Infection Prevention eBug Bytes August 2014

1. Infection PreventioneBug BytesAugust 2014 Eloba Virus

2. Woman suspected of Ebola dies in the UAE • The national airline of the United Arab Emirates said Monday it has disinfected one of its planes after health authorities there announced that a Nigerian woman who died after flying in to the capital, Abu Dhabi, may have been infected with the Ebola virus. • The health authority in Abu Dhabi said in a statement carried by state news agency WAM that the 35-year-old woman was traveling from Nigeria to India for treatment of advanced metastatic cancer. • Her health deteriorated while in transit at Abu Dhabi International Airport. As medics were trying to resuscitate her, they found signs that suggested a possible Ebola virus infection. The health authority noted, however, that her preexisting medical condition also could have explained her death. • Medical staff treating the woman followed safety and precautionary measures in line with World Health Organization guidelines, the health authority statement added. • Source: http://abcnews.go.com/Health/wireStory/nigerian-woman-suspected-ebola-dies-uae-25017915

3. MRSA colonization common in groin, rectal areas • Colonization of methicillin-resistant Staphylococcus aureus (MRSA) allows people in the community to unknowingly harbor and spread this life-threatening bacteria. The inside of the front of the nose is where this bacteria is most predominant, but new research shows nearly all colonized individuals have this bacteria living in other body sites. While people colonized with MRSA may not be sick, the bacteria can become aggressive and lead to infection in the person or others. Because of the risk of transmission, hospitals have developed infection control and prevention efforts that identify individuals with nasal MRSA colonization. Isolation and decolonization may be used. These strategies have been used to prevent MRSA infections and to decrease risk of spread of MRSA to other patients. Several states also mandate these MRSA surveillance programs. Researchers collected surveillance swab specimens for nose and other body sites from patients at Stroger Hospital of Cook County within 72 hours of admission from March 2011-April 2012. After analyzing the samples, researchers observed that, following the nose, the rectal and groin areas were frequent sites of colonization of community-associated MRSA. The bacteria were found in these body sites more often in men than women. "Our findings show that MRSA colonization is not limited to the nose. This may have important implications MRSA surveillance programs nationwide” • Source: Popovich et al. Anatomic Sites of Colonization with Community-Associated Methicillin-ResistantStaphylococcus aureus. ICHE,, 2014; 35 (9): 1192

4. Highly Drug-Resistant, Virulent Strain of Pseudomonas aeruginosa Arises in Ohio The strain of P. aeruginosa contained a gene for a drug resistant enzyme called a metallo beta-lactamase. Beta-lactamases enable broad-spectrum resistance to beta-lactam antibiotics, including carbapenems, cephalosporins, and penicillins, because they can break the four atom beta-lactam ring, a critical component of these antibiotics' structure. The initial isolate of metallo-beta-lactamase-producing P. aeruginosa was identified in March, 2012, in a foot wound of a 69-year-old man with type 2 diabetes living in a long-term care facility. During 2012-2013, the investigators identified this highly antibiotic-resistant infection in six other patients. One of the seven patients subsequently died of the infection. The cases are linked epidemiologically via admission to a community hospital and residence in long-term care facilities in Northeast Ohio. The one exception was a patient from Qatar who was transferred into a tertiary medical center in Ohio. Source: American Society for Microbiology (due for publication in October)

5. Gloves after hand washing associated with fewer infections in preterm babies • Extremely premature babies in a neonatal intensive care unit had fewer infections when medical staff wore gloves after washing their hands compared with hand washing alone. Even after hand washing, medical staff can still have microorganisms on their hands. This can be dangerous for extremely preterm newborns because of their immature immune systems and underdeveloped skin and mucosal barriers. Late-onset infections (more than 72 hours after birth) and necrotizing enterocolitis (NEC, tissue death in the intestines) can cause death and neurodevelopmental impairment in extremely premature babies. The randomized clinical trial at a single hospital NICU included 120 infants who were enrolled during a 30-month study period from December 2008 to June 2011. Infants were divided in two groups: 60 infants in group A where nonsterile gloves were used after hand washing and 60 infants in group B where hand washing alone was used. Late-onset invasive infection or NEC occurred in 32 % of infants (19 of 60) in group A compared with 45 % of infants (27 of 60) in group B. In group A compared with group B, there also were 53 % fewer gram-positive bloodstream infections and 64 percent fewer central line-associated bloodstream infections. Source: David A. Kaufman, Amy Blackman, Mark R. Conaway, Robert A. Sinkin. Nonsterile Glove Use in Addition to Hand Hygiene to Prevent Late-Onset Infection in Preterm Infants. JAMA Pediatrics, 2014; DOI: 10.1001/jamapediatrics.2014.953 • Susan E. Coffin. Fighting Infections in the Neonatal Intensive Care Unit. JAMA Pediatrics, 2014;

6. Scientists Develop Nasal Test for Human Prion Disease • A nasal brush test can rapidly and accurately diagnose Creutzfeldt-Jakob disease (CJD), an incurable and ultimately fatal neurodegenerative disorder, according to a study by National Institutes of Health (NIH) scientists and their Italian colleagues. • Up to now, a definitive CJD diagnosis required testing brain tissue obtained after death or by biopsy in living patients. The study describing the less invasive nasal test appears in the Aug. 7 issue of the New England Journal of Medicine. • CJD is a prion disease. These diseases originate when, for reasons not fully understood, normally harmless prion protein molecules become abnormal and gather in clusters. Prion diseases affect animals and people. Human prion diseases include variant, familial and sporadic CJD. The most common form, sporadic CJD, affects an estimated 1 in one million people annually worldwide. Other prion diseases include scrapie in sheep; chronic wasting disease in deer, elk and moose; and bovine spongiform encephalopathy (BSE), or mad cow disease, in cattle. Scientists have associated the accumulation of these clusters with tissue damage that leaves sponge-like holes in the brain. • Source: NEJM Aug 7 2014

7. Bacteria growing less susceptible to common antiseptic • Bacteria that cause life-threatening bloodstream infections in critically ill patients may be growing increasingly resistant to a common hospital antiseptic. Chlorhexidine gluconate (CHG) has been increasingly used in hospitals in light of recent evidence that daily antiseptic baths for patients in intensive care units (ICUs) may prevent infections and stop the spread of healthcare-associated infections. • In the study, investigators compared bacterial resistance between cultures from patients in eight ICUs receiving daily antiseptic washes to patients in 30 non-ICUs who did not bathe daily with CHG. Bacterial cultures obtained from patients with regular antiseptic baths showed reduced susceptibility to CHG when compared with those from patients who did not have antiseptic baths. Regardless of unit protocol, 69 percent of all bacteria showed reduced CHG susceptibility, a trend that requires vigilant monitoring. The investigators caution that the clinical implications of their findings remain unclear. For example, antibiotic susceptibility tests are commonly used to determine whether patients will respond to antibiotic treatment. A similar correlation between antiseptic susceptibility and response to an antiseptic are not as well defined. Source: Suwantarat el al, High Prevalence of Reduced Chlorhexidine Susceptibility in Organisms Causing Central Line–Associated Bloodstream Infections. ICHE, 2014; 35 (9): 1183

8. FDA Warns Inks Used in Certain Tattoo Kits Cause Infections • Recently, the Food and Drug Administration (FDA) became aware of a problem after testing inks in home-use tattoo kits marketed by White and Blue Lion, Inc. FDA has confirmed bacterial contamination in unopened bottles of the company’s inks. According to Linda Katz, MD, MPH, director of FDA’s Office of Cosmetics and Colors, using these inks for tattoos could cause infection. • Specifically, how can you identify kits and inks that you should not use because they may be contaminated? FDA advises you to watch out for inks intended for permanent makeup or traditional body tattoos that:- have no brand name, carry a dragon logo, and/or are missing the name and place of business of the manufacturer or distributor,- are sold singly and in kits containing anywhere from five to 54, or perhaps more, bottles of inks of various colors, and- are marked with “Lotch” [sic] and Batch numbers, and “Date produced” and “Best if used by” dates. Reporting an infection to FDA and the artist is important in order for FDA to investigate, and to enable the artist to take steps to prevent others from becoming infected,” says epidemiologist Katherine Hollinger, DVM, MPH, from the Office of Cosmetics and Colors. Source: FDA

9. Potential MERS transmission between bats, humans • Researchers have identified the mechanism used by the deadly MERS virus to transmit from bats to humans. Bats are a native reservoir for MERS and the finding could be critical for understanding the animal origins of the virus, as well as preventing and controlling the spread of MERS and related viruses in humans. MERS (Middle East respiratory syndrome) was first diagnosed in 2012 and has infected over 800 people worldwide since then. About 40 percent of those infected were killed by the disease. Research has linked MERS to the same coronavirus family as the epidemic virus SARS. Both are believed to have originated in bats. • "Overall, our findings suggest that MERS virus has successfully adapted to human cells for efficient infections, and HKU4 virus can potentially infect human cells," said Li. "MERS and MERS-related bat viruses present a constant and long-term threat to human health. So far little is known about these bat viruses that are evolutionary ancestors to human viruses. We need to look at bat viruses carefully, learn how they infect cells and jump species, and then develop strategies to block their transmission to humans.“ • Source: Yang et al. Receptor usage and cell entry of bat coronavirus HKU4 provide insight into bat-to-human transmission of MERS coronavirus. Proceedings of the National Academy of Sciences, 2014

10. Comprehensive UV Light Disinfection Study • This past week, a groundbreaking 28-month-long study funded by the Centers for Disease Control and Prevention (CDC) examining the real-world effectiveness of automated UV-C disinfection robot's impact on infection outcomes concluded the data collection phase of the research, with results expected to be published in the second quarter of 2015. • The study by the Duke University Prevention Epicenter Program, "The Benefits of Enhanced Terminal Room (BETR) Disinfection," is the most comprehensive research assessing automated UV-C disinfection completed to date and will present outcomes related to clostridium difficile (C. diff.), methicillin-resistant staphylococcus aureus (MRSA), multidrug-resistant acinetobacter baumanni and vancomycin-resistant enterococci. • Infection control researchers from Duke University Medical Center in Durham, North Carolina, and The University of North Carolina at Chapel Hill, have been collecting data across 10 hospitals and 25,000 disinfection cycles for more than 100,000 patient days to determine how UV-C emitting devices capable of measuring a specific UVC dose may improve patient outcomes and the quality of care. • Previous reports released from the study point to the effectiveness of TRU-D for patient rooms that are disinfected using the robot, as the researchers have seen more than 90 percent of pathogenic bacteria eradicated using only TRU-D with no manual pre-cleaning. • Source: http://www.infectioncontroltoday.com/news/2014/08/trud-tested-in-most-comprehensive-uv-disinfection-study-to-date.aspx