Transcript File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
February 2016
Zika is possibly the scariest virus
since HIV
• Other viruses are known to harm neonates. For example genital herpes can be fatal
to a newborn, but this can be overcome by choosing a C-section over a natural
birth. Rubella (German measles) also causes birth defects, but there has been a
highly effective vaccine available since 1969. But, neither is spread by mosquitos,
which is why this scare is quite different, and why Zika is still a big unknown. It is
primarily being spread by the Aedes aegypti mosquito, which clearly prefers warm
areas, but they are not the only carrier. It was just revealed that Zika was detected
in amniotic fluid of two Brazilian women who gave birth to babies with
microcephaly. This suggests that the virus can cross the placenta. And a few days
earlier, the first evidence was produced of Zika in the brains of babies whose
mothers were (probably) infected with the virus during their first trimesters. The
first cases were seen on Bonaire this week. Puerto Rico is now using only imported
blood for transfusions, and a travel alert has been issued for Aruba. There have
been 82 cases reported in the U.S., all from travelers. The virus has been detected
in semen, urine, and saliva. There is very little that we know about this virus. It is
not unreasonable that Zika could infect more common mosquito species, such as
Culex, which could then put much of the country at potential risk. Although there
are successful vaccines for other flavivirus infections (yellow fever), it will take
years at a minimum to develop a Zika vaccine. Source: http://acsh.org/news
Bed bugs developing resistance to
common insecticides
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Researchers from Virginia Tech and New Mexico State University say the overuse of
commercial chemicals has made many of the pests resistant to the compounds. Now
researchers say bedbugs are becoming resistant to the most common insecticides used to
kill them. Specifically, the researchers looked at a group of commonly used pesticides called
neonicotinoids, which are often used together with pyrethroids to treat bedbugs.
To determine the bed bugs' resistance levels, the researchers took samples of the creatures
from several locations. Some had been exposed to neonicotinoids and some had been
isolated in a lab with no exposure to pesticides. In yet another group, the bugs had been
exposed to the poison, but not since 2008. The bugs from the non-exposed group died
when exposed to a small amount of insecticide, while those exposed in 2008 showed
"moderate resistance. The groups which had been exposed to pesticide had much higher
levels of resistance. When exposed to neonicotinoids, bed bugs produce "detoxifying
enzymes" to fight the effects of the chemicals. Those bugs with a history of exposure
appeared to have more of the enzymes than their susceptible counterparts.
This, researchers say, could mean having to look for other ways to stem the spread of the
blood-sucking insects. "Unfortunately, the insecticides we were hoping would help solve
some of our bed bug problems are no longer as effective as they used to be, so we need to
re-evaluate some of our strategies for fighting them," said Anderson.
Source: http://www.voanews.com/content/mht-bed-bugs-developing-resistance-tocommon-insecticides/3166627.html
10 Essential Facts About MERS
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1. The current MERS outbreak is centered in South Korea, with only one case each confirmed
in China, the Philippines, and Thailand this year. Most cases since the discovery of the virus
have been in one country — Saudi Arabia. MERS infections were first reported in 2012 in
that country. Only two U.S. cases of MERS have been reported — in 2014 — and both were
in health workers from Saudi Arabia who traveled to the United States (to Indiana and
Florida).
2. About 37 percent of patients who were diagnosed with MERS have died. While MERS is
rare, it can be deadly. As of June 19, a total of 1,338 cases and 475 deaths from MERS.
3. MERS-CoV belongs to a group of related pathogens known as coronaviruses.
4. MERS-CoV infections of camels have been reported and may put a person at risk too,
according to the CDC. Camels not only carry MERS but can also be a source of infection for
people
5. A person with a chronic condition is more susceptible to a severe case of MERS.
6. Coughing is one way the disease may be passed on to close contacts. Symptoms may
appear anywhere from 2 to 14 days after you’re exposed to MERS-CoV.
7. There is no MERS vaccine and no MERS-specific drug treatment.
8. If you are believed to have MERS and come to the United States, the CDC may detain you.
9. You can protect yourself from MERS by washing your hands frequently (and avoiding
camels).
10. The U.S. general public is at very low risk for MERS
Why it took years for the FDA to warn
about infections tied to medical scopes
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An outbreak at a Pennsylvania hospital in late 2012 should have been an early warning
that a reusable medical scope was spreading deadly infections and nearly impossible to
disinfect. But staff at the federal FDA lost the report, one of multiple missteps that
allowed doctors and hospitals to continue using the scope for three more years even as
dozens of patients were sickened. The missing paperwork, revealed in a recent Senate
inquiry, underscores the serious shortcomings in the antiquated national database used to
monitor the safety of medical devices.. Regulators did not warn hospitals about its risks
until after the Los Angeles Times reported an outbreak at UCLA that killed three patients.
Not only is the FDA's existing database of device injuries and deaths difficult to use, but it
relies on hospitals and manufacturers to report problems they are often reluctant to
disclose because of the possibility of litigation. In their Jan. 13 report, Senate investigators
found that not one of 16 or more hospitals with outbreaks linked to scopes properly filed
the federal report required when a medical device kills or injures a patient. By the time
the FDA began looking Olympus and another scope manufacturer had sent five reports of
outbreaks to the agency. But when the FDA staff searched the database, they found just
one of those reports. It took another 17 months for the agency to warn hospitals the
scope was almost impossible to clean. By then, at least 195 patients in 16 hospitals across
the country had been sickened. The FDA now makes a disclaimer when it uses information
from its database to evaluate the safety of a device.
Source: HPN Feb 2015
C section Study: CHG/alcohol vs
Iodine/alcohol
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An estimated 1.3 million women in the US delivered their babies by C-section in 2013, with
surgical-site infections complicating 5 to 12 percent of those deliveries. The average cost of
treating those cesarean-related infections in the hospital is $3,500 and may be much
higher for severe infections.
The research shows patients in the chlorhexidine-alcohol group developed significantly
fewer infections than patients in the iodine-alcohol group. Those who received the
chlorhexidine-alcohol combination had a 4 percent infection rate, which is nearly half that
of the patients who received the iodine-alcohol combination—7.3 percent. The clinical trial
included 1,147 patients who underwent cesarean sections at Barnes-Jewish Hospital from
2011 to 2015. Of 572 patients randomly assigned to receive the chlorhexidine-alcohol
combination, 23 developed an infection at the site of the surgery within 30 days of the
procedure. Of 575 patients who randomly received the iodine-alcohol combination, 42
developed a surgical-site infection. The investigators pointed out that all other standard
procedures for reducing the risk of infection after surgery, including giving preventive
antibiotics beforehand, were the same in both groups. The superiority of the
chlorhexidine-alcohol combination was consistent whether the C-section was scheduled or
unscheduled, whether or not the patient was obese, whether staples or sutures were used
to close the wound, and whether the patient had chronic medical conditions, including
diabetes. Source: NEJM Feb 4 2016
Island of Hawaii declares state of
emergency over dengue fever
• The mayor of Hawaii's Big Island declared a state of emergency on Monday to
deal with a growing outbreak of dengue fever, spread by infected mosquitoes,
with 250 cases confirmed over the past four months. As a result of Hawaii County
Mayor Billy Kenoi's order people on the Big Island will be allowed to resume
disposing of old tires in landfills, since tires which are left lying around are a
known breeding spot for mosquitoes. There have been 250 confirmed cases of
dengue fever on the island since Oct. 29, making it the largest outbreak in the
state since the 1940s, according to the mayor's declaration and Hawaii health
officials. Dengue fever causes flu-like symptoms and can develop into the deadly
dengue hemorrhagic fever. Hawaii Governor David Ige said in a statement he
supported the efforts on the Big Island but would not issue a statewide
emergency declaration unless the outbreak spread to other islands or expanded
to include other diseases, such as the Zika virus. Last month, a baby born with
brain damage at a hospital in Oahu, Hawaii, was apparently the first case of the
mosquito-borne Zika virus in a birth on U.S. soil. Dengue is not endemic to Hawaii
but has occasionally spread after being imported by infected travelers. The
outbreak on the Big Island is the first cluster of locally-acquired dengue fever
since a 2011 outbreak on Oahu, the Hawaii Department of Health said.
Booster vaccine aimed at protecting teens
against whooping cough may wear off
• A latest study has suggested that a booster vaccine aimed to protect teens from
whooping cough could wear off eventually. Eesearchers analyzed 1,200 cases of
whooping cough in 280,000 California teens between January 2006 and March
2015. Despite the presence of soaring vaccination rates against the disease in
teens, two major outbreaks occurred in this group in California, in the years 2010
and 2014. The researchers discovered that within the first year after a teen got
vaccinated withTdap there was a moderate effectiveness. It prevented 69% of
whooping cough cases in teens who got exposed. But, that effectiveness fell to
below 9% by four years after vaccination. In the 1990s the US shifted from wholecell pertussis (DTwP) vaccine to the acellular pertussis (DTaP) vaccine. The move
was taken because of the concerns regarding the side effects. Presently, five doses
of DTaP vaccine is given during childhood, at the ages 2 months, 4 months, 6
months, 12 to 18 months, and 4 to 6 years. Despite soaring vaccination rates, the
US and other developed countries have seen a rise in whopping cough cases since
the shift to DTaP. Just over 1,200 children and teens were diagnosed with whooping
cough between 2006 and 2015. Most fell ill during two statewide epidemics, in
2010 and 2014, the research found.
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Source: http://perfscience.com/content/2143214-booster-vaccine-aimed-protecting-teens-against-whooping-coughmay-wear-over-time
Ursinus College, PA – Norovirus
Outbreak
• Test results confirmed that Norovirus swept across the Collegeville campus,
sickening at least 214 students, plus faculty and staff, since last Tuesday.
• "This is the agent we have suspected since this outbreak began," said
Montgomery County Commissioner Valerie Arkoosh, a physician and interim
medical director of the county health department.
• But how it emerged and spread on Ursinus campus is unclear. And officials "will
probably never know" the original source, said Montgomery County spokesman
Frank Custer. Campus dining facilities were temporarily closed last week for
cleaning after a health inspection found 17 violations, though not necessarily
related to the illness. As of Sunday night, school officials said, 214 students had
reported symptoms of vomiting, diarrhea, and abdominal pain. Ten of those
became sick during the weekend, and some called in from home to report their
symptoms, which typically subside after 12 to 24 hours.
Source:
http://www.philly.com/philly/education/20160216__Ursinus_plague__on_wan
e__classes_resume.html#8C6mhOIdVJZgqCIO.99
CDC: Superbugs threaten
hospital patients www.cdc.gov
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The national data in this Vital Signs report, along with data from CDC's latest annual progress report on
HAI prevention, show that acute care hospitals have achieved:
• A 50 percent decrease in central line-associated bloodstream infections (CLABSIs)
between 2008 and 2014.
• 1 in 6 remaining CLABSIs are caused by urgent or serious antibiotic-resistant bacteria.
• A 17 percent decrease in surgical site infections (SSIs) between 2008 and 2014 related to 10
procedures tracked in previous HAI progress reports.
• 1 in 7 remaining SSIs are caused by urgent or serious antibiotic-resistant bacteria.
• No change in the overall catheter-associated urinary tract infections (CAUTIs) between 2009
and 2014. During this time, however, there was progress in non-ICU settings, progress in all
settings between 2013 and 2014, and most notably, even more progress in all settings towards
the end of 2014.
• 1 in 10 CAUTIs are caused by urgent or serious antibiotic-resistant bacteria.
The six antibiotic-resistant threats are:
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Carbapenem-resistant Enterobacteriaceae (CRE)
Methicillin-resistant Staphylococcus aureus (MRSA)
ESBL-producing Enterobacteriaceae (extended-spectrum βlactamases)
Vancomycin-resistant Enterococcus (VRE)
Multidrug-resistant Pseudomonas aeruginosa
Multidrug-resistant Acinetobacter
CDC: The Vital Signs
• The Vital Signs report examines the role of Clostridium difficile (C. difficile), the
most common type of bacteria responsible for infections in hospitals. C. difficile
caused almost half a million infections in the United States in 2011 alone. CDC's
annual progress report shows that progress has been made in decreasing
hospital-onset C. difficile infections by 8 percent between 2011 and 2014.
• Along with the updated annual progress report, CDC released the Antibiotic
Resistance Patient Safety Atlas, a new web app with interactive data on HAIs
caused by antibiotic resistant bacteria. The tool provides national, regional, and
state map views of superbug/drug combinations showing percent resistance
over time. The Atlas uses data reported to CDC's National Healthcare Safety
Network from 2011 to 2014 from more than 4,000 healthcare facilities.
• CDC is calling on doctors, nurses, healthcare facility administrators, and state
and local health departments to continue to do their part to prevent HAIs. The
report recommends doctors and nurses combine three critical efforts to
accomplish this: Prevent the spread of bacteria between patients; Prevent
infections related to surgery and/or placement of a catheter; and
• Congress has recognized the urgent need to combat antibiotic resistance.
• www.cdc.gov