Transcript File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
June 2014
Clostridium difficile spores
Composition of the 2014–15
Influenza Vaccines
• Although influenza activity in summer in the United States typically is low, cases
of influenza, and even influenza outbreaks, are detected in the United States
throughout the summer. Health-care providers should remain vigilant and
consider influenza as a potential cause of summer respiratory illnesses, and also
consider treatment with influenza antiviral medications for those at high risk for
influenza-associated complications, as recommended by the Advisory
Committee on Immunization Practices. Health-care providers also should
consider novel influenza virus infections in persons with ILI and swine exposure,
and those with severe acute respiratory infection after travel to areas where
those viruses have been identified previously. Public health laboratories should
immediately send to CDC any specimens that cannot be typed or subtyped using
standard methods and submit all specimens that are otherwise unusual,
including all summer specimens, as soon as possible after identification. The
FDA’s Vaccines and Related Biological Products Advisory Committee has
determined that the 2014–15 influenza vaccines used in the United States have
the same antigenic composition as those used in 2013–14..
• MMWR: Vol. 63, No. 22 June 6, 2014
Foodborne Norovirus
Outbreaks
CDC analyzed 2009–2012 data on suspected and confirmed norovirus outbreaks
reported by state, local, and territorial health departments through the National
Outbreak Reporting System (NORS) to characterize the epidemiology of foodborne
norovirus outbreaks.
During 2009–2012, a total of 1,008 foodborne norovirus outbreaks were reported
to NORS, constituting 48% of all foodborne outbreaks with a single known cause.
Outbreaks were reported by 43 states and occurred year round. Restaurants were
the most common setting (64%) of food preparation reported in outbreaks. Of 520
outbreaks with factors contributing to contamination reported, food workers were
implicated as the source in 70%. Of 324 outbreaks with an implicated food, most
resulted from food contaminated during preparation (92%) and food consumed
raw (75%). Specific food categories were implicated in only 67 outbreaks; the most
frequently named were vegetable row crops (e.g., leafy vegetables) (30%), fruits
(21%), and mollusks (19%). Noroviruses are the leading cause of reported
foodborne disease outbreaks and most often associated with contamination of
food in restaurants during preparation by infected food workers.
MMWR: June 6, 2014 / 63(22);491-495
Measles — January 1–May 23, 2014
• Measles is a highly contagious, acute viral illness that can lead to serious
complications and death. Although measles elimination (i.e., interruption of yearround endemic transmission) was declared in the United States in 2000 (1),
importations of measles cases from endemic areas of the world continue to occur,
leading to secondary measles cases and outbreaks in the United States, primarily
among unvaccinated persons. Measles cases have been reported from 18 states
and New York City. Most cases were reported from Ohio (138), California (60), and
New York City (26). Fifteen outbreaks have accounted for 227 (79%) of the 288
cases. The median outbreak size has been five cases (range: 3–138 cases). There is
an ongoing outbreak involving 138 cases, occurring primarily among unvaccinated
Amish communities in Ohio. In the three largest outbreaks of 2014, which account
for over a half of all cases this year, transmission occurred after introduction of
measles into communities with pockets of persons who were unvaccinated because
of philosophical or religious beliefs. Importations from endemic countries continue
to occur and have caused an unusually high number of measles cases in 2014. The
most frequent sources of importations were unvaccinated U.S. travelers returning
from abroad, with subsequent transmission among clusters of unvaccinated
persons. MMWR: June 6, 2014 / 63(22);496-499
Hospital claims Hepatitis C lawsuits
costing too much
• The hospital recently took legal action against Steadfast Insurance Company, a
Delaware corporation which provided coverage when former patients filed more
than 30 lawsuits after they became infected with hepatitis C by ex-hospital lab
worker David Kwiatkowski. The patients' suits, many of which have been settled,
accused the hospital of failing to prevent infection, intentional affliction of
emotional distress, and negligent employment, hiring, training and supervision
after Kwiatkowski was hired and spread his strain of hepatitis C through a drug
diversion scheme. The hospital is now disputing the amount it had to pay in order
for Steadfast Insurance's coverage to kick in. The suit claims Steadfast Insurance
required Exeter to pay the $4 million through its self-insurance instead of the $1
million single limit before Steadfast would defend the hospital through its
umbrella coverage. The hospital argues that a single alleged act - its alleged
negligent hiring, training and supervision - resulted in a series of hepatitis C
infections and therefore it should only have been required to satisfy the single $1
million limit of its self-insurance. Meanwhile, the hospital is also pursuing a
separate lawsuit it brought last year against Kwiatkowski, Maxim Healthcare
Services Inc., the American Registry of Radiological Technologists, American
Healthcare Services Association LLC, and Triage Staffing Inc.
FDA OKs Tedizolid for Skin Infections
• The FDA has approved a new antibiotic for skin and soft tissue infections for the
second time in a month. Tedizolid phosphate (Sivextro) is approved to treat acute
skin and soft tissue infections, the agency announced Friday.
• The drug is a protein synthesis inhibitor that targets Gram-positive organisms and
can be given orally or by injection. Its approval comes after the agency gave the
nod last month to dalbavancin (Dalvance), a lipoglycopeptide antibacterial that
weakens the cell walls of Gram-positive pathogens and to a lesser extent those of
Gram-negatives. It is given by injection and is also indicated for skin and soft tissue
infections. Approval of tedizolid was based on results of two phase III trials (studies
112 and 113), both randomized, active controlled, double-blind, double dummy,
multicenter noninferiority studies, in which the comparator drug was linezolid
(Zyvox).
• In both trials, the study drug met a standard noninferiority criterion -- the lower
bound of the 95% confidence interval of the treatment difference was greater than
minus 10%. In study 112, researchers compared 6 days of oral tedizolid at 200 mg
daily with 10 days of oral linezolid at 600 mg twice daily. In study 113, the
comparison was between 200 mg of IV tedizolid once a day, with an option to
switch to oral drug, and 600 mg twice a day of IV linezolid, again with the option to
switch to oral drug. http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/46430
Increase in MRSA Prompts Updated
IDSA Guidelines for Skin and Soft Tissue
Infections
The number of skin and soft tissue infections (SSTI) has skyrocketed due to the spread of
MRSA. But many SSTIs – even those caused by the superbug MRSA – are minor and either
heal on their own or are easily treated without antibiotics, according to updated practice
guidelines for the diagnosis and management of SSTIs published by the Infectious Diseases
Society of America (IDSA).
SSTIs can be caused by microbes that normally are on the skin, or from other sources such as
fresh or salt water or contact with another person. Bacteria can enter through open wounds
or surgical incisions, animal bites, human bites or penetrating injuries to the skin. MRSA
commonly is transmitted among sports teams or in gyms, in high schools and prisons; and
infection can occur when the bacteria enters the skin through a cut or sore. (MRSA typically
is a bigger concern when it causes other types of infections, such as pneumonia and those in
the blood.) Emergency room visits due to SSTIs nearly tripled from 1.2 million in 1995 to 3.4
million in 2005, much of the increase driven by MRSA. SSTIs account for more than 6 million
visits to doctors’ offices every year. Yet most pus-filled SSTIs clear on their own or should be
treated with incision and draining alone, not antibiotics, he said. Using antibiotics
unnecessarily contributes to the development of drug-resistant superbugs.
SSTIs typically are red, swollen, hot to the touch and painful. Purulent SSTIs are usually are
no larger than a few inches, have a focal point of infection and are filled with pus.
Source: Infectious Diseases Society of America (IDSA)
Joint Commission issues alert on
single use vial misuse
Thousands of patients have been adversely affected by the misuse of singledose/single-use and multiple-dose vials. The misuse of these vials has caused harm
to individual patients through occurrences and outbreaks of bloodborne pathogens
and associated infections, including hepatitis B and C virus,1,2 meningitis, and
epidural abscesses.3 Adverse events caused by this misuse have occurred in both
inpatient and outpatient settings, according to the Centers for Disease Control and
Prevention (CDC). Since 2001, at least 49 outbreaks have occurred due to the
mishandling of injectable medical products, according to the CDC. Twenty-one of
these outbreaks involved transmission of hepatitis B or C; the other 28 were
outbreaks of bacterial infections, primarily invasive bloodstream infections. While
many of these outbreaks occurred in inpatient settings, a high percentage occurred in
pain management clinics, where injections often are administered into the spine and
other sterile spaces using preservative-free medications, and in cancer clinics, which
typically provide chemotherapy or other infusion services to patients who may be
immuno-compromised. In addition, more than 150,000 patients required notification
during this time frame to undergo bloodborne pathogen testing after their potential
exposure to unsafe injections. http://www.jointcommission.org/assets/1/6/SEA_52.pdf
CDC Lab Determines Possible
Staff Exposure to Anthrax
• The Centers for Disease Control and Prevention (CDC) announced on June 19th
that approximately 75 Atlanta-based staff are being monitored or provided
antibiotics because they may have been unintentionally exposed to live Bacillus
anthracis (anthrax) after established safety practices were not followed. Early
reports show that one of its Roybal campus biosafety level 3 (BSL3) labs was
preparing B. anthracis samples for research in other CDC labs at lower biosafety
levels to yield new means of detecting dangerous pathogens in environmental
samples. However, the lab used a procedure that did not adequately inactivate
the samples. The potentially infectious samples were moved and used for
experimentation in three CDC Roybal campus laboratories not equipped to handle
live B. anthracis. Workers, believing the samples were inactivated, were not
wearing adequate personal protective equipment while handling the material.
• Lab safety investigators also determined that procedures used in two of the three
labs may have aerosolized the spores. Environmental sampling was done, lab and
hallway areas were decontaminated and laboratories will be re-opened when safe
to operate. www.cdc.gov
Research Finds That Cell Phones
Reflect Our Personal Microbiome
• University of Oregon researchers sequenced microbes from the dominant-hand
index fingers and thumbs of 17 subjects and from the touchscreens of their
smartphones, during a recent Robert Wood Johnson Foundation workshop in
Princeton, New Jersey. The study found smartphones closely resembled the
microbiome sampled from their owner's finger, with 82 percent of the most
common bacteria on participants' fingers also found on their phones.
Interestingly, women were found to be more closely connected, microbiologically
speaking, to their phones than were men.
• The most commonly found bacteria were from three genera that are ubiquitous
on and in humans: Streptococcus, which is commonly found in the mouth, and
Staphylococcus and Corynebacterium, both common skin residents.
• The analyses, utilizing short-read 16S sequencing, focused on categorizing whole
microbial communities rather than identifying pathogens. The findings emerged
from sequences representing more than 7,000 different types of bacteria found
in the 51 samples taken from fingers and phones.
• Source: June 24 issue of the online open-access, peer-reviewed journal PeerJ.
Ebola Viral Disease Outbreak
West Africa, 2014
• On March 21, 2014, the Guinea Ministry of Health reported the outbreak of an
illness characterized by fever, severe diarrhea, vomiting, and a high case-fatality
rate (59%) among 49 persons. Specimens from 15 of 20 persons tested at
Institut Pasteur in Lyon, France, were positive for an Ebola virus by polymerase
chain reaction. Diagnosis is made most commonly through detection of Ebola
virus RNA or Ebola virus antibodies in blood.
• Keys to controlling EVD outbreaks include 1) active case identification and
isolation of patients from the community to prevent continued virus spread; 2)
identifying contacts of ill or deceased persons and tracking the contacts daily for
the entire incubation period of 21 days; 3) investigation of retrospective and
current cases to document all historic and ongoing chains of virus transmission;
4) identifying deaths in the community and using safe burial practices; and 5)
daily reporting of cases (4,7,8). Education of health-care workers regarding safe
infection-control practices, including appropriate use of personal protective
equipment, is essential to protect them and their patients because health-care–
associated transmission has played a part in transmission during previous
outbreaks Source: MMWR June 27, 2014 / 63(25);548-551
3 Dead, 15 Test Positive In Greenville
Health System Surgical Infection Case
• Greenville Health System is now reporting that three people are dead in
connection with a rare mycobacterial infection in surgical patients at Greenville
Memorial Hospital. That's two more since last Friday's report. An additional
patient has tested positive for the infection, bringing the total number of those
infected to 15.
• GHS says the infections are caused by an atypical mycobacterium, which is found
in the natural environment in water, soil and dust. Officials tell us there aren't
specific symptoms for this organism. They say it's similar to any post-surgery
infection. The hospital, CDC and the South Carolina Department of Health and
Environmental Control are working to identify the source of the infections,
however they think it may be related to a piece of equipment which has been
removed from use. Mycobacteria usually doesn't cause infections or adverse
health effects, according to a GHS release Friday.
• Other possible patients are also being notified. In addition to the suspected piece
of equipment, all other pieces of equipment which may be involved have been
removed from use. http://www.wspa.com/story/25881415/3-dead-15-test-positive-inghs-infection-case#.U61jtxD_qqI.wordpress