Unit Based Champions Infection Prevention eBug Bytes

1
Unit Based ChampionsInfection PreventioneBug
Bytes

• January 2012

2
CDC Clinical Reminder Insulin Pens Must Never
Be Used for More than One Person

• Insulin pens containing multiple doses of insulin
  are meant for use on a single person only, and
  should never be used for more than one person,
  even when the needle is changed.
• Insulin pens should be clearly labeled with the
  persons name or other identifying information to
  ensure that the correct pen is used only on the
  correct individual.
• Hospitals and other facilities should review
  their policies and educate their staff regarding
  safe use of insulin pens and similar devices.
• If reuse is identified, exposed persons should be
  promptly notified and offered appropriate
  follow-up including bloodborne pathogen testing.
• These recommendations apply to any setting where
  insulin pens are used, including assisted living
  or residential care facilities, skilled nursing
  facilities, clinics, health fairs, shelters,
  detention facilities, senior centers, schools,
  and camps as well as licensed healthcare
  facilities. Use of insulin pens for more than one
  person, like other forms of syringe reuse imposes
  unacceptable risks and should be considered a
  'never event'.
• References Sonoki K, Yoshinari M, Iwase M,
  Tashiro K, Iino K, Wakisaka M, Fujishima M.
  Regurgitation of blood into insulin cartridges in
  the pen-like injectors. Diabetes Care.
  200124(3)603-4.

3

Pneumonia Most Common Infection After Heart
Surgery

• Researchers analyzed more than 5,100 patients in
  a heart surgery registry. Patients, average age
  64, were treated at nine U.S. academic medical
  centers and one Canadian center. The median time
  to major infection was 14 days after heart
  surgeries. Forty-three percent of all major
  infections occurred after hospital discharge. In
  this study, which excluded patients who were
  infected before surgery, researchers found 761
  infections 300 were classified as major
  infections (occurring in 6 percent of patients)
  and 461 were minor (in 8.1 percent of patients).
  Of the major infections
• Pneumonia, infection of the lungs, occurred in
  2.4 percent of all patients.
• C. difficile colitis, an intestinal infection,
  occurred in 1.0 percent.
• Bloodstream infections occurred in 1.1 percent.
• Deep-incision surgical site infections occurred
  in 0.5 percent.
• Minor infections included urinary tract and
  superficial incision site infections.
• References Presented at the American Heart
  Association's Scientific Sessions 2011

4
'Brain-Eating' amoeba kills second neti pot user

• Louisiana state health officials are warning
  patients about potential dangers of using tap
  water in the sinus-irrigating neti pot after two
  patients died of Naegleria fowleri infection. N.
  fowleri is known as a "brain-eating" amoeba
  because it can enter a patient's nose, infect the
  brain, and cause primary amebic
  meningoencephalitis (PAM), a brain-tissue
  destroying condition. The first Louisiana
  patient died of neti pot-induced infection in
  June. An additional two patients died of N.
  fowleri infection in August after swimming in
  warm, fresh water.
• Patients that irrigate their noses with a neti
  pot should use distilled, sterile, or previously
  boiled water
• Symptoms of PAM include headache, fever, nausea,
  vomiting, and stiff neck, and may take one to
  seven days to start. Later symptoms include
  confusion, lack of attention to environment, loss
  of balance, seizures, hallucinations, and, in one
  to 12 days after infection, death.
• Source MedPage Today - December 29, 2011

5
CDC reports two novel flu infections

• The Centers for Disease Control and Prevention
  (CDC) have
• identified two novel flu infections, including an
  H1N1 variant previously not reported in humans
  and a novel H3N2 variant identified in 11
  patients. The novel H1N1 virus is a
  triple-reassortant that has acquired the M gene
  of the 2009 H1N1 virus and has sickened an adult
  in Wisconsin who had occupational contact with
  swine
• From August 17 to December 23, 2011, CDC received
  reports of 12 human infections with influenza A
  (H3N2)v viruses that have the matrix (M) gene
  from the influenza A (H1N1) virus (formerly
  called swine-origin influenza A H3N2 and
  pandemic influenza A H1N1 2009 viruses,
  respectively. The 12 cases occurred in five
  states (Indiana, Iowa, Maine, Pennsylvania, and
  West Virginia), and 11 were in children. Six of
  the 12 patients had no identified recent exposure
  to swine. Three of the 12 patients were
  hospitalized, and all have recovered fully.
• A case in an adult male in Indiana with
  occupational exposure to swine was among the 12,
  and two children in West Virginia who regularly
  attended the same day care accounted for the
  latest cases. This report describes those cases
  and swine influenza virus (SIV) surveillance
  being conducted by the U.S. Department of
  Agriculture (USDA). MMWR December 23, 2011

6
Microbial Communities on Skin Affect Humans'
Attractiveness to Mosquitoes

• The microbes on your skin determine how
  attractive you are to mosquitoes, which may have
  important implications for malaria transmission
  and prevention. Without bacteria, human sweat is
  odorless to the human nose, so the microbial
  communities on the skin play a key role in
  producing each individual's specific body odor.
• The researchers conducted their experiments with
  the Anopheles gambiae sensu stricto mosquito,
  which plays an important role in malaria
  transmission. They found that individuals with a
  higher abundance but lower diversity of bacteria
  on their skin were more attractive to this
  particular mosquito. They speculate individuals
  with more diverse skin microbiota may host a
  selective group of bacteria that emits compounds
  to interfere with the normal attraction of
  mosquitoes to their human hosts, making these
  individuals less attractive, and therefore lower
  risk to contracting malaria. This finding may
  lead to the development of personalized methods
  for malaria prevention.
• Reference Verhulst NO, Qiu YT, Beijleveld H,
  Maliepaard C, Knights D, et al. (2011)
  Composition of Human Skin Microbiota Affects
  Attractiveness to Malaria Mosquitoes. PLoS ONE
  6(12) e28991. doi10.1371/journal.pone.0028991

7
Over-reliance on gloves leads to poor worker
hand hygiene
Stone and his colleagues observed more than 7,000
patient contacts in 56 ICUs and geriatric care
units in 15 hospitals. They found that proper
hand hygiene compliance rates were
disappointingly low, at 47.7 a statistic,
experts contend, that contributes to the costs
associated with healthcare-associated
infections.Proper hand hygiene protocol
includes changing gloves and washing one's hands.
Hands can be contaminated by back spray when
gloves are removed after contact with bodily
fluid, researchers said. Some germs can get
through latex gloves, investigators note. Stone
and his team suggested that more studies are
needed to determine behavioral reasons behind
poor hand hygiene habits.The study, The Dirty
Hand in the Latex Glove A Study of Hand-Hygiene
Compliance When Gloves Are Worn, was published
in the December issue of Infection Control and
Hospital Epidemiology. From the January 2012
Issue of McKnight's Long Term Care News
8
Temporary central venous catheter utilization
patterns in a large tertiary care center

• Intravenous literature Tejedor, S., Tong, D.,
  Stein, J., Payne, C., Dressler, D., Xue, W. and
  Steinberg, J.P. (2012) Temporary central venous
  catheter utilization patterns in a large tertiary
  care center tracking the idle central venous
  catheter. Infection Control Hospital
  Epidemiology. 33(1), p.50-7.
• AbstractObjectives Although central venous
  catheter (CVC) dwell time is a major risk factor
  for catheter-related bloodstream infections
  (CR-BSIs), few studies reveal how often CVCs are
  retained when not needed (idle). We describe
  use patterns for temporary CVCs, including
  peripherally inserted central catheters (PICCs),
  on non-ICU wards.
• Design A retrospective observational study.
• Setting A 579-bed acute care, academic tertiary
  care facility.
• See next slide for results and conclusions

9
Temporary central venous catheter utilization
patterns in a large tertiary care center

• Methods A retrospective observational study of a
  random sample of patients on hospital wards who
  have a temporary, nonimplanted CVC, with a focus
  on on daily ward CVC justification. A uniform
  definition of idle CVC-days was used.
• Results We analyzed 89 patients with 146 CVCs
  (56 of which were PICCs) of 1,433 ward
  CVC-days, 361 (25.2) were idle. At least 1 idle
  day was observed for 63 of patients. Patients
  had a mean of 4.1 idle days and a mean of 3.4
  days with both a CVC and a peripheral intravenous
  catheter (PIV). After adjusting for ward length
  of stay, mean CVC dwell time was 14.4 days for
  patients with PICCs versus 9.0 days for patients
  with non-PICC temporary CVCs (other CVCs
  Formula see text). Patients with a PICC had
  5.4 days in which they also had a PIV, compared
  with 10 days in other CVC patients (Formula see
  text). Patients with PICCs had more days in
  which the only justification for the CVC was
  intravenous administration of antimicrobial
  agents (8.5 vs 1.6 days Formula see text).
• Conclusions Significant proportions of ward
  CVC-days were unjustified. Reducing idle
  CVC-days and facilitating the appropriate use of
  PIVs may reduce CVC-days and CR-BSI risk.

10
Legionnaires' Disease Outbreak Linked to
Hospital's Decorative Fountain

• Environmental testing within the hospital
  detected notable amounts of Legionella in samples
  collected from the water wall decorative
  fountain located in the hospitals main lobby.
• The investigation revealed that all eight
  patients had spent time in the main lobby where
  the fountain is located. This, along with the
  proximity of each patients onset of illness and
  the degree of Legionella contamination in the
  fountain strongly support the conclusion that the
  decorative fountain was the source of the
  outbreak. Hospital officials quickly shut down
  the fountain when it was first suspected as a
  source, and notified staff and approximately
  4,000 potentially exposed patients and visitors.
  Prior to the investigation, the decorative
  fountain underwent routine cleaning and
  maintenance. Since this investigation, many
  healthcare facilities in Wisconsin shut down or
  removed decorative fountains in their facilities,
  while others enhanced their regular testing
  protocols to reduce the risk of Legionnaires
  disease, the researchers report.
• Reference Haupt TE, et al. An outbreak of
  Legionnaires disease associated with a decorative
  water wall fountain in a hospital. Infection
  Control and Hospital Epidemiology. 332. February
  2012.