Transcript File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
February 2014
Microbial contamination confirmed in
Rx Formulations’ sterile product
The FDAis alerting health care providers, hospital supply managers, and pharmacists
that 2 to 3 millimeter, irregularly shaped floating matter was observed in calcium
gluconate injection from an intact, unused vial produced at Rx Formulations, Mesa,
Ariz. Rx Formulations informed FDA that it is recalling products marketed as sterile
that were made in the same area of the facility as the contaminated product. The
following products, compounded in Hood #2 between Nov. 7 and Dec. 11, 2013, are
subject to the recall by Rx Formulations: Calcium Gluconate 10%, Magnesium
Sulfate Potassium Phosphates 4.4 mEq/ml, Oxytocin 10 Units/ml, Sodium
Bicarbonate 8.4%, Bupivacaine 3%
A contaminated injectable drug can put patients at risk of adverse health
consequences and possibly a serious infection. Therefore, these products should
not be administered to patients. Health care providers and hospital staff should
immediately check their medical supplies, quarantine the products being recalled,
and follow the recall instructions from Rx Formulations. FDA has not received any
adverse event reports associated with calcium gluconate injection from Rx
Formulations. FDA asks health care providers and consumers to report adverse
reactions to the FDA’s MedWatch5 Adverse Event Reporting program:
Surgery Patients May Have Been
Exposed to CJD at N.C. Hospital
Doctors and hospital officials from Novant Health Forsyth Medical Center in
Winston-Salem, North Carolina, are notifying 18 neurosurgery patients that they
might have been exposed to Creutzfeldt-Jakob disease, a serious and incurable
neurological disorder. "Today we are reaching out to 18 neurosurgery patients who
were exposed to Creutzfeldt-Jakob disease over the last three weeks at Forsyth
Medical Center”. According to the National Institute of Neurological Disorders and
Stroke, CJD affects about one person in every 1 million people per year worldwide.
The hospital confirmed that on January 18, an operation was performed on a
patient with CJD symptoms who later tested positive for the illness. Even though
the surgical instruments were sterilized by standard hospital procedures, they
should have gone through enhanced sterilization procedures used when there are
confirmed or suspected cases of CJD. The Centers for Disease Control and
Prevention, as well as the World Health Organization, recommends that surgical
equipment used on CJD patients be destroyed or decontaminated through an
intense disinfecting process. Although CJD can be transferred through surgical
equipment, hospital officials say the likelihood of these patients contracting the
disease is very low. http://www.cnn.com/2014/02/10/health/north-carolina-creutzfeldt-jakob/
ASGE Issues Guidelines for Safety in
the Gastrointestinal Endoscopy Unit
The American Society for Gastrointestinal Endoscopy (ASGE) has issued "Guidelines for
safety in the gastrointestinal endoscopy unit." The purpose of this new guideline is to
present recommendations for endoscopy units in implementing and prioritizing safety
efforts and to provide an endoscopy-specific guideline by which to evaluate endoscopy
units. Historically, safety in the gastrointestinal (GI) endoscopy unit has focused on
infection control, particularly around the reprocessing of endoscopes. Although ASGE has
previously published guidelines on staffing, sedation, infection control, and endoscope
reprocessing for endoscopic procedures, rare reports of outbreaks in which the
transmission of infectious agents were related to GI endoscopy have highlighted the need
to address potential areas in the endoscopy care continuum that could impact patient
safety. Changes to the Centers for Medicare and Medicaid Services (CMS) Ambulatory
Surgical Center Conditions for Coverage that went into effect in 2009 eliminated the
distinction between a sterile surgical room and a non-sterile procedure room, providing
further impetus for this guideline. As a result of these conditions, non-sterile procedure
environments, including endoscopy units, are now held to the same standards as sterile
operating rooms even though requirements for facilities, infection control, staffing, and
sedation applicable to the sterile operating room may not be relevant or necessary for
endoscopy units.
Nursing assistants most
likely to pick up C. diff spores
Researchers examined caregivers' hands after contact with patients with C. diff
infections. They found that even when clinicians take precautions like wearing
disposable gowns with full-length gloves and sleeves, about 25 percent of
healthcare workers had C. diff spores on their hands after providing routine care to
the patients. The likelihood of contamination increased in cases of high-risk contact
like changing bed linen or digital rectal exams. The research team observed hand
contamination in 42 percent of nursing assistants, compared to 23 percent of
physicians and 19 percent of nurses. Researchers attributed the higher levels due
to the fact nursing assistants had a greater amount of high-risk contact.
Duration of high-risk contact was positively associated with hand contamination. To
our knowledge, this is the first time that duration of contact has been reported as a
risk factor for hand contamination. Landelle also emphasized the need to follow
proper hand-washing protocols to safeguard against infections, according to the
article.
Source: Infec Contr Hosp Epid – Jan 2014
CRE Outbreaks Linked to
Contaminated Endoscopes
Advocate Lutheran General Hospital (Park Ridge, IL) reported in 2013 that it had,
recently and unprecedentedly, notified 243 patients of the potential for them to
have been infected during a medical procedure with a “superbug” (so named
primarily because of its resistance to antibiotics) called carbapenem-resistant
Enterobacteriaceae, or “CRE” for short.
These 243 patients were considered “at risk” and told by hospital officials to be
screened and evaluated for infection with CRE because of the outbreak
investigation’s determination that each of these patients may have been exposed
to a routinely used medical instrument contaminated with this superbug while
having undergone a certain gastrointestinal (GI) procedure called endoscopic
retrograde cholangiopancreatography, or “ERCP,” performed at this hospital
between January, 2013, and September, 2013.
Of these 243 patients, over 100 returned to the hospital to be tested, and —
representing the largest outbreak of this superbug in U.S. history, to date — 38
patients were found to be either infected or colonized with the outbreak’s strain
of CRE. http://endoscopereprocessing.com/2014/01/multiple-superbug-outbreaks-linked-contaminatedendoscopes-u-s-europe-smoking-gun/
Hepatitis C probe continues at
Brantford General Hospital (BGH)
Infection control specialists spent the week completing audits of the hospital’s
procedures, which looked at staff and physician practices, sterilization techniques,
medical administration and other procedural aspects. Last Thursday, it was
announced that hospital staff recently became aware of a possible breach in
protocols after two people who received endoscopies at the hospital became
infected with Hepatitis C. The two patients who contracted the disease each
underwent an endoscopy about five months apart, on May 29 and Nov. 8.
The investigation led to the possibility that human error caused crosscontamination of medication supplies used between affected patients.
Moving forward, the hospital will implement explicit and comprehensive guidelines
on the preparation, labeling, delivery, storage, documentation and discarding of all
medications used in endoscopy.
Additional training on sterilization techniques for all staff involved in endoscopies
and the implementation of additional guidelines in the storage, sterilization and
disinfection of equipment – above and beyond standard practice – will also become
part of procedures at BGH.
http://www.brantnews.com/news-story/4329410-hep-c-probe-continues-at-bgh/
C. diff infections hit record
high
People getting medical care can catch serious infections called health careassociated infections (HAIs). While most types of HAIs are declining, one – caused
by the germ C. difficile – remains at historically high levels.
C. difficile causes diarrhea linked to 14,000 American deaths each year. Those
most at risk are people, especially older adults, who take antibiotics and also get
medical care. When a person takes antibiotics, good germs that protect against
infection are destroyed for several months.
During this time, patients can get sick from C. difficile picked up from
contaminated surfaces or spread from a health care provider's hands. About 25%
of C. difficile infections first show symptoms in hospital patients; 75% first show
in nursing home patients or in people recently cared for in doctors' offices and
clinics. C. difficile infections cost at least $1 billion in extra health care costs
annually. Hospital stays from C. difficile infections tripled in the last decade,
posing a patient safety threat especially harmful to older Americans. Hospitals
following infection control recommendations lowered C. difficile infection rates
by 20% in less than 2 years.
http://www.cdc.gov/VitalSigns/Hai/StoppingCdifficile/
Hospital water taps
contaminated with bacteria
Researchers found the total microbial load was up to 10 times
greater when aerators were in place than after they had been
sterilized. Their findings show that opportunist micro-organisms like
Legionella spp., Acinetobacter spp. and other Gram-negative
bacteria were significantly higher at the faucet than in the plumbing
system
Throughout the study, researchers consistently noted chlorine
levels that were too low and hot water temperatures that were
below the minimal temperature needed to prevent the growth of
Legionella
Both of these factors promote the growth of waterborne
pathogens.
http://www.shea-online.org/View/ArticleId/251/Hospital-Water-Taps-Contaminated-withBacteria.aspx
More than 300 people fall ill
aboard cruise ship
The CDC are investigating how more than 300 people have fallen ill on
board a ship cruising the Caribbean. The CDC said that health officials
would board Royal Caribbean's Explorer of the Seas Sunday, when it is
scheduled to dock at St. Thomas, U.S. Virgin Islands.
In all, 281 passengers and 22 crew members have reportedly fallen ill
during the voyage, with most reporting vomiting and diarrhea. The CDC
said it was not immediately clear what had caused the apparent outbreak.
In response, the agency said that the ship's crew had stepped up its
cleaning and disinfecting actions, encouraged passengers to report
possible new cases, and prepared for new crew members to join the
voyage midway through the journey.
The ship had departed Cape Liberty, NJ on January 21 for a scheduled
10-day cruise to the island of St. Maarten, which included scheduled
stops in Haiti and Puerto Rico. There are a total of 3,050 passengers and
1,165 crew on board. Fox News
VA Hospital finds ways to tame MRSA
super bug; hospitals urged to follow
example
Before 2007, the potentially deadly super bug MRSA stalked patients at the
Louisville Veterans Affairs Medical Center - with infection rates 20 times higher
than they are today. That was before the VA began screening every patient
admitted or moved from one unit to another, to see if they unknowingly carried
the antibiotic-resistant and highly contagious bacteria, and then, if they found it,
taking extra care to ensure it wouldn't spread.
The result? MRSA infections have fallen to 0.09 infections per 1,000 "bed days of
care," or days patients stay in a bed, compared with 1.89 infections per 1,000 in
2008. Lisa McGiffert, director of the Safe Patient Project at Consumers Union, a
national consumer protection organization, pointed out that five other states
require hospitals to conduct at least some MRSA screening.