Transcript File - Working Toward Zero HAIs

Unit Based Champions
Infection Prevention
eBug Bytes
October 2013
Hong Kong quarantines 19
people after second case of H7N9
Hong Kong health officials have quarantined 19 people who had contact with
an 80-year-old man confirmed to have the city's second case of H7N9
influenza, which has killed 45 people in China this year. The patient is a
long-term resident of mainland China who was hospitalized in the border city
of Shenzhen from Nov. 13 to Nov. 29 for treatment of an underlying chronic
illness, the Hong Kong government said in a statement on Dec. 6. He moved
to Hong Kong on Dec. 3 and was admitted to Tuen Mun Hospital, where he
tested positive for the new strain of bird flu after developing a fever, the
statement shows.
The government said it will transfer the patient, who is in stable condition, to
the isolation ward at Princess Margaret Hospital. It's not yet known if he had
contact with live poultry though he is thought to have eaten chicken, Hong
Kong's Commercial Radio reported yesterday, citing Ko Wing-man, the city's
health secretary.
A total of 19 people had contact with the man after he arrived in Hong Kong,
including 13 patients in Tuen Mun Hospital, five relatives and one taxi driver.
Source: http://www.bloomberg.com/news/2013-12-08/hong-kong-quarantines-19people-aftersecond-case-of-h7n9.html
Resistant H7N9 flu virus keeps
contagiousness
• H7N9 erupted in eastern China earlier this year. The first laboratory-confirmed
cases occurred among three people in the Shanghai area and were reported
on March 31. In all, 139 human cases of H7N9 have been reported, with 45
deaths, according to the WHO's website. H7N9 is believed to have spread to
humans from poultry, where it circulates naturally. The UN's World Health
Organization (WHO) says that "so far", no evidence has emerged of "sustained"
transmission of H7N9 among people.
• Replicating the virus in high-security conditions, they found it had a mutation
that made it resistant to the two frontline antiviral drugs-Tamiflu (lab name
oseltamivir) and Peramivir-and partially resistant to a third drug, Relenza
(zanamivir). The mutant variety of H7N9 replicated as easily and as virulently
as the non-mutant strain in human respiratory cells in a lab dish, in mice lungs
and in guinea pigs.
• The discovery is unusual as "seasonal" influenza-common-or-garden flu strains
that erupt every winter-typically loses some of its contagiousness when a
strain becomes drug-resistant. Source: Nature Communications Dec 2013
Public gets early snapshot of MRSA and
C. difficile infections in individual
hospitals
• New data gathered through the Centers for Disease Control and Prevention's
(CDC) National Healthcare Safety Network (NHSN) gives patients a first look at
how their local hospitals are doing at preventing Clostridium difficile infections
(deadly diarrhea) and methicillin-resistant Staphylococcus aureus (MRSA)
bloodstream infections.
• C. difficile causes at least 250,000 hospitalizations and 14,000 deaths every year,
and was recently categorized by CDC as an urgent threat to patient safety. On the
other hand, although still a common and severe threat to patients, invasive
MRSA infections in healthcare settings appear to be declining. Between 2005 and
2011 overall rates of invasive MRSA dropped 31 percent. Success began with
preventing central-line-associated bloodstream infections caused by MRSA, for
which rates fell nearly 50 percent from 1997 to 2007. Major teaching hospitals,
hospitals with more than 400 beds and those with high community-onset rates
continue to have the highest risk for C. difficile and MRSA bloodstream
infections, all of which is taken into account by risk adjustment when the clinical
quality measure is calculated.
FDA: Anti-bacterial soaps
may not curb bacteria
• Triclosan is an ingredient added to many consumer products to reduce or prevent
bacterial contamination. It may be found in products such as clothing, kitchenware,
furniture, and toys. It also may be added to antibacterial soaps and body washes,
toothpastes, and some cosmetics—products regulated by the U.S. Food and Drug
Administration (FDA). Triclosan is not currently known to be hazardous to humans.
But several scientific studies have come out since the last time FDA reviewed this
ingredient that merit further review. Animal studies have shown that triclosan
alters hormone regulation. However, data showing effects in animals don’t always
predict effects in humans. Other studies in bacteria have raised the possibility that
triclosan contributes to making bacteria resistant to antibiotics.
• The Federal Drug Administration proposed a rule Dec 16th which would require
manufacturers of antibacterial cleaners to prove their products are not only safe,
but more effective than plain soap and water. The FDA proposes that if the
antibacterial manufacturers cannot demonstrate their products to be more
effective and less harmful then soap and water, their products will have to be
reformulated, relabeled, or removed from the market.
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm205999.htm
Yogurt a solution to
hospital infection?
• In a medical system rife with complex equipment and outrageously expensive
drugs, a Pennsylvania hospital has turned to a cheap, low-tech solution for one
of modern medicine’s most challenging problems. Holy Redeemer in
Montgomery County, Pa., is using yogurt — the kind you could buy at the grocery
store — to fight C. difficile, a hospital-acquired infection that has been growing
throughout the country.
• After dietitians began encouraging patients taking antibiotics to eat yogurt, the
infection rate fell by two-thirds. Holy Redeemer has now expanded the program
to its nursing-home residents. “We were really surprised by how easy it was and
how quick it worked,” said Jeanie Ryan, a registered dietitian, who helped
coordinate the effort. “It was just so sudden and such a big impact, that it was
striking.” The Hospital & Health system Association of Pennsylvania earlier this
year gave Holy Redeemer an Innovation Award for the program. Other hospitals
remain skeptical. Thomas Jefferson University Hospital uses probiotics, or
beneficial yeast and bacteria, in pill form only in clinically stable patients who
must take antibiotics for long periods.
http://www.reporternews.com/news/2013/dec/17/yogurt-a-solution-to-hospital-infection/
Epidemic of E.coli infections traced
to one strain of bacteria
• In the past decade, a single strain of Escherichia coli, or E. coli, has become the
main cause of bacterial infections in women and the elderly by invading the
bladder and kidneys, according to a study published in the American Society for
Microbiology's open access journal mBio.
• Besides becoming more resistant to antibiotics, the strain H30-Rx gained an
unprecedented ability to spread from the urinary tract to the blood, leading to the
most lethal form of bacterial infections - sepsis- and posing a looming threat to the
more than 10 million Americans who annually suffer from urinary tract infections
(UTIs). This new study could help trace the evolutionary history of this superbug
and possibly lead to the development of a vaccine. H30-Rx, appears to be much
more adept than other E. coli at ascending from the bladder to the kidneys and
then into the bloodstream, where it can be lethal, and the study suggests that H30Rx may be responsible for 1.5 million UTIs and tens of thousands of deaths annually
in the United States. This study shows that, by focusing on H30-Rx, researchers
might find a vaccine that could prevent many infections. Vaccines for highly
resistant strains of superbugs could protect people from ever getting sick in the
first place. http://sphhs.gwu.edu/content/epidemic-escherichia-coli-infections-traced-one-strain-
Bipolaris in cardiac surgery
patients - Call for cases
• The Centers for Disease Control and Prevention (CDC), together with state and
local health department partners, continues to investigate an outbreak of
Bipolaris surgical site infections among cardiothoracic surgery patients.
Mediastinal infections due to molds following cardiothoracic surgery are a rare
but known complication, however Bipolaris is a very rare cause of these.
• To date, 13 culture-confirmed cases from six hospitals in two states have been
identified. Positive cultures were obtained between December 2008 and
November 2013; nine cases have occurred since May 2013. Cases ranged in age
from 1 month to 82 years, all cases are male. Commonalities include a history
of recent open cardiothoracic surgery (including CABG, heart transplantation
and valve replacement/repair); ICU care; and extended periods of open chest
wounds prior to eventual closure. Bipolaris isolates were obtained from tissue
and pleural/mediastinal fluid samples. Associated mortality has been high.
• Please report any cultures of Bipolaris obtained since 2008 from chest surgery
patients to Dr. Anne Purfield ([email protected]) of the Mycotic Diseases Branch of
the CDC.
E anophelis outbreak in an
intensive-care unit
• The hospital infection-control team at the National University Hospital of
Singapore identified three patients in the cardiothoracic intensive-care unit (ICU)
and two patients from the surgical ICU that were colonized with Elizabethkingia
during a 3 week period in 2012. The five patients, who were ventilated via
tracheostomy and had central venous catheters in situ, received multiple courses
• of broad-spectrum antibiotics. Before isolation of Elizabethkingia, three of the
patients had underlying solid-organ malignancy, one patient had multiple
abdominal surgeries, two patients underwent thoracic surgery, and one patient
was on extracorporeal membrane oxygenation. After isolation of the
Elizabethkingia strain, all patients were treated with intravenous piperacillin and
tazobactam, cotrimoxazole, or levofloxacin, either alone or in combination. Three
of the five patients died during their hospitalization. The history of this
microorganism starts with its description as a cause of infant meningitis by
Centers for Disease Control and Prevention (CDC). It was first isolated in 1959 and
named it Flavobacterium meningosepticum. It was subsequently renamed
Chryseobacterium meningosepticum, and classified in the new genus
Elizabethkingia, in 2005 . Source: Lancet. 2013 Sep 7;382(9895):855-6