Transcript File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
December 2014
Airport Exit and Entry Screening for Ebola
August–November 10, 2014
• In response to the Ebola epidemic, CDC, the World Health Organization, and
other international organizations collaborated in August to screen for Ebola
persons at airports who were exiting countries with widespread transmission.
• Since the program began, an estimated 80,000 travelers have departed by air
from the three countries with widespread Ebola transmission.
• In October, an enhanced U.S. entry screening program was begun at five U.S.
airports as an added measure. Of 1,993 travelers screened, a total of 86 (4.3%)
were referred to CDC for additional evaluation, and seven (8.1%) were
symptomatic and referred for medical evaluation. None of the seven were
diagnosed with Ebola.
• Source: Clive M Brown, MBBS, Aaron E Aranas, MPH, Gabrielle A Benenson,
MPH, et al. MMWR Morb Mortal Wkly Rep 2014;63(Early Release):1-6
Research on farmers' markets shows
presence of Salmonella, E. coli
The study focused on farmers' markets in Los Angeles and Orange counties in
California, as well as in the Seattle, Washington, area. Specifically tested were
samples of the herbs cilantro, basil and parsley. Of the 133 samples tested from 13
farmers' markets, 24.1 percent tested positive for E. coli and one sample tested
positive for Salmonella. A total of 16 samples had average E. coli counts considered
to be unsatisfactory according to guidelines established by the Public Health
Laboratory Service. When tested for Salmonella, 15 samples had suspicious growth
but only one tested positive -- a parsley sample from a Los Angeles County farmers'
market. Orange County farmers' markets had the highest percentage of samples
with E. coli growth followed by farmers' markets in the greater Seattle area and Los
Angeles County.
Salmonella symptoms include diarrhea, abdominal cramps and fever around 12 to
72 hours after consumption that can last four to seven days. Symptoms for
pathogenic forms of E. coli include severe stomach cramps, diarrhea that often
becomes bloody, and vomiting.
Source: Donna J Levy, Nicola K Beck, Alexandra L Kossik, Taylor Patti, J Scott Meschke, Melissa Calicchia,
Rosalee S Hellberg. Microbial safety and quality of fresh herbs from Los Angeles, Orange County and
Seattle farmers' markets. Journal of the Science of Food and Agriculture, 2014
Kitchens are source of multi-drug
resistant bacteria
• Researchers from University Hospital in Basel, Switzerland collected and examined
298 cutting boards (154 from University Hospital and 144 from private households)
after preparation of various meats (i.e., poultry, beef/veal, pork, lamb, game and
fish) and before being cleaned. They also collected 20 pairs of gloves from hospital
kitchen employees after they handled raw poultry. These samples were tested for
the presence of ESBL-producing Enterobacteriaceae, a family of gram-negative
bacteria that includes Salmonella, E. coli and Klebsiella.
• In testing the cutting boards, researchers found that 6.5 percent of hospital cutting
boards used in preparation of poultry were contaminated with ESBL-producing E.
coli. For boards used in households, researchers found ESBL-producing E. coli on 3.5
percent of these surfaces. They also found that 50 percent of the hospital kitchen
gloves were contaminated with this drug-resistant E. coli. The researchers found
that none of the cutting boards used in preparing beef/veal, pork, lamb, game or
fish were contaminated with any ESBL-producing bacteria. They also found that the
meat's country of origin did not play a factor in the presence of bacteria on any of
the surfaces.
•
Source: Sarah Tschudin-Sutter, Reno Frei, Roger Stephan, Herbert Hächler, Danica Nogarth, Andreas F.
Widmer. Extended-Spectrum β-Lactamase (ESBL)–Producing Enterobacteriaceae: A Threat from the
Kitchen. Infection Control and Hospital Epidemiology, 2014; 35 (5): 581
Five dead, dozens ill from bacteria
linked to caramel apples
• Dec 19 2014: Five people have died and 21 others have been hospitalized in
recent weeks in a listeria outbreak linked to caramel apples. A total of 28 people
infected with listeria have been reported from 10 states. The CDC warned
consumers not to eat any pre-packaged, commercially-produced caramel apples,
including those with other toppings such as nuts, chocolate or sprinkles, until
more information is available.
• Of the 28 victims, 26 were hospitalized and five of those people died, the CDC
said, adding that listeriosis contributed to at least four of the deaths. Nine of the
cases involved a pregnant woman or her newborn infant. Listeriosis is an infection
that primarily affects older adults, pregnant women, newborns and people with
weakened immune symptoms. Symptoms include fever, muscle aches, headache,
confusion and convulsions.
• No illnesses related to the outbreak have been linked to apples that are not
caramel-coated and are not prepackaged, or to caramel candy. The cases were
diagnosed in late October and November.
• Source: http://www.cdc.gov/listeria/
Bacterial infections differ based on
geography, healthcare spending
• Where you live affects the type of bacteria that cause bloodstream infections,
according to researchers at Rhode Island Hospital and an international team of
investigators. The closer you live to the equator, the greater the likelihood of a
bloodstream infection caused by a group of bacteria called Gram-negative
bacteria, which thrive in warm and moist environments, compared to another
group of bacteria referred to as Gram-positive bacteria. The study also found that
the proportion of a country's GDP spent on health care impacted the type of
bacteria causing such infections.
• A five-member international steering committee that collected and studied data
from 2007-2011 from 23 medical centers (with two hospitals participating from
Sao Paolo, Brazil) including in the U.S., Greece, Egypt, Israel, Australia, Canada,
Japan, Italy, Netherlands, Thailand, Switzerland and Argentina. For each site, data
was obtained regarding latitude, longitude, mean annual precipitation, mean
daily temperature, population density, per-capita gross domestic product and the
percentage of GDP in that country allocated for health care.
•
Source: David Fisman, Eleni Patrozou, Yehuda Carmeli, Eli Perencevich, Ashleigh R. Tuite, Leonard A. Mermel.
Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with
Proximity to the Equator and Health Care Expenditure. PLoS ONE, 2014; 9 (12): e114548 DOI:
10.1371/journal.pone.0114548
Addition of Vancomycin to Cefazolin Prophylaxis Is
Associated With Acute Kidney Injury After Primary
Joint Arthroplasty
•
Researchers studied 1828 patients undergoing primary hip and knee arthroplasty over a 2year period who received either cefazolin (n = 500) or cefazolin and vancomycin (n = 1328)
as perioperative antibiotic prophylaxis. During the study period, a perceived high
prevalence of MRSA infections led some surgeons to add vancomycin to the prophylactic
antibiotic regimen. The patient characteristics, case mix, and preoperative renal function
and baseline creatinine clearance were similar between the two groups. AKI was defined
according to the published Acute Kidney Injury Network (AKIN) criteria, and the risk of AKI
in both groups was compared. Patients receiving dual antibiotics were more likely to
develop AKI compared with those receiving cefazolin alone (13% versus 8%, p = 0.002).
Dual-antibiotic prophylaxis also was associated with greater severity; patients in the dual
antibiotic group had higher rates of Grade II and III acute kidney injury (3% versus 0%, p =
0.003). Without a clear advantage in reducing surgical site infections, the utility and safety
of routine addition of vancomycin to the prophylactic regimen in all patients undergoing
primary hip and knee arthroplasty should be avoided. Further prospective studies should
look at the efficacy of preoperative MRSA screening, decolonization, and selective use of
vancomycin in high-risk patients.
• Source: Courtney PM et al. Clinical Orthopaedics and Related Research 11/2014
Portable UV light as an
alternative for decontamination
• Targeted surface disinfection is a key infection control measure. Usually,
decontamination of surfaces is performed by wiping the surface with some kind
of disinfecting agent or, in the case of auxiliary devices, submerging the entire
product in a disinfecting solution. In all of these cases, the success of surface
disinfection depends mainly on the type of pathogen, the type and concentration
of the active chemical substances, and the overall duration of the disinfection
process. Ultraviolet (UV) irradiation, which inactivates microorganisms by the
formation of DNA/RNA dimers, is widely used for the decontamination of safety
cabinets, for water decontamination, and in the food processing industry. This
study evaluated the capability of a new hand-held UV device to provide surface
decontamination
• The following species were tested: spores of Geobacillus stearothermophilus
Bacillus pumilus, Bacillus atropheaus and Clostridium difficile, and vegetative cells
from Staphylococcus aureus, Enterococcus faecium, Escherichia coli and
Acinetobacter baumannii. A minimum 90% reduction of viable organisms was
achieved within 40 seconds for all 4 spore species. In contrast, reproducible total
(100%) inactivation of the 4 non-spore-producing species occurred in less than 5
seconds. Source: Peterssen LP et al: American Journal of Infection Control 42 (2014) 1334-6
•
Buffer zone guidelines may be inadequate to
protect produce from feedlot contamination
The pathogen Escherichia coli O157:H7 can spread, likely airborne, more than one tenth mile
downwind from a cattle feedlot onto nearby produce. The high percentages of leafy greens
contaminated with E. coli suggest great risk for planting fresh produce 180 m [590 feet] or
less from a feedlot. That suggests that current buffer zone guidelines of 120 meters [400 feet]
from a feedlot may be inadequate. In the study, the investigators sampled leafy greens
growing in nine plots; three each at 60, 120, and 180 meters downwind from the cattle
feedlot at the research center, over a two year period. The rate of contamination with the
pathogenic E. coli O157:H7 declined with distance from an average of 3.5 percent of samples
per plot at 60 meters to 1.8 percent at 180 meters. The researchers sampled the produce six
times between June and September of each year. They also sampled the feedlot surface
manure in 10 feedlot pens for E. coli O157:H7, finding it in an average of 71.7 to 73.3 percent
of samples in 2012 and 2011, respectively. Moreover, the study's long-term nature enabled
sampling under a greater diversity of weather conditions. A variety of conditions can affect
the level of contamination. For example, following a period of high cattle management
activity when the feedlot was dry and dusty, including removal of around 300 head of cattle
for shipping, the rate of total non-pathogenic E. coli-contaminated samples per plot at 180
meters shot up to 92.2 percent. Conversely, total E. coli-positive leafy green samples were
notably lower on one August sample date than on any other date, a finding the investigators
attribute to cleaning and removal of feedlot surface manure from the nearby pens a few
weeks earlier. The highest levels of contamination found on leafy greens, in August and
September of 2012. Source: American Society for Microbiology December 2014
Trial confirms Ebola vaccine candidate safe,
equally immunogenic in Africa
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•
•
Two experimental DNA vaccines to prevent Ebola virus and the closely related Marburg virus
are safe, and generated a similar immune response in healthy Ugandan adults as reported in
healthy US adults earlier this year. Scientists from the NIAID developed the DNA vaccines
that code for Ebola virus proteins from the Zaire and Sudan strains and the Marburg virus
protein.
In this phase 1 trial, the Makerere University Walter Reed Program enrolled 108 healthy
adults aged between 18 and 50 from Kampala, Uganda between November, 2009 and April,
2010. Each volunteer was randomly assigned to receive an intramuscular injection of either
the Ebola vaccine (30 volunteers), Marburg vaccine (30), both vaccines (30), or placebo (18)
at the start of the study, and again 4 weeks and 8 weeks later. The vaccines given separately
and together were safe and stimulated an immune response in the form of neutralising
antibodies and T-cells against the virus proteins. Four weeks after the third injection, just
over half of the volunteers (57%; 17 of 30) had an antibody response to the Ebola Zaire
protein as did 14 of 30 participants who received both the Ebola and Marburg vaccines.
However, the antibodies were not long-lasting and returned to undetectable levels within 11
months of vaccination. Both DNA vaccines were well tolerated in Ugandan adults with
similar numbers of local and systemic reactions reported in all groups. Only one serious
adverse event (neutropenia; low white blood cell count) was reported in a Marburg vaccine
only recipient, but was not thought to be vaccine related.
Source: The Lancet, December 2014