Transcript File - Working Toward Zero HAIs

Unit Based Champions
Infection Prevention
eBug Bytes
October 2013
Universal Gown, Glove Use by
Employees in ICU Reduces MRSA 40%
• The study involved 20 medical and surgical ICUs across 15 states, and examined
nearly 92,000 cultures from more than 26,000 patients over a nine-month period
in 2012. Participating ICUs were randomly assigned to either the intervention or
control group. Healthcare workers in the intervention group were required to
wear gloves and gowns for all patient contact when entering any patient room.
Healthcare workers in the control group followed CDC guidelines for patient
contact, and only wore gloves and gowns for contact with patients with known
antibiotic-resistant bacteria.
• While researchers did not find a decrease in VRE, the reduction in MRSA was
notable, as was an increase in handwashing by the healthcare workers upon
leaving patient rooms. "Based on the results of this study, it would be prudent for
ICUs to consider adoption of universal gowning and gloving policies on intensive
care units at highest risk for MRSA infections, regardless of whether patients
have been positively cultured. Concerns about healthcare personnel acceptance
of and compliance with universal gowning and gloving can be overcome with
creative efforts focused on early engagement and positive reinforcement.“
Source: Anthony D. Harris. Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant
Bacteria in the ICU. JAMA, 2013
Drop in C.diff and VRE infection rates
when Xenex UV room disinfection utilized
as alternative to bleach
• The University of Texas MD Anderson Cancer Center recently conducted two
studies to evaluate the efficacy of pulsed xenon UV light room disinfection on C.diff
and VRE infection rates. In both studies, use of the Xenex UV room disinfection
system (instead of bleach for rooms that housed patients with C. diff infections)
resulted in a reduction in the number of patients contracting these infections. The
current standard for C. diff surface decontamination in the healthcare setting is a
bleach solution, which may damage hospital materials and may create a toxic
environment for hospital workers. Xenex's pulsed xenon UV light room disinfection
system was proven effective against C. diff in the laboratory and in patient outcome
results at hospitals utilizing Xenex devices. In the VRE study, the Xenex room
disinfection device was implemented as part of a routine disinfection protocol of
VRE isolation rooms after terminal cleaning on the Leukemia and Stem Cell
Transplant (SCT) units in January 2013. Patients that occupy a room after a VRE
patient are more likely to develop VRE than other patients. MD Anderson showed
that the Xenex UV disinfection device was superior to manual cleaning at
eliminating environmental VRE contamination.
•
Source: Implementing a Novel Pulsed-Xenon Ultraviolet Disinfection System in the Hospital Setting" in
September 2013 at the Infection Prevention Society's "Infection Prevention 2013" conference in London
'PPMOs' offer new approach
to bacterial infection:
Molecular Medicine
• The new PPMOs offer a fundamentally different attack on bacterial infection. They
specifically target the underlying genes of a bacterium, whereas conventional
antibiotics just disrupt its cellular function and often have broader, unwanted
impacts. PPMOs should offer a completely different and more precise approach to
managing bacterial infection, or conceptually almost any disease that has an
underlying genetic component.
• PPMO stands for a peptide-conjugated phosphorodiamidate morpholino oligomer a synthetic analog of DNA or RNA that has the ability to silence the expression of
specific genes. Compared to conventional antibiotics, which are often found in
nature, PPMOs are completely synthesized in the laboratory with a specific genetic
target in mind. In animal laboratory tests against A. baumannii, PPMOs were far
more powerful than some conventional antibiotics like ampicillin. They were also
effective in cases where the bacteria were resistant to antibiotics.
• PPMOs have not yet been tested in humans.
• Source: Journal of Infectious Diseases October 28 2013
Tainted steroid shots led
to varying ailments
• Patients made sick by contaminated steroid injections had a "broad spectrum of
disease," ranging from stroke to abscess. The pattern of disease varied over
time, with meningitis dominating early in the outbreak and non-central nervous
system (CNS) disease showing up later. And illnesses varied in severity from mild
to life threatening to fatal. The outbreak included 751 cases and 64 deaths in 20
states -- all linked to epidural, paraspinal, or joint injections of contaminated
methylprednisolone acetate from a single compounding pharmacy. The most
commonly identified contaminant was a black mold, Exserohilum rostratum,
which only rarely causes human disease. This has been the largest outbreak of
healthcare-associated infections ever reported in the United States. Since the
outbreak began, additional outbreaks have been identified and linked to
contaminated products from other compounding pharmacies. These outbreaks
show the urgent need to address shortfalls in the oversight and safety of
compounded drugs to reduce the inherent risks associated with these products,
which have not undergone review and approval by the Food and Drug
Administration. Source: NEJM Oct 24, 2013
Obesity May Increase Risk of
Clostridium Difficile Infection
• Researchers from Boston Medical Center (BMC) and Boston University School of
Medicine (BUSM) have identified obesity as a possible risk factor for clostridium
difficile infection (CDI). These findings, which appear online in Emerging
Infectious Diseases, may contribute to improved clinical surveillance of those at
highest risk of disease. The researchers examined three groups of patients with
CDI--those who were admitted from the community with no risk factors, those
who had prior exposure to hospitals or clinics, and those who had onset of
disease in the hospital. The researchers found that cases with community onset
infection were four times more likely to be obese compared to those who had
prior known exposure to a healthcare facility. These patients were also five times
more likely to have inflammatory bowel disease (IBD). "We were also surprised
to note that our patients who were presenting from the community were almost
twice as likely to be obese as the general population in Massachusetts (34
percent compared to 23 percent). Hence, like IBD, obesity may be associated
with higher risk of CDI," added Bhadelia.
•
Journal Reference: Florence F. et al: Possible Association between Obesity and Clostridium difficile
Infection. Emerging Infectious Diseases, October 2013
Communion May Have Exposed
North Dakota Parishioners to
Hepatitis A Virus
The North Dakota Department of Health has determined through a case
investigation that people who attended the following Catholic churches in North
Dakota and had communion on the following dates may have been exposed to
hepatitis A virus, which causes an infection of the liver:
Sept. 27, 2013: Holy Spirit Church in Fargo, N.D. (school mass)
Sept. 29 – Oct. 2, 2013: St. James Basilica in Jamestown, N.D. (priest convention)
Oct. 6, 2013: Cathedral of St. Mary in Fargo, N.D.
Oct. 7, 2013: St. Paul’s Catholic Newman Center in Fargo, N.D.
Exposed individuals are encouraged to consult their healthcare provider if they
develop symptoms. Symptoms of hepatitis A include fever, tiredness, loss of
appetite, nausea, abdominal discomfort, dark urine, pale stools, or jaundice. It can
take about 15 to 50 days (average is one month) after being exposed to hepatitis A
to develop symptoms. Hepatitis A symptoms generally last about two months. If
hepatitis A symptoms develop, individuals should exclude themselves from
activities for one week after onset of symptoms.
The risk of people getting hepatitis A in this situation is low, but the Department of
Health felt it was important for people to know about the possible exposure.
MRSA Cases Continue to Decline in
Veterans Hospitals Nationwide
Five years after implementing a national initiative to reduce methicillin-resistant
Staphylococcus aureus (MRSA) rates in Veterans Affairs (VA) medical centers,
MRSA cases have continued to decline, according to a study in the November
issue of the American Journal of Infection Control, the The MRSA Prevention
Initiative, implemented in 2007, resulted in significant decreases in both the
transmission (colonization with the organism) of MRSA (17 percent for intensive
care units [ICUs] and 21 percent for non-ICUs) and healthcare-associated infection
(HAI) rates within the hospitals (62 percent for ICUs, 45 percent for non-ICUs). In
the two-year period following the first wave of the initiative (data previously
published), both MRSA transmissions and HAIs continued to decrease in non-ICU
settings (declining an additional 13.7 percent and 44.8 percent, respectively),
while holding steady in ICUs. The MRSA Prevention Initiative utilizes a bundled
approach that includes screening every patient for MRSA, use of gowns and gloves
when caring for patients colonized or infected with MRSA, hand hygiene, and an
institutional culture change focusing on individual responsibility for infection
control. It also created the new position of MRSA Prevention Coordinator at each
medical center. AJIC November 2013
Outbreaks of Cyclospora
cayetanensis
• During June–August 2013, Clocal public health officials, and the Food and Drug
Administration (FDA) investigated an unusually large DC, state and number of
reports of cyclosporiasis (compared with annual reports to the National Notifiable
Disease Surveillance System [e.g., 123 cases in 2012]), an intestinal infection
caused by the parasite Cyclospora cayetanensis (1). By September 20, CDC had
been notified of 643 cases from 25 states, primarily Texas (278 cases), Iowa (153),
and Nebraska (86). Investigations in Iowa and Nebraska showed that restaurantassociated cases in these two states were linked to a salad mix that contained
iceberg lettuce, romaine lettuce, red cabbage, and carrots (2). Most patients in
Iowa and Nebraska became ill during June 15–29; cases reported during July and
August were primarily from Texas.
• CDC collaborated with Texas and the FDA to investigate a cluster of illnesses among
patrons of a Mexican-style restaurant in Fort Bend County, Texas (restaurant A). A
case of restaurant A–associated gastroenteritis was defined as gastrointestinal
illness in a person who had eaten at restaurant A after June 1, 2013. Of 30 persons
who ate at restaurant A, 22 had laboratory-confirmed C. cayetanensis infections,
and eight had no laboratory confirmation. MMWR: Vol 62, No 43 Nov 1 2013