Transcript File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
September 2014
How large a problem is sepsis?
• In 2011, the Healthcare Cost and Utilization Project (H-CUP)
identified 836,000 hospital discharges in 2009 where sepsis
was a principal diagnosis, and 829,500 discharges where sepsis was a secondary
diagnosis. The in-hospital mortality rates for each were 16.3% and 14.7%,
respectively, totaling 258,204 deaths per year directly attributable to sepsis.
• With more than 258,000 lives being lost per year, sepsis ranks as the third leading
cause of death in the U.S. (after heart disease and cancer). Using data by the
Centers for Disease Control and Prevention (CDC), sepsis would rank higher than
chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, and
accidental deaths. The same H-CUP report identified that there are more than
1.6 million cases of sepsis every year and survivors often face long-term effects
post-sepsis, including amputations, anxiety, memory loss, chronic pain and
fatigue, and more. Almost 60% of sepsis survivors experience worsened cognitive
(mental) and/or physical function. Many sepsis survivors also require rehospitalization. Over 62% of people who had a primary diagnosis of sepsis had to
be readmitted to the hospital within 30 days of first leaving the hospital. Sepsis is
also the most expensive in-hospital condition in the U.S., costing more than $20
billion each year counting just acute care in-hospital costs.
• http://www.sepsisalliance.org
Single Animal-to-Human Transmission
Responsible for 2014 Ebola Outbreak
• Scientists used advanced genomic sequencing technology to identify a single point
of infection from an animal reservoir to a human in the current Ebola outbreak in
West Africa. This research has also revealed the dynamics of how the Ebola virus
has been transmitted from human to human, and traces how the genetic code of
the virus is changing over time to adapt to human hosts. The 2014 Ebola outbreak
is now the largest outbreak in history, with current estimates of 2,473 infections
and 1350 deaths since it began in late December 2013 according to the World
Health Organization. This outbreak is also the first in West Africa and the first to
affect urban areas. There are no approved drugs for Ebola virus disease, though
prompt diagnosis and aggressive supportive care can improve survival. The disease
is characterized by high fever, headache, body aches, intense weakness, stomach
pain, and lack of appetite. This is followed by vomiting, diarrhea, rash, impaired
kidney and liver function and in some cases, internal and external bleeding. Using
advanced technology to analyze the genetics of the Ebola samples extremely
rapidly and with high levels of accuracy, the researchers pinpointed a single late
2013 introduction from an unspecified animal reservoir into humans.Studying RNA
changes occurring during the outbreak suggests that the first human infection of
the outbreak was followed by exclusive human to human transmissions.
• Source: National Institutes of Health (NIH) Pardis Sabeti, MD, PhD, and her team.
Perdue Foods reaches milestone in reducing
antibiotic use, sets standard
• Perdue Foods announces that it has removed all antibiotics from its chicken
hatcheries, another step in setting a standard that defines the responsible use of
antibiotics in poultry production. Perdue does not use antibiotics for growth
promotion in its chicken production, and has not since 2007. The company does
use an animal-only antibiotic to control an intestinal parasite, and will use
antibiotics to treat and control illness in sick flocks. Perdue Foods started the move
away from conventional antibiotic use in 2002, in response to growing consumer
concern and our own questions about the practice. By 2007, the company had
successfully removed all human antibiotics from its feed. “We also found that it is
not realistic or responsible to eliminate all antibiotics. No matter how carefully you
raise animals, some are going to be exposed to infections that can only be treated
with antibiotics. As veterinarians, we have a responsibility to properly treat those
animals.” Along the way, Perdue Foods was among the first to phase out the use
arsenic in chicken feed – well before its market withdrawal. The final step in
Perdue’s journey toward responsible antibiotics use was eliminating their use in
the hatchery, a process that began in 2009 and culminated in the summer of 2014
See more at: http://www.perduefarms.com/News_Room/Press_Releases
TRU-D SmartUVC disinfection robots
to aid in Ebola crisis in Liberia
• After a 10-day mission in Monrovia, Republic of Liberia, with inventor Dr. Jeffrey L.
Deal, two TRU-D SmartUVC devices continue to aid in the battle against the Ebola
virus outbreak at JFK and ELWA hospitals. Deal, a Fellow in the Royal Society of
Tropical Medicine and Hygiene, traveled to the Republic of Liberia on Aug. 18 to
lead the installment of the robots and the training of hospital staff to operate the
devices. History was made on Aug. 20, as the first automated decontamination
system to be used in Africa was activated. TRU-D worked around the clock to
disinfect a number of hospital environments, making them safer for healthcare
workers, volunteers, patients and family members. The crisis has left many
healthcare facilities with a shortage of workers, and even doctors, due to deaths
and the absence of others who feared coming to work and contracting the disease.
In early August, the CDC drastically increased its ongoing efforts in West Africa and
released infection prevention and control recommendations for Ebola in U.S.
hospitals. When the proper gear and decontamination procedures have been
followed, no healthcare workers have contracted the illness. TRU-D, short for Total
Room Ultraviolet Disinfector, is a portable UV disinfection device which
automatically calculates and effectively delivers lethal doses of UV-C light to
eliminate pathogens in healthcare settings.
How Quickly Viruses Can Contaminate
Buildings and How to Stop Them
• Touching surfaces or objects contaminated with norovirus then putting your fingers
in your mouth is a common source of infection. In a study presented at the
American Society of Microbiology, researchers used bacteriophage MS-2 as a
surrogate for the human norovirus, as it is similar in shape, size and resistance to
disinfectants. The phage was placed on 1 to 2 commonly touched surfaces (door
knob or table top) at the beginning of the day in office buildings, conference room
and a health care facility.
• After various periods of time (two to eight hours) they sampled 60 to 100 fomites,
surfaces capable of carrying infectious organisms (light switches, bed rails, table
tops, countertops, push buttons, coffee pots handles, sink tap handles, door knobs,
phones and computer equipment), for the phages.
• Within two to four hours between 40 percent to 60 percent of the fomites sampled
were contaminated with virus,
• Source: American Society for Microbiology. ASM's 54th ICAAC held Sept. 5-9, 2014
in Washington, D.C.
Study Shows Nationwide Declines in Central Line
Infections and Ventilator-Associated Pneumonia
• An analysis of CLABSIs, VAPs and CAUTIs among critically ill children in the U.S. for
173 neonatal intensive care units (NICUs) and 64 pediatric intensive care units
(PICUs) from 2007 to 2012. Over the last several years in neonatal and pediatric
intensive care units around the country, we began to pay attention to the high rates
of hospital-associated infections. Complications from these infections are serious,
including death and long-term neurological injury and they are also costly to the
healthcare system. For all of these reasons, hospitals began to develop protocols to
reduce hospital-associated infections.
• The study concluded that among the hospitals there was substantial decline in
some infections during the investigation period. NICUs and PICUs both saw a 61
percent decline in central line-associated bloodstream infections. NICUs also saw a
50 percent reduction in ventilator-assisted pneumonias while PICUs rates dropped
by 76 percent. Rates fell among neonates of all birth weights and among children.
• Rates of catheter-associated urinary tract infections did not change significantly
which could be attributed to variances in how CAUTIs are defined for surveillance
purposes. Source: The study was supported by a grant from the Agency for
Healthcare Research and Quality (R01HS018414-04). Vanderbilt University Medical
Center
For Ebola Healthcare Workers, How PPE is
Removed Poses Risk of Deadly Exposure,
Experts Caution
• In a commentary published online on Aug. 26 in the Annals of Internal Medicine,
the physician-specialists from Johns Hopkins and the University of North Carolina
say rigorous steps exist — and must be taken — to avoid inadvertent contact of
frontline caregivers’ exposed skin and mucous membranes to infected body fluids.
• Personal protective equipment, including goggles or face shields, gloves and gowns,
are effectively decreasing West African caregivers’ exposure to infected bodily
fluids, but workers are still at risk “if removal of protective clothing that is
contaminated with infectious bodily fluids is not done in a manner that prevents
exposure,” say the authors, who include Trish M. Perl, MD, MS, and Noreen Hynes,
MD, MPH, two Johns Hopkins infectious disease experts.
• “The physical exhaustion and emotional fatigue that come with caring for patients
infected with Ebola may further increase the chance of an inadvertent exposure to
bodily fluids on the outside of the personal protective equipment, leading to
unwanted contact when the gear is removed,” the authors say. “The impulse to
wipe away sweat in the ever-present hot, humid environment during personal
protective equipment removal may lead to inadvertent inoculation of mucous
membranes” in and on the nose, mouth and eyes. Source: IC Today
Stay safe from stomach bugs
at the country fair and petting zoos
• Do your autumn plans include a trip to a country fair? Spending a day at the fair is
fun, but it’s important to make hand hygiene an important part of your day,
especially if you will be coming into contact with certain animals.
• E. coli O157:H7 infections are associated with animal contact at fairs, petting zoos,
or animal exhibition halls. E. coli O157:H7 is commonly found in cattle, goats, and
sheep. Outbreaks associated with these animals are common. People who
contact these animals at any venue, public or private, are at risk for infection with
E. coli O157:H7 as well as a variety of other germs including Salmonella and
Campylobacter. Symptoms of E. coli O157:H7 illness typically include severe
stomach cramps and diarrhea, often with bloody stools, but only a low-grade or
no fever. People typically become ill 2 to 5 days after exposure, but this time
period can range from 1 to at least 8 days. Most people recover in 5 to 10 days;
however, E. coli O157:H7 infections sometimes lead to hemolytic uremic
syndrome (HUS), a complication of E. coli that can lead to kidney failure. HUS
most commonly affects children and the elderly. Diarrhea associated with an E.
coli O157:H7 infection should NOT be treated with antibiotics, as this practice can
promote the development of HUS.
•
Source: http://www.health.state.mn.us/news/pressrel/2014/ecoli081214.html
Hospital stay ups risk of multidrug resistant infection
Researchers gathered and analyzed historical data from 949 documented cases of
Gram-negative bacterial infection at their academic medical center in the US. In
the first few days of hospitalization, the percentage of infections associated with
Gram-negative bacteria, classified as multidrug-resistant, was about 20 percent
and rose fairly steadily until four or five days, then jumped dramatically, peaking
at over 35 percent at 10 days. Statistical analysis suggested an additional one
percent risk per day of hospitalization. . Hospital acquired infections represent a
large and possibly preventable segment of hospital related deaths and have been
rising in recent years.
On any given day, about 1 in 25 hospital patients has at least one healthcare
associated infection and over a third of these infections are caused by Gramnegative bacteria, many of which are resistant to one or more classes of
antibiotics.
The findings were recently presented at the 54th Interscience Conference on
Antimicrobial Agents and Chemotherapy (ICAAC) in Washington, DC.