Transcript File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
July 2014
TB Transmission
Study Examines Rate of
HIV Diagnosis in U.S.
• The annual HIV diagnosis rate in the U.S. decreased more than 30 percent from
2002-2011, with declines observed in several key populations, although increases
were found among certain age groups of men who have sex with men, especially
young men. There has been increasing emphasis on care and treatment for persons
with human immunodeficiency virus (HIV) in the United States during the past
decade, including the use of antiretroviral therapy for increasing survival and
decreasing transmission. Accurate HIV diagnosis data recently became available for
all states, allowing for the first time an examination of long-term national trends.
• During 2002-2011, 493,372 persons were diagnosed with HIV in the United States.
The annual diagnosis rate decreased by 33.2 percent, from 24.1 per 100,000
population in 2002 to 16.1 in 2011. Statistically significant decreases in diagnosis
rates over time were found in nearly every demographic population with the largest
changes observed in women, persons 35-44 years of age, and persons of multiple
races. Changes were not evident for Asians or Native Hawaiians/other Pacific
Islanders. The annual number of HIV diagnoses decreased in persons with infection
attributed to injection drug use or to heterosexual contact.
• Source: July 23/30 issue of JAMA, a theme issue on HIV/AIDS
Low-cost TB test means quicker,
more reliable diagnosis for patients
• A new test for tuberculosis could dramatically improve the speed and accuracy of
diagnosis for one of the world's deadliest diseases. Although preventable, TB
claims three lives every minute, making it the second leading cause of mortality
from an infectious disease in the world. Findings show the test can determine
that a patient has tuberculosis with 86 percent sensitivity and 73 percent
specificity. Smear microscopy, the most widely used test in the world, has a
significantly lower ability to detect TB, ranging between 50 to 60 percent
sensitivity. Spread through the air when an individual with active TB infection
coughs or sneezes, reports show that if left untreated, a person with active TB
infects an average of 10 to 15 people each year, leaving a great need for faster,
more reliable testing.
• Once sputum samples are combined with the reactive substance, a batterypowered, portable tabletop device, the TB REaD™, is then used to detect any
fluorescence and deliver the diagnosis in as little as 10 minutes. The device
significantly undercuts current diagnostic methods, important, given the
staggering statistic that if left untreated -- a common scenario in countries lacking
infrastructure or resources to efficiently screen and follow up with infected
patients -- a person with active TB has only a 50 percent chance of survival.
Outbreak of Pseudomonas aeruginosa and
Klebsiella pneumoniae bloodstream infections
at an outpatient chemotherapy center
• Background
• Four patients were hospitalized July 2011 with Pseudomonas aeruginosa
bloodstream infection (BSI), 2 of whom also had Klebsiella pneumoniae BSI. All 4
patients had an indwelling port and received infusion services at the same
outpatient oncology center.
• Methods
• Cases were defined by blood or port cultures positive for K pneumoniae or P
aeruginosa among patients receiving infusion services at the oncology clinic
during July 5-20, 2011. Pulsed-field gel electrophoresis (PFGE) was performed on
available isolates. Interviews with staff and onsite investigations identified lapses
of infection control practices. Owing to concerns over long-standing deficits, living
patients who had been seen at the clinic between January 2008 and July 2011
were notified for viral blood-borne pathogen (BBP) testing; genetic relatedness
was determined by molecular testing.
• Continued………
Outbreak of Pseudomonas aeruginosa and
Klebsiella pneumoniae bloodstream infections
at an outpatient chemotherapy center
• Results
• Fourteen cases (17%) were identified among 84 active clinic patients, 12 of
which involved symptoms of a BSI. One other patient had a respiratory
culture positive for P aeruginosa but died before blood cultures were
obtained. Available isolates were indistinguishable by PFGE. Multiple
injection safety lapses were identified, including overt syringe reuse among
patients and reuse of syringes to access shared medications. Available BBP
results did not demonstrate iatrogenic viral infection in 331 of 623 notified
patients (53%).
• Conclusions
• Improper preparation and handling of injectable medications likely caused
the outbreak. Increased infection control oversight of oncology clinics is
critical to prevent similar outbreaks.
•
Source: AJIC Volume 42, Issue 7 , Pages 731-734, July 2014
Sustained reduction of central line–associated bloodstream
infections outside the intensive care unit with a multimodal
intervention focusing on central line maintenance
Background
• Central venous catheter use is common outside the intensive care units (ICUs),
but prevention in this setting is not well studied. We initiated surveillance for
central line–associated bloodstream infections (CLABSIs) outside the ICU
setting and studied the impact of a multimodal intervention on the incidence
of CLABSIs across multiple hospitals.
• Methods
• This project was constructed as a prospective preintervention-postintervention
design. The project comprised 3 phases (preintervention [baseline],
intervention, and postintervention) over a 4.5-year period (2008-2012) and
was implemented through a collaborative of 37 adult non-ICU wards at 6
hospitals in the Rochester, NY area. The intervention focused on engagement
of nursing staff and leadership, nursing education on line care maintenance,
competence evaluation, audits of line care, and regular feedback on CLABSI
rates. Quarterly rates were compared over time in relation to intervention
implementation.
Sustained reduction of central line–associated
bloodstream infections outside the intensive care
unit with a multimodal intervention focusing on
central line maintenance
• Results
• The overall CLABSI rate for all participating units decreased
from 2.6/1000 line-days preintervention to 2.1/1,000 linedays during the intervention and to 1.3/1,000 line-days
postintervention, a 50% reduction (95% confidence interval,
.40-.59) compared with the preintervention period (P .0179).
• Conclusion
• A multipronged approach blending both the adaptive and
technical aspects of care including front line engagement,
education, execution of best practices, and evaluation of both
process and outcome measures may provide an effective
strategy for reducing CLABSI rates outside the ICU.
• Source: Volume 42, Issue 7 , Pages 723-730, July 2014
Video observation to map hand contact
and bacterial transmission in operating
rooms
• Background
• Hand hygiene (HH) is considered a primary intervention to avoid transmission
of bacteria in health care settings and to prevent health care-associated
infections. Despite efforts to decrease the incidence of health care-associated
infections by improving HH, HH compliance rates vary widely depending on
the hospital environment.
• Methods
• We used intraoperative video observation to map temporal patterns of
anesthesia provider hand contact with anesthesia work environment (AWE)
surfaces and to assess HH compliance. Serial bacterial cultures of high
contact objects were subsequently used to characterize bacterial
transmission over time.
• Continued……..
Video observation to map hand contact
and bacterial transmission in OR
• Results
• Using World Health Organization criteria, we found a large number of HH
opportunities and a low rate of HH compliance by anesthesia providers (mean,
2.9%). We observed an inverse correlation between provider hand hygiene
compliance during induction and emergence from anesthesia (3.2% and 4.1%,
respectively) and the magnitude of AWE surface contamination (103 and 147
CFU, respectively) at these time points. We found no correlation between
frequency of hand contact with the AWE and bacterial contamination.
• Conclusions
• Compliance with current HH recommendations by anesthesia providers is not
feasible. However, there does appear to be a correlation between HH
compliance rates and bacterial contamination of the AWE, an observation that
should stimulate further work to design new methods for control of bacterial
transmission in operating rooms
• Source: Volume 42, Issue 7 , Pages 698-701, July 2014
Hospital elevator buttons carry
more bacteria than toilet surfaces
Researchers swabbed 120 elevator buttons and 96 toilet surfaces over separate
intervals at three large, urban teaching hospitals on weekends and weekdays in
Toronto, Ontario. They swabbed the up and down buttons on the outside of the
elevator, along with the ground floor and a randomly selected upper-level floor
button, while they swabbed the handles of the bathroom door, the privacy latch on
the door and the toilet flusher. There was a 61 percent prevalence of colonization on
elevator buttons, which didn't vary based on location of the buttons, day of the week
or panel position within the elevator, according to the study. Coagulase-negative
staphylococci were the most common organism cultured, while Enterococcus and
Pseudomonas species were infrequent. Toilet surfaces, on the other hand, only had a
43 percent prevalence of colonization. Although absence of pathogenic organisms
reflects good hand hygiene and staff cleaning, the prevalence of colonization shows
patients remain at risk for cross contamination because of the frequent use of elevator
buttons, according to the study. Researcher noted that they took the samples during
flu season, which could have influenced the bacteria count because of the increased
use of hand sanitizer, or conversely, may have increased hospital traffic and
generalized exposures. Source: Open Medicine, Vol 8, No 3 (2014)
Safety of fecal transplant to treat
C. difficile examined in study
Researchers have found that fecal transplantation is effective and safe for treating C. difficile
in immunocompromised patients. The study and its findings have been published online in
advance of print in the American Journal of Gastroenterology. Increased lengths of stay in
hospitals and extended-care facilities, in addition to broad-spectrum antibiotics, increase C.
diff infection risk among immunocompromised patients. The infection is responsible for 15
to 25 percent of hospital acquired antibiotic-associated diarrhea and has increased rapidly
over the past 10 years to an incidence of 10.4 cases per 1,000 patient admissions.
Recurrence is common and occurs in up to 20 percent of patients after initial treatment for
C. diff infection. Researchers reviewed the records of 75 adult and five pediatric patients
with fecal transplant for C. diff infection. Reasons for being immunocompromised included:
HIV/AIDS, solid organ transplant, an oncologic condition, immunosuppressive therapy for
inflammatory bowel disease, and other medical conditions/medications, such as cirrhosis
and end stage kidney disease. Analysis found an overall cure rate of 89 percent. While not
directly related to fecal transplant, 12 patients had serious adverse effects (such as
hospitalization) within 12 weeks of the procedure. Among these were two deaths -- one
resulted from aspiration during sedation for the colonoscopy used to administer fecal
transplant; the other was unrelated to fecal transplant. Some patients with inflammatory
bowel disease experienced disease flares after transplant, but no patient suffered infections
related to fecal transplant. Source: Fecal Microbiota Transplant for Treatment of Clostridium difficile Infection in
Immunocompromised Patients. The American Journal of Gastroenterology, 2014; 109 (7): 1065 DOI: 10.1038/ajg.2014.133
Deadliest, rarest form of plague
contracted near Denver
• A Colorado man is infected with the rarest and most fatal form of plague, an
airborne version that can be spread through coughing and sneezing. It is the first
case of pneumonic plague seen in the state since 2004. The may have been
exposed in Adams County near Denver. He may have contracted the illness from his
dog, which died suddenly and has also been found to carry the disease.
• Plague in all of its forms infects only about seven people yearly in the U.S. The
disease occurs when a bacterium named Yersinia pestis infects the body, according
to the U.S. Centers for Disease Control and Prevention. The difference between the
pneumonic and bubonic varieties is that the bacteria take hold in the lungs in the
first case, rather than underneath the skin through insect bites. Both types are
treated with antibiotics. The state is working to investigate the source of exposure
and to identify those who may have been exposed through close contact with the
individual. Any individuals exposed will be recommended for antibiotic treatment.
Colorado has had 60 cases of all types of plague since 1957, and nine people have
died. Colorado officials recommend that residents keep pets away from wildlife,
especially dead rodents. The plague can spread from animals after a large die-off of
prairie dogs, when fleas with the bacteria seek new hosts. Source:
http://www.bloomberg.com/news/2014-07-11/deadliest-rarest-form-of-plague-contracted-near-denver.html
Voluntary Nationwide Recall of Tattoo
Ink, Tattoo Needles, Tattoo kits Due to
Microbial Contamination
• July 11, 2014 - July 11, 2014- White & Blue Lion, Inc. in the City of Industry, CA is
recalling all lots of tattoo Inks and tattoo needles due to pathogenic bacterial
contamination. Use of these products may cause bacterial infection and can lead
to sepsis, a potentially life-threatening complication of an infection. The recall
includes all tattoo inks, tattoo needles, and tattoo kits distributed by White & Blue
Lion.
• The inks and needles are sold in tattoo kits and the inks are also sold separately
by 8Decades and White & Blue Lion, Inc. through www.amazon.com.
• There was a report of one illness as of today’s date. FDA Laboratory testing has
found microbial bacterial contamination in both the inks and needles.
• This recall is being made with the knowledge of the US Food and Drug
Administration. Consumers with any questions should contact us at 1-626-5863485 from Monday to Friday between the hours of 9am to 6pm PST.
It's here: Local Chikungunya
cases in Florida
Chikungunya has been reported in a Florida man and woman who had not recently traveled,
health officials said Thursday - the first indication that the painful virus has taken up residence
in the United States.
Health experts had said it was only a matter of time before the virus, carried by mosquitoes,
made its way to the U.S. It's been spreading rapidly in the Caribbean and Central America. It's
infected 350,000 and killed 21. There have been other U.S. cases but all have been among
people who had recently traveled to affected regions. Florida health officials later said there
were two cases: a 41-year-old woman in Miami-Dade County and a 50-year-old man in Palm
Beach County.
Since 2006, the United States has averaged 28 imported cases of chikungunya (chik-un-GUHNya) per year in travelers returning from countries where the virus is common. To date this
year, 243 travel-associated cases have been reported in 31 states and two territories," CDC
said. However, the newly reported case represents the first time that mosquitoes in the
continental United States are thought to have spread the virus to a non-traveler. This year,
Puerto Rico and the U.S. Virgin Islands reported 121 and two cases of locally acquired
chikungunya respectively. Chikungunya is not usually deadly, but it can cause a very bad
headache, joint pain, rash and fever. The Aedes aegypti and Aedes albopictus mosquitoes that
spread chikungunya are found across the southern United States and as far north as New
York. http://www.nbcnews.com/health/health-news/its-here-first-local-chikungunya-casesflorida-n158746
West Virginia clinic reused needles
• Health officials on Monday advised patients of a West Virginia pain
management clinic to be tested for blood-borne infectious diseases after an
investigation found that needles had been reused.
• The investigation by West Virginia health officials found that, prior to
November 2013, needles and syringes were reused at Valley Pain
Management in McMechen to administer pain medications and saline
solutions. They said the same pain medication vial was used for more than
one patient.
• These injection practices potentially exposed patients to diseases such as
hepatitis B, hepatitis C and HIV, according to health department officials in
West Virginia and Ohio. Health officials urged patients from both states to be
tested. Health officials from both states advised patients to be tested for
blood-borne infections if they had an injection between the clinic's 2010
opening and Nov. 1, 2013. Both agencies said the clinic has not cooperated
with their requests for a patient list, which they are seeking so patients can
be notified of their potential risk of exposure and testing options.
Sierra Leone's chief Ebola doctor
contracts the virus
• The head doctor fighting the deadly tropical virus Ebola in Sierra Leone has
himself caught the disease, the government said. The 39-year-old Sheik Umar
Khan, hailed as a "national hero" by the health ministry, was leading the fight
to control an outbreak that has killed 206 people in the West African
country. Across Guinea, Liberia and Sierra Leone, more than 600 people have
died from the illness, according to the World Health Organization, placing great
strain on the health systems of some of Africa's poorest countries.
• Khan, a Sierra Leonean virologist credited with treating more than 100 Ebola
victims, has been transferred to a treatment ward run by medical charity
Medecins Sans Frontieres, according to the statement released late on Tuesday
by the president's office.
• Three days ago, three nurses working in the same Ebola treatment center
alongside Khan died from the disease.
• http://news.msn.com/world/sierra-leones-chief-ebola-doctor-contracts-thevirus
•