Unit Based Champions Infection Prevention eBug Bytes

1
Unit Based ChampionsInfection PreventioneBug
Bytes

• December 2012

2
Investigators Conduct Meta-Analysis of
Antimicrobial CVCs
Antimicrobial catheters have been utilized to
reduce risk of catheter colonization and
infection. Researchers sought to determine if
there is a greater than expected risk of
microorganism-specific colonization associated
with the use of antimicrobial central venous
catheters (CVCs). The researchers performed a
meta-analysis of 21 randomized, controlled trials
comparing the incidence of specific bacterial and
fungal species colonizing antimicrobial CVCs and
standard CVCs in hospitalized patients. The
proportion of minocycline-rifampin colonized CVCs
that were colonized with Candida species was
greater than the proportion associated with
standard colonized CVCs. In comparison, the
proportion of colonized chlorhexidine-silver
sulfadiazine CVCs specifically colonized with
Acinetobacter species or diphtheroids was less
than the proportion of similarly colonized
standard CVCs. No such differences were found
with CVCs colonized with staphylococci. Reference
Novikov A, et al. Impact of catheter
antimicrobial coating on species-specific risk of
catheter colonization a meta-analysis.
Antimicrobial Resistance and Infection Control
2012, 140 doi10.1186/2047-2994-1-40
3
Flesh-Eating Fungus Responsible for Five Deaths
in Wake of Massive Tornado

• A fast growing, flesh-eating fungus killed 5
  people following a massive tornado that
  devastated Joplin, Mo., according to the Centers
  for Disease Control and Prevention (CDC). Health
  officials should be aware of infections caused by
  the fungus Apophysomyces, according to the
  studies, which tracked 13 people infected by the
  pathogen during the Class EF-5 tornado -- the
  most powerful category -- whose 200-plus mph
  winds plowed through Joplin on May 22, 2011,
  initially killing 160 and injuring more than
  1,000.
• The common fungus -- which lives in soil, wood or
  water -- usually has no effect on people. But
  once it is introduced deep into the body through
  a blunt trauma puncture wound, it can grow
  quickly if the proper medical response is not
  immediate, the studies said. Five of the 13
  people infected through injuries suffered during
  the Joplin tornado died within two weeks.
• Dr. Benjamin Park, chief of the Epidemiology Team
  at the CDC's Mycotic Diseases Branch, said the
  victims were infected when their injuries from
  the tornado were contaminated with debris from
  the storm, including gravel, wood and soil, as
  well as the aerosolized fungus.
• Sources New England Journal of Medicine, 2012
  367 (23) 2194

4
'Sticky' Stomach Flu Virus Stands Up to Typical
Restaurant Dishwashing Measures

• Restaurant dishes and silverware may be an
  overlooked place where people can catch stomach
  viruses. Norovirus is the leading cause of
  epidemic gastroenteritis and the major cause of
  foodborne illness worldwide, responsible for at
  least 50 of all gastroenteritis outbreaks in the
  United States.
• To carry out the experiment, the research team
  infused cream cheese and reduced fat milk -- two
  foods that are known for being difficult to clean
  off -- with murine norovirus (MNV-1), Escherichia
  coli (E. coli K-12) or Listeria innocua (L.
  innocua). The scientists then applied the dairy
  products to stainless steel utensils, ceramic
  plates and glassware, and put the tableware
  through a variety of chlorine and quaternary
  ammonium compound (QAC)-based sanitary protocols
  delivered via a commercial dishwasher or hand
  washing. The team found that while both the
  commercial dishwasher and manual washing reduced
  bacterial loads of E. coli K-12 and L. innocua
  enough to meet safety standards, neither
  technique was able to significantly reduce the
  presence of MNV-1. Reference Lizanel Feliciano,
  Jianrong Li, Jaesung Lee, Melvin A. Pascall.
  Efficacies of Sodium Hypochlorite and Quaternary
  Ammonium Sanitizers for Reduction of Norovirus
  and Selected Bacteria during Ware-Washing
  Operations.
• PLoS ONE, 2012 7 (12)

5
Surgeon infected 5 patients atCedars-Sinai,
hospital reports

• Cedars-Sinai Medical Center, LA said Friday that
  a heart surgeon unwittingly infected five
  patients during valve replacement surgeries, due
  to tiny tears in his latex surgical glove,
  earlier this year. The infections caused four of
  the patients to need a second operation,
  officials said.
• The infections occurred after the tears in the
  latex surgical gloves routinely worn by the
  doctor allowed bacteria from a skin inflammation
  on his hand to pass into the patients' hearts,
  according to the hospital. The patients survived
  the second operations and are still recovering,
  hospital officials said. Hospital officials
  called it a "very unusual occurrence" probably
  caused by an unfortunate confluence of events
  the nature of the surgery, the microscopic rips
  in the gloves and the surgeon's skin condition.
  Valve replacement requires the surgeon to use
  thick sutures and tie more than 100 knots, which
  can cause extra stress on the gloves.
• The infections raise questions about what health
  conditions should prevent a surgeon from
  operating and how to get the best protection from
  surgical gloves. Surgeons with open sores or
  known infections aren't supposed to operate, but
  there is no national standard on what to do if
  they have skin inflammation

6
FDA to Hold Public Hearing on Antiseptic Patient
Preoperative Skin Preparation Products

• The Food and Drug Administration (FDA) is holding
  a public hearing Dec. 12-13, 2012 to obtain input
  on how to address microbial contamination of
  patient preoperative skin preparation drug
  products. Currently, patient preoperative skin
  preparations are not required to be sterile.
  Bacteria can contaminate these products at the
  time of manufacture or during product use.
  Contaminated patient preoperative skin
  preparations have been associated with clinical
  infections and adverse outcomes. At this public
  hearing, the FDA is interested in obtaining
  public comment about certain scientific and
  product use issues related to patient
  preoperative skin preparations.
• Patient preoperative skin preparations are
  over-the-counter (OTC) topical antiseptic drug
  products used to reduce the number of bacteria on
  the skin prior to medical procedures or
  injections. Although they are marketed
  predominantly to healthcare facilities, the use
  of these products extends beyond the healthcare
  facility setting. For example, consumers with
  medical conditions requiring regular injections
  (e.g., of insulin or heparin) may use these
  products at home.

7
Bed Bugs Not Repelled by Commercial Ultrasonic
Frequency Devices

• According to an article in the Journal of
  Economic Entomology, commercial devices that
  produce ultrasound frequencies are NOT promising
  tools for repelling bed bugs. In "Efficacy of
  Commercially Available Ultrasonic Pest Repellent
  Devices to Affect Behavior of Bed Bugs
  (Hemiptera Cimicidae)," authors K. M. Yturralde
  and R. W. Hofstetter report the results of their
  tests of four commercially available electronic
  pest repellent devices designed to repel insect
  and mammalian pests by using sound. The devices,
  which were purchased online, were used according
  to manufacturers' instructions. A sound arena was
  created for each ultrasonic device, in addition
  to a control arena which featured no sound.
  However, the authors found that there were no
  significant differences in the number of bed bugs
  observed in the control (no sound) and sound
  arenas, and that bed bugs were neither deterred
  nor attracted to the arena with the sound device.
  
• Bed bugs are commonly exposed to frequencies made
  by their host species (humans) and by appliances
  and machines found in homes. Therefore, it may be
  possible that bed bugs also would exploit sounds
  made by their human hosts, such as breathing or
  snoring.

8
Vaccine rule is said to hurt health efforts

• Representatives from governments around the world
  will meet in Geneva next month in a session
  convened by the United Nations Environmental
  Program to prepare a global treaty to reduce
  health hazards by banning certain products and
  processes that release mercury into the
  environment. But a proposal that the ban include
  thimerosal, which has been used since the 1930s
  to prevent bacterial and fungal contamination in
  multidose vials of vaccines, has drawn strong
  criticism from pediatricians.
• In the United States, thimerosal has not been
  used in children's vaccines since the early 2000s
  after the Food and Drug Administration and public
  health groups came under pressure from advocacy
  groups that believed there was an association
  between the compound and autism in children.
• Since then, however, there has been a lot of
  research, and the evidence is overwhelming that
  thimerosal is not harmful. Science clearly
  documented no hazards from thimerosal in
  vaccines. The preservative plays a critical role
  in distribution of vaccine to the global
  community.
• Source NY Times Dec 17 2012

9
 Beagle sniffs out bacterial infection

• A 2-year-old beagle in the Netherlands has been
  trained to sniff out Clostridium difficile, a
  skill that could help doctors catch the deadly
  infection days before laboratory tests.
  Clostridium difficile infections often occur in
  people who are already taking antibiotics,
  causing symptoms that range from mild diarrhea to
  severe inflammation of the colon. And to make
  matters worse, the bug is particularly adept at
  spreading through hospitals, uncontrolled by the
  usual surface cleansers.
• The clever canine, called Cliff, correctly
  identified 50 stool samples containing the
  bacterium, which kills 14,000 Americans each
  year, according to the U.S. Centers for Disease
  Control and Prevention. Cliff also identified 47
  of 50 stool samples that were Clostridium
  difficile-free (he couldn't make up his mind
  about the last three).
• Laboratory tests for Clostridium difficile -
  dubbed C. diff - can take up to 48 hours. But
  Cliff gives his answer immediately by sitting or
  lying down. Stool from patients with the C. diff
  has a characteristic smell, often likened to
  horse manure, which Cliff learned to identify
  over two months of training. Now he can smell the
  bug even without the stool, correctly identifying
  25 of 30 patients with the infection and 265 of
  270 without

10
Hospital super-bug strains traced back to US,
Canada

• Researchers have now shown that the
  gastrointestinal illness that spread to various
  hospitals across the world was caused by two
  different but related strains of Clostridium
  difficile. One of the strains originated in the
  U.S. while the other came from Canada. The
  outbreak occurred between 2002 and 2006 in
  hospitals across UK, U.S.A., Canada and Europe.
  Researchers were able to determine the source as
  well as track its spread across the countries.
  "We found that this outbreak came from two
  separate epidemic strains or lineages of C.
  difficile, FQR1 and FQR2, both emerging from
  North America over a very short period and
  rapidly spread between hospitals around the
  world. C. difficile produces highly resistant
  spores. These spores help the organism survive
  harsh conditions and spread to other geographical
  areas. The strains of C. difficile infection
  linked with the outbreak had developed resistance
  to a commonly used drug, fluoroquinolone. It was
  an effective treatment for C. difficile infection
  but these strains acquired resistance to this
  frontline antibiotic. It is now virtually useless
  against this organism, but resistance seems to
  have been a major factor in the continued
  evolution and persistence of these strains in
  hospitals and clinical settings.
• Source Nature Genetics