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Infection Prevention eBug Bytes June 2016


A leading proponent of this shift is infection prevention expert William Rutala, ... endoscopes represent a significant risk of disease transmission. – PowerPoint PPT presentation

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Title: Infection Prevention eBug Bytes June 2016

Infection PreventioneBug BytesJune 2016
Zika Virus
A New Way to Clean GI Scopes
  • Some are now calling for a radical shift in scope
    reprocessing from high-level
    disinfection to steam sterilization. A leading
    proponent of this shift is infection prevention
    expert William Rutala, PhD, MPH. "Sterilization
    is the only way to unify reprocessing and reduce
    the infection risk," says Dr. Rutala, a professor
    in the division of infectious diseases at the
    University of North Carolina's School of
  • Although the incidence of post-procedure
    infection remains very low, endoscopes represent
    a significant risk of disease transmission."Dr.
    Rutala will recommend to the FDA that it mandate
    that all GI scopes be sterilizable by 2018. A
    scope you could steam sterilize would be a
    "game-changer," says Donna Nucci, RN, BSN, CIC,
    an infection preventionist at Yale New Haven
    (Conn.) Hospital. "Nobody is going to get to zero
    microbial contamination all the time. Even if
    you're following the new CDC guidelines, that
    might not be enough. "Based on outbreak data, Dr.
    Rutala estimates that you can eliminate about 85
    of outbreaks if you curb deficiencies associated
    with what takes place in the soiled utility room
    cleaning, disinfection, automated endoscope
    reprocessors (AERs), contaminated water and
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New case of Elizabethkingia confirmed in
  • The Wisconsin Department of Health Services have
    confirmed another case of Elizabethkingia,
    bringing the total number of confirmed cases in
    the state to 61. A total of 18 Wisconsin
    residents with confirmed infections have died,
    though it is not clear if the infections were
    directly attributable to the deaths due to the
    fact that the majority of those infected were
    over the age of 65 and had preexisting
    comorbidities. There are also four suspected
    cases of infection in the state with one
    associated death among those cases. These cases
    cannot be confirmed because there are no longer
    specimens available for testing Both a Michigan
    resident and a resident from Illinois with
    confirmed infections related to the Wisconsin
    outbreak have also died. A cluster of ten
    infections in Illinois were found to belong to a
    strain of Elizabethkingia not associated with the
    outbreak in Wisconsin. Recently, Elizabethkingia
    was detected in a Wisconsin infant this too was
    found to be a strain unrelated to the outbreak.
  • Disease detectives from the WDHS and the CDC are
    conducting an ongoing investigation into the
    outbreak. The source of the infection remains
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First Discovery in U.S. of Colistin Resistance in
an E. coli Infection
  • The Multidrug Resistant Organism Repository and
    Surveillance Network (MRSN) at the Walter Reed
    Army Institute of Research (WRAIR) characterized
    a transferrable gene for colistin resistance in
    the US that may herald the emergence of truly
    pan-drug resistant bacteria. Colistin is the
    last agent used to combat bacteria that are
    resistant to the strongest antibiotics. Colistin
    has remained the best tool available to treat
    MDROs because bacteria were not exchanging genes
    for its resistance. This latest discovery shows
    that bacteria may be exchanging resistance genes
    for colistin. This colistin-resistance gene has
    been reported in China, Europe and Canada and, as
    of now, is reported in the U.S. A clinical sample
    from a urinary tract infection was collected from
    a patient in a military treatment facility in
    Pennsylvania. The sample was sent to the Walter
    Reed National Military Medical Center (WRNMMC)
    where colistin susceptibility was tested. The
    results showed that no safe dosage of colistin
    would be effective to treat such a bacterial
    infection. WRNMMC recognized colistin-resistance
    and sent a sample to WRAIR's MRSN for sequencing,
    which identified the colistin-resistant gene,
  • Source Antimicrobial Agents and Chemotherapy
    (AAC) of the American Society for Microbiology

Lyme discovery Borrelia bacteria hides inside
parasitic worms, causing chronic brain diseases
  • The examination of autopsied brain tissues from
    patients who died of neurological conditions has
    revealed that many tick-borne infections, such as
    Lyme disease, go undiagnosed and untreated. Alan
    B. MacDonald, MD, presented research that found
    three Borrelia pathogens, including B.
    burgdorferi the causative agent of Lyme disease,
    thriving inside parasitic nematode worms, worm
    eggs or larvae in the brain tissue of nineteen
    deceased patients. These microscopic worms are
    endosymbionts, meaning the Borrelia bacteria
    dwell inside the worms. A tick bite delivers the
    nematode into the human body. Current tests, like
    the ELISA and Western blot, do not adequately
    detect the presence of Borrelia bacteria.
    MacDonald says his discovery also shows while
    patients are wrongly declared free of Lyme and
    other tick-borne infections, in reality, too
    often they contract serious neurodegenerative
    diseases which can kill them. The Rocky
    Mountain Multiple Sclerosis Center Tissue Bank
    provided MacDonald with ten specimens from
    deceased MS patients all ten specimens showed
    evidence of Borrelia infected nematodes. Infected
    worms were also found in five tissue specimens
    from patients who succumbed to the highly
    malignant brain tumor Glioblastoma multiforme,
    the same cancer which took the life of Senator
    Edward Kennedy (D-MA). Ironically, in 1993,
    Senator Kennedy chaired a hearing of the Labor
    and Human Resources committee titled Lyme
    disease A Diagnostic and Treatment Dilemma.
    Finally, four specimens from patients who died
    from Lewy Body dementia, the same illness which
    afflicted comedian Robin Williams, also showed
    the presence of infected nematodes. Source

Gold Medal, Gold Medal Wondra, and Signature
Kitchens Flour Recalled Due to Possible E. coli
O121 Contamination
  • General Mills is collaborating with health
    officials to investigate an ongoing, multistate
    outbreak of E. coli O121 that may be potentially
    linked to Gold Medal flour, Wondra flour, and
    Signature Kitchens flour (sold in Safeway,
    Albertsons, Jewel, Shaws, Vons, United, Randalls,
    and Acme). Out of an abundance of caution, a
    voluntary recall is being made. To date, E. coli
    O121 has not been found in any General Mills
    flour products or in the flour manufacturing
    facility and the company has not been contacted
    directly by any consumer reporting confirmed
    illnesses related to these products. State and
    federal authorities have been researching 38
    occurrences of illnesses across 20 states related
    to a specific type of E. coli (E. coli O121),
    between December 21, 2015, and May 3, 2016. While
    attempting to track the cause of the illness, CDC
    found that approximately half of the individuals
    reported making something homemade with flour at
    some point prior to becoming ill. Some reported
    using a General Mills brand of flour. Based on
    the information that has been shared with General
    Mills, some of the ill consumers may have also
    consumed raw dough or batter. Consumers are
    reminded to not consume any raw products made
    with flour.

11 deaths at Pasadena's Huntington Hospital may
be linked to dirty scopes
  • Pasadena health officials said June 1st that 16
    patients were infected by dangerous bacteria from
    medical scopes at Huntington Hospital from
    January 2013 to August 2015, including 11 who
    have died. It is not clear how many of those
    patients died from their infections. The
    hospital had previously said just three patients
    were infected in the outbreak that officials said
    was limited to the middle of 2015. The
    infections were detailed in an investigation into
    the outbreak, which blamed both the design of the
    scope and also problems by the hospital in
    disinfecting them. For example, the hospital had
    been using canned compressed air from Office
    Depot to dry the scopes. Huntington hospital
    officials had confirmed last August that three
    patients were sickened the previous month but
    declined to say more about their condition. They
    later told Olympus Corp of at least three deaths,
    according to the company's report to federal
    regulators. When the regulatory reports were
    discovered, hospital officials said that they
    believed patient privacy laws prevented them from
    telling the public that the unnamed patients had
    died. In January, Olympus recalled one model of
    its duodenoscopes because of the possibility of
    infections. The reusable scope suspected of
    causing the Pasadena outbreak had a different,
    older design from the one that Olympus recalled.

UPMC settles one mold infection lawsuit for
  • After four patients contracted mold infections in
    two UPMC hospitals in Pittsburgh, the system
    faced two lawsuits from patients' family members.
    One such case was recently settled for 1.35
    million, according to the Pittsburgh
    Post-Gazette. The daughter of Tracy Fischer, who
    was the first of the four transplant patients to
    die after contracting the mold infection, settled
    her suit following a month of mediation. The
    settlement was made official by Allegheny County
    Common Pleas Judge Ronald Folino on Wednesday. In
    the settlement, UPMC agreed to pay the family
    850,000 now and 500,000 in one year. "We again
    extend our sympathy to the family of Ms. Fischer
    and appreciate their graciousness," UPMC said in
    a statement emailed to the Post-Gazette. UPMC
    still faces a suit from the family of Che DuVall,
    who died nearly a year after Ms. Fischer. The
    family's attorney, Brendan Lupetin, said this
    case is different because Mr. DuVall's death
    happened so long after Ms. Fischer's. "The
    conditions were more aggravated because there
    were things that should have been looked into,"
    he told the Post-Gazette. In May, the CDC pointed
    to the improper use of negative-pressure rooms as
    a possible source of the mold infections.

Memphis VA cited by OSHA after body tissue found
in drain
  • Memphis VA Medical Center is under investigation
    by the Occupational Safety and Health
    Administration upon discovery that human body
    tissue is not being properly disposed of at the
  • According to OSHA's complaint, an engineer
    pipe-fitter was exposed to body tissue in March
    while unclogging a drain at Memphis VA Medical
    Center. The sink, in a housekeeping closet of the
    third-floor surgical unit, was full of brown
    water. As the pipe-fitter cleared the drain, body
    tissue floated to the top. He collected the
    tissue in a bucket and placed it outside of a
    building on the hospital's campus without a
    biohazard label, according to OSHA.
  • The pipe-fitter's exposure to the body tissue was
    deemed a "serious" violation by OSHA. According
    to the complaint, the pipe-fitter had not been
    provided the hepatitis B vaccine and was not
    trained in blood borne pathogens.

Infant with Zika-related microcephaly born in
New Jersey
  • On Tuesday, a baby girl was born in a New Jersey
    hospital with severe Zika-related microcephaly,
    according to The New York Times. The mother is 31
    years old and reportedly contracted the virus in
    her home country of Honduras. Manny Alvarez, MD,
    chairman of the Department of Obstetrics,
    Gynecology and Reproductive Science at Hackensack
    (N.J) University Medical Center, told the Times
    the mother knew she had the virus before coming
    to the U.S. to visit relatives. Physicians at the
    Donna A. Sanzari Women's Hospital in Hackensack
    opted to deliver the baby via caesarean section
    after scans revealed the infant was underweight
    for her gestational age. According to ABC News,
    this is the first infant born in the continental
    U.S. with Zika-related microcephaly a baby was
    born in Hawaii in January with microcephaly
    related to the virus. Microcephaly is a
    neurologically debilitating birth defect in which
    babies are born with abnormally small heads. The
    infant is also suffering from intestine and
    vision issues. Regarding the birth, Dr. Alvarez
    told the Times, "It tells you that Zika is
    real...there is still a lot of work to be done
    insofar as controlling the virus.
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Investigation of Hep C Transmission with
Injection Therapy for Chronic Pain
  • On November 26, 2014, the California DPH
    contacted CDC concerning a report from the Santa
    Barbara DPH regarding acute hepatitis C virus
    (HCV) infection in a repeat blood donor. The
    patient, who was asymptomatic, was first alerted
    of the infection by the blood bank and had no
    traditional risk factors for HCV infection. One
    such exposure occurred at a doctors office
    (clinic A) where the blood donor received an
    injection procedure as part of prolotherapy.
    Prolotherapy, also known as regenerative
    injection therapy, is an increasingly popular,
    injection-based complementary and alternative
    medical therapy used to treat chronic
    musculoskeletal pain . In addition, some patients
    also received platelet rich plasma therapy, that
    involves injection of autologous blood with a
    high platelet-to-plasma ratio. The initial
    investigation into clinic A revealed infection
    control breaches that included reentering
    multidose medication vials with a used syringe,
    use of single-dose medication vials for multiple
    patients, poor hand hygiene and inconsistent
    glove use, and lack of aseptic technique when
    handling injection equipment and medication.
    Clinic A was advised to stop these practices, and
    staff members were educated on blood borne
    pathogen transmission. Six other patients were
    determined to have HCV infection. Among these six
    patients, five were unaware of their HCV
    infection status. Four of the patients without a
    prior HCV diagnosis or risk factors for HCV had
    injection procedures performed in clinic A on the
    same day as the index patient. A common injected
    substance used in all the infected patients was
    not identified through medical chart review.
    MMWR June 3, 2016 / 65(21)547549

Needle stealing case highlights issue with
tracking health workers
  • Authorities say an HIV-positive surgical tech
    stole syringes with fentanyl and endangered
    patients at a suburban Denver hospital -- the
    third incident of this type in the state in less
    than a decade. Colorado lawmakers are trying to
    tighten regulations but experts say it is a
    national concern. Surgery technician Rocky Allen,
    who jumped from hospital to hospital before he
    was caught, was taking a syringe filled with
    painkillers from an operating room in January.
    The hospital and state health officials issued a
    public call for the approximately 2,900 patients
    who had surgery during Allen's time at the
    hospital to be tested for hepatitis and HIV. No
    reported cases of HIV have been detected but
    about 1,000 people still either need to be tested
    or get follow up tests. Allen, who has pleaded
    not guilty to federal charges, had a long history
    of problems. The former Navy medic was court
    martialed for stealing fentanyl at a military
    hospital in Kandahar in 2011 and received a
    general discharge after agreeing to a plea deal.
    The current law only requires techs such as Allen
    to self-disclose any civil, criminal or
    administrative action related to their job duties
    and to provide their employment history over the
    previous five years. But Allen, who was fired
    from at least five hospitals in Colorado and
    other states, left off some hospitals where he
    worked from his resume, making it more difficult
    to vet his background. Under a bill awaiting
    Colorado Gov. John Hickenlooper's signature,
    surgical technicians would have to pass a
    fingerprint-based criminal background check and a
    drug test before being allowed to work in the

Researchers Drop the No-EatingRule Before
  • There may be a better way to get stubborn or
    procrastinating patients to sign up for
    potentially life-saving colonoscopies Let 'em
    eat macaroni and cheese. Researchers speculate
    that a 1-day, low-residue diet which could
    include such foods as scrambled eggs, white
    bread, butter, chicken breasts, pretzels and good
    old mac-and-cheese as opposed to the
    traditional all-liquid prep, may, in addition to
    making patients a lot happier, actually do a
    better job with bowel preparation. They studied
    83 patients who were randomly assigned to one
    group or the other. All patients were also given
    a split-dose polyethylene glycol electrolyte
    lavage solution. The low-residue group not only
    scored higher on the Boston Bowel Preparation
    Scale (a mean of 7.98 vs. a mean of 7.54), they
    were also much less hungry in the evening, much
    less tired in the morning and much happier with
    their diets reporting a 97 satisfaction rate
    versus 46.
  • "In the U.S., we've been over-restrictive with
    the diet with clear liquids," says lead author
    Jason B. Samarasena, MD. "This is another study
    that adds to that data pool showing that a
    low-residue diet is as good as, and potentially
    even better than, clear liquids. Hopefully, that
    will encourage patients to have colonoscopies and
    repeat their colonoscopies if they have to."
  • http//

Zika virus could spread through oral sex and
kissing, scientists warn
  • Dr. John T. Brooks, an epidemiologist at the
    Centers for Disease Control and Prevention, told
    The New York Times it's not out of the question
    that Zika could be transmitted by oral sex. But
    he also said he thought it was unlikely that the
    virus could be transmitted through kissing.
    Although Zika has been detected in saliva
    samples, so far, there have been no documented
    cases of the virus being transmitted by saliva,
    according to scientists. Zika transmission via
    sexual contact has been reported in the U.S.,
    Canada, France, Italy and several other
    countries. Public health officials warn that
    mosquitos carrying the Zika virus could start
    infecting Americans as soon as this month.
    Preventing mosquito bites at home should be at
    the top of every summer to-do list.
  • According to new research from Consumer Reports,
    most "natural" bug sprays won't effectively ward
    off the mosquitos that carry the virus known to
    cause birth defects. Although products derived
    from oils might smell better, they don't last
    nearly as long as synthetic chemical-based
    repellants like picaridin and DEET. If used as
    directed, products containing picaridin and DEET
    are safe for use by pregnant and even
    breast-feeding women, according to the U.S.
    Centers for Disease Control and Prevention. Here
    are the top three picks for warding off the
    zika-spreading Aedes mosquitos, according to
    Consumer Reports Sawyer Picaridin, Ben's 30
    Deet Tick Insect Wilderness Formula, and Repel
    Lemon Eucalyptus.
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141 Allina patients possibly exposed to TB
  • Some patients of Allina Health may have been
    exposed to TB by two workers who helped deliver
    care at two major hospitals. In late May, Allina
    Health, Minneapolis, began notifying 141
    patients--warning them of the possible exposure.
    The patients were treated at either Abbott
    Northwestern Hospital or Mercy Hospital earlier
    this year. Allina learned that a worker in each
    location, who helped deliver care, had active TB.
  • According to the CDC, the number of TB cases in
    the United States rose last year for the first
    time in a quarter-century. In Minnesota, the CDC
    reported 147 cases in 2014 and 150 in 2015.
  • Allina Health's statement went on to say, "All of
    these patients have or will receive a telephone
    call and letter notifying them of the exposure
    and advising them to seek medical attention if
    they have experienced any symptoms of TB, or to
    schedule a free blood test for TB at one of our
    clinics. Allina Health will pay for all testing
    and any necessary follow up treatment related to
    the potential exposure.
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Mumps moves across Nebraska 21 confirmed cases
  • A mumps outbreak that began at Midland University
    in Fremont, Neb., has spread to new areas of the
    state as most students have returned home for the
    summer. The number of confirmed cases in the
    state recently jumped from 10 to 21, according to
    the Nebraska Department of Health and Human
  • "Mumps is an illness caused by a highly
    contagious virus and this outbreak is ongoing
    with potential for further spread," said Tom
    Safranek, MD, an epidemiologist with DHHS. "If
    people start experiencing mumps-like symptoms,
    they should contact their healthcare provider,
    and healthcare providers should be on the lookout
    for mumps cases.
  • The mumps made a resurgence on college campuses
    in the spring semester of 2016, most prominently
    at Harvard University in Cambridge, Mass., where
    nearly 60 confirmed cases threatened to impede
    commencement ceremonies.
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Hospital worker cellphones are hotbeds for
  • The Candida fungus was found on the majority of
    cellphones belonging to employees at a hospital
    in Poland. Candida can live on the skin and
    mucous membranes without causing an infection,
    but, according to the CDC, "overgrowth of these
    organisms can cause symptoms to develop." Candida
    can cause thrush, yeast infections and
    bloodstream infections.
  • Researchers tested 175 mobile phones and the
    hands of staff members at University Hospital in
    Bialystock, Poland. They found 131, or 74.9
    percent, of the tested phones were colonized with
    the fungus. The dominant species identified were
    Candida albicans, C. glabrata and C. krusei.
  • Further, just 19.4 percent of participants
    reported cleaning the surface of their phones.
    The prevalence of mobile phone contamination by
    Candida is high in the University Hospital in
    Bialystok, Poland. Candida albicans, C. glabrata,
    and C. krusei were the dominant species in the
    samples collected from mobile phones and hands.
    These results pose the need to develop guidelines
    for mobile phone disinfection. "These results
    pose the need to develop guidelines for mobile
    phone disinfection," the study authors concluded.
  • http//

Ditch the flowers and balloons Leave gifts at
  • Here are five items increasingly banned in some
    healthcare facilities
  • 1. Flowers and plants are restricted in some
    hospitals based on recommendations from the CDC
    to protect immunosuppressive patients, given
    plants' potential to grow mold. CDC arecommends
    healthcare workers administering patient care
    refrain from handling flowers. Pollen can stick
    to a healthcare worker's clothes and be
    transferred to patients who are allergic to it
  • 2. Balloons, especially those made of latex, can
    trigger allergic reactions.
  • 3. Cell phones are restricted for many reasons,
    including fear of electromagnetic wave
    interference with medical equipment. However,
    there is little evidence of this threat. Cell
    phones are sometimes banned to prevent noisiness,
    tripping hazards when attached to chargers. Cell
    phones also carry 10 times more bacteria than
    what is found on most toilet seats, according to
    a 2012 University of Arizona study.
  • 4. Stuffed animals can cause harm if their
    attached eyes, noses, beads or buttons fall off
    and get into the hands of young patients, who may
    swallow them.
  • 5. Food can be banned from facilities in an
    effort to keep patients who suffer from food
    allergies and dietary restricts safe. Children's
    hospitals are especially unlikely to allow food
    unless a nursing supervisor has approved.
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