Transcript Unit Based Champions Infection Prevention eBug Bytes

Unit Based Champions
Infection Prevention
eBug Bytes
July 2012
Oregon’s hospitals reported a reduction in
healthcare-associated infections (HAIs)
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Central line-associated bloodstream infections (CLABSIs) in hospital
intensive care units (ICUs) have decreased 55% from 2009 - 2011, and
the estimated healthcare cost savings for this infection ranges from
$600,000 to $2.5 million during those years.
In addition, Oregon has demonstrated a 10% reduction in surgical site
infections (SSIs) from coronary artery bypass graft surgeries and a 20%
reduction in SSIs from knee replacement surgeries since 2009.
In 2011, Oregon introduced 5 new HAI measures and 4 are now below
the national average.
*CLABSIs in ICUs (44% lower)
*Abdominal hysterectomy SSIs (21% lower)
*Colon surgery SSIs (20% lower)
*Laminectomy SSIs (31% lower)
However, the hip replacement SSI rate was reported to be 13% higher
than the national average.
http://www.oregon.gov/oha/OHPR/pages/hai_report.aspx
Invasive Staphylococcus aureus Infections
Associated with Pain Injections and
Reuse of Single-Dose Vials – Part 1
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The U.S. Centers for Disease Control and Prevention (CDC) reported in
MMWR on Staphylococcus aureus infections resulting from unsafe injection
practices in outpatient facilities in Arizona and Delaware.
In both cases, practitioners used medication on multiple patients from vials
labeled for single use, causing severe infections and hospitalizations for 10
patients.
Since 2007, 20 outbreaks associated with use of single-dose or single-use
medications for more than one patient have been reported (1; CDC,
unpublished data, 2012). These outbreaks demonstrate the critical role of
public health experts in investigating clusters of health-care–associated
infections.
When outbreaks or clusters are identified, prompt notification of public
health authorities is imperative to ensure that appropriate case-finding
activities and infection control measures are implemented to prevent
additional.
Source: MMWR July 13, 2012 / 61(27);501-504
Invasive Staphylococcus aureus Infections
Associated with Pain Injections and
Reuse of Single-Dose Vials – Part 2
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Investigation 1: MRSA Infections in an Outpatient Pain Management Clinic – AZ
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When: April 2012
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Who: Three patients who received pain remediation and contrast injections
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Breaches: Use of single-dose/single-use vials of contrast media and saline solution for
multiple patients and failure to wear facemasks during injection procedures
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Patient Impact: Three patients admitted to the hospital for severe infections including
mediastinitis, bacterial meningitis, epidural abscess, and sepsis. A fourth patient who received
contrast from the same vial was found deceased at home. The cause of death was reported
as multiple-drug overdose; however, invasive MRSA infection could not be ruled out.
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Investigation 2: Joint Infections (staph) in an Outpatient Orthopedic Clinic – Delaware
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When: March 2012
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Who: Seven patients who received joint injections to relieve pain
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Breach: Use of single-dose/single-use vials of bupivacaine for multiple patients. Two staff
members responsible for preparing the injections were found to be colonized with S. aureus,
one of whom had an identical match to the outbreak strain.
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Patient Impact: Seven patients admitted to the hospital with septic arthritis and/or bursitis.
Three additional patients who received bupivacaine injections on the same days developed
symptoms suggestive of infection and were treated as outpatients.
Source: MMWR July 13, 2012 / 61(27);501-504
N.H. hospital hepatitis scare spreads to
Kansas
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Kansas officials have begun notifying about 460 former Hays Medical Center
patients that they may have been exposed to hepatitis C by a traveling hospital
technician accused of causing an outbreak of the disease in New Hampshire,
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David Kwiatkowski was charged with obtaining controlled substances by fraud
and tampering with a consumer product. Kwiatkowski allegedly infected patients
with hepatitis C while working at a New Hampshire hospital.
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Kwiatkowski also worked in the cardiac catheterization laboratory at Hays
Medical Center, HaysMed, from May 24, 2010 through Sept. 22, 2010. About 460
patients the lab treated during that time were advised on how to get free testing
for the disease, which is a blood-borne viral infection that can cause liver
damage and chronic health problems.
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Kwiatkowski worked as a "traveler," sent by staffing agencies to hospitals around
the country, usually for temporary jobs. In announcing the federal drug charges
in New Hampshire, U.S. Attorney John Kacavas called him a "serial infector" who
has worked in at least six states since 2007. Authorities have not publicly
identified all of the other states. Kwiatkowski is accused of stealing anesthetic
drugs from the lab, injecting himself and contaminating syringes that were later
used on patients, 30 of whom have been diagnosed with the same strain of
hepatitis C that Kwiatkowski carries.
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Source: MWUR – New Hampshire news
Five-Second Rule Has Plenty of Bugs
The hot dog that rolls off the plate, the baby’s cookie that falls on the floor, the candy
bar that slides across the table – conventional wisdom has that you have five seconds
to pick it up before it is contaminated. (Or would a healthcare worker apply the
same principle to a patient care item dropped onto the floor?)
All items that come into contact with a surface pick up bacteria (and dirt!). How
much bacteria and what kind of microbes depends on the object dropped and the
surface it is dropped upon, Dr. Parada, MD, MPH, FACP, FIDSA, medical director of
the infection prevention and control program at Loyola University Health System.
“If you rinse off a dropped hot dog you will will probably greatly reduce the amount
of contamination, but there will still be some amount of unwanted and potentially
nonbeneficial bacteria on that hot dog,” says Parada, who admits to employing the
five-second ruleon occasion. “Maybe the dropped item only picks up 1,000 bacteria,
but typically the innoculum, or amount of bacteria that is needed for most people to
actually get infected, is 10,000 bacteria – well, then the odds are that no harm will
occur. But what if you have a more sensitive system, or you pick up a bacteria with a
lower infectious dose? Then, you are rolling the dice with your health or that of your
loved one.” And using your own mouth to “clean off” a dropped baby pacifier? “That
is double-dipping – you are exposing yourself to bacteria and you are adding your
own bacteria to that which contaminated the dropped item. No one is spared
anything with this move,” says Parada.
Patients Speak Out on Hepatitis C
Exposures in Hospitals
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Nearly 60,000 patients in southern Nevada were notified in 2008 that
they may have been exposed to hepatitis B, hepatitis C, or HIV because
of unsafe injection practices. It was one of the largest health scares in
the country.
More than 100 people did end up with hepatitis C. Some of those
patients spoke Wednesday at the Infection Control Conference in Las
Vegas in hopes of preventing another outbreak from happening. It's been
four years hepatitis C was transmitted after procedures at the Desert
Shadow Endoscopy Center.
HONOR, Hepatitis Outbreaks National Organization for Reform, is a
campaign to educate medical professionals on the dangers of unsafe
syringe use.
Nevada does have legislation that requires every health care person,
responsible for giving an injection, to follow CDC guidelines.
Source: KLAS TV – Las Vegas July 18 2012
Adding Vitamin B12 to Standard
Drugs Might Help Fight Hepatitis C
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Taking vitamin B12 supplements may help boost the effectiveness of antiviral drugs
for patients infected with hepatitis C virus, a new study suggests.
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This effect was especially strong in patients whose infection was particularly tough
to treat, note Italian researchers led by Dr. Gerardo Nardone of the University of
Naples. According to Nardone's team, the standard treatment of two drugs -interferon (peg IFN) and ribavarin -- clears the virus in about 50 percent of
patients infected with strain 1 of the virus and 80 percent of those infected with
strains 2 or 3. The new study included 94 patients with hepatitis C infection who
were randomly assigned to receive standard treatment with antiviral drugs or
standard treatment plus 5,000 micrograms of vitamin B12 every month for
between six and 12 months.
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The ability of the patients' bodies to clear the virus was assessed after one month
and three months (dubbed a "rapid viral response"), at the end of treatment
("complete early viral response"), and six months after the end of treatment
("sustained viral response"). After one month of treatment, there was no
difference in response between patients receiving standard treatment and those
receiving standard treatment plus vitamin B12. However, patients receiving vitamin
B12 showed significantly greater response at all of the other time points,
particularly by six months after the end of treatment.
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Source: GUT (journal) July 17 2012
Obesity and Diabetes
Increase Risk of SSI
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First Study: Of 790 patients, there were 268 open fractures and 21 surgical-site
infections (SSIs) at 30-day follow-up. Age, race, co-morbidities, injury severity,
and blood transfusion were not associated with SSI at 30 days.
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Specific study details: SSIs developed in 13 of 294 patients (4.4 percent) who had
more than one glucose value greater than or equal to 200 mg/dL and 8 of 496
patients (1.6 percent) without more than one glucose value greater than or
equal to 200 mg/dL. The authors concluded that hyperglycemia was an
independent risk factor for thirty-day SSI in orthopaedic trauma patients
without a history of diabetes.
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A second study found that diabetes and morbid obesity increased the risk of
infection following hip and knee replacement. "Obesity, Diabetes, and
Preoperative Hyperglycemia as Predictors of Periprosthetic Joint Infection"
analyzed 7,181 hip and knee replacements and found that 52 post-operative
joint infections occurred within the first year, and that the infection rate
increased from a .37 percent in patients with a normal body index to 4.66
percent in the morbidly obese group. Diabetes more than doubled the risk of a
post-operative joint infection independent of obesity. The infection rate was
the highest in morbidly obese, diabetic patients.
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Source: Journal of Bone and Joint Surgery July 2012