Transcript File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
July 2015
The U.S. just recorded its first
confirmed measles death in 12 years
• Health officials on Thursday confirmed the country's first measles death since 2003,
and they believe the victim was most likely exposed to the virus in a health facility
in Washington state during an outbreak there. The woman died in the spring; a
later autopsy confirmed that she had an undetected measles infection, the
Washington State Department of Health said in a statement. The official cause of
death was announced as "pneumonia due to measles.“ The woman was at a
Clallam County health facility "at the same time as a person who later developed a
rash and was contagious for measles," the health department statement read. "The
woman had several other health conditions and was on medications that
contributed to a suppressed immune system. She didn’t have some of the common
symptoms of measles such as a rash, so the infection wasn’t discovered until after
her death.“ According to the U.S. Centers for Disease Control and Prevention, 178
people from 24 states and the District were reported to have measles from Jan. 1
through June 26 of this year. Two-thirds of the cases, the CDC noted, were "part of
a large multi-state outbreak linked to an amusement park in California.“ This
newly confirmed case marks Washington's 11th reported instance of measles this
year, and state health officials urged people to vaccinate against the virus.
Source: http://www.washingtonpost.com/news/to-your-health/wp/2015/07/02/the-u-s-
Greenville Health System Settles a Lawsuit
Claiming Negligence Caused a Patient’s
Infection, Death
• Greenville Health System has settled a wrongful death lawsuit with the
beneficiaries of a surgical patient who died after contracting an infection, court
documents show.mmGHS offered $600,000 for full settlement of claims arising
from the hospital's medical treatment of Ella Mae Mattison, according to a court
order approving the settlement in late June.
• Mattison, 59, was admitted to Greenville Memorial Hospital on Aug. 28, 2013, for
coronary artery disease, according to court documents. She underwent coronary
artery bypass surgery on Sept. 2, 2013, and was diagnosed with Mycobacterium
abscessus on March 10, 2014, according to the court records. She died June 23,
2014.m The lawsuit alleged employees of GHS were negligent in their care of
Mattison, resulting in her death. GHS denied any and all liability, according to the
court document.
• Fifteen patients were infected and four died after contracting the
Mycobacterium abscessus infection at Greenville Memorial Hospital, officials
said last year.
Your mobile phone may be 'patient
zero' for hospital infections
• In a paper published in the Journal of Occupational and Environmental Hygiene,
Australian researchers sought to investigate the potential role mobile phones
play as reservoirs for infection and bacterial colonization in the hospital setting.
• The researchers screened a group of 226 staff members comprising 146
physicians and 80 medical students at a regional Australian hospital between
January 2013 and March 2014.
• They concluded that 74 percent of staff members' mobile phones were
contaminated with bacteria, of which 5 percent was deemed potentially
harmful.
• Similar organisms were found on the dominant hands of staff members.
• Junior medical staff members were found to be at greater risk for heavy
microbial growth.
– Of the 226 participants, 31 percent reported cleaning their phones routinely.
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Of those who cleaned their phones, only 21 percent reported using alcohol containing wipes.
The researchers concluded that disinfection guidelines for cell phone use in hospitals should be developed
and implemented.
Source: Journal of Occupational and Environmental Hygiene June 2015
Reconsidering Contact Precautions for
Endemic MRSA and VRE
BACKGROUND Whether contact precautions (CP) are required to control the endemic
transmission of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant
Enterococcus (VRE) in acute care hospitals is controversial in light of improvements in hand
hygiene, MRSA decolonization, environmental cleaning and disinfection, fomite elimination,
and chlorhexidine bathing.
OBJECTIVE To provide a framework for decision making around use of CP for endemic MRSA
and VRE based on a summary of evidence related to use of CP, including impact on patients
and patient care processes, and current practices in use of CP for MRSA and VRE in US
hospitals.
DESIGN A literature review, a survey of Society for Healthcare Epidemiology of America
Research Network members on use of CP, and a detailed examination of the experience of a
convenience sample of hospitals not using CP for MRSA or VRE.
PARTICIPANTS Hospital epidemiologists and infection prevention experts.
RESULTS No high quality data support or reject use of CP for endemic MRSA or VRE. Our survey
found more than 90% of responding hospitals currently use CP for MRSA and VRE, but
approximately 60% are interested in using CP in a different manner. More than 30 US hospitals
do not use CP for control of endemic MRSA or VRE.
CONCLUSIONS Higher quality research on the benefits and harms of CP in the control of
endemic MRSA and VRE is needed. Until more definitive data are available, the use of CP for
endemic MRSA or VRE in acute care hospitals should be guided by local needs and resources.
Source: Infect Control Hosp Epidemiol 2015;00(0):1–10
OSHA Issues New Guidance for Healthcare
Entities
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According to the Occupational Health and Safety Administration (“OSHA”), 2013 statistics
demonstrate that healthcare workers have a rate of work-related illness and injury that is
nearly twice as high as the overall rate seen in private industry.1 In the last five years, OSHA
has issued a number of guidance documents on topics ranging from prevention of workplace
violence against healthcare workers to safer patient handling methods intended to protect
both patients and healthcare workers. Now, OSHA has issued Inspection Guidance for
inspections to be conducted in inpatient healthcare settings with North American Industry
Classification System (NAICS) Major Group codes 622 (hospitals) and 623 (nursing and
residential care facilities). All inspections of hospitals, nursing facilities, and residential care
facilities conducted after June 25, 2015, will include inspections related to the following
hazards, in addition to whatever triggered the inspection in the first:
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Musculoskeletal Disorders (MSDs) related to patient or resident handling; Workplace Violence;
Bloodborne Pathogens; Tuberculosis; and Slips, trips, and falls.
In addition to these hazards, OSHA inspections of affected healthcare facilities may also
include inspections to ascertain whether there is any exposure to multi-drug resistant
organisms (MDROs), such as Methicillin-resistant Staphylococcus aureus (MRSA) and to
hazardous chemicals, such as sanitizers, disinfectants, anesthetic gases, and hazardous
drugs.
OSHA claims the rate of work-related illness and injury in healthcare was 6.4 incidents per
100 employees in 2013. Source: https://www.osha.gov/dsg/hospitals/
Variation In Antibiotic Prescribing
Among VA Physicians
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A previous study estimated that antibiotics were prescribed in 10% of 95 million office visits. By 1999,
22% of adult and 14% of pediatric prescriptions for broad-spectrum antibiotics were for URIs, conditions
which are largely viral. Similarly, a 2007-9 survey showed that more than 25% of prescriptions were for
conditions not warranting antibiotics.
There are large geographic differences in prescribing not readily explained by patterns of disease. While
some inappropriate antibiotic use has declined, sites with high-prescription rates had a higher
proportion of antibiotic-resistant invasive pneumococcal infections, which are life threatening as well as
far more costly to treat. This was especially true for overuse of cephalosporins and macrolides (e.g.,
azithromycin or clarithromycin). In this study, researchers looked at differences in individual prescribing
patterns, examining all VA outpatient records from 2005-12 for patients seen for ARIs. Importantly, they
excluded patients who had underlying conditions (comorbidities) like diabetes or COPD that might have
put them at higher risk for a serious bacterial infection. They also looked only at providers who had seen
at least 100 patients with this condition.
Disappointingly, despite educational efforts to reduce antibiotic use over the past decade, the
proportion of the 1 million ARI visits examined that led to antibiotic prescription increased from 67.5%
to 69.2%. Macrolide prescriptions alone increased from 36.8 to 47%. The most interesting finding was
the huge variation in prescribing patterns. Lead author Barbara Jones, M.D., M.S., assistant professor of
internal medicine at the University of Utah and clinician at the VA Salt Lake City Health Care System,
commented that she expected prescriptions in 10-40% of visits. Yet they found a higher rate—more
than 20% higher—and this was driven by individual practitioner’s habits, rather than by differences in
patients’ illness or underlying characteristics.
Source: Annals of Internal Medicine 21 July 2015, Vol. 163. No. 2
Healthcare Workers are Not
Removing PPE Correctly
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Fewer than 1 in 6 healthcare workers (HCW) followed all Centers for Disease Control and
Prevention (CDC) recommendations for the removal of personal protective equipment (PPE) after
patient care, according to a brief report published in the July issue of the American Journal of
Infection Control.
In this study undertaken by researchers from the University of Wisconsin, a trained observer
watched healthcare personnel entering and exiting patient rooms specified as following isolation
precautions on various units of the hospital. Isolation precautions are used to help stop the
spread of germs from one person to another and may require use of gowns, gloves, and face
protection. Observations took place Oct. 13-31, 2014.
The CDC recommends that gloves should be removed first, followed by the gentle removal of the
gown from the back while still in the patient's isolation room. Of the 30 HCWs observed removing
PPE, 17 removed the gown out of order, 16 wore their PPE out into the hallway, and 15 removed
their gown in a manner that was not gentle, which could cause pathogens from the gown to
transfer to their clothes. "As a result of the current Ebola outbreak, the critical issue of proper
PPE removal has come front and center," the authors state. "Healthcare facilities should use this
opportunity of heightened interest to undertake practice improvement focused on PPE removal
protocol, including technique, for all healthcare-associated conditions that require the donning
and doffing of PPE." Source: “Variation in health care worker removal of personal protective
equipment” by Caroline Zellmer, Sarah Van Hoof, and Nadia Safdar appears in the American
Journal of Infection Control, Volume 43, Issue 7 (July 2015).
Rapid Ebola test could play key role
in efforts to end lingering outbreak
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More than 11,000 people have died since the Ebola epidemic began in March 2014, and
though cases have been declining, the international emergency response that the outbreak
prompted has not been able to drive the virus back underground. The fight against the
disease achieved a significant victory in May, when Liberia -- one of the nations hardest hit
by the virus -- was declared Ebola-free by WHO. Less than 2 months after this win,
however, new cases of the disease were discovered in the country. The first of these was a
17-year-old boy who was misdiagnosed with malaria and who, before passing away, came
into contact with at least 102 people who may have caught the disease from him. This case
tragically illustrates the need for a fast way to accurately identify Ebola cases so that
patients get the care they need and transmission can be halted.
ReEBOV Antigen Rapid Test Kit uses a few drops of blood and the same technology used in
at-home pregnancy tests to provide results in 15 minutes. In comparison, the current gold
standard test for Ebola, qRT-PCR, can take up to a day to return a diagnosis. The WHO
study, conducted in Ebola-hotspot Sierra Leone, compares ReEBOV's performance with
that of qRT-PCR. By testing 292 stored patient samples with both methods, researchers
found that ReEBOV performed nearly as well as the gold standard, and agreed with qRTPCR on 91.8% of infected samples and 84.6% of non-infected samples.
Source: American Association for Clinical Chemistry (AACC). "Rapid Ebola test could play
key role in efforts to end lingering outbreak." ScienceDaily 27 July 2015
Breath of Fresh Air: An Observational Study of Factors
That Compromise Operating Room Air Quality
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BACKGROUND: Understanding what leads to high airborne particulate levels in the operating room (OR)
is crucial for improving patient safety and surgical outcomes. This study examined whether the number
of times OR doors are opened affects airborne particulate counts.
METHODS: Particulate levels and observations were recorded from a single location in a modern,
positive pressure OR approximately every five minutes during eight surgical procedures over five days.
Observations recorded: which OR door was opened (whether to the sterile core or to the outer
corridor); the number of times the door was opened; the job title of the person opening it; and the
reason for opening it. Baseline data was collected in the morning before any activity. Reference samples
were taken in the OR, sterile core, outer corridor and surgical wing front desk.
RESULTS: One or more OR doors were open during 48% of all readings (333/697). Overall airborne
particulate count increased when either door was open (p<0.1950). For particles larger than 0.5
microns, there was a significant increase in particulate counts when either door was open (p<0.0001).
Particulate levels were higher during cases than between cases (p<0.0286). The most common reasons
for opening either door were for case equipment (29%, 95% CI [25%, 34%]), status updates (12%) and
work-related conversations (8%).
CONCLUSIONS: Each time an OR door is opened, the number of airborne particulates increases: this
increases the risk of airborne particulates entering the sterile field. This data supports interventions
aimed at increasing the use of intercoms/viewing monitors, equipment bundling, kit review, and
maximizing teamwork. These strategies will minimize unnecessary door openings and help prevent
surgical site infections. Although unanticipated circumstances are a fact of life in academic hospitals,
medical institutions must develop best practices that maximize patient safety without compromising
the pedagogic mission. Source: Oral Abstracts / American Journal of Infection Control 43 (2015) S3-S17
Pay Attention to the Microbe
Behind the Curtain
• A total of 35 patient, privacy curtains were hung in several different units of the
hospital. The curtains were identical in appearance and touch and were swabbed
twice weekly for four weeks and then once a week for eight weeks. The hand grip
area on each curtain was sampled using saline-soaked swabs and plated onto
blood agar. Colony counts were plotted by time and compared to occupancy
levels for each unit. In total, 582 swabs were collected during the trial.
• Contamination was rapid. Twenty-eight curtains demonstrated contamination on
the first swab; all curtains were contaminated by week two. Contamination levels
increased substantially at week five, followed by steady increases each week
thereafter. 52%. Methicillin-resistant Staphylococcus aureus (MRSA) was found
on 12 (34%) of the curtains. Vancomycin resistant-enterococci (VRE) were
identified on 1/12 of Unit 4 curtains.No Carbapenem-resistantEnterobacteriaceae
(CRE) were detected.
• Patient, privacy curtains are a source of microbial contamination. Results suggest
increased contamination rates with higher room occupancy and that curtains
should be removed, cleaned and sanitized after approximately five weeks of use.
• Source: Michelle M. Bushey, et al. APIC 2015 abstract
Evaluating the Efficacy of UV
Technology in Acute Care
• Sampling was carried out on 28 types of surfaces present in 21 rooms in two
hospitals. The total bacterial load was determined by swabbing each surface in
triplicate, then plating and incubating on Rodac (contact) plates for 48 hours at 37
C. Each surface was swabbed after manual disinfection but prior to treatment
with an automated UV-C device, and then again following UV-C treatment.
• Treatment of 21 hospital rooms with an automated UV-C device following manual
disinfection procedures resulted in complete or near complete bacteria kill for the
28 surface types tested. Although the distance between each surface and the UVC device varied, the mean plate count after UV-C treatment was zero or near zero
in all cases (Figure 1). The difference between mean plate count before and after
treatment was statistically significant for all but two of the rooms examined.
• Treating hospital rooms with an automated UV-C device may be a safe and
effective way to reduce or eliminate microorganism presence that remains after
manual disinfection, particularly for high-touch or vertical surfaces that are
incompatible with solution-based methods.
• Source: Maurice E. Croteau,, et al. APIC 2015 abstract
Implementation of an Operating Room
Management Plan for the Prevention
of Perioperative Hypothermia
• A multidisciplinary workgroup determined the most common co-morbidities in
patients undergoing those specific surgeries, cross referenced with those that
place patients at higher risk of perioperative hypothermia (PH). The risk
assessment was then constructed for various temperature ranges, and risk
assigned according to probability, patient effect and our preparedness to reestablish normothermia. Patients who undergo bariatric, spine, pediatric and
total joint procedures are at a high risk of PH in operating rooms with
temperatures less than 62F. As a result, a new process was created that required
intraoperative warming of all patients in this risk category, as well as frequent,
documented temperature checks, and possible room temperature adjustment. A
brief evaluation of the new process demonstrated a lack of significant
temperature changes between patients in the higher and lower risk categories.
Though surgeons have varying temperature preferences for operating rooms, it is
important to protect our patients from the complications associated with PH,
while remaining flexible. The risk assessment allowed us to customize our
processes to best accomplish this task. We have seen success n the prevention of
perioperative hypothermia among our patients. Source: APIC 2015 abstract