Infection Prevention eBug Bytes February 2015 - PowerPoint PPT Presentation

1 / 12
About This Presentation

Infection Prevention eBug Bytes February 2015


Infection Prevention eBug Bytes February 2015 – PowerPoint PPT presentation

Number of Views:124
Avg rating:3.0/5.0
Slides: 13
Provided by: Spenc91


Transcript and Presenter's Notes

Title: Infection Prevention eBug Bytes February 2015

Infection PreventioneBug BytesFebruary 2015
Duodenoscopes and CRE Outbreaks
  • Duodenoscopes are used for endoscopic retrograde
    cholangiopancreatography, or ERCP, a procedure in
    which a scope is inserted down the throat,
    through the stomach and into the start of the
    small intestine. A thin catheter is passed from
    the end of the endoscope into bile ducts leading
    to the pancreas and gallbladder.
  • Outbreaks of a drug-resistant superbug in
    Chicago, Seattle and Pittsburg have been linked
    to ERCP duodenoscopes.
  • Infection control experts believe CRE, or
    carbapenem-resistant Enterobacteriaceae, are
    passed from patient to patient on duodenoscopes,
    with parts like the elevator - that are
    difficult to sanitize between uses. Some in the
    U.S. medical community said the FDA and device
    manufacturers need to do more to keep patients
    safe. The CDC identified nine other patients in
    northeastern Illinois who had positive cultures
    for the superbug from March through July 2013.
    Six of the eight treated at one hospital had
    treatment with a duodenoscope. Previous studies
    have shown an association between ERCP endoscopes
    and transmission of multidrug-resistant bacteria.
    The design of the ERCP endoscopes might pose a
    particular challenge for cleaning and
  • Source

Design of Endoscopic Retrograde
Cholangiopancreatography (ERCP) Duodenoscopes May
Impede Effective Cleaning
  • More than 500,000 ERCP procedures using
    duodenoscopes are performed in the United States
    annually. The procedure is the least invasive way
    of draining fluids from pancreatic and biliary
    ducts blocked by cancerous tumors, gallstones, or
    other conditions. Duodenoscopes are flexible,
    lighted tubes that are threaded through the
    mouth, throat, stomach, and into the top of the
    small intestine (the duodenum). Unlike most other
    endoscopes, duodenoscopes also have a movable
    elevator mechanism at the tip. The elevator
    mechanism changes the angle of the accessory
    exiting the accessory channel, which allows the
    instrument to access the ducts to treat problems
    with fluid drainage.
  • Some parts of the scopes may be extremely
    difficult to access and effective cleaning of all
    areas of the duodenoscope may not be possible.
  • The FDA is closely monitoring the association
    between reprocessed duodenoscopes and the
    transmission of infectious agents, including
    multidrug-resistant bacterial infections caused
    by Carbapenem-Resistant Enterobacteriaceae (CRE)
    such as Klebsiella species and Escherichia coli.
    In total, from January 2013 through December
    2014, the FDA received 75 MDRs encompassing
    approximately 135 patients in the United States
    relating to possible microbial transmission from
    reprocessed duodenoscopes.
  • FDA recommends meticulously cleaning of the
    elevator mechanism and the recesses surrounding
    the elevator mechanism by hand, even when using
    an automated endoscope reprocessor (AER).

UCLA outbreak Family of 48-year-old who died
sues scope maker
  • Feb. 26--Following a CRE outbreak at UCLA, the
    family of a 48-year-old patient who died there
    filed suit against Olympus Corp. on 2/25 The
    patient was exposed to a contaminated Olympus
    duodenoscope at UCLA's Ronald Reagan Medical
    Center in October and as a result "suffered
    significant injury and died.
  • In addition to wrongful death, the family's
    complaint accuses the company of negligence and
    fraud in selling and promoting a "defective"
  • Another patient sued Olympus on 2/23 for
    negligence in connection with his CRE infection.
    The 18-year-old high-school student is still
    hospitalized at UCLA.
  • UCLA and the University of California regents may
    be added as defendants in these cases as more
    details emerge.
  • The university has said seven patients were
    infected with CRE from scopes made by Olympus.
    The infections contributed to the deaths of two
    of those patients and 179 other patients may have
    been exposed from Oct. 3 to Jan. 28.
  • CRE, which stands for carbapenem-resistant
    Enterobacteriaceae, is highly resistant to
    antibiotics and can kill up to 50 of infected
  • Last week, the company said it was monitoring the
    issue of patient infections and had given medical
    providers additional instructional materials on
    cleaning the scopes.
  • Source LA Times Feb 26 2015

Measles Outbreak in US
  • On January 5, 2015, the California Department of
    Public Health was notified about a suspected
    measles case. The patient was a hospitalized,
    unvaccinated child, aged 11 years with rash onset
    on December 28. The only notable travel history
    during the exposure period was a visit to one of
    two adjacent Disney theme parks located in Orange
    County, CA. On the same day, CDPH received
    reports of four additional suspected measles
    cases in California residents and two in Utah
    residents, all of whom reported visiting one or
    both Disney theme parks during December 1720. By
    January 7, seven measles cases had been
    confirmed, and CDPH issued a press release and
    notification to other states regarding this
    outbreak. As of February 11, a total of 125
    measles cases with rash occurring during December
    28, 2014February 8, 2015, had been confirmed in
    U.S. residents connected with this outbreak. Of
    these, 110 patients were CA residents.
    Thirty-nine (35) of the CA patients visited one
    or both of the two Disney theme parks during
    December 1720, where they are thought to have
    been exposed to measles, 37 have an unknown
    exposure source (34), and 34 (31) are secondary
    cases. Among the 34 secondary cases, 26 were
    household or close contacts, and 8 were exposed
    in a community setting. 15 cases linked to the
    two Disney theme parks have been reported in
    seven other states Arizona (seven), Colorado
    (one), Nebraska (one), Oregon (one), Utah
    (three), and Washington (two), as well as linked
    cases reported in two neighboring countries,
    Mexico (one) and Canada (10). Source CDC

Fears of measles crossing southern border into
U.S. are unfounded
  • Conservative radio commentator Rush Limbaugh and
    others have blamed the current measles outbreak
    on children illegally crossing the southern
    border of the U.S. While there are many serious
    diseases that have moved north to the United
    States from Mexico and Central America, measles
    is not one of them. Mexico, El Salvador,
    Guatemala and Honduras all have measles
    immunization programs comparable to the United
    States, making them unlikely sources of the
  • According to the latest figures from the World
    Health Organization, the U.S. in 2012 had a
    measles vaccination rate of 91 Mexico's was
    89, El Salvador's 94, Guatemala's 85 and
    Honduras' 89. The CDC notes that the genotype of
    the measles virus in this country is identical to
    one that caused a serious outbreak in the
    Philippines in 2014. In 2013, the CDC recorded 42
    cases of measles that were brought into the U.S.
    from overseas. Of those, half of the infected
    people came from the World Health Organization's
    European region, which covers Europe and parts of
    central Asia. A particularly large outbreak that
    year in North Carolina involving 22 people was
    traced to an unvaccinated person who had traveled
    to India.
  • Source http//

New FDA Approved MTB PCR test can help
physicians remove patients with suspected TB
from isolation earlier
  • Despite the continued decline in U.S. TB cases
    and rates since 1993, the goal of TB elimination
    in the United States remains unmet. Most states
    reported fewer cases of TB in 2013. However,
    elevated rates of TB in specific populations
    remain a major challenge that impedes progress
    toward TB elimination. The TB incidence rate
    among foreign-born persons in 2013 was
    approximately 13 times greater than the incidence
    rate among U.S.-born persons, and the proportion
    of TB cases occurring in foreign-born persons
    continues to increase, reaching 64.6 in 2013.
  • Although the incidence of tuberculosis in the
    U.S. is low, due in large part to successful
    public health strategies, the number of patients
    being evaluated for possible tuberculosis is
    still significant. Cepheids GeneXpert MTB/RIF
    returns test results in two hours, allowing
    clinicians to discontinue airborne infection
    isolation precautions quickly rather than waiting
    days or weeks for the return of three negative
    smear tests. The ability to quickly differentiate
    patients that require TB respiratory isolation
    from those that do not pose a risk of
    transmitting TB will allow hospitals to focus
    their infection control efforts where they can
    have the greatest impact. Source Cepheid
    Press Release

Transmission of Hepatitis C Virus Associated with
Surgical Procedures New Jersey 2010 and
Wisconsin 2011
  • During 2010 and 2011, separate, unrelated,
    occurrences of HCV infections in New Jersey and
    Wisconsin associated with surgical procedures
    were investigated to determine sources of HCV and
    mechanisms of HCV transmission. Molecular
    analyses of HCV strains and epidemiologic
    investigations indicated that transmission likely
    resulted from breaches of infection prevention
  • Patients A and B had different surgeons,
    different procedures, and different operating
    rooms with different surgical equipment, but had
    the same anesthesiologist, who performed
    procedures that can result in HCV transmission.
    An anesthesiologist moved an anesthesia cart and
    medications from patient to patient throughout
    the day. Medications were drawn into syringes and
    placed on the anesthesia cart surface during
    procedures. No policies or procedures regarding
    cleaning and disinfection of carts between
    patients existed. On March 9, the
    anesthesiologist treated patient B and
    immediately thereafter treated patient A.
    Propofol was the only medication common to both
    procedures. The anesthesiologist said there was
    no reuse of needles and syringes or reuse of
    single-dose vials the number of vials used could
    not be verified by pharmacy records. two
    unrelated cases of health careassociated HCV
    infection highlights the importance of hepatitis
    C surveillance and investigations of possible
    health care transmission.
  • Source MMWR February 27, 2015 / 64(07)165-170

Source http//
CDC Report Burden of Clostridium difficile
Infection in the US
  • In 2011, we performed active population- and
    laboratory-based surveillance across 10
    geographic areas in the United States to identify
    cases of C. difficile infection (stool specimens
    positive for C. difficile on either toxin or
    molecular assay in residents 1 year of age).
    Cases were classified as community-associated or
    health careassociated. In a sample of cases of
    C. difficile infection, specimens were cultured
    and isolates underwent molecular typing. We used
    regression models to calculate estimates of
    national incidence and total number of
    infections, first recurrences, and deaths within
    30 days after the diagnosis of C. difficile
  • A total of 15,461 cases of C. difficile infection
    were identified in the 10 geographic areas 65.8
    were health careassociated, but only 24.2 had
    onset during hospitalization. After adjustment
    for predictors of disease incidence, the
    estimated number of incident C. difficile
    infections in the United States was 453,000 .The
    incidence was estimated to be higher among
    females , whites, and persons 65 years of age or
    older. The estimated number of first recurrences
    of C. difficile infection was 83,000, and the
    estimated number of deaths was 29,300. The North
    American pulsed-field gel electrophoresis type 1
    (NAP1) strain was more prevalent among health
    careassociated infections than among
    community-associated infections (30.7 vs. 18.8,
  • C. difficile was responsible for almost half a
    million infections and was associated with
    approximately 29,000 deaths in 2011.
  • Source N Engl J Med 2015372825-34

MRSA colonization common in groin, rectal areas
  • Colonization of MRSA allows people in the
    community to unknowingly harbor and spread this
    life-threatening bacteria. The inside of the
    front of the nose is where this bacteria is most
    predominant, but new research shows nearly all
    colonized individuals have this bacteria living
    in other body sites, including the groin and
    rectal areas. Because of the risk of
    transmission, many hospitals identify individuals
    with nasal MRSA colonization prior to admission
    or surgery. These patients may be placed in
    isolation or decolonized of MRSA. These
    strategies have been used to prevent MRSA
    infections for the patient and to decrease risk
    of spread of MRSA to other patients. Several
    states also mandate these MRSA surveillance
  • Researchers collected surveillance swab specimens
    for nose and other body sites within 72 hours of
    admission from March 2011-April 2012. Researchers
    observed that, following the nose, the rectal and
    groin areas were frequent sites of colonization
    of community-associated MRSA. The bacteria were
    found in these body sites more often in men than
    women. Source Kyle J et al. Anatomic Sites of
    Colonization with Community-Associated
    Methicillin-ResistantStaphylococcus aureus.
    Infection Control and Hospital Epidemiology,
    2014 35 (9

CDC investigates deadly bacteria's link to
doctors' offices
  • The Centers for Disease Control is raising a red
    flag that a potentially deadly bacteria may be
    lurking in your doctor's office. The bacteria, C.
    difficile, is typically found in hospitals, but a
    study reports a substantial number of people
    contracted the bug who hadn't been in a hospital,
    but had recently visited the doctor or dentist.
    The bacteria can cause deadly diarrhea, according
    to the CDC, with infections on the rise. The new
    report shows nearly half a million Americans
    infected in various locations in one year, with
    15,000 deaths directly attributed to C. diff. In
    a 2013 study, researchers found C. diff present
    in six out of seven outpatient clinics tested in
    Ohio, including on patients' chairs and examining
    tables. The CDC is so concerned that they're
    starting a new study to try to assess nationally
    whether people are getting C. diff in doctors'
    offices. The CDC study said 150,000 people who
    had not been in the hospital came down with C.
    diff in 2011. Of those, 82 had visited a
    doctor's or dentist's office in the 12 weeks
    before their diagnosis. The CDC is hoping its new
    study will help determine cause and effect,
    because it's possible the patients had C. diff to
    begin with and went to the doctor to get help.
    It's also possible that antibiotics prescribed
    during the doctor's visit, and not microbes at
    the doctor's office, caused the infection.
  • Source N Engl J Med 2015372825-34
Write a Comment
User Comments (0)