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Unit Based Champions Infection Prevention eBug Bytes October 2013

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Title: Unit Based Champions Infection Prevention eBug Bytes October 2013


1
Unit Based Champions Infection Prevention eBug
Bytes October 2013
2
Hong Kong quarantines 19 people after second case
of H7N9
Hong Kong health officials have quarantined 19
people who had contact with an 80-year-old man
confirmed to have the city's second case of H7N9
influenza, which has killed 45 people in China
this year. The patient is a long-term resident
of mainland China who was hospitalized in the
border city of Shenzhen from Nov. 13 to Nov. 29
for treatment of an underlying chronic illness,
the Hong Kong government said in a statement on
Dec. 6. He moved to Hong Kong on Dec. 3 and was
admitted to Tuen Mun Hospital, where he tested
positive for the new strain of bird flu after
developing a fever, the statement shows. The
government said it will transfer the patient, who
is in stable condition, to the isolation ward at
Princess Margaret Hospital. It's not yet known if
he had contact with live poultry though he is
thought to have eaten chicken, Hong Kong's
Commercial Radio reported yesterday, citing Ko
Wing-man, the city's health secretary. A total of
19 people had contact with the man after he
arrived in Hong Kong, including 13 patients in
Tuen Mun Hospital, five relatives and one taxi
driver. Source http//www.bloomberg.com/news/2013
-12-08/hong-kong-quarantines-19people-after-second
-case-of-h7n9.html
3
Resistant H7N9 flu virus keeps contagiousness
  • H7N9 erupted in eastern China earlier this year.
    The first laboratory-confirmed cases occurred
    among three people in the Shanghai area and were
    reported on March 31. In all, 139 human cases of
    H7N9 have been reported, with 45 deaths,
    according to the WHO's website. H7N9 is believed
    to have spread to humans from poultry, where it
    circulates naturally. The UN's World Health
    Organization (WHO) says that "so far", no
    evidence has emerged of "sustained" transmission
    of H7N9 among people.
  • Replicating the virus in high-security
    conditions, they found it had a mutation that
    made it resistant to the two frontline antiviral
    drugs-Tamiflu (lab name oseltamivir) and
    Peramivir-and partially resistant to a third
    drug, Relenza (zanamivir). The mutant variety of
    H7N9 replicated as easily and as virulently as
    the non-mutant strain in human respiratory cells
    in a lab dish, in mice lungs and in guinea pigs.
  •  The discovery is unusual as "seasonal"
    influenza-common-or-garden flu strains that erupt
    every winter-typically loses some of its
    contagiousness when a strain becomes
    drug-resistant. Source Nature Communications
    Dec 2013

4
Public gets early snapshot of MRSA and C.
difficile infections in individual hospitals
  • New data gathered through the Centers for Disease
    Control and Prevention's (CDC) National
    Healthcare Safety Network (NHSN) gives patients a
    first look at how their local hospitals are doing
    at preventing Clostridium difficile infections
    (deadly diarrhea) and methicillin-resistant
    Staphylococcus aureus (MRSA) bloodstream
    infections.
  • C. difficile causes at least 250,000
    hospitalizations and 14,000 deaths every year,
    and was recently categorized by CDC as an urgent
    threat to patient safety. On the other hand,
    although still a common and severe threat to
    patients, invasive MRSA infections in healthcare
    settings appear to be declining. Between 2005 and
    2011 overall rates of invasive MRSA dropped 31
    percent. Success began with preventing
    central-line-associated bloodstream infections
    caused by MRSA, for which rates fell nearly 50
    percent from 1997 to 2007. Major teaching
    hospitals, hospitals with more than 400 beds and
    those with high community-onset rates continue to
    have the highest risk for C. difficile and MRSA
    bloodstream infections, all of which is taken
    into account by risk adjustment when the clinical
    quality measure is calculated.

5
FDA Anti-bacterial soaps may not curb bacteria
  • Triclosan is an ingredient added to many consumer
    products to reduce or prevent bacterial
    contamination. It may be found in products such
    as clothing, kitchenware, furniture, and toys. It
    also may be added to antibacterial soaps and body
    washes, toothpastes, and some cosmeticsproducts
    regulated by the U.S. Food and Drug
    Administration (FDA). Triclosan is not currently
    known to be hazardous to humans. But several
    scientific studies have come out since the last
    time FDA reviewed this ingredient that merit
    further review. Animal studies have shown that
    triclosan alters hormone regulation. However,
    data showing effects in animals dont always
    predict effects in humans. Other studies in
    bacteria have raised the possibility that
    triclosan contributes to making bacteria
    resistant to antibiotics.
  • The Federal Drug Administration proposed a rule
    Dec 16th which would require manufacturers of
    antibacterial cleaners to prove their products
    are not only safe, but more effective than plain
    soap and water. The FDA proposes that if the
    antibacterial manufacturers cannot demonstrate
    their products to be more effective and less
    harmful then soap and water, their products will
    have to be reformulated, relabeled, or removed
    from the market.
  • http//www.fda.gov/ForConsumers/ConsumerUpdates/u
    cm205999.htm

6
Yogurt a solution to hospital infection?
  • In a medical system rife with complex equipment
    and outrageously expensive drugs, a Pennsylvania
    hospital has turned to a cheap, low-tech solution
    for one of modern medicines most challenging
    problems. Holy Redeemer in Montgomery County,
    Pa., is using yogurt the kind you could buy at
    the grocery store to fight C. difficile, a
    hospital-acquired infection that has been growing
    throughout the country.
  • After dietitians began encouraging patients
    taking antibiotics to eat yogurt, the infection
    rate fell by two-thirds. Holy Redeemer has now
    expanded the program to its nursing-home
    residents. We were really surprised by how easy
    it was and how quick it worked, said Jeanie
    Ryan, a registered dietitian, who helped
    coordinate the effort. It was just so sudden and
    such a big impact, that it was striking. The
    Hospital Health system Association of
    Pennsylvania earlier this year gave Holy Redeemer
    an Innovation Award for the program. Other
    hospitals remain skeptical. Thomas Jefferson
    University Hospital uses probiotics, or
    beneficial yeast and bacteria, in pill form only
    in clinically stable patients who must take
    antibiotics for long periods. http//www.reportern
    ews.com/news/2013/dec/17/yogurt-a-solution-to-hosp
    ital-infection/

7
Epidemic of E.coli infections traced to one
strain of bacteria
  • In the past decade, a single strain of
    Escherichia coli, or E. coli, has become the main
    cause of bacterial infections in women and the
    elderly by invading the bladder and kidneys,
    according to a study published in the American
    Society for Microbiology's open access journal
    mBio.
  •  Besides becoming more resistant to antibiotics,
    the strain H30-Rx gained an unprecedented ability
    to spread from the urinary tract to the blood,
    leading to the most lethal form of bacterial
    infections - sepsis- and posing a looming threat
    to the more than 10 million Americans who
    annually suffer from urinary tract infections
    (UTIs). This new study could help trace the
    evolutionary history of this superbug and
    possibly lead to the development of a vaccine.
    H30-Rx, appears to be much more adept than other
    E. coli at ascending from the bladder to the
    kidneys and then into the bloodstream, where it
    can be lethal, and the study suggests that H30-Rx
    may be responsible for 1.5 million UTIs and tens
    of thousands of deaths annually in the United
    States. This study shows that, by focusing on
    H30-Rx, researchers might find a vaccine that
    could prevent many infections. Vaccines for
    highly resistant strains of superbugs could
    protect people from ever getting sick in the
    first place. http//sphhs.gwu.edu/content/epidemic
    -escherichia-coli-infections-traced-one-strain-bac
    teria

8
Bipolaris in cardiac surgery patients - Call for
cases
  • The Centers for Disease Control and Prevention
    (CDC), together with state and local health
    department partners, continues to investigate an
    outbreak of Bipolaris surgical site infections
    among cardiothoracic surgery patients.
    Mediastinal infections due to molds following
    cardiothoracic surgery are a rare but known
    complication, however Bipolaris is a very rare
    cause of these.
  • To date, 13 culture-confirmed cases from six
    hospitals in two states have been identified.
    Positive cultures were obtained between December
    2008 and November 2013 nine cases have occurred
    since May 2013. Cases ranged in age from 1 month
    to 82 years, all cases are male. Commonalities
    include a history of recent open cardiothoracic
    surgery (including CABG, heart transplantation
    and valve replacement/repair) ICU care and
    extended periods of open chest wounds prior to
    eventual closure. Bipolaris isolates were
    obtained from tissue and pleural/mediastinal
    fluid samples.  Associated mortality has been
    high.  
  • Please report any cultures of Bipolaris obtained
    since 2008 from chest surgery patients to Dr.
    Anne Purfield (aip4_at_cdc.gov) of the Mycotic
    Diseases Branch of the CDC.

9
E anophelis outbreak in an intensive-care unit
  • The hospital infection-control team at the
    National University Hospital of Singapore
    identified three patients in the cardiothoracic
    intensive-care unit (ICU) and two patients from
    the surgical ICU that were colonized with
    Elizabethkingia during a 3 week period in 2012.
    The five patients, who were ventilated via
    tracheostomy and had central venous catheters in
    situ, received multiple courses
  • of broad-spectrum antibiotics. Before isolation
    of Elizabethkingia, three of the patients had
    underlying solid-organ malignancy, one patient
    had multiple abdominal surgeries, two patients
    underwent thoracic surgery, and one patient was
    on extracorporeal membrane oxygenation. After
    isolation of the Elizabethkingia strain, all
    patients were treated with intravenous
    piperacillin and tazobactam, cotrimoxazole, or
    levofloxacin, either alone or in combination.
    Three of the five patients died during their
    hospitalization. The history of this
    microorganism starts with its description as a
    cause of infant meningitis by Centers for Disease
    Control and Prevention (CDC). It was first
    isolated in 1959 and named it Flavobacterium
    meningosepticum. It was subsequently renamed
    Chryseobacterium meningosepticum, and classified
    in the new genus Elizabethkingia, in 2005 .
    Source Lancet. 2013 Sep 7382(9895)855-6
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