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Infection Prevention eBug Bytes September 2015

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Title: Infection Prevention eBug Bytes September 2015


1
Infection Prevention eBug Bytes September 2015
Influenza Virus
2
UPMC Presbyterian ICU remains closed due
to mold
  • There are no plans yet to reopen the
    cardiothoracic intensive care unit at UPMC
    Presbyterian after mold was found there two weeks
    ago. No surgeries have been canceled at the
    Oakland hospital and the cleanup continues, UPMC
    spokeswoman Wendy Zellner said Monday. She
    confirmed that on Sept. 3, a critical care
    medicine doctor discovered a male transplant
    patient had mold in an external wound. After
    opening up a wall nearby, mold was found and
    further investigation found mold in other areas.
  • The entire 20-bed unit was closed Sept. 8, with a
    total of 18 patients moved to other parts of the
    hospital to get the intensive care they needed,
    Zellner said. The first patient was the only one
    with a confirmed association with the mold, she
    said.
  • Even in otherwise healthy people, mold can affect
    health, according to a 2004 report from the
    Institute of Medicine, which found evidence that
    linked indoor exposure to mold with upper
    respiratory tract symptoms, coughs and wheezing.
  • Working on the hospital cleanup are staff members
    in the infection prevention, facilities and
    housekeeping departments, as well as outside mold
    cleanup experts. Source http//www.epa.gov/mold/

3
Your mobile phone may be 'patient zero' for
hospital infections
  • Infection preventionists, hospital staff and
    clinicians search high and low for weak spots in
    hospital-setting disinfection and cleanliness,
    but may need to focus more on what's in their own
    pockets, according to new research.
  • In a paper published in the Journal of
    Occupational and Environmental Hygiene,
    Australian researchers sought to investigate the
    potential role mobile phones play as reservoirs
    for infection and bacterial colonization in the
    hospital setting.
  • The researchers screened a group of 226 staff
    members comprising 146 physicians and 80 medical
    students at a regional Australian hospital
    between January 2013 and March 2014. They
    concluded that 74 percent of staff members'
    mobile phones were contaminated with bacteria, of
    which 5 percent was deemed potentially harmful.
    Similar organisms were found on the dominant
    hands of staff members.
  • Junior medical staff members were found to be at
    greater risk for heavy microbial growth. Of the
    226 participants, 31 percent reported cleaning
    their phones routinely. Of those who cleaned
    their phones, only 21 percent reported using
    alcohol containing wipes. The researchers
    concluded that disinfection guidelines for cell
    phone use in hospitals should be developed and
    implemented.
  • Source Journal of Occupational and Environmental
    Hygiene

4
Poor Contact Lens Hygiene Puts Users at Risk of
Serious Infections
  • According to a recent CDC report, 99 of contact
    lens wearers in a survey reported having at least
    one questionable hygiene practice. The report
    noted that nearly a third of the 1,000 lens
    wearers who took the survey had experienced a red
    or painful eye requiring a doctors visit. An
    estimated 40.9 million adults in the U.S. wear
    contact lenses, according to the report. Wearing
    contact lenses increases a persons risk of an
    eye infection by about 10 times compared with
    people who dont wear contact lenses, and they
    are the cause of 30 of all corneal infections.
    Pseudomonas is often extremely inflammatory, with
    a sudden onset of redness, pain, tearing and poor
    vision.
  • Sleeping in contact lenses is one of the most
    common ways people get the infections. Bacteria
    comes into the eye from the contact lens or lens
    case and can bind to the cornea, causing an
    ulcer. Experts say multiple bad habits often
    lead to trouble. Another common no-no is reusing
    old disinfectant solution when storing contact
    lenses in a case. Many people re-use the same
    solution for a few days, or top off each case
    with new solution. Experts recommend cleaning
    contact-lens cases every day and replacing them
    every three months. Cases should be rinsed out
    with disinfecting contact-lens solution and
    air-dried every day.
  • Another source of eye infections is the parasite
    called Acanthamoeba, an invasive pathogen that
    can be found in all kinds of water sources,
    including swimming pools, tap water and fresh or
    saltwater bodies. Once on a contact lens, the
    pathogen can invade the eye and cause permanent
    vision loss and even blindness.
  • Source Wall Street Journal

5





 
When should precleaning of flexible endoscopes occur?
Pre-cleaning of flexible endoscopes and accessories should occur at the point of use before organic material has dried on the surface of the endoscope, and before transport to the decontamination area. Flexible endoscopes, by virtue of the body cavities in which they are used, acquire high levels of microbial contamination during each use. Failure to completely follow the defined cleaning process, beginning with precleaning, has been shown to cause inadequate decontamination leading to patients being exposed to infectious agents. Precleaning of endoscopes and related equipment at the point of use before transport to the decontamination area helps prevent drying of the organic material on the flexible endoscope surfaces. To learn more, refer to the AORN Cleaning and Processing Flexible Endoscopes September 2015 www.aorn.org
6
Study examines how to reduce infection risk in
pediatric playrooms
  • As hospitals increasingly focus on improving the
    patient experience, many have considered allowing
    hospitalized children to receive sibling visitors
    in pediatric playrooms. Doing so requires special
    measures to reduce the risk of infection
    transmission, according to a study published in
    the American Journal of Infection Control. "Most
    guidelines recommend that siblings not be
    permitted to visit playrooms," wrote the study
    authors. "This approach was not seen as
    consistent with family-centered care in our
    setting."
  • To make care more family-centered, the
    researchers conducted a literature review and
    reviewed current benchmarking strategies on
    playroom infection control standards. They also
    worked with members of patients' families, child
    life specialists, care teams and infection
    prevention and control services to develop a
    screening form for sibling visitors. The
    researchers' pilot project tracked the use of
    these forms for siblings and other visitors. In
    the first two years of the project, the screening
    form identified that approximately 10 percent of
    the visiting siblings had a potentially
    communicable illness. In the cases where the form
    revealed an infection risk, the family was
    informed that the visiting sibling would not be
    able to visit the playroom until his or her
    condition improved, "The lack of clear published
    strategies to screen siblings-visitors to patient
    play areas and the lack of knowledge sharing
    about experience in this area of infection
    prevention and control is a gap and should, we
    propose, be remedied," concluded the study
    authors. "Screening of siblings can reduce
    infection and allow hospitalized children to
    benefit from ongoing interaction.
  • Reducing infection transmission in the playroom
    Balancing patient safety and family-centered care
    AJIC Sep 2015

7
AAP Mandatory flu immunization of health care
workers ethical, necessary
  • The Academy has reaffirmed its support for a
    mandatory influenza immunization policy for all
    health care personnel (HCP) nationwide.
  • Many individuals at high risk of influenza and
    its associated complications are in frequent,
    close contact with HCP because of their need to
    seek medical services. Therefore, immunization of
    HCP is a crucial step in efforts to protect those
    at risk of health care-associated influenza,
    according to the AAP policy statement Influenza
    Immunization for All Health Care Personnel Keep
    it Mandatory. The policy is available at
    www.pediatrics.org/cgi/doi/10.1542/peds.2015-2920
    and will be published in the October issue of
    Pediatrics.
  • Mandatory influenza vaccine for all HCP is
    ethical, just and necessary to benefit the health
    of employees, their patients and community
    members, according to the policy. In addition,
    influenza immunization is cost-effective. The
    cost associated with influenza in the U.S. is
    estimated to be 87 billion per year, which
    includes medical care in outpatient and inpatient
    settings, work absenteeism and mortality.
  • The Academy has developed guidance on
    implementing a mandatory influenza immunization
    policy that addresses supply, payment, coding and
    liability issues. These documents can be found at
    www.aapredbook.org/implementation

8
Active surveillance reduces SSIs after
neurosurgery 5 study findings
  • Surgical site infections after neurosurgery can
    have devastating consequences, but active
    surveillance can reduce the likelihood of SSI
    risk factors being overlooked, according to a
    recent study published in the American Journal of
    Infection Control.
  • Researchers conducted their prospective cohort
    study over a 24-month period in a university
    center. All total, nearly 950 adult patients
    undergoing neurosurgical procedures, with the
    exception of open skull fractures, were included.
  • During the study period, the hospital established
    an active surveillance program with regular
    feedback and isolated specific microorganisms to
    identify independent risk factors for surgical
    site infections. Highlighted below are five
    findings from the study.
  • 1) Of all the patients studied, 43 were diagnosed
    with an SSI, or 4.5 percent of the patients. 2)
    The researchers observed a significant reduction
    in post neurosurgical SSIs from 5.8 percent in
    2009 to 3 percent in 2010. 3) During the study
    period, the most common microorganisms isolated
    from SSIs were Staphylococcus aureus (in 23
    percent of the cases), Enterobacteriaceae (21
    percent) and Propionibacterium acnes (12
    percent). 4) The following independent risk
    factors were linked with postcranial surgery
    SSIs an intensive care unit stay of seven days
    or longer, a drainage that lasted three or more
    days and cerebrospinal fluid leakages. 5) For
    post spinal surgery, SSIs were linked with the
    following an intensive care unit stay of seven
    days or longer, a coinfection and a drainage that
    lasted three or more days. Ultimately, the
    researchers concluded that active surveillance
    with regular feedback is an effective
    SSI-reducing strategy and infection control
    measures that target the postoperative period are
    promising.

9
Infections Increase Death Risk by 35 for ICU
Patients, Study Finds
  • Elderly patients admitted to intensive care units
    (ICUs) are about 35 percent more likely to die
    within five years of leaving the hospital if they
    develop an infection during their stay, a new
    study finds. Preventing two of the most common
    health care-associated infections bloodstream
    infections caused by central lines and pneumonia
    caused by ventilators can increase the odds
    that these patients survive and reduce the cost
    of their care by more than 150,000. The study
    looked at outcomes for 17,537 elderly Medicare
    patients admitted to 31 hospitals in 2002 to
    assess the cost and effectiveness of infection
    prevention efforts. Then, the researchers used an
    additional five years of Medicare claims data to
    assess the long-term outcomes and health costs
    attributed to health care-associated infections.
    While 57 percent of all the elderly ICU patients
    died within five years, the researchers found
    that infections made death more likely. For those
    who developed central line associated bloodstream
    infections, or CLABSI, 75 percent died within
    five years, as did 77 percent of those who
    developed ventilator-associated pneumonia, or
    VAP. Effective prevention programs for CLABSI
    resulted in an estimated gain of 15.55 years of
    life on average for all patients treated in the
    ICU, the study found. Source A decade of
    investment in infection prevention A
    cost-effectiveness analysis, AJIC Jan 2015

10
Hundreds of children tested after infection scare
at hospital
  • More than 300 children have been tested for
    hepatitis and HIV infections in less than a week,
    after Seattle Childrens officials warned
    thousands of patients and families that surgical
    tools used at the hospitals Bellevue Clinic and
    Surgery Center may not have been properly
    cleaned. At least three of those children have
    posted what officials are calling false-positive
    results for hepatitis, testing mildly positive
    in an initial test, but then negative upon second
    review. More than 2,000 parents and family
    members have contacted the hospital since
    officials announced last Thursday that theyd
    detected lapses in cleaning protocol and were
    offering blood tests to children and young adults
    whod undergone day surgeries since the clinics
    opening in 2010.
  • Some families have had children tested for
    hepatitis B and hepatitis C and for HIV at
    approved laboratories close to their homes, while
    others have been tested at the Seattle Childrens
    lab. Washington state health officials have
    launched an investigation into the potential
    infection risk, a process that could take several
    months
  • http//www.seattletimes.com/seattle-news/health/hu
    ndreds-of-kids-tested-after-infection-scare-at-sea
    ttle-childrens/

11
Pneumonia Associated with an Influenza A H3
Outbreak at a Skilled Nursing Facility
  • In December 2014, the Florida Department of
    Health, Bureau of Epidemiology, was notified that
    18 of 95 (19) residents at a skilled nursing
    facility had radiographic evidence of pneumonia
    and were being treated with antibiotics. Two
    residents were hospitalized, one of whom died. A
    second resident died at the facility. The Florida
    Department of Health conducted an outbreak
    investigation to ascertain all cases through
    active case finding, identify the etiology,
    provide infection control guidance, and recommend
    treatment or prophylaxis, if indicated. An
    outbreak-associated case was defined as the onset
    of fever or respiratory illness in a nursing
    facility resident or staff member from November
    29December 29, 2014. Overall, 50 persons,
    including 44 (46) residents and six (8) of 75
    staff members met the case definition. The
    earliest reported onset date was November 29 68
    of cases occurred during December 1218 (Figure).
    Antibiotics were prescribed to 36 (72) patients.
    Nine (20) ill residents were hospitalized. Two
    additional resident deaths occurred on December
    21 and December 22, for a total of four,
    increasing the fatality rate to 9 among
    residents meeting the case definition (n 44).
    All asymptomatic residents and staff were
    considered to have been exposed, and courses of
    prophylactic oseltamivir were offered to exposed
    persons on December 21 and December 22. The
    facility cancelled group activities, initiated
    droplet precautions, and stopped accepting
    admissions. Additional measures included
    implementation of respiratory precautions for
    visitors and exclusion of ill staff from work
    until 24 hours after symptom resolution. No cases
    were identified after December 21. Source MMWR
    September 11, 2015 / 64(35)985-986

12
Ebola Virus Disease Sierra Leone and Guinea,
August 2015 MMWRSeptember 11, 2015 /
64(35)981-984
  • In August 2015, a medical student who did not
    report his Ebola exposure and did not adhere to
    contact follow-up procedures was admitted to a
    hospital in Conakry, where he shared a room with
    another patient. Before receiving a diagnosis of
    Ebola, the medical student was assisted by one of
    his roommate's visitors. When Ebola was diagnosed
    in the medical student, the roommate's visitor
    and his family could not initially be found,
    despite intensive efforts at contact tracing. The
    roommate's visitor subsequently developed Ebola,
    visited multiple doctors and hospitals via 12
    taxis, and transmitted Ebola to his mother, a
    cousin, another person, and a taxi driver.
    Deliberate evasion of disease control
    interventions can hamper monitoring of contacts
    and identification of cases. In late July, on day
    4 of contact monitoring, a female contact of an
    Ebola patient in Conakry stopped adhering to
    provisions of the 21-day period of close
    community monitoring. The contact left the
    community and traveled widely through several
    areas of the adjacent Forécariah prefecture by
    multiple motorcycle taxis. She visited a
    traditional healer and might have crossed into
    Sierra Leone before Ebola was diagnosed and she
    was isolated in an Ebola treatment unit on day
    16. Contact identification for this patient was
    particularly challenging, because she provided
    inconsistent information. Obscure transmission
    chains might reveal weaknesses in surveillance or
    hidden reservoirs of disease. In August 2015, an
    Ebola case was diagnosed through routine
    postmortem swab surveillance in Forécariah
    prefecture. Although health officials initially
    thought this case resulted from contact with a
    recently deceased relative who was buried
    secretly, molecular sequencing demonstrated a
    likely chain of transmission from a different
    community. Delayed consideration of Ebola as a
    cause of illness or death can lead to
    transmission and sometimes reintroduction of the
    virus into areas where transmission was
    previously interrupted. In late July, a man
    traveled from Freetown to Tonkolili District in
    Sierra Leone for a religious event. He sought
    care at two facilities, where he potentially
    exposed many health care workers and ultimately
    died. Ebola was confirmed by postmortem swab,
    ending the district's 150-day period without an
    Ebola case.

13
Eleven more MERS cases in Saudi Arabia, 2 in
Jordan
  • Saudi Arabia's health ministry reported 11 more
    MERS-CoV cases in the past 3 days, 9 of them in
    Riyadh where a hospital-linked outbreak is under
    way, and Jordan's media is reporting 2 more
    cases, pushing the number of recently detected
    cases there to 6. Disease activity in Jordan and
    in neighboring Saudi Arabia are raising concerns,
    coming just weeks ahead of the busy international
    travel season surrounding the Hajj religious
    observance in Saudi Arabia. In separate
    announcements over the past 3 days, Saudi
    Arabia's Ministry of Health (MOH) reported 11 new
    lab-confirmed cases, 9 in Riyadh, 1 in Ha'il in
    the north central part of the country, and 1 in
    Najran, a city in the southern part of the
    country that has now reported four cases since
    early August.
  • The country also reported 7 more MERS deaths, 6
    in Riyadh and 1 in Najran. All but one of the
    deaths involved previously announced patients.
  • Of the 9 new cases in Riyadh, 8 likely have links
    to the hospital outbreak centered at King
    Abdulaziz Medical City, a large National Guard
    hospital in the city. Seven of the 8 patients
    were contacts of a suspected or confirmed
    MERS-CoV case in the hospital or in the
    community, and the contact status is still under
    review for the eighth patient. Source
    http//www.cidrap.umn.edu/news-perspective/2015/08
    /eleven-more-mers-cases-saudi-arabia-2-jordan

14
Cucumber-linked Salmonella outbreak total climbs
to 341
  • The US Centers for Disease Control and Prevention
    (CDC) said today that 56 more illnesses have been
    reported in a multistate Salmonella Poona
    outbreak linked to cucumbers imported from
    Mexico, raising the total so far to 341 cases.
  • Three more states (Hawaii, Kentucky, and
    Pennsylvania) have reported cases, lifting the
    number of affected states to 30. One more person
    has died from their illness, a patient from
    Texas, putting the fatality count at two.
    Meanwhile, the number of people who have been
    hospitalized for their infections has climbed
    from 53 to 70, or 33 of cases with available
    information.
  • The CDC announced the outbreak linked to
    cucumbers distributed by Andrew Williamson
    Fresh Produce, based in San Diego, on Sep 4. On
    the same day the Food and Drug Administration
    posted a recall notice, which noted that the
    products had been distributed to at least 22
    different states, and perhaps others.
  • In its update today, the CDC said a handful of
    states have made progress with testing the
    cucumbers for Salmonella. Nevada's health
    department has isolated one of the outbreak
    strains on samples from retail cucumbers, and
    Arizona and Montana have isolated Salmonella from
    similar samples, with DNA fingerprinting under
    way to determine the subtype. Tests on Salmonella
    isolated by San Diego health officials on
    cucumbers from the company's produce facility are
    still under way.
  • Source http//www.cdc.gov/salmonella/poona-09-15/
    index.html
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