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Infection Prevention eBug Bytes December 2014


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Title: Infection Prevention eBug Bytes December 2014

Infection PreventioneBug BytesDecember 2014
Airport Exit and Entry Screening for Ebola
AugustNovember 10, 2014
  • In response to the Ebola epidemic, CDC, the World
    Health Organization, and other international
    organizations collaborated in August to screen
    for Ebola persons at airports who were exiting
    countries with widespread transmission.
  • Since the program began, an estimated 80,000
    travelers have departed by air from the three
    countries with widespread Ebola transmission.
  • In October, an enhanced U.S. entry screening
    program was begun at five U.S. airports as an
    added measure. Of 1,993 travelers screened, a
    total of 86 (4.3) were referred to CDC for
    additional evaluation, and seven (8.1) were
    symptomatic and referred for medical evaluation.
    None of the seven were diagnosed with Ebola.
  • Source Clive M Brown, MBBS, Aaron E Aranas,
    MPH, Gabrielle A Benenson, MPH, et al. MMWR Morb
    Mortal Wkly Rep 201463(Early Release)1-6

Research on farmers' markets shows presence of
Salmonella, E. coli
The study focused on farmers' markets in Los
Angeles and Orange counties in California, as
well as in the Seattle, Washington, area.
Specifically tested were samples of the herbs
cilantro, basil and parsley. Of the 133 samples
tested from 13 farmers' markets, 24.1 percent
tested positive for E. coli and one sample tested
positive for Salmonella. A total of 16 samples
had average E. coli counts considered to be
unsatisfactory according to guidelines
established by the Public Health Laboratory
Service. When tested for Salmonella, 15 samples
had suspicious growth but only one tested
positive -- a parsley sample from a Los Angeles
County farmers' market. Orange County farmers'
markets had the highest percentage of samples
with E. coli growth followed by farmers' markets
in the greater Seattle area and Los Angeles
County. Salmonella symptoms include diarrhea,
abdominal cramps and fever around 12 to 72 hours
after consumption that can last four to seven
days. Symptoms for pathogenic forms of E. coli
include severe stomach cramps, diarrhea that
often becomes bloody, and vomiting. Source
Donna J Levy, Nicola K Beck, Alexandra L Kossik,
Taylor Patti, J Scott Meschke, Melissa Calicchia,
Rosalee S Hellberg. Microbial safety and quality
of fresh herbs from Los Angeles, Orange County
and Seattle farmers' markets. Journal of the
Science of Food and Agriculture, 2014
Kitchens are source of multi-drug resistant
  • Researchers from University Hospital in Basel,
    Switzerland collected and examined 298 cutting
    boards (154 from University Hospital and 144 from
    private households) after preparation of various
    meats (i.e., poultry, beef/veal, pork, lamb, game
    and fish) and before being cleaned. They also
    collected 20 pairs of gloves from hospital
    kitchen employees after they handled raw poultry.
    These samples were tested for the presence of
    ESBL-producing Enterobacteriaceae, a family of
    gram-negative bacteria that includes Salmonella,
    E. coli and Klebsiella.
  • In testing the cutting boards, researchers found
    that 6.5 percent of hospital cutting boards used
    in preparation of poultry were contaminated with
    ESBL-producing E. coli. For boards used in
    households, researchers found ESBL-producing E.
    coli on 3.5 percent of these surfaces. They also
    found that 50 percent of the hospital kitchen
    gloves were contaminated with this drug-resistant
    E. coli. The researchers found that none of the
    cutting boards used in preparing beef/veal, pork,
    lamb, game or fish were contaminated with any
    ESBL-producing bacteria. They also found that the
    meat's country of origin did not play a factor in
    the presence of bacteria on any of the surfaces.
  • Source Sarah Tschudin-Sutter, Reno Frei, Roger
    Stephan, Herbert Hächler, Danica Nogarth, Andreas
    F. Widmer. Extended-Spectrum ß-Lactamase
    (ESBL)Producing Enterobacteriaceae A Threat
    from the Kitchen. Infection Control and Hospital
    Epidemiology, 2014 35 (5) 581

Five dead, dozens ill from bacteria linked to
caramel apples
  • Dec 19 2014 Five people have died and 21 others
    have been hospitalized in recent weeks in a
    listeria outbreak linked to caramel apples. A
    total of 28 people infected with listeria have
    been reported from 10 states. The CDC warned
    consumers not to eat any pre-packaged,
    commercially-produced caramel apples, including
    those with other toppings such as nuts, chocolate
    or sprinkles, until more information is
  • Of the 28 victims, 26 were hospitalized and five
    of those people died, the CDC said, adding that
    listeriosis contributed to at least four of the
    deaths. Nine of the cases involved a pregnant
    woman or her newborn infant. Listeriosis is an
    infection that primarily affects older adults,
    pregnant women, newborns and people with weakened
    immune symptoms. Symptoms include fever, muscle
    aches, headache, confusion and convulsions.
  • No illnesses related to the outbreak have been
    linked to apples that are not caramel-coated and
    are not prepackaged, or to caramel candy. The
    cases were diagnosed in late October and
  • Source http//

Bacterial infections differ based on geography,
healthcare spending
  • Where you live affects the type of bacteria that
    cause bloodstream infections, according to
    researchers at Rhode Island Hospital and an
    international team of investigators. The closer
    you live to the equator, the greater the
    likelihood of a bloodstream infection caused by a
    group of bacteria called Gram-negative bacteria,
    which thrive in warm and moist environments,
    compared to another group of bacteria referred to
    as Gram-positive bacteria. The study also found
    that the proportion of a country's GDP spent on
    health care impacted the type of bacteria causing
    such infections.
  • A five-member international steering committee
    that collected and studied data from 2007-2011
    from 23 medical centers (with two hospitals
    participating from Sao Paolo, Brazil) including
    in the U.S., Greece, Egypt, Israel, Australia,
    Canada, Japan, Italy, Netherlands, Thailand,
    Switzerland and Argentina. For each site, data
    was obtained regarding latitude, longitude, mean
    annual precipitation, mean daily temperature,
    population density, per-capita gross domestic
    product and the percentage of GDP in that country
    allocated for health care.
  • Source David Fisman, Eleni Patrozou, Yehuda
    Carmeli, Eli Perencevich, Ashleigh R. Tuite,
    Leonard A. Mermel. Geographical Variability in
    the Likelihood of Bloodstream Infections Due to
    Gram-Negative Bacteria Correlation with
    Proximity to the Equator and Health Care
    Expenditure. PLoS ONE, 2014 9 (12) e114548 DOI

Addition of Vancomycin to Cefazolin Prophylaxis
Is Associated With Acute Kidney Injury After
Primary Joint Arthroplasty
  • Researchers studied 1828 patients undergoing
    primary hip and knee arthroplasty over a 2-year
    period who received either cefazolin (n 500) or
    cefazolin and vancomycin (n 1328) as
    perioperative antibiotic prophylaxis. During the
    study period, a perceived high prevalence of MRSA
    infections led some surgeons to add vancomycin to
    the prophylactic antibiotic regimen. The patient
    characteristics, case mix, and preoperative renal
    function and baseline creatinine clearance were
    similar between the two groups. AKI was defined
    according to the published Acute Kidney Injury
    Network (AKIN) criteria, and the risk of AKI in
    both groups was compared. Patients receiving dual
    antibiotics were more likely to develop AKI
    compared with those receiving cefazolin alone
    (13 versus 8, p 0.002). Dual-antibiotic
    prophylaxis also was associated with greater
    severity patients in the dual antibiotic group
    had higher rates of Grade II and III acute kidney
    injury (3 versus 0, p 0.003). Without a clear
    advantage in reducing surgical site infections,
    the utility and safety of routine addition of
    vancomycin to the prophylactic regimen in all
    patients undergoing primary hip and knee
    arthroplasty should be avoided. Further
    prospective studies should look at the efficacy
    of preoperative MRSA screening, decolonization,
    and selective use of vancomycin in high-risk
  • Source Courtney PM et al. Clinical Orthopaedics
    and Related Research 11/2014

Portable UV light as an alternative for
  • Targeted surface disinfection is a key infection
    control measure. Usually, decontamination of
    surfaces is performed by wiping the surface with
    some kind of disinfecting agent or, in the case
    of auxiliary devices, submerging the entire
    product in a disinfecting solution. In all of
    these cases, the success of surface disinfection
    depends mainly on the type of pathogen, the type
    and concentration of the active chemical
    substances, and the overall duration of the
    disinfection process. Ultraviolet (UV)
    irradiation, which inactivates microorganisms by
    the formation of DNA/RNA dimers, is widely used
    for the decontamination of safety cabinets, for
    water decontamination, and in the food processing
    industry. This study evaluated the capability of
    a new hand-held UV device to provide surface
  • The following species were tested spores of
    Geobacillus stearothermophilus Bacillus pumilus,
    Bacillus atropheaus and Clostridium difficile,
    and vegetative cells from Staphylococcus aureus,
    Enterococcus faecium, Escherichia coli and
    Acinetobacter baumannii. A minimum 90 reduction
    of viable organisms was achieved within 40
    seconds for all 4 spore species. In contrast,
    reproducible total (100) inactivation of the 4
    non-spore-producing species occurred in less than
    5 seconds. Source Peterssen LP et al American
    Journal of Infection Control 42 (2014) 1334-6

Buffer zone guidelines may be inadequate to
protect produce from feedlot contamination
  • The pathogen Escherichia coli O157H7 can spread,
    likely airborne, more than one tenth mile
    downwind from a cattle feedlot onto nearby
    produce. The high percentages of leafy greens
    contaminated with E. coli suggest great risk for
    planting fresh produce 180 m 590 feet or less
    from a feedlot. That suggests that current buffer
    zone guidelines of 120 meters 400 feet from a
    feedlot may be inadequate. In the study, the
    investigators sampled leafy greens growing in
    nine plots three each at 60, 120, and 180 meters
    downwind from the cattle feedlot at the research
    center, over a two year period. The rate of
    contamination with the pathogenic E. coli O157H7
    declined with distance from an average of 3.5
    percent of samples per plot at 60 meters to 1.8
    percent at 180 meters. The researchers sampled
    the produce six times between June and September
    of each year. They also sampled the feedlot
    surface manure in 10 feedlot pens for E. coli
    O157H7, finding it in an average of 71.7 to 73.3
    percent of samples in 2012 and 2011,
    respectively. Moreover, the study's long-term
    nature enabled sampling under a greater diversity
    of weather conditions. A variety of conditions
    can affect the level of contamination. For
    example, following a period of high cattle
    management activity when the feedlot was dry and
    dusty, including removal of around 300 head of
    cattle for shipping, the rate of total
    non-pathogenic E. coli-contaminated samples per
    plot at 180 meters shot up to 92.2 percent.
    Conversely, total E. coli-positive leafy green
    samples were notably lower on one August sample
    date than on any other date, a finding the
    investigators attribute to cleaning and removal
    of feedlot surface manure from the nearby pens a
    few weeks earlier. The highest levels of
    contamination found on leafy greens, in August
    and September of 2012. Source American Society
    for Microbiology December 2014

Trial confirms Ebola vaccine candidate safe,
equally immunogenic in Africa
  • Two experimental DNA vaccines to prevent Ebola
    virus and the closely related Marburg virus are
    safe, and generated a similar immune response in
    healthy Ugandan adults as reported in healthy US
    adults earlier this year. Scientists from the
    NIAID developed the DNA vaccines that code for
    Ebola virus proteins from the Zaire and Sudan
    strains and the Marburg virus protein.
  • In this phase 1 trial, the Makerere University
    Walter Reed Program enrolled 108 healthy adults
    aged between 18 and 50 from Kampala, Uganda
    between November, 2009 and April, 2010. Each
    volunteer was randomly assigned to receive an
    intramuscular injection of either the Ebola
    vaccine (30 volunteers), Marburg vaccine (30),
    both vaccines (30), or placebo (18) at the start
    of the study, and again 4 weeks and 8 weeks
    later. The vaccines given separately and together
    were safe and stimulated an immune response in
    the form of neutralising antibodies and T-cells
    against the virus proteins. Four weeks after the
    third injection, just over half of the volunteers
    (57 17 of 30) had an antibody response to the
    Ebola Zaire protein as did 14 of 30 participants
    who received both the Ebola and Marburg vaccines.
    However, the antibodies were not long-lasting and
    returned to undetectable levels within 11 months
    of vaccination. Both DNA vaccines were well
    tolerated in Ugandan adults with similar numbers
    of local and systemic reactions reported in all
    groups. Only one serious adverse event
    (neutropenia low white blood cell count) was
    reported in a Marburg vaccine only recipient, but
    was not thought to be vaccine related.
  • Source The Lancet, December 2014
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