Infection Prevention eBug Bytes December 2015

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Infection PreventioneBug BytesDecember 2015
Clostridium difficile
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Harmful Bacteria Can Survive in Sandwich
Crackers, Cookies for Months

• Researchers at the University of Georgia found
  that pathogens, like salmonella, can survive for
  at least six months in cookies and crackers. The
  recent study was prompted by an increased number
  of outbreaks of foodborne diseases linked to
  low-water-activity, or dry, foods. Researchers
  found that not only can harmful bacteria survive
  in dry foods, like cookie and cracker sandwiches,
  but they can also live for long periods of time.
  For the recent study, published in the Journal of
  Food Protection, researchers used five different
  serotypes of salmonella that had been isolated
  from foods involved in previous foodborne
  outbreaks.
• Focusing on cookie and cracker sandwiches, the
  researchers put the salmonella into four types of
  fillings found in cookies or crackers and placed
  them into storage. The researchers used cheese
  and peanut butter fillings for the cracker
  sandwiches and chocolate and vanilla fillings for
  the cookie sandwiches. These "are the kind that
  we find in grocery stores or vending machines,"
  After storing, the UGA scientists determined how
  long salmonella was able to survive in each
  filling. There was survival in all types but
  salmonella survived longer in some types of the
  fillings than in others. The salmonella didn't
  survive as well in the cracker sandwiches as it
  did in the cookie sandwiches. In some cases, the
  pathogen was able to survive for at least to six
  months in the sandwiches. http//www.?ncbi.?nlm.?n
  ih.?gov/?pubmed/?26408131.

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Drug-resistant bacteria carried by nursing home
patients focus of study

• Miriam Hospital study found that a small
  percentage of nursing home patients carrying
  multi drug-resistant bacteria are admitted to
  hospitals without showing symptoms caused by the
  bacteria.
• The research, published in the American Journal
  of Infection Control, highlights the importance
  of hospital and nursing home infection control
  practices. Controlling the spread of such
  bacteria is paramount since infections caused by
  these microorganisms are associated with
  increased morbidity, mortality and cost. Mermel
  and colleagues documented patients admitted to
  Rhode Island Hospital and The Miriam Hospital
  from area nursing homes in 2012. They screened
  these patients for the presence of
  carbapenem-resistant Enterobacteriaceae (CRE)
  since there is little data in the medical
  literature regarding how prevalent these
  drug-resistant bacteria are among asymptomatic
  nursing home patients at the time of admission to
  hospitals.
• The researchers identified highly resistant
  bacteria in 23 of the 500 acute care hospital
  admissions from the nursing homes, seven of these
  were carbapenem-resistant Enterobacteriaceae.
  They found that the use of a feeding tube was
  associated with gastrointestinal carriage of
  these bacteria.
• Source Screening of nursing home residents for
  colonization with carbapenem-resistant
  Enterobacteriaceae admitted to acute care
  hospitals Incidence and risk factors. American
  Journal of Infection Control Dec (2015)

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Rigid containers allowed bacterial contamination,
while wrapped instrument trays tested had no
detectable contamination

• According to a new scientific study published in
  the December publication of the American Journal
  of Infection Control, 87 percent of tested
  sterilized rigid containers - used in the
  sterilization of surgical instruments - allowed
  ingress of aerosolized bacteria under the test
  conditions used. This study calls into question
  the assumption that rigid containers, regardless
  of duration of use, can maintain the sterility of
  their contents post-sterilization. The two
  primary types of sterile packaging systems (SPS)
  include rigid containers and sterilization wrap.
  Rigid containers are reusable and come in a
  variety of materials (various metals, aluminum
  and polymers) and sizes, while single-use
  sterilization wrap is often composed of
  polypropylene. The study used a dynamic aerosol
  test method that allowed for air exchanges to
  occur in SPSs that may simulate normal air
  exchanges in hospital settings. The study found
  that  1) Rigid containers, both used and unused,
  failed to maintain barrier performance under
  these test conditions 87 percent (97 out of 111)
  of the rigid containers failed to maintain
  barrier performance, allowing ingress of the
  challenge microorganism. 2) Rigid containers with
  5-9 years of use were significantly more likely
  to have bacterial ingress than unused rigid
  container. 3) Sterilization wraps provided no
  detectable ingress of bacteria 100 percent (161
  out of 161) of the wrapped trays using
  sterilization wrap maintained barrier
  performance, preventing any bacterial ingress and
  protecting sterility.
  
  Source Sterility
  Maintenance Study Dynamic Evaluation of
  Sterilized Rigid Containers and Wrapped
  Instrument Trays to Prevent Bacterial Ingress
  AJIC Dec 15

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Nurse with TB may have exposed over
1,000 people, including 350 infants at
Santa Clara Valley Medical Center
As many as 350 infants, 308 employees and 368
parents may have been exposed to tuberculosis
after a San Jose, Calif-based Santa Clara Valley
Medical Center maternity wing nurse was diagnosed
with the disease, according to a news release
from the hospital. "While it is very unlikely
that infants who may have been exposed will come
down with the disease, the consequences of
infection in infants can be serious," the news
release reads. "SCVMC will provide both
diagnostic testing and preventative daily
treatments of isoniazid, an antibiotic that kills
tuberculosis and can successfully prevent infants
from becoming ill. The 350 infants that may have
been exposed will be monitored closely for signs
of active tuberculosis. Moms and employees who
may have been exposed will be screened and
provided preventative treatment if needed. The
hospital was notified mid-November that the nurse
was suspected of having active tuberculosis, and
the employee was placed on leave at that time.The
patients the hospital is notifying of possible
exposure are those who were in SCVMC's Mother
Infant Care Center between mid-August and
mid-November of this year. The bacteria is
contracted through the air, but only active
strains are able to spread. Source
https//www.scvmc.org/newsroom/Pages/Tuberculosis-
Exposure-Detected.aspx
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Shingles isn't just nasty. It could kill you,
too

• Shingles isn't just a nasty and extremely painful
  experience. It can also cause strokes and heart
  attacks. Researchers found elderly people who
  suffered a bout of the excruciating blisters were
  more than twice as likely to have a stroke in the
  first week after an attack started, and nearly
  twice as likely to have a heart attack. Shingles,
  also called herpes zoster, is a souvenir of
  childhood chicken pox infection. Both are caused
  by the same virus, although it's called varicella
  when it causes chicken pox. Like all herpes
  viruses, it stays in the body forever, moving
  along the nerves. Usually the immune system can
  control it after the first outbreak of chicken
  pox, but as people get older, or if they get
  cancer or another condition that depresses the
  immune system, it can erupt in a band of
  blisters. Unlike itchy chicken pox, shingles can
  cause months of pain after the blisters heal.
  Researchers from the London School of Hygiene and
  Tropical Medicine looked at the medical records
  of more than 67,000 U.S. Medicare patients who
  had shingles and suffered either a stroke or
  heart attack within a year afterwards. There are
  two possible causes, they said. The virus may be
  replicating inside the walls of the arteries,
  causing fatty buildups to break off and cause a
  stroke or heart attack. Or it might be the risks,
  the researchers said.

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Wipes in the pipes 'Flushable' wipes causing
major plumbing problems

• Holland, Mich. Dont flush those wipes! Waste
  water officials are warning consumers that
  flushable wipes arent so flushable. Tissues,
  paper towels and flushable wipes all remain
  intact to one degree or another and can clog up
  home drains and sewer lift stations, pumps and
  other areas down the line.
• Over the past five to 10 years, the Holland Board
  of Public Works has seen an increase in
  maintenance at its lift stations as a direct
  result of wipes binding up the works, according
  to Waste Water Treatment Plant Superintendent
  Joel Davenport. Three years ago, the municipal
  utility replaced its headworks facility at a cost
  of 5.3 million. The headworks sifts out large
  pieces of debris such as wipes. In the past two
  fiscal years, the headworks has removed about 450
  tons (900,000 pounds) of material. Pumps
  partially plugged will continue to run, but are
  much less efficient, according to BPW documents.
  This requires them to run longer and increases
  the wear on the equipment. Toilet paper disperses
  after about 20 seconds, while wet wipes remained
  intact after 24 hours, according to a 2012
  experiment by the Orange County California
  Sanitation District.
• Flushable has no legal definition, and the
  Federal Trade Commission does not regulate what
  products can carry the label. Both the wipes
  industry and utilities organizations are working
  to establish standards.
• Anything made of paper or cloth, the BPW terms
  rags. Paper towels, flushable wipes, even
  diapers and cloth towels are found in the sewer,
  Davenport said.
• I dont think most people realize toilet paper
  is designed so that as soon as you flush, its
  gone, Davenport said. The more durable it is
  when you use it, the harder its going to be to
  breakdown.

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Air travel and communicable diseases
Comprehensive federal plan needed for
U.S. aviation system's preparedness

• A national aviation-preparedness plan would
  provide airports and airlines with an adaptable
  and scalable framework with which to align their
  individual plans-to help ensure that individual
  airport and airline plans work in accordance with
  one another. DOT and CDC officials agree that a
  national plan could add value. Such a plan would
  provide a mechanism for the public-health and
  aviation sectors to coordinate to more
  effectively prevent and control a communicable
  disease threat while minimizing unnecessary
  disruptions to the national aviation system.
• Employees at aviation services firms that GAO
  spoke with-including contract workers who clean
  aircraft-raised concerns about the availability
  of training and access to equipment to control
  exposure to communicable diseases. Some airports
  GAO reviewed developed additional mechanisms to
  ensure adequate training and preparation during
  the Ebola threat. A national aviation-preparedness
  plan could serve as the basis for testing
  communication mechanisms among responders to
  ensure those mechanisms are effective prior to a
  communicable disease outbreak as well as to
  provide the basis for ensuring that airport and
  airline staff receive appropriate training and
  equipment to reduce their risk of exposure to
  communicable diseases during an outbreak.

9
Our water pipes crawl with millions of bacteria

• Researchers from Lund University in Sweden have
  discovered that our drinking water is to a large
  extent purified by millions of "good bacteria"
  found in water pipes and purification plants. So
  far, the knowledge about them has been
  practically non-existent, but this new research
  is about to change that. A glass of clean
  drinking water actually contains ten million
  bacteria. But that is as it should be -- clean
  tap water always contains harmless bacteria.
  These bacteria and other microbes grow in the
  drinking water treatment plant and on the inside
  of our water pipes, which can be seen in the form
  of a thin, sticky coating -- a so-called biofilm.
  All surfaces from the raw water intake to the tap
  are covered in this biofilm. The diversity of
  species of bacteria in water pipes is huge, and
  that bacteria may play a larger role than
  previously thought. Among other things, the
  researchers suspect that a large part of water
  purification takes place in the pipes and not
  only in water purification plants. A previously
  completely unknown ecosystem has revealed itself
  to us. Formerly, you could hardly see any
  bacteria at all and now, thanks to techniques
  such as massive DNA sequencing and flow
  cytometry, we suddenly see eighty thousand
  bacteria per millilitre in drinking water. We
  suspect there are 'good' bacteria that help
  purify the water and keep it safe -- similar to
  what happens in our bodies. Our intestines are
  full of bacteria, and most the time when we are
  healthy, they help us digest our food and fight
  illness. Although the research was conducted in
  southern Sweden, bacteria and biofilms are found
  all over the world, in plumbing, taps and water
  pipes. This knowledge will be very useful for
  countries when updating and improving their water
  pipe systems. Source Microbes and
  Environments 2015 30 (1) 99

10
28 states ill-prepared for infectious disease
outbreak

• The report graded states on 10 key indicators
  surrounding various types of outbreaks, including
  flu vaccination rates and vaccine requirements
  for schools, HIV/AIDS surveillance, climate
  change adaptation plans and E. coli testing
  rates.
• Five states Delaware, Kentucky, Maine, New York
  and Virginia tied for the high score of passing
  eight of the 10 indicators.
• But 28 states and the District of Columbia fared
  much worse. Below is a breakdown of their scores
• Five out of 10 Arizona, Colorado, Connecticut,
  Georgia, Hawaii, Mississippi, Missouri, Montana,
  Pennsylvania, Rhode Island, Texas, Washington
• Four out of 10 Alabama, the District, Florida,
  Indiana, Louisiana, Nevada, South Carolina, South
  Dakota, Tennessee, Wyoming
• Three out of 10 Idaho, Kansas, Michigan, Ohio,
  Oklahoma, Oregon, Utah
• "We need to reboot our approach so we support the
  health of every community by being ready when new
  infectious threats emerge," said Paul Kuehnert, a
  RWJF director. Source http//www.abqjournal.com/6
  91445/news-around-the-region/whooping-cough-on-the
  -rise-in-san-juan-county.html

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2 states report whooping cough outbreaks

• Areas of Minnesota and New Mexico are in the
  midst of pertussis, or whooping cough, outbreaks,
  according to their departments of public health.
  Minnesota public health officials reported to
  WCCO that there have been 36 confirmed cases in
  Olmsted County in the last six weeks. Olmsted
  County contains Rochester, where the Mayo Clinic
  is located. The number of cases jumps to 76 when
  confirmed, probable and suspected whooping cough
  cases are included. In New Mexico, officials
  have recorded seven confirmed and probable cases
  of the illness and 11 more suspected cases in San
  Juan County, according to the Albuquerque
  Journal. Whooping cough cases appear to be on the
  rise across the country, according to CDC data.
  In 2014, there were 32,971 confirmed cases of
  pertussis reported to the agency, a 15 percent
  increase from 2013. Last year, California
  experienced a major whooping cough outbreak,
  consisting of 9,935 cases reported in the state
  from Jan. 1 to Nov. 26. Officials from the
  state's department of public health blamed the
  epidemic on fewer people receiving the whooping
  cough vaccine. Pertussis can be a serious
  illness in babies, children, teens and adults,
  according to the CDC. The agency says the most
  effective way to prevent whooping cough is
  through vaccination.

12
Chipotle hit with another E. Coli outbreak

• The Centers for Disease Control and Prevention
  (CDC) said Monday it is investigating another
  recent E. coli outbreak linked to Chipotle.
• Five people have been infected with a different,
  rare E. coli strain, health officials said. All
  of them reported eating at the Mexican grill
  chain in the week before coming down with the
  illness in November. The cases were identified in
  Kansas, North Dakota and Oklahoma, the CDC said.
• It's unclear if the infections are related to the
  earlier outbreak, which has affected 53 people in
  nine states, health officials said. At least 43
  of them had reported eating at Chipotle in the
  week leading up to their illness.
• Chipotle has increased its food safety measures,
  which include testing all local produce before it
  gets to the restaurants and testing the quality
  of ingredients throughout their shelf life.
• http//time.com/4157690/chipotle-ecoli-outbreak-cd
  c/

13
How a medical device maker kept U.S. hospitals
in the dark about deadly infections

• The hunt for a deadly superbug that sickened 22
  patients at a Dutch hospital began just before
  noon on a spring day in 2012. Inside a lab in the
  tiny hamlet of Zoeterwoude, a technician
  carefully peeled back the tip of a state-of-the
  art medical scope. Watching him intently was a
  small group of hospital officials and executives
  from Olympus Corp., the maker of the device. The
  Olympus technician found trouble right away. He
  spotted a brown, grimy film inside parts of the
  flexible, snake-like scope - parts that were
  supposed to be sealed. A rubber ring designed to
  keep bacteria out was cracked and worn. The same
  bacteria that had sickened the patients were
  found on the scope. An investigator hired by
  Olympus and the hospital concluded that the
  scope's design could allow blood and tissue to
  become trapped, spreading bacteria from one
  patient to another. In his report, he called on
  Olympus to conduct a worldwide investigation and
  recall all its scopes if similar problems turned
  up. Over the next three years, 21 people died and
  at least two dozen more became ill from
  infections related to scopes in Pittsburgh,
  Seattle and Los Angeles. An unknown number of
  other patients have been infected. The Food and
  Drug Administration has identified 10 outbreaks,
  seven of which involve Olympus scopes.
• After each outbreak, Olympus contended that its
  scopes did not cause the infections and blamed
  the hospitals for not cleaning them properly. The
  company treated each case as an isolated
  incident, not telling the U.S. hospitals that
  they weren't alone.
• Source http//graphics.latimes.com/superbug-scope
  /

14
Costco E. coli outbreak appears to be over
according to CDC

• An outbreak of E. coli linked to rotisserie
  chicken salad sold by warehouse club operator
  Costco Wholesale Corp appears to be over, the
  U.S. Centers for Disease Control (CDC) said on
  Tuesday. The most recent illness in this outbreak
  reported to CDC started on Nov. 3. The U.S. Food
  and Drug Administration conducted a trace back
  investigation to determine which ingredient was
  linked to the illnesses, but the probe could not
  identify a common source of contamination, the
  CDC said. Five of the 19 sickened people were
  hospitalized and two developed a type of kidney
  failure associated with the E. coli strain, STEC
  O157H7. No deaths were reported and the
  infections occurred in Montana, Utah, Colorado,
  California, Missouri, Virginia and Washington,
  the CDC said. The Costco outbreak was initially
  traced to a celery-and-onion mix made by Taylor
  Farms Pacific Inc used in making the chicken
  salad. Taylor Farms, a major producer of
  fresh-cut vegetables and bagged salads, last
  month recalled more than 154,000 lots of numerous
  products from various grocery store chains in 17
  states "out of an abundance of caution". Products
  were recalled from chains including Costco,
  Safeway, Starbucks Corp, Wal-Mart Stores Inc, and
  Target Corp. Source http//news.yahoo.com/cos
  tco-e-coli-outbreak-appears-over-cdc-174159650--se
  ctor.html

15
CDC Source of UPMC mold that killed 3 could not
be found

• Pennsylvania Secretary of Health Karen Murphy
  issued a statement on the CDC preliminary report
  on an infection cluster found at the University
  of Pittsburgh Medical Center (UPMC). In September
  2015, the Department of Health asked the CDC to
  investigate a cluster of four cases of
  mucormycosis, a rare infection caused by a group
  of environmental molds. The infections occurred
  over the course of a year among organ transplant
  recipients at the University of Pittsburgh
  Medical Center (UPMC). These infections are not
  spread person to person and are usually acquired
  through inhaling mold spores in the air.
  Transplant patients are at increased risk of
  infection because their immune systems have been
  suppressed or weakened. The on-site investigation
  conducted by the CDC in collaboration with the
  state Department of Health and Allegheny County
  Department of Health was completed on October 7.
  No additional infections were identified, and no
  single source has thus far been found to account
  for all four reported cases. Three of the four
  infected patients spent a significant amount of
  their hospitalizations in the same intensive care
  unit room. The room was known as a "negative
  pressure room," which is designed to draw air
  from outside the room into the room and may have
  exposed patients to mold spores that were present
  in the surrounding environment. Environmental
  testing of the room by the CDC team identified
  some common environmental molds but no
  mucormycetes. The unit in which the room was
  located had already been closed at the time of
  the investigation and was undergoing remediation
  to address any potential mold sources that
  limited the testing that could be performed.
  Source http//www.prnewswire.com/news-releases/de
  partment-of-health-issues-statement-on-cdc-report-
  on-infection-cluster-at-university-of-pittsburgh-m
  edical-center-300196343.html