Infection Prevention eBug Bytes February 2014

1. Infection PreventioneBug BytesFebruary 2014

2. Microbial contamination confirmed in Rx Formulations’ sterile product The FDAis alerting health care providers, hospital supply managers, and pharmacists that 2 to 3 millimeter, irregularly shaped floating matter was observed in calcium gluconate injection from an intact, unused vial produced at Rx Formulations, Mesa, Ariz. Rx Formulations informed FDA that it is recalling products marketed as sterile that were made in the same area of the facility as the contaminated product. The following products, compounded in Hood #2 between Nov. 7 and Dec. 11, 2013, are subject to the recall by Rx Formulations: Calcium Gluconate 10%, Magnesium Sulfate Potassium Phosphates 4.4 mEq/ml, Oxytocin 10 Units/ml, Sodium Bicarbonate 8.4%, Bupivacaine 3% A contaminated injectable drug can put patients at risk of adverse health consequences and possibly a serious infection. Therefore, these products should not be administered to patients. Health care providers and hospital staff should immediately check their medical supplies, quarantine the products being recalled, and follow the recall instructions from Rx Formulations. FDA has not received any adverse event reports associated with calcium gluconate injection from Rx Formulations. FDA asks health care providers and consumers to report adverse reactions to the FDA’s MedWatch5 Adverse Event Reporting program:

3. Surgery Patients May Have Been Exposed to CJD at N.C. Hospital Doctors and hospital officials from Novant Health Forsyth Medical Center in Winston-Salem, North Carolina, are notifying 18 neurosurgery patients that they might have been exposed to Creutzfeldt-Jakob disease, a serious and incurable neurological disorder. "Today we are reaching out to 18 neurosurgery patients who were exposed to Creutzfeldt-Jakob disease over the last three weeks at Forsyth Medical Center”.According to the National Institute of Neurological Disorders and Stroke, CJD affects about one person in every 1 million people per year worldwide.The hospital confirmed that on January 18, an operation was performed on a patient with CJD symptoms who later tested positive for the illness. Even though the surgical instruments were sterilized by standard hospital procedures, they should have gone through enhanced sterilization procedures used when there are confirmed or suspected cases of CJD.The Centers for Disease Control and Prevention, as well as the World Health Organization, recommends that surgical equipment used on CJD patients be destroyed or decontaminated through an intense disinfecting process. Although CJD can be transferred through surgical equipment, hospital officials say the likelihood of these patients contracting the disease is very low. http://www.cnn.com/2014/02/10/health/north-carolina-creutzfeldt-jakob/

4. ASGE Issues Guidelines for Safety in the Gastrointestinal Endoscopy Unit The American Society for Gastrointestinal Endoscopy (ASGE) has issued "Guidelines for safety in the gastrointestinal endoscopy unit." The purpose of this new guideline is to present recommendations for endoscopy units in implementing and prioritizing safety efforts and to provide an endoscopy-specific guideline by which to evaluate endoscopy units.Historically, safety in the gastrointestinal (GI) endoscopy unit has focused on infection control, particularly around the reprocessing of endoscopes. Although ASGE has previously published guidelines on staffing, sedation, infection control, and endoscope reprocessing for endoscopic procedures, rare reports of outbreaks in which the transmission of infectious agents were related to GI endoscopy have highlighted the need to address potential areas in the endoscopy care continuum that could impact patient safety. Changes to the Centers for Medicare and Medicaid Services (CMS) Ambulatory Surgical Center Conditions for Coverage that went into effect in 2009 eliminated the distinction between a sterile surgical room and a non-sterile procedure room, providing further impetus for this guideline. As a result of these conditions, non-sterile procedure environments, including endoscopy units, are now held to the same standards as sterile operating rooms even though requirements for facilities, infection control, staffing, and sedation applicable to the sterile operating room may not be relevant or necessary for endoscopy units.

5. Nursing assistants most likely to pick up C. diff spores Researchers examined caregivers' hands after contact with patients with C. diff infections. They found that even when clinicians take precautions like wearing disposable gowns with full-length gloves and sleeves, about 25 percent of healthcare workers had C. diff spores on their hands after providing routine care to the patients. The likelihood of contamination increased in cases of high-risk contact like changing bed linen or digital rectal exams.The research team observed hand contamination in 42 percent of nursing assistants, compared to 23 percent of physicians and 19 percent of nurses. Researchers attributed the higher levels due to the fact nursing assistants had a greater amount of high-risk contact. Duration of high-risk contact was positively associated with hand contamination. To our knowledge, this is the first time that duration of contact has been reported as a risk factor for hand contamination.Landelle also emphasized the need to follow proper hand-washing protocols to safeguard against infections, according to the article. Source: InfecContr Hosp Epid – Jan 2014

6. CRE Outbreaks Linked to Contaminated Endoscopes Advocate Lutheran General Hospital (Park Ridge, IL) reported in 2013 that it had, recently and unprecedentedly, notified 243 patients of the potential for them to have been infected during a medical procedure with a “superbug” (so named primarily because of its resistance to antibiotics) called carbapenem-resistant Enterobacteriaceae, or “CRE” for short. These 243 patients were considered “at risk” and told by hospital officials to be screened and evaluated for infection with CRE because of the outbreak investigation’s determination that each of these patients may have been exposed to a routinely used medical instrument contaminated with this superbug while having undergone a certain gastrointestinal (GI) procedure called endoscopic retrograde cholangiopancreatography, or “ERCP,” performed at this hospital between January, 2013, and September, 2013. Of these 243 patients, over 100 returned to the hospital to be tested, and — representing the largest outbreak of this superbug in U.S. history, to date — 38 patients were found to be either infected or colonized with the outbreak’s strain of CRE. http://endoscopereprocessing.com/2014/01/multiple-superbug-outbreaks-linked-contaminated-endoscopes-u-s-europe-smoking-gun/

7. Hepatitis C probe continues at Brantford General Hospital (BGH) Infection control specialists spent the week completing audits of the hospital’s procedures, which looked at staff and physician practices, sterilization techniques, medical administration and other procedural aspects. Last Thursday, it was announced that hospital staff recently became aware of a possible breach in protocols after two people who received endoscopies at the hospital became infected with Hepatitis C. The two patients who contracted the disease each underwent an endoscopy about five months apart, on May 29 and Nov. 8.The investigation led to the possibility that human error caused cross-contamination of medication supplies used between affected patients. Moving forward, the hospital will implement explicit and comprehensive guidelines on the preparation, labeling, delivery, storage, documentation and discarding of all medications used in endoscopy. Additional training on sterilization techniques for all staff involved in endoscopies and the implementation of additional guidelines in the storage, sterilization and disinfection of equipment – above and beyond standard practice – will also become part of procedures at BGH. http://www.brantnews.com/news-story/4329410-hep-c-probe-continues-at-bgh/

8. C. diff infections hit record high People getting medical care can catch serious infections called health care-associated infections (HAIs). While most types of HAIs are declining, one – caused by the germ C. difficile – remains at historically high levels. C. difficile causes diarrhea linked to 14,000 American deaths each year. Those most at risk are people, especially older adults, who take antibiotics and also get medical care. When a person takes antibiotics, good germs that protect against infection are destroyed for several months. During this time, patients can get sick from C. difficile picked up from contaminated surfaces or spread from a health care provider's hands. About 25% of C. difficile infections first show symptoms in hospital patients; 75% first show in nursing home patients or in people recently cared for in doctors' offices and clinics. C. difficile infections cost at least $1 billion in extra health care costs annually. Hospital stays from C. difficile infections tripled in the last decade, posing a patient safety threat especially harmful to older Americans. Hospitals following infection control recommendations lowered C. difficile infection rates by 20% in less than 2 years. http://www.cdc.gov/VitalSigns/Hai/StoppingCdifficile/

9. Hospital water taps contaminated with bacteria Researchers found the total microbial load was up to 10 times greater when aerators were in place than after they had been sterilized. Their findings show that opportunist micro-organisms like Legionella spp., Acinetobacter spp. and other Gram-negative bacteria were significantly higher at the faucet than in the plumbing system Throughout the study, researchers consistently noted chlorine levels that were too low and hot water temperatures that were below the minimal temperature needed to prevent the growth of Legionella Both of these factors promote the growth of waterborne pathogens. http://www.shea-online.org/View/ArticleId/251/Hospital-Water-Taps-Contaminated-with-Bacteria.aspx

10. More than 300 people fall ill aboard cruise ship The CDC are investigating how more than 300 people have fallen ill on board a ship cruising the Caribbean. The CDC said that health officials would board Royal Caribbean's Explorer of the Seas Sunday, when it is scheduled to dock at St. Thomas, U.S. Virgin Islands.   In all, 281 passengers and 22 crew members have reportedly fallen ill during the voyage, with most reporting vomiting and diarrhea. The CDC said it was not immediately clear what had caused the apparent outbreak. In response, the agency said that the ship's crew had stepped up its cleaning and disinfecting actions, encouraged passengers to report possible new cases, and prepared for new crew members to join the voyage midway through the journey. The ship had departed Cape Liberty, NJ on January 21 for a scheduled 10-day cruise to the island of St. Maarten, which included scheduled stops in Haiti and Puerto Rico. There are a total of 3,050 passengers and 1,165 crew on board. Fox News

11. VA Hospital finds ways to tame MRSA super bug; hospitals urged to follow example Before 2007, the potentially deadly super bug MRSA stalked patients at the Louisville Veterans Affairs Medical Center - with infection rates 20 times higher than they are today. That was before the VA began screening every patient admitted or moved from one unit to another, to see if they unknowingly carried the antibiotic-resistant and highly contagious bacteria, and then, if they found it, taking extra care to ensure it wouldn't spread.  The result? MRSA infections have fallen to 0.09 infections per 1,000 "bed days of care," or days patients stay in a bed, compared with 1.89 infections per 1,000 in 2008. Lisa McGiffert, director of the Safe Patient Project at Consumers Union, a national consumer protection organization, pointed out that five other states require hospitals to conduct at least some MRSA screening.