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Title: Unit Based Champions Infection Prevention eBug Bytes


1
Unit Based ChampionsInfection PreventioneBug
Bytes
  • August 2012

2
Infections After C-Section Reduced By
Administering Antibiotics During Surgery
  • The previous practice of waiting to give
    antibiotics until after the surgical delivery of
    the baby evolved out of concern that these drugs
    might hide signs of blood infection in the
    newborn. But other recent studies have shown that
    giving antibiotics in the hour before surgery
    both reduced the risk of infection in the mother
    and had no effect on the health of the infant.
    Researchers tracked C-section deliveries and
    associated surgical site infections at
    Barnes-Jewish Hospital between January
    2003-December 2010. Based on reduced infection
    rates following other types of surgeries, the
    hospital changed its policy to administering
    antibiotics before C-section surgery in January
    2004. The American College of Obstetricians and
    Gynecologists recommended the same change in
    practice in 2011. In 2003, the year before the
    policy changed, the infection rate oscillated
    around nine or 10 infections per 100 cesarean
    deliveries. A downward trend in the infection
    rate began after the policy switch and by 2010,
    the rate was about two infections per 100
    cesarean sections. On average, the researchers
    calculated about five fewer infections per 100
    surgeries due to changing the timing of the
    antibiotics. Over the entire eight-year period,
    the researchers observed 303 infections following
    8,668 cesarean deliveries.
  • Kittur ND, McMullen KM, Russo AJ, Ruhl L, Kay HH,
    Warren DK. Long-term effect of infection
    prevention practices and case mix on cesarean
    surgical site infections. Obstetrics
    Gynecology. August 2012

3
Researchers Identify Levels of Bacterial
Contamination on Hospital Beds
  • Hospital beds on a bariatric surgery ward were
    randomized to either receive or not receive a
    launderable cover (Trinity Guardion). Bacterial
    counts on the surface of the mattress, the bed
    deck, and the launderable cover were then
    collected using Petrifilm Aerobic Count Plates at
    three time periods (before patient use, after
    discharge, and after terminal cleaning). Standard
    hospital linen was used in all rooms.
  • The launderable cover (n28) was significantly
    cleaner prior to patient use than were the
    cleaned mattresses (n38) (1.1 CFU/30cm2 vs. 7.7
    CFU/30cm2 p0.0189). The mattresses without
    launderable covers became significantly
    contaminated during use (7.7CFU/30cm2 on
    admission vs. 79.1 CFU/30cm2 after discharge
    plt0.001).
  • The mattresses with launderable covers did not
    become contaminated (3.0 CFU/30cm2 on admission
    vs. 2.5 CFU/30cm2 at discharge p0.703). After
    terminal cleaning, the mattress surface
    contamination decreased to 12.8 CFU/30cm2 (median
    3 CFU/30cm2 SD 7.8), but the bed deck was more
    contaminated (6.7 CFU/30cm2 after discharge
    compared to 30.9 CFU/30cm2 after terminal
    cleaning p0.031).
  • EA, Allen S, Gray L and Kaufman C. A randomized
    trial to evaluate a launderable bed protection
    system for hospital beds. Antimicrobial
    Resistance and Infection Control. 2012, 127
    doi10.1186/2047-2994-1-27

4
Nurse Staffing, Burnout Linked to Hospital
Infections Part I
Center for Health Outcomes and Policy Research at
the University of Pennsylvania School of Nursing
analyzed data previously collected by the
Pennsylvania Health Care Cost Containment
Council, the American Hospital Association Annual
Survey, and a 2006 survey of more than 7,000
registered nurses from 161 hospitals in
Pennsylvania to study the effect of nurse
staffing and burnout on catheter-associated
urinary tract infections (CAUTI) and surgical
site infections (SSI), two of the most common
HAIs. Job-related burnout was determined by
analyzing the emotional exhaustion subscale from
the Maslach Burnout Inventory-Human Services
Survey (MBI-HSS) that was obtained from nurse
survey responses. The MBI-HSS filters 22 items on
job-related attitudes into emotional exhaustion,
depersonalization, and personal accomplishment,
identifying emotional exhaustion as the key
component to burnout syndrome. More than
one-third of survey respondents got an emotional
exhaustion score of 27 or greater, the MBI-HSS
definition for healthcare personnel burnout.
5
Nurse Staffing, Burnout Linked to Hospital
Infections Part II
  • Comparing CAUTI rates with nurses patient loads
    (5.7 patients on average), the researchers found
    that for each additional patient assigned to a
    nurse, there was roughly one additional infection
    per 1,000 patients (or 1,351 additional
    infections per year, calculated across the survey
    population). Additionally, each 10 percent
    increase in a hospitals high-burnout nurses
    corresponded with nearly one additional CAUTI and
    two additional SSIs per 1,000 patients annually
    (average rate of CAUTIs across hospitals was 9
    per 1,000 patients for SSIs it was 5 per 1,000
    patients).
  • Using the per-patient average costs associated
    with CAUTIs (749 to 832 each) and SSIs (11,087
    to 29,443 each), the researchers estimate that
    if nurse burnout rates could be reduced to 10
    percent from an average of 30 percent,
    Pennsylvania hospitals could prevent an estimated
    4,160 infections annually with an associated
    savings of 41 million.
  • Reference Jeannie P. Cimiotti, APIC August
    2012

6
Expensive Hospital Readmissions Linked to HAIs
  • New research finds a strong link between
    healthcare-associated infections (HAIs) and
    patient readmission after an initial hospital
    stay. The findings, published in the June 2012
    issue of Infection Control and Hospital
    Epidemiology, suggest that reducing such
    infections could help reduce readmissions,
    considered to be a major driver of unnecessary
    healthcare spending and increased patient
    morbidity and mortality.
  • 136,513 patients admitted to the University of
    Maryland Medical Center over eight years
    (2001-2008) were studied for readmissions within
    one year after discharge, as well as the number
    of patients with positive cultures for one of
    three major HAIs (MRSA), (VRE), or (C.
    difficile) more than 48 hours after admission,
    considered a proxy for an HAI.
  • 4,737 patients with positive clinical cultures
    for MRSA, VRE or C. difficile after more than 48
    hours following hospital admission. These
    patients were 40 percent more likely to
    readmitted to the hospital within a year and 60
    percent more likely to be readmitted within 30
    days than patients with negative or no clinical
    cultures.
  • Reference Carley B. Emerson, Lindsay M.
    Eyzaguirre, Jennifer S. Albrecht, Angela C.
    Comer, Anthony D. Harris, Jon P. Furuno.
    Healthcare-Associated Infection and Hospital
    Readmission. Infection Control and Hospital
    Epidemiology 336. June 2012

7
Klebsiella Cases Tied to Handwashing Sinks
Part I
  • An outbreak of class A extended-spectrum
    ß-lactamaseproducing K. oxytoca occurred at a
    472-bed, acute tertiary-care facility in Toronto.
  • Klebsiella oxytoca is an opportunistic pathogen
    that causes primarily hospital-acquired
    infections, most often involving
    immunocompromised patients or those requiring
    intensive care. Reported outbreaks have most
    frequently involved environmental sources. K.
    oxytoca, like other Enterobacteriaceae, may
    acquire extended-spectrum ß-lactamases (ESBL) and
    carbapenemases outbreaks of multidrug-resistant
    K. oxytoca infection pose an increasing risk to
    hospitalized patients.
  • From October 2006 through March 2011, a total of
    66 patients acquired K. oxytoca with one of two
    related pulsed-field gel electrophoresis
    patterns. Isolates were considered hospital
    acquired if the first specimen (clinical culture
    or rectal swab) yielding resistant K. oxytoca was
    obtained gt3 days after the admission date or if
    the specimen was obtained lt3 days after admission
    in a patient who had been hospitalized at the
    outbreak hospital within the previous three
    months. Patients were characterized as infected
    or colonized.

8
Klebsiella Cases Tied to Handwashing Sinks
Part II
  • New cases continued to occur despite
    reinforcement of infection control practices,
    prevalence screening, and contact precautions for
    colonized/infected patients. Cultures from
    handwashing sinks in the intensive care unit
    yielded K. oxytoca with identical pulsed-field
    gel electrophoresis patterns to cultures from the
    clinical cases. No infections occurred after
    implementation of sink cleaning three times
    daily, as well as sink drain modifications, and
    an antimicrobial stewardship program. In
    contrast, a cluster of four patients infected
    with K. oxytoca in a geographically distant
    medical ward without contaminated sinks was
    contained with implementation of active screening
    and contact precautions.
  • The researchers emphasize that sinks should be
    considered potential reservoirs for clusters of
    infection caused by K. oxytoca.
  • Reference Lowe C, Willey B, et al. Outbreak of
    Extended-Spectrum ß-Lactamaseproducing
    Klebsiella oxytoca Infections Associated with
    Contaminated Handwashing Sinks. Vol. 18, No. 8.
    Emerg Infect Dis. August 2012.

9
MRSA infections double in 5 years at academic
hospitals
  • According to a recent report published in the
    August issue of Infection Control and Hospital
    Epidemiology, infections caused by
    methicillin-resistant Staphylococcus aureus
    (MRSA) doubled at academic medical centers
    nationwide in five years. University of Chicago
    Medicine and University Health System Consortium
    (UHC) researchers estimated that hospital
    admissions for MRSA infections increased from
    about 21 out of every 1,000 patients hospitalized
    in 2003 to about 42 out of every 1,000 in 2008,
    or almost 1 in 20 inpatients.
  • The new findings counter a recent Centers for
    Disease Control and Prevention (CDC) study that
    found MRSA cases in hospitals were declining. The
    CDC study looked only at cases of invasive MRSA,
    which are infections found in the blood, spinal
    fluid or deep tissue. It excluded infections of
    the skin, which the UHC study includes. The study
    utilized the UHC database, which includes data
    from 90 percent of all not-for-profit academic
    medical centers in the U.S. However, like many
    such databases, the UHC data are based on billing
    codes hospitals submit to insurance companies,
    which often underestimate MRSA cases.
  • Source August issue of Infection Control and
    Hospital Epidemiology,

10
CDC reports cases 18-29 of H3N2v virusinfection
continues to recommend interim precautions when
interacting with pigs
  • This week CDC reports 12 additional human
    infections with influenza A (H3N2) variant virus
    in 3 states Hawaii (1 case), Ohio (10 cases) and
    Indiana (1 case). The H3N2v virus contains the M
    gene from the human influenza A (H1N1)pdm09 (2009
    H1N1) virus, as have the previous 17 cases
    detected since July 2011. All of this week's
    reported cases occurred in people who had direct
    or indirect contact with swine prior to their
    illness.
  • The 10 cases in Ohio were associated with
    attendance at a fair where reportedly ill swine
    were present. The H3N2v case reported by Indiana
    also occurred in a person who attended a fair
    where swine were present. CDC continues to
    recommend preventive actions people can take to
    make their fair experience a safe and healthy
    one.
  • Most human illness with H3N2v virus infection has
    resulted in signs and symptoms of influenza
    (fever, cough, runny nose, sore throat, muscle
    aches) 3 hospitalizations have occurred. All of
    the people hospitalized had high risk conditions.
    All H3N2v virus cases have recovered fully.

11
Man pours bleach in dialysis machines
  • When a kidney dialysis center accused a worker of
    asking patients for painkillers, authorities said
    he became so enraged he sneaked back into the
    clinic and poured bleach into dialysis machines.
    Workers at the Fresenius Medical Care clinic in
    West Columbia, SC, discovered the contaminated
    water before anyone was hurt. A month long
    investigation led deputies to Donald Foster III,
    who has been charged with attempted murder and
    second-degree burglary. Foster was suspended from
    his job as an equipment technician and patient
    care technician on July 2, but he came back less
    than a week later and tainted the water
  • Foster poured bleach into tanks that hold the
    purified water used to filter waste from the
    bodies of 20 patients, hoping the deaths from his
    sabotage would bankrupt the firm, police said.
  • Pure water is so critical to the dialysis process
    that workers check the tanks several times a day,
    including before any patients are hooked up to
    the machines
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