the worst HIV outbreak in state history, and has local and federal officials scrambling to stem the spread of the disease. • Long before the first HIV diagnosis, the city has been coping with another epidemic: intravenous drug use. Used needles can be found strewn across yards and roadsides, but just as often wind up in the hands of other users, contributing to the spread of infection. • On Monday, investigators from the Centers for Disease Control and Prevention were dispatched to Scott County, where Austin is located, to investigate the outbreak and determine whether the virus is a new strain or one that has been circulating for a while. Intravenous drug use has been identified as the mode of infection in nearly all of the 72 confirmed cases. • Indiana Gov. Mike Pence (R), said he would consider implementing a targeted needle exchange program to combat the disease's spread. Such programs, which allow people to trade-in used hypodermic needles for clean ones, are currently illegal in Indiana. • Indiana HIV Cases Due to IV Drug Use

4. Inside the plane that flies Ebola patients • If it were easy, any company or government could do it. But flying an Ebola patient halfway around the world -while keeping that person alive, and everyone safe -is complicated.mProbably no one knows that better than Phoenix Air, a Georgia-based company that is the go-to for transporting Ebola victims by air. Since August, it has made approximately 40 trips -about half to Europe, the rest to the United States. • Gulfstream G-III aircraft consists of three major elements: • 1. The metal frame follows the contours of the jet, creating a space set off from the rest of the cabin. Air is filtered as it enters the unit and as it leaves • 2. The liner is hung from the exoskeleton. It's made from a special heavy-duty plastic. The liner is the main device that keeps fluids and contagions from getting into the aircraft itself. • 3. Items inside the liner are designed for single use. They include a stretcher, a toilet, lights and a communications system. • Once the plane has landed and the patient has left, the whole system is sealed. The aircraft then flies to a high-security hanger in Cartersville, Georgia, where it undergoes a complete decontamination process, which can take up to 24 hours.

5. Norovirus sickens nearly 3 dozen at Phoenix VA • Norovirus has sickened nearly three dozen patients and staff members at the Phoenix VA Health Care System, prompting the hospital to halt admission of new patients to two mental-health units contaminated with the highly contagious virus. • Phoenix VA officials said that laboratory-confirmed norovirus has infected 16 patients and 19 staff members. All have recovered except three people who are being treated in a medical unit. The Carl T. Hayden Veterans Affairs Medical Center stopped taking new patients at two mental-health units with 48 beds on the hospital's fifth floor. • VA officials have embarked on a cleaning regimen to rid the hospital of the virus. Some steps include limiting staff members who are allowed to access the affected floors and using paper trays to deliver food. The virus is often spread at schools and assisted-living centers, and it is so common that public-health agencies typically do not alert the public about such outbreaks. • VA Health Care System in Phoenix with Norovirus Outbreak

6. Listeria outbreak linked to Via Christi-St. Francis Hospital • A listeria outbreak from Blue Bell ice cream is linked to a Wichita hospital. A spokesman for Blue Bell confirms the outbreak is linked to Via Christi-St. Francis. The company said it did not issue an official recall for the products, but consumers who believe they may have the affected products should discard them. • Via Christi Hospital St. Francis identified five patients who became ill with listeriosis during their hospitalizations for unrelated causes between December 2013 and January 2015. Via Christi worked closely with the Kansas Department of Health & Environment (KDHE) to investigate the cause of the listeriosis cases in these five patients, which has now been linked to pre-packaged ice cream from Blue Bell Creameries believed to have been consumed by these patients. Via Christi was not aware of any listeria contamination in the Blue Bell Creameries ice cream products and immediately removed all Blue Bell Creameries products from all Via Christi locations once the potential contamination was discovered. The U.S. Food and Drug Administration (FDA) warned consumers about the potential contamination in Blue Bell Creameries' products. • The Kansas Department of Health and Environment says three people have died from listeriosis in Kansas. The KDHE says five Kansans became ill between January 2014 and January 2015 after hospitalizations for unrelated causes at the same hospital. Most were believed to have eaten Blue Bell Creameries ice cream at the same hospital. • Kansas - Three Died from Listeria

7. Three leprosy cases confirmed in Florida • In the last five months, three people in Volusia County have been diagnosed with leprosy. Two of the cases are thought to be linked to recent contact with nine-banded armadillos. The animal is suspected to be a carrier of the bacteria in the southern U.S. Leprosy, also known as Hansen's disease, is a rare condition caused by the bacteria mycobacterium lepra. While a majority of humans are not susceptible to the bacteria, it's transmitted through droplets from the nose, mouth and through close contact with someone who is sick but has not been medically treated with drugs. • The bacteria multiply slowly in the human body, and the incubation period can last as long as 20 years before the symptoms actually emerge. Leprosy affects the skin, peripheral nerves, lining of the respiratory tract and eyes. Over the years, it damages tissue and can cause disfigurement of the skin, bone and cartilage. Tumor-like growths, collapsed facial features and claw hands are common once the disease has progressed. The U.S. CDC, reports there are approximately 100 new cases of leprosy each year, and most are seen in southern states including Texas, Louisiana and Florida. Between 1994 and 2011 there were just over 2,300 new cases of leprosy diagnosed in the U.S. Source: www.CDC.gov

8. Superbug outbreak extends to Cedars-Sinai hospital, linked to scope • Cedars-Sinai Medical Center in Los Angeles said it has discovered that four patients were infected with a deadly superbug from a contaminated medical scope and 68 more people may have been exposed. The hospital said Wednesday it began investigating the possibility of patient infections after a similar outbreak at UCLA's Ronald Reagan Medical Center. In that outbreak, five people became infected and two died after being treated with scopes carrying carbapenem-resistant Enterobacteriaceae (CRE), bacteria. • Patients at Cedars-Sinai may have been exposed to the lethal superbug from one Olympus Corp. duodenoscope in use from August 2014 to mid-February, according to the hospital. Cedars-Sinai said one of the four infected patients has died, but it was unrelated to a CRE infection. •  The infections at UCLA and now Cedars-Sinai are the latest in a string of similar scope-related outbreaks across the United States. • The Food and Drug Administration said last month that it was aware of 135 possible patient infections from January 2013 to December 2014 linked to duodenoscopes. • Source:LA Times - Cedar Sinai Duodenoscope Infections

9. Chlorhexidine (CHG) cleaning of Umbilical Cords • A Cochrane review found that when chlorhexidine CHG) reduced the number of newborn babies who died or suffer from infections. One-third of deaths in newborn babies are caused by infections. Chlorhexidine (CHG) has been used in hospitals and other medical settings to prevent bacterial infections for many decades. • The researchers reviewed data from 12 trials involving over 87,000 newborns. Seven of the trials took place in southeast Asia, two in Africa, two in Europe and one in South America. Of the 12 trials, the five carried out in community settings, which involved 72,030 newborns, provided the highest quality evidence. These trials included home births. They showed that cleansing cords with chlorhexidine reduced infant deaths by 12 percent compared to keeping cords dry. Using CHG also halved the number of newborn babies that suffered from omphalitis, swelling of the cord stump commonly caused by bacterial infections. • "Based on our review, using chlorhexidine to clean the umbilical cord saves newborn babies lives," says lead researcher Anju Sinha, who is based at the Indian Council of Medical Research in New Delhi, India. Source: IC Today 3/10/15 • The authors conclude that further evidence from African countries is needed to help to support the findings. "The greatest benefits were seen in the South-East Asian studies," says Sinha. "The results from African studies are less convincing, so we would like to see whether the results from ongoing trials in Zambia and Tanzania can substantiate this evidence."

10. Tulane primate lab employee found positive for dangerous bacteria • A Tulane lab employee is the first human to test positive for a deadly bacteria that mysteriously escaped a Tulane primate research laboratory, a Tulane University spokeswoman said. • At least eight monkeys at the Tulane National Primate Center in New Orleans initially tested positive for exposure to burkholderia pseudomallei, a potentially deadly form of bacteria more commonly found in Southeast Asia and Northern Australia. A federal investigator also tested positive for being exposed to the bacteria, but in that case it wasn't clear if he was exposed at the center or during a visit to an infected region, according to the U.S. Centers for Disease Control and Prevention. But blood tests from an animal clinic employee at the center showed current or prior exposure to the dangerous bacteria, Tulane officials announced Wednesday. However, the antibodies found in the blood that indicate the positive reading were still very low and the employee showed no symptoms. CDC officials have said there is no risk to the public from the outbreak. It's unclear how the bacteria from the high-tech security lab at the research center initially infected the primates. • Source: Tulane Primate Lab Worker Contracts Rare Bacteria