Infection Prevention eBug Bytes December 2014

1
Infection PreventioneBug BytesDecember 2014
2
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

3
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
4
Kitchens are source of multi-drug resistant
bacteria

• 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

5
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
  available.
• 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
  November.
• Source http//www.cdc.gov/listeria/

6
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
  10.1371/journal.pone.0114548

7
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
  patients.
• Source Courtney PM et al. Clinical Orthopaedics
  and Related Research 11/2014

8
Portable UV light as an alternative for
decontamination

• 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
  decontamination
• 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

9
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

10
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