Transcript File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
November 2015
Influenza Virus
Antidepressant Microbes In Soil:
How Dirt Makes You Happy
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Mycobacterium vaccae is the substance under study and has indeed been found to mirror
the effect on neurons that drugs like Prozac provide. The bacterium is found in soil and
may stimulate serotonin production, which makes you relaxed and happier. Studies were
conducted on cancer patients and they reported a better quality of life and less stress. Lack
of serotonin has been linked to depression, anxiety, obsessive compulsive disorder and
bipolar problems. The bacterium appears to be a natural antidepressant in soil and has no
adverse health effects. These antidepressant microbes in soil may be as easy to use as just
playing in the dirt. Most avid gardeners will tell you that their landscape is their “happy
place” and the actual physical act of gardening is a stress reducer and mood lifter.
Antidepressant microbes in soil cause cytokine levels to rise, which results in the
production of higher levels of serotonin. The bacterium was tested both by injection and
ingestion on rats and the results were increased cognitive ability, lower stress and better
concentration to tasks than a control group.
Gardeners inhale the bacteria, have topical contact with it and get it into their
bloodstreams when there is a cut or other pathway for infection. The natural effects of the
soil bacteria antidepressant can be felt for up to 3 weeks if the experiments with rats are
any indication. So get out and play in the dirt and improve your mood and your life.
Source: “Identification of an Immune-Responsive Mesolimbocortical Serotonergic System: Potential
Role in Regulation of Emotional Behavior,” by Christopher Lowry et al., published online on March 28,
2007 in Neuroscience
California Shigella outbreak update:
More than 180 people infected
• An outbreak of Shigella bacteria believed to have originated from a seafood
restaurant in San Jose, Calif., has now infected more than 180 people. Eleven
patients had been admitted to ICUs as of Oct. 21 with symptoms of Shigellosis,
including diarrhea and fever. Santa Clara County Public Health Department
officials said the number infected has since risen to 188, of which 85 have been
confirmed by laboratory tests. Of that number, 150 are Santa Clara County
residents and the remaining 38 cases affect people who live in other counties.
Health investigators believe nearly all the cases stemmed from Mariscos San Juan,
on Fourth Street, which they state served contaminated food on two consecutive
days, Oct. 16 and 17. Officials suspect the bacteria was spread by a contaminated
food handler, but the food source remains under investigation. Shigella bacteria
may cause severe diarrhea and fever. It can spread quickly in restaurant settings,
most often when an infected person doesn't wash their hands after using the
bathroom and then handles food.
• At least three lawsuits have been filed in the case so far, alleging the restaurant
served contaminated food on Oct. 16 and 17. Officials suspect a contaminated
food worker was the initial cause of the contamination, but the source remains
under investigation. Source:
WellSpan York notifies 1,300 patients of possible
bacterial exposure after 4 die from infection
• WellSpan York (Pa.) Hospital is notifying about 1,300 patients who underwent
open-heart surgery at its facility in the past four years that they may have been
exposed to harmful bacteria from a medical device used during the procedure. A
joint investigation by the CDC, the state Department of Health and WellSpan
identified eight open-heart patients at WellSpan York Hospital who developed
bacterial infections, and four of those patients have died. Less than 1 percent of
patients who received open-heart surgery at the hospital in the last four years
have presented signs of the infection, according to WellSpan. The bacteria in
question, a nontuberculous mycobacterium, is commonly found in nature and
typically is not harmful. However, in people with weakened immune systems, it
can be a more serious concern.
• The devices in question — heater-cooler machines — are used during open-heart
surgery to regulate temperature. There is potential for the water used in the
machine to become contaminated with the bacteria. The bacteria can become
airborne through a vent on the device and then transmit to patients, according to
the Food and Drug Administration.
Source: http://www.beckershospitalreview.com/quality/wellspan-york-notifies-1-300-patientsof-possible-bacterial-exposure-after-4-patients-die-from-infection.html
Chipotle Closes 43 Restaurants
Amid E. Coli Outbreak
• Chipotle closed 43 of its restaurants in Washington state and Oregon as health
officials investigated an E. coli outbreak that appears to be linked to the fast casual
chain.
• As of Saturday, there were three cases of E. coli in Oregon and at least 19 in
Washington, said state health officials. One-third of those sickened were
hospitalized, officials said. "While the outbreak appears to be linked to food served
at Chipotle restaurants, the food or other source of contamination hasn't yet been
determined and remains under investigation," the Washington State Department
of Health said. The illnesses were reported in Clark, King, Skagit and Cowlitz
Counties in Washington, as well as Clackamas and Washington Counties in Oregon,
officials said. "Anyone who thinks they may have become ill from eating at a
Chipotle restaurant in the past three weeks should consult their healthcare
provider," said Dr. Scott Lindquist of the Washington State Department of Health.
"The elderly and very young children are more likely to become severely ill from
this kind of E. coli infection.”
• Source: http://abcnews.go.com/Health/chipotle-closes-43-restaurants-amid-colioutbreak/story?id=34890437
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Introduction: Millions of U.S. residents become ill from foodborne pathogens each year.
Most foodborne outbreaks occur among small groups of persons in a localized area.
However, because many foods are distributed widely and rapidly, and because detection
methods have improved, outbreaks that occur in multiple states and that even span the
entire country are being recognized with increasing frequency. (MMWR 11-3-15)
Methods: This report analyzes data from CDC’s Foodborne Disease Outbreak Surveillance
System to describe multistate foodborne outbreaks that occurred in the United States during
2010–2014.
Results: During this 5-year period, 120 multistate foodborne disease outbreaks (with
identified pathogen and food or common setting) were reported to CDC. These multistate
outbreaks accounted for 3% (120 of 4,163) of all reported foodborne outbreaks, but were
responsible for 11% (7,929 of 71,747) of illnesses, 34% (1,460 of 4,247) of hospitalizations,
and 56% (66 of 118) of deaths associated with foodborne outbreaks. Salmonella (63
outbreaks), Shiga toxin-producing E. coli (34), and Listeria monocytogenes (12) were the
leading pathogens. Fruits (17), vegetable row crops (15), beef (13), sprouts (10), and seeded
vegetables (nine) were the most commonly implicated foods. Traceback investigations to
identify the food origin were conducted for 87 outbreaks, of which 55 led to a product recall.
Imported foods were linked to 18 multistate outbreaks.
Conclusions: Multistate foodborne disease outbreaks account for a disproportionate
number of outbreak-associated illnesses, hospitalizations, and deaths relative to their
occurrence. Working together, food industries and public health departments and agencies
can develop and implement more effective ways to identify and to trace contaminated foods
linked to multistate outbreaks. Lessons learned during outbreak investigations can help
improve food safety practices and regulations, and might prevent future outbreaks. CDC
Up to 4,800 patients potentially
exposed to hepatitis C at Utah hospital
• The Utah Department of Health has been investigating a recent Hepatitis C
infection of a patient who received treatment in the Emergency Department at
McKay-Dee Hospital. Through this review, it was learned that some of the patients
treated in the McKay-Dee Hospital Emergency Department may have been exposed
to Hepatitis C. The nurse, Elet Neilson, was fired from the hospital in November
2014 after she admitted to stealing emergency department drugs intended for
patient use, according to information the hospital released on Friday. In September
2014, the Utah Department of Health informed McKay-Dee that a patient being
treated in the hospital's emergency department and Ms. Neilson were both
infected with the same hepatitis C genotype and that the two infections might be
related. The 2b genotype, found in both the nurse and patient, is rare, accounting
for only 10 percent of cases. The hospital identified every patient who may have
come into contact with Ms. Neilson or the infected patient out of an abundance of
caution, Mr. Dallin told the Tribune. He also said it is possible that most patients
receiving care at that time were not at risk, and that it is possible no patients were
infected. The investigation is ongoing and McKay-Dee representatives told the
Standard Examiner that any patients who may have contracted the infection would
have their treatment paid for by the hospital. The Utah Department of Health has
set up a web page for updates on the investigation. Source: Salt Lake City Tribune
Why We Come To Work Sick
Healthcare workers are at risk for infection while providing care to patients. They are also at
risk for spreading infection when they fail to use appropriate personal protective equipment
or practice hand hygiene. However, when a healthcare worker provides care while they
themselves have a symptomatic infectious disease, they put their colleagues and patients at
even higher risk. Previous studies have focused on the reasons nurses and physician trainees
come to work while symptomatic. Szymczak et al. surveyed all attending physicians and APCs
at The Children's Hospital of Philadelphia to determine how frequently and why they (we)
come to work sick. Over 95% of respondents (502 of 529) believed that working while sick
puts patients at risk. However, 83% of respondents reported working while sick at least once
in the past 5 years and 50 respondents (9.3%) reported coming to work sick at least 5 times
in the past year. Similar rates were seen among attendings and advanced practice clinicians
(APCs). Attendings were more likely to say they would work with each of the symptoms than
APCs. Rates of symptoms with which respondents would come to work were lowest for
"vomiting only" (7.5% of attendings, 2.7% of APCs) and highest for "cough and rhinorrhea
only" (79.6% of attendings and 69.1% of APCs). The explanations for why people come to
work sick include "I do not want to let my colleagues down" (98.7%), "concern that not
enough staff would be available to care for patients" (94.9%) and "I do not want to let my
patients down" (92.5%). APCs were more likely to report "fearing ostracism from colleagues"
(71% vs 57.8%;P=.001) and "unsupportive leadership" (68.1% vs 45%; P<.001). Attendings
were more likely to report being worried about continuity of care (69.1% vs 57.8%; P=.007).
Source: Reasons Why Physicians and Advanced Practice Clinicians Work While Sick: A Mixed-Methods Analysis.
Szymczak JE, Smathers S, Hoegg C, Klieger S, Coffin SE, Sammons JS. JAMA Pediatr. 2015 Sep 1;169(9):815-21.
FDA Panel Says Fluoroquinolones
Need Stronger Warnings
Fluoroquinolone labels need much stronger warnings about the risks for serious adverse
events, including tendinitis and tendon rupture, prolongation of the QT interval, and
peripheral neuropathy, according to a joint panel of the US Food and Drug Administration
(FDA). The FDA's Antimicrobial Drugs Advisory Committee (ADMAC) and the Drug Safety and
Risk Management Advisory Committee met jointly to discuss the use of fluoroquinolone
antibacterial drugs for treatment of acute bacterial sinusitis (ABS), acute bacterial
exacerbation of chronic bronchitis in those with chronic obstructive pulmonary disease
(ABECB-COPD), and uncomplicated urinary tract infection. Fluoroquinolone labeling
currently has warnings about the risks for tendonitis, tendon rupture, central nervous
system effects, peripheral neuropathy, myasthenia gravis exacerbation, QT prolongation and
Torsades de Pointes, phototoxicity, and hypersensitivity. But panel members called for
stronger wording, with some suggesting the risks be called out with a black box warning.
Fluoroquinolones currently approved for one or more of these illnesses are ciprofloxacin,
levofloxacin, moxifloxacin, ofloxacin, and gemifloxacin. The Infectious Diseases Society of
America recommends fluoroquinolones for second-line treatment of patients with allergies
to other antibiotics, patients with treatment failure to primary antibiotics, and patients with
pathogens that are resistant to first-line antibacterials.
Source:http://www.medscape.com/viewarticle/854067?src=wnl_edit_medn_wir&uac=1634
82EZ&spon=34&impID=888128&faf=1
Sharp increase in U.S. babies born
with syphilis: CDC
• As syphilis cases increase among U.S. women, doctors are seeing
more babies born with the serious infection, health officials report.
• Congenital syphilis cases, which are transmitted from an infected mother to her
unborn child, increased 38 percent between 2012 and 2014, according to the U.S.
Centers for Disease Control and Prevention. Last year, 458 newborns were
diagnosed with the infection. This spike represents a rapid turnaround from just a
few years ago. Rates of the sexually transmitted infection dropped between 2008
and 2012, and reports of syphilis-infected infants decreased from 10.5 cases per
100,000 live births to 8.4 cases per 100,000 live births. But syphilis cases in
women jumped 22 percent between 2012 and 2014, likely foreshadowing the
jump in infant infections. A child born with syphilis can have major health
problems, including brain damage, or die. Last year, congenital syphilis caused 25
stillbirths and eight deaths within 30 days of delivery, the researchers said. These
women should have had prenatal care that included testing for syphilis in the first
trimester. But of the 458 syphilis-infected babies born in 2014, 22 percent of the
mothers had no prenatal care. Among women who had at least one prenatal visit,
43 percent were not treated for syphilis, although nearly half were diagnosed
with the disease. In addition, 15 percent were never tested for syphilis during
their pregnancy. Source: https://www.nlm.nih.gov/medlineplus/news/fullstory_155687.html
Custom Ultrasonics scope-washing machines
investigation showed ongoing problems
• The Food and Drug Administration (FDA) said Friday it ordered Custom Ultrasonics
had continued to recall their endoscopic reprocessors because they violated federal
law and those lapses could result in an increased risk of infection for patients. The
agency said an estimated 2,800 automated endoscope reprocessors made by
Custom Ultrasonics are used by hospitals and outpatient clinics in the U.S.
• UCLA has used Custom Ultrasonics washers for its duodenoscopes and called in the
company as part of its outbreak investigation earlier this year. The university found
"there was no functional issue with the units." The FDA said several healthcare
facilities with confirmed or possible duodenoscope-associated infections used the
System 83 Plus unit made by Custom Ultrasonics. Custom Ultrasonics machines
can cost $30,000 to $50,000 and typically take about 30 minutes to wash scopes
with disinfectant following some manual cleaning. In a recent inspection in April,
the FDA said it found numerous violations at a Custom Ultrasonics facility.
Regulators said the company couldn't validate that its equipment can adequately
wash and disinfect endoscopes. The FDA also cited Custom Ultrasonics for failing to
report adverse events in a timely manner.
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Source: http://www.latimes.com/business/la-fi-fda-recall-scope-washers-20151113story.html
FDA new rules aim for clean
fruit, veggies
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The FDA released new rules aimed at making sure that fresh produce and imported foods
are free of dangerous germs and other contaminants. The new rules require importers and
producers to make sure the food is clean, and provide for outside auditors to check into
procedures at foreign food suppliers. Currently, the FDA waits until there are outbreaks
and then responds to them - often far too late to save people from eating food that makes
them sick. Now, the industry has a responsibility to stop outbreaks before they happen.
The recent multistate outbreak of Salmonella in imported cucumbers that has killed four
Americans, hospitalized 157 and sickened hundreds more, is exactly the kind of outbreak
these rules can help prevent. Contaminated food is an extremely common problem. The
CDC estimates that germs in food make 48 million Americans sick every year - that's one
out of six people. About 128,000 are made sick enough to be hospitalized, and 3,000 die.
Some of the worst examples in recent years include an outbreak of listeria traced to
Colorado cantaloupe that sickened at least 147 people and killed 33 of them in 2011, and
an outbreak of cyclospora disease from Mexican cilantro that made more than 380 people
sick this past summer. Most recently, an outbreak of E. coli traced to Chipotle outlets in
Washington and Oregon made at least 42 people sick. Health officials haven't been able to
find the source. In fact, the source of such outbreaks is often never identified. That's one
reason the FDA and other agencies want to stop them at the source, before food ever gets
into stores. Source: http://www.nbcnews.com/health/health-news/food-drugadministrations-new-rules-aim-clean-fruit-veggies-n463076
Too much traffic in OR may put
patients at risk, study finds
• Many operating rooms have too many people coming and going during
surgeries, which puts patients at increased risk for infections, a new study
suggests. Most operating rooms in U.S. hospitals have special ventilation
systems meant to keep out potentially contaminated air from surrounding
corridors. But every time the doors open, outside air can get into the operating
room. In this study, researchers recorded the number and length of door
openings during nearly 200 knee and hip surgeries at the Johns Hopkins Bayview
Medical Center in Baltimore. In one-third of the operations, there were enough
door openings to potentially defeat the safety effects of the doorway airflow
system, according to the study published in the journal Orthopedics. It's likely
this is a common problem nationwide, the Johns Hopkins University researchers
said. The researchers conducted their study without the knowledge of operating
room staff, so they couldn't ask why so many people went in and out during
surgeries. Only one of the patients in the study developed an infection after
surgery, and the cause of that infection was unknown. Source: Orthopedics.
2015; 38(11):e991–e994
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Also check out AORN Journal. STOP: Can We Minimize OR Traffic? October 2015, Vol.
102, No. 4
New SARS-like virus can jump directly
from bats to humans, no treatment available
• Researchers from the University of North Carolina at Chapel Hill have discovered a
new bat SARS-like virus that can jump directly from its bat hosts to humans without
mutation. However, researchers point out that if the SARS-like virus did jump, it is still
unclear whether it could spread from human to human. The discovery, reported in
Nature Medicine, is notable not only because there is no treatment for this newly
discovered virus, but also because it highlights an ongoing debate over the government's
decision to suspend all gain of function experiments on a variety of select agents earlier
this year. The move has put a substantial standstill on the development of vaccines or
treatments for these pathogens should there be an outbreak. Studies have predicted the
existence of nearly 5,000 coronaviruses in bat populations and some of these have the
potential to emerge as human pathogens. SARS first jumped from animals to humans in
2002-2003 and caused a worldwide outbreak, resulting in 8,000 cases, including one
case in Chapel Hill. With nearly 800 deaths during that outbreak, SARS-CoV presents
much like flu symptoms but then can accelerate, compromise breathing and bring on a
deadly form of pneumonia. The outbreak was controlled through public health
interventions and the original virus was thought to have been extinct since 2004. This
virus is highly pathogenic and treatments developed against the original SARS virus in
2002 and the ZMapp drugs used to fight Ebola fail to neutralize and control this
particular virus. Source: http://uncnews.unc.edu/2015/11/09/new-sars-like-virus-canjump-directly-from-bats-to-humans-no-treatment-available/
Costco Points to Vegetable Mix as
Possible Source of Bacterial Infections
• Costco Wholesale Corp. COST 0.12 % said federal investigators are examining
whether the celery and onion mix used in the retailer’s rotisserie chicken salad was
the source of an E. coli outbreak that infected 19 people. Costco vice president
responsible for food safety Craig Wilson said there is no problem with the retailer’s
rotisserie chickens which it continues to sell. No further infections have been
reported, Mr. Wilson said. The CDC said five people had been hospitalized and two
developed hemolytic uremic syndrome, a type of kidney failure. Costco’s Mr.
Wilson said all of the hospitalized people have been discharged. The majority of the
infections were in the western U.S., the CDC said. The retailer removed the chicken
salad from its shelves after the CDC notified the company of the issue on Friday.
Another recent E. coli outbreak, linked to Chipotle Mexican Grill Inc., CMG 0.53
%widened from the Pacific Northwest to other states, the CDC said Friday. The CDC
said 45 people have become ill from the E. coli strain linked to Chipotle. Chipotle
said it has conducted deep cleaning at the restaurants that have been linked to the
incident, replaced ingredients in those restaurants and changed food-preparation
procedures. The Costco product being investigated is labeled “Chicken Salad made
with Rotisserie Chicken” with item number 37719.
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Source: http://www.wsj.com/articles/costco-points-to-vegetable-mix-as-possible-source-of-bacterialinfections-1448486087?tesla=y&alg=y