Transcript File - Working Toward Zero HAIs

Unit Based Champions
Infection Prevention
eBug Bytes
December 2011
Pneumonia Most Common
Infection After Heart Surgery







Researchers analyzed more than 5,100 patients in a heart surgery registry.
Patients, average age 64, were treated at nine U.S. academic medical centers
and one Canadian center. The median time to major infection was 14 days
after heart surgeries. Forty-three percent of all major infections occurred
after hospital discharge. In this study, which excluded patients who were
infected before surgery, researchers found 761 infections: 300 were
classified as major infections (occurring in 6 percent of patients) and 461
were minor (in 8.1 percent of patients). Of the major infections:
Pneumonia, infection of the lungs, occurred in 2.4 percent of all patients.
C. difficile colitis, an intestinal infection, occurred in 1.0 percent.
Bloodstream infections occurred in 1.1 percent.
Deep-incision surgical site infections occurred in 0.5 percent.
Minor infections included urinary tract and superficial incision site
infections.
References: Presented at the American Heart Association's Scientific
Sessions 2011
2 Out of 3 Medical Students Don't
Know When to Wash Their Hands

Three researchers from the Institute for Medical
Microbiology and Hospital Epidemiology at Hannover
Medical School in Hannover, Germany collected surveys
from 85 medical students in their third year of study during a
lecture class that all students must pass before bedside
training and contact with patients commences. Students
were given seven scenarios, of which five (“before contact to
a patient,” “before preparation of intravenous fluids,” “after
removal of gloves,” “after contact to the patient’s bed,” and
“after contact to vomit”) were correct hand hygiene (HH)
indications. Only 33 percent of the students correctly
identified all five true indications, and only 21 percent
correctly identified all true and false indications.
C. diff Infection Prolongs Hospital
Length of Stay



Hospital-acquired infection with C. difficile was identified in 1,393 of 136
877 admissions to hospita. l The crude median length of stay in hospital wa
greater for patients with hospital-acquired C. difficile (34 d) than for those
without C. difficile (8 d). Survival analysis showed that hospital-acquired
infection with C. difficile increased the median length of stay in hospital by
six days. In adjusted analyses, hospital-acquired C. difficile was significantly
associated with time to discharge, modified by baseline risk of death and
time to acquisition of C. difficile.
The researchers concluded that hospital-acquired infection with C. difficile
significantly prolonged length of stay in hospital independent of baseline
risk of death. Their research was published in the Canadian Medical
Association Journal.
Reference: Forster AJ, Taljaard M, Oake N, Wilson K, Roth V and van
Walrave C. The effect of hospital-acquired infection with Clostridium
difficile on length of stay in hospital. CMAJ Dec. 5, 2011. doi:
10.1503/cmaj.110543
Patient Isolation Associated With
Hospital Delirium



A team of researchers led by Dr. Hannah Day of the University of
Maryland School of Medicine examined two years of data from the
university's 662-bed medical center. They found that patients who
were placed on contact precautions at some point after admission
to the hospital were 1.75 times more likely to develop delirium.
However, patients on contact precautions starting at admission
were no more likely to develop delirium. That finding, the
researchers say, suggests that it may not be the precautions
themselves causing delirium. "Patients in our study who were
placed on contact precautions later in their hospitalization were
generally sicker than those who were on contact precautions from
the outset," said Dr. Day. "So it's possible that the underlying illness
rather than the precautions themselves is responsible for the
association with delirium."
Journal Reference:
Hannah R. Day, Eli N. Perencevich, Anthony D. Harris, Ann L. Gruber-Baldini, Seth S.
Himelhoch, Clayton H. Brown, Emily Dotter, and Daniel J. Morgan. The
Association between Contact Precautions and Delirium at a Tertiary
Care Center. Infection Control and Hospital Epidemiology, 33:1 (January 2012)
Survival of Bacterial Pathogens on Paper
and Bacterial Retrieval from Paper to
Hands

Samples of four bacterial pathogens (Escherichia coli, Staphylococcus aureus,
Pseudomonas aeruginosa, and Enterococcus hirae) were prepared according to standard
laboratory procedures. Sterile swatches of office paper were inoculated with the
pathogens and bacterial survival was tested over seven days. To test the transmission
of bacteria from one person's hands to paper and back to another person's hands,
the fingertips of volunteers were inoculated with a nonpathogenic strain of E. coli;
these volunteers then pressed the inoculum onto sterile paper swatches. Another
group of volunteers whose hands had been moistened pressed their fingertips onto
the contaminated paper swatches. Bacteria transferred to the moistened fingertips
were cultivated according to standard laboratory procedures.

Results: The four tested organisms showed differences in length of survival
depending on environmental room conditions, but were stable on paper for up to 72
hours and still cultivable after seven days. Test organisms were transferred to paper,
survived on it, and were retransferred back to hands.

Conclusion: Paper can serve as a vehicle for cross-contamination of bacterial
pathogens in medical settings if current recommendations on hand hygiene aren't
meticulously followed.

Reference: AJN, American Journal of Nursing: December 2011 - Volume 111 - Issue
12 - pp 30-34
Microbial Contamination of
OJ in Bars and Restaurants
Around 40 percent of the fresh orange juice consumed in Spain is
squeezed in bars and restaurants. According to a study conducted by
researchers at the University of Valencia (UV) though, poor handling of the
oranges and insufficient cleaning of the juicer equipment stimulates
bacterial contamination.
The team collected 190 batches of squeezed orange juice from different
catering locations and analysed their microbiological content on the same
day. The results reveal that 43 percent of the samples exceeded the
enterobacteriaceae levels deemed acceptable by food regulations in Spain
and Europe. Furthermore, 12 percent of samples exceeded mesophilic
aerobic microorganism levels.
According to the data published in the Food Control Journal, the presence
of Staphylococcus aureus and the Salmonella species was found in
1percent and 0.5 percent of samples respectively.
Isabel Sospedra, one of the authors of the study warns that "generally a
percentage of oranges juice is consumed immediately after squeezing but,
as in many cases, it is kept unprotected in stainless steel jugs."
Reference: I. Sospedra, J. Rubert, J.M. Soriano, J. Mañes. "Incidence of microorganisms
from fresh orange juice processed by squeezing machines". Food Control 23 (1): 282-285,