Transcript File - Working Toward Zero HAIs

Unit Based Champions
Infection Prevention
eBug Bytes
March 2013
Thousands of Oklahoma dental
patients urged to get tested for HIV
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Thousands of patients of an Oklahoma dentist are being urged to get
tested for HIV and hepatitis after public health officials found evidence of
practices that could have exposed patients to the viruses. The Oklahoma
and Tulsa health departments said Thursday approximately 7,000 people
who were treated at clinics operated by Dr. W. Scott Harrington could
have been exposed to Hepatitis B, hepatitis C, and HIV, the virus that
causes AIDS, calling the dentist "a menace to public health.“ State and
county health inspectors went to Harrington's practice after a patient with
no known risk factors tested positive for both hepatitis C and the virus
that causes AIDS.
The agencies found "major violations“ - employees using dirty equipment,
reusing needles and administering drugs without a license, multiple
sterilization issue, the use of a separate, rusty, set of instruments for
patients who were known to carry infectious diseases. Rusted
instruments are porous and cannot be properly sterilized," the board said
in a 17-count complaint against the dentist.
Source: Fox News March 29 2013
Ottawa Hospital C. difficile outbreak blamed
on clutter, poor cleaning
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C. difficile is an antibiotic-resistant infection that colonizes in a person’s
bowels. It is common in hospitals where it can spread easily on surfaces
that require intensive cleaning to remove it and is more severe in elderly
patients and those with compromised immune systems. Infection rates first
spiked last spring at The Ottawa Hospital and have remained stubbornly
high. The General campus then saw historically high rates in January with 15
new C. difficile infections, matching the number from December. While
infections fell to six new cases in February, the Civic campus saw a jump
from eight infections in January to 14 in February.
In response, the hospital introduced the SWAT teams, which are made up
of clinic, housekeeping and infection control staff and are designed to
provide quick responses to outbreaks. The hospital has also introduced
new cleaning inspection practices by using ultraviolet lights to detect areas
that have been missed. Worthington recognized that overcrowding was also
a factor in the battle against C. difficile, and nurses at the hospital say the
problem is not getting better. Patients regularly stay on beds in hallways and
patients have been kept overnight in recovery rooms because there is
nowhere else to put them. www.ottawacitizen.com
C. diff prevention activities fail
to halt spread
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According to the new survey, 70 percent of infection preventionists have adopted
additional interventions in their healthcare facilities to address C. difficile infection
(CDI) since March of 2010, but only 42 percent have seen a decline in their
healthcare facility-associated CDI rates during that time period; 43 percent have
not seen a decline. While CDI rates have climbed to all-time highs in recent years,
few facilities (21 percent of respondents) have added more infection prevention
staff to address the problem. APIC conducted the 2013 CDI Pace of Progress
survey in January 2013 to assess activities that have been implemented in U.S.
healthcare facilities in the last three years to prevent and control CDI, a healthcareassociated infection that kills 14,000 Americans each year.
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Survey also noted an inconsistency between cleaning efforts and monitoring. More
than nine in 10 respondents (92 percent) have increased the emphasis on
environmental cleaning and equipment decontamination practices since March
2010, but 64 percent said they rely on observation, versus more accurate and
reliable monitoring technologies to assess cleaning effectiveness. Fourteen percent
said that nothing was being done to monitor room cleaning.
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Sixty percent of respondents have antimicrobial stewardship programs at their
facilities, compared with 52 percent in 2010. Because antimicrobial use is one of the
most important risk factors for CDI, stewardship programs that promote judicious
use of antimicrobials should be encouraged.
Antibiotic-Resistant Strain of E. Coli
Increasing Among Older Adults and
Residents of Nursing Homes
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Antibiotic-resistant Escherichia coli (E. coli) continues to proliferate, driven
largely by expansion of a strain of E. coli know as sequence type ST131. A
new study points to hospitals and long-term care facilities (LTCF) as settings
in which this antibiotic-resistant strain is increasingly found. E. coli is the
most common gram-negative pathogen, causing both gastrointestinal disease
and extraintestinal infections such as pneumonia, meningitis, and
bloodstream, urinary tract, abdominal, and wound infections. Strains of E. coli
that are resistant to single or multiple classes of antibiotics are becoming
more prevalent. E. coli ST131 is commonly associated with fluoroquinolone
resistance. In this retrospective study, investigators evaluated nearly 300
consecutive patients in Olmsted County, Minnesota with extraintestinal E.
coli infections and found ST131 to be a dominant, antimicrobial-resistant
clonal group associated with older age, long-term care facility residence,
complicated infections, history of urinary tract infection, and prior
antimicrobial use. Patients with ST131 isolates were often treated with
ineffective antibiotics at first and as a result they had recurrent or persistent
symptoms. Reference: ICHE, March 2013
Nurse Shortage, NICU Infection
Rates Linked
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Neonatal intensive care units (NICUs) are widely understaffed, potentially
increasing the risk of infection in critically ill babies, researchers reported.
In a retrospective study, hospitals understaffed nearly one-third of their
NICU infants and more than 90% of their high-acuity NICU infants in 2009,
relative to staffing guidelines, Jeannette Rogowski, PhD, of the University of
Medicine and Dentistry of New Jersey in Piscataway, and colleagues reported
online in JAMA Pediatrics. In addition, infection rates for very low birth weight
infants were 16.5% in 2008 and 13.9% in 2009, with higher levels of nurse
understaffing associated with 40% higher odds of infant infection. National
guidelines specify nurse-to-patient staffing levels that are typically based on
acuity. For instance, the lowest-acuity infants have a recommended nurse-topatient ratio of 1 to 3 or 4, but the highest-acuity infants have ratios of
greater than one nurse per patient. But studies have shown shortfalls in
NICU nurse staffing, which have been associated with higher rates of
nosocomial infections, particularly among infants with very low birth weights.
The researchers conducted a retrospective cohort study using 67 NICUs
from the Vermont Oxford Network, with data on 5,771 very low birth
weight babies from 2008 and 5,630 very low weight babies from 2009.
Reference: JAMA Pediatrics March 2013
Drug-Resistant MRSA Bacteria Here to
Stay in Hospital and Community Settings
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Researchers at Princeton University used mathematical models to explore
what will happen to community and hospital MRSA strains, which differ
genetically. Originally methicillin-resistant Staphylococcus aureus (MRSA)
was confined to hospitals. However, community-associated strains
emerged in the past decade and can spread widely from person to person
in schools, athletic facilities and homes.
Both community and hospital strains cause diseases ranging from skin and
soft-tissue infections to pneumonia and septicemia. Hospital MRSA is
resistant to numerous antibiotics and is very difficult to treat, while
community MRSA is resistant to fewer antibiotics.
The new study found that these differences in antibiotic resistance,
combined with more aggressive antibiotic usage patterns in hospitals
versus the community setting, over time will permit hospital strains to
survive despite the competition from community strains. Hospital-based
antibiotic usage is likely to successfully treat patients infected with
community strains, preventing the newcomer strains from spreading to
new patients and gaining the foothold they need to out-compete the
hospital strains. www.infectioncontroltoday.com
Tamiflu Resistance May
Be Rising
The pandemic H1N1 influenza A strain -- now circulating as seasonal flu -appears to be developing resistance to oseltamivir (Tamiflu) in Australia, a
researcher is reporting there. And increasingly the resistance is being seen
among patients never treated with the drug, according to Aeron Hurt, PhD, of
the World Health Organization's Collaborating Centre for Reference and
Research on Influenza in Melbourne, Australia.
That finding, Hurt is scheduled to tell attendees at the annual meeting of the
Australasian Society for Infectious Diseases, which begins Wednesday,
suggests that strains resistant to oseltamivir might be fit enough to spread
widely in the community. The fear is not without precedent -- an oseltamivirresistant seasonal influenza A strain (also H1N1) spread globally in 2008,
which reduced the effectiveness of the drug. Oseltamivir is prescribed to
prevent complications of the flu. And Hurt and colleagues reported in 2011
that the pandemic strain showed oseltamivir resistance in a cluster of cases
in the Australian state of New South Wales. In that cluster, 29 of 182 patients
-- or 15.9% -- had virus that was resistant to the drug.
Source reference:
Hurt AC, et al. "Antiviral resistance in influenza: The current situation and future risks" ASID 2013.
New Heart Warning for Popular
Z-Pak Antibiotics
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An antibiotic used to treat common infections may carry serious heart
risks, according to a new warning from the U.S. Food and Drug
Administration. The drug, called azithromycin but sold under the brand
names Zithromax and Zmax as Z-Pak capsules, is prescribed for
infections of the ears, lungs, sinuses, skin, throat, and reproductive
organs, according to the FDA. But the antibiotic can interfere with the
heart’s electrical activity, disturbing its rhythm with potentially fatal
consequences. “Health care professionals should consider the risk of
fatal heart rhythms with azithromycin when considering treatment
options for patients who are already at risk for cardiovascular events,”
the FDA said in a statement. Elderly people and those with irregular
heart rates, arrhythmias, and low blood levels of potassium or
magnesium are at a particularly high risk for the deadly heart condition,
according to the FDA. The warning comes 10 months after a study
published in the New England Journal of Medicine found a small
increase in cardiovascular deaths among people treated with Zithromax
compared to those given the antibiotics amoxicillin or ciprofloxacin or
no treatment at all. Source: NEJM
FDA alert: Compounding
pharmacy recall
A New Jersey compounding pharmacy is voluntarily recalling a
number of antibiotics and anesthetic/analgesic solutions due
to mold contamination, according to an FDA alert.
Med Prep Consulting, Inc. in Tinton Falls, N.J., was notified by a
Connecticut hospital that found visible particulate
contaminants in 50 ml bags of magnesium sulfate 2gm in
dextrose 5% in water, 50 ml for injection intravenous solution
confirmed to be mold. Administration of an intravenous
product that is contaminated with mold could result in a fatal
infection in a broad array of patients. To date, no injuries or
illnesses have been reported, according to the alert.
(UHS does not use this compounding company)
ACIP considers revising Tdap
revaccination recommendations
The Advisory Committee on Immunization Practices (ACIP) is considering an
alternative revaccination schedule for the tetanus-diptheria- acellular
pertussis (Tdap) vaccine to improve the vaccine’s coverage of pertussis
The occurrence of pertussis in the United States has drastically reduced
since the vaccine’s inception and the overall burden has been reduced, but in
recent years there have been increases in pertussis with notable epidemic
years. National overall pertussis incidence in 2012 was 13.4 cases per
100,000 with the rate reaching as high as 100 cases per 100,00 in some
states, according to preliminary data cited by Thomas Clark, MD, medical
epidemiologist for the CDC.
A group is considering data to assess the safety and cost-effectiveness of
shortening the intervals between revaccination with the Tdap vaccine to
combat waning immunity to pertussis, and it hopes to have recommendations
for the ACIP meeting in June.
Trends in Tuberculosis —
United States, 2012
In 2012, a total of 9,951 new tuberculosis (TB) cases were reported in the
United States, an incidence of 3.2 cases per 100,000 population. This
represents a decrease of 6.1% from the incidence reported in 2011 and is the
20th consecutive year of declining rates. Of the 3,143 counties in the United
States, 1,388 (44.2%) did not report a new TB case during 2010–2012.
The TB rate in foreign-born persons in the United States was 11.5 times as
high as in U.S.-born persons. In comparison with non-Hispanic whites, TB
rates among non- Hispanic Asians, Hispanics, and non-Hispanic blacks were
25.0, 6.6, and 7.3 times as high, respectively.
Although the number of cases dropped below 10,000 for the first time since
standardized national reporting of TB began in 1953, a number of challenges
remain that slow progress toward the goal of TB elimination in the United
States.
Initiatives to increase TB awareness and testing and treatment of latent
infection and disease will be critical to TB elimination efforts, especially
among foreign-born populations, racial/ethnic minorities, and other groups
that are disproportionately affected. MMWR / Vol. 62 / No. 11