Unit Based Champions
Infection Prevention
eBug Bytes
February 2013
Single-Patient Rolls of Medical Tapes
Reduce Cross-Contamination Risk
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Studies have shown that medical tapes, once opened and put into use can
be sources of contamination. In a recent study published in January 2012,
which evaluated tapes collected at three hospitals in the Hunter New
England Area Health Service, Harris, et al. (2012) concluded that surgical
tapes are frequently contaminated with multidrug-resistant organisms.
Berkowitz (1974) recovered Staphylococcus aureus, Pseudomonas
aeruginosa and various species of Enterobacteriaceae in a seven-day study
of 23 rolls of adhesive tape being used in a 16-bed intensive care unit.
Wilcox, et al. (2000) studied a five-year outbreak of methicillin-susceptible
Staphylococcus aureus among 202 babies in a neonatal unit in which the
infection was related to an adhesive used as a skin protectant. Also, studies
of mucormycosis by Alsuwaida and an extensive literature review of 169
mucormycosis cases by Rammaert, et al. (2012) identified instances in
which adhesive bandages were the source of contamination. Additional
studies of medical tapes and cross-contamination have been published by
Dickinson (1998) and Everett (1979).
Source: Infection Control Today - January 22, 2013
Nearly 2,000 patients at Olean General
Hospital may have been contaminated
by reused insulin pens
Olean General Hospital in Western New York is contacting nearly 2,000
patients who may have been exposed to HIV, hepatitis B or C due to the
improper reuse of insulin pens.
Olean General Hospital is notifying nearly 2,000 diabetic patients that they
may have been exposed to HIV, hepatitis B or hepatitis C after the improper
reuse of insulin pens, NPR News reported Thursday.It is the second such
incident at a Western New York hospital in as many weeks.
Patients who received insulin at the hospital between November 2009 and
last Wednesday are being advised to get blood tests, the Associated Press
reported.
"The pens were never intended for multiple use. All nurses who received inservices on insulin pens know that.“ Hospital officials said there was no
evidence yet of the "transmission of any blood borne infections during the
stay of any patient who received insulin from the pens.“
Source: http://www.globalpost.com/dispatch/news/regions/americas/unitedstates/130124/olean-general-hospital-reused-insulin-pens
Transmission of Hepatitis C
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A study in injecting drug users in Greece indicated that each infected person spread
the disease to 20 others - 10 of these in the first two years. The researchers said
their results would help tackle the disease's spread. Globally up to 180 million
people live with the virus, most are unaware that they have it. Those infected do not
develop symptoms for up to 20 years and spread it to others without realizing.
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To overcome this problem, the researchers looked at four hepatitis C epidemics in
Greece, using data from 943 patients collected between 1995 and 2000. But to
provide more detail on how it spreads, they also included genetic information on the
virus taken from 100 samples. Plugging the details into a computer model, they
calculated that injecting drug users were "super-spreaders", each transmitting the
virus to 20 other people. Most importantly they discovered that most of the
transmissions occurred in the first couple of years, they report in PLoS Computational
Biology. The researchers said that people were more infectious at in the early days of
catching hepatitis C because they had higher levels of virus. The evidence they have
produced suggests programs targeting the diagnosis and treatment of hepatitis C in
high-risk groups as early as possible would prevent many new infections and
associated healthcare costs many years down the line.
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About 20% of those infected will develop cancer or liver scarring after 20 years of
infection, at which point the only treatment is liver transplantation, which costs
about £100,000 ($160,000). http://www.bbc.co.uk/news/health-21282381
New whooping cough strain in
US raises questions
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NEW YORK (AP) - Researchers have discovered the first U.S. cases of
whooping cough caused by a germ that may be resistant to the vaccine.
Health officials are looking into whether cases like the dozen found in
Philadelphia might be one reason the nation just had its worst year for
whooping cough in six decades. The new bug was previously reported in
Japan, France and Finland.
The U.S. cases are detailed in a brief report from the CDC and other
researchers in Thursday's New England Journal of Medicine. Whooping cough
is a highly contagious disease that can strike people of any age but is most
dangerous to children. It was once common, but cases in the U.S. dropped
after a vaccine was introduced in the 1940s. An increase in illnesses in recent
years has been partially blamed on a version of the vaccine used since the
1990s, which doesn't last as long. Last year, the CDC received reports of
41,880 cases, according to a preliminary count. That included 18 deaths. The
new study suggests that the new whooping cough strain may be why more
people have been getting sick. Experts don't think it's more deadly, but the
shots may not work as well against it.
Outbreak of Carbapenem-Resistant
Klebsiella pneumoniae Producing New
Delhi
On August 16, 2012, the Colorado Department of Public Health and Environment was notified of two patients at
an acute-care hospital in Denver with carbapenem-resistant Enterobacteriaceae (CRE), specifically Klebsiella
pneumoniae (CRKP), isolated from respiratory specimens during July–August. Both isolates produced New Delhi
metallo-beta-lactamase (NDM). A review of microbiology records identified a third patient with NDM-producing
CRKP isolated from a respiratory specimen, admitted in May. Active surveillance cultures in September identified
an additional five patients colonized with NDM-producing CRKP. An investigation was launched by the hospital
and the Colorado Department of Public Health and Environment to guide infection control measures and limit
transmission.
A case was defined as NDM-producing CRE isolated from clinical or active surveillance cultures collected from a
patient while hospitalized during January 1–October 30, 2012. Medical records were reviewed for clinical and
epidemiologic characteristics. Relatedness of isolates was evaluated by pulsed-field gel electrophoresis (PFGE).
The eight patients were aged 23–75 years and had been hospitalized at one or more of 11 different units in the
hospital for a median of 18 days (range: 12–83 days) before CRKP identification. Three were treated for CRKP
infection, and five were found to be asymptomatically colonized; none died. Initial isolates were resistant to all
antimicrobials except tigecycline, to which all were susceptible. Colistin minimum inhibitory concentrations for six
isolates were low (≤2 µg/mL), suggesting this agent might be a treatment option. All isolates were highly related
by PFGE. Epidemiologic tracing to determine temporal overlap of patients on units in the hospital indicated
multiple transmission events had occurred, and three units were likely transmission sites. Acquisition of NDMproducing CRE by some patients was not explained by direct overlap and suggested that undetected,
asymptomatically colonized patients were involved in some transmission routes. How NDM-producing CRE was
introduced to the facility is unclear.
NDM, a carbapenemase enzyme first described in 2009 in a patient who had received medical care in India (1),
has since been detected and reported worldwide (2). In the United States, before this outbreak, only 16 isolates in
clusters with two or fewer cases had been identified since 2009; 14 isolates were from patients who had received
medical care in endemic (South Asian) regions. The cases described here represent the largest U.S. outbreak of
NDM-producing CRE to date, highlighting the risk for spread of these organisms among persons receiving
medical care inside the United States. Evidence that undetected, asymptomatically colonized patients likely
contributed to the size of the outbreak highlights the importance of timely active surveillance cultures when CRE is
identified to direct infection control measures and limit further transmission (3). www.cdc.gov.mmwr.
Salmonella Bredeney Infections Linked
to a Brand of Peanut Butter
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During June 11–November 8, 2012, a total of 41 cases of Salmonella Bredeney infections were
identified in 20 states. The median age of patients was 6 years (range: <1–79 years); 63% of
patients were aged <10 years, and 60% were male. Among 36 patients for whom information
was available, 10 (28%) were reported to have been hospitalized. No deaths have been
reported. Of the 32 patients for whom information was available, 25 (78%) had eaten a Trader
Joe's brand Valencia peanut butter product manufactured by Sunland, Inc. Testing conducted by
the New Jersey Department of Health,Virginia Division of Consolidated Laboratory Services,
and Washington State Department of Agriculture laboratories isolated the outbreak strain of
Salmonella Bredeney from three opened jars of Trader Joe's Creamy Salted Valencia Peanut
Butter collected from three different patients' homes.
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During September 17–October 16, 2012, FDA conducted an inspection of Sunland, Inc.
manufacturing facilities (2). Environmental samples and samples from unopened peanut butter
jars collected by FDA from the nut butter production facility yielded the outbreak strain of
Salmonella Bredeney. On September 24, 2012, Sunland, Inc. announced a voluntary recall of
almond butter and peanut butter products manufactured in the Sunland, Inc. nut butter
production facility during May 1–September 24, 2012. On October 4, 2012, Sunland, Inc.
expanded its recall to include all products made in its nut butter production facility during
March 1, 2010–September 24, 2012. On October 12, 2012, Sunland, Inc. extended the voluntary
recall to include raw and roasted shelled and in-shell peanuts processed in its peanut
processing plant (2). Approximately 300 products have been recalled (3).
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CDC recommends that consumers not eat recalled Sunland, Inc. products or foods containing
recalled products and discard or return any remaining recalled products. www.cdc.gov/mmwr
CDC warns of super-gonorrhea
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A report from the U.S. Center for Disease Control released last week
describes how Neisseria gonorrhoeae, the bacteria that causes the sexually
transmitted infection, or STI, gonorrhea, has become resistant to many
forms of antibiotics since the 1930s. The bug continues to trouble disease
experts as it morphs into strains that scientists call "multidrug-resistant
gonorrhea.“ Lab studies show that cephalsporins, the current class of
antibiotics used to treat gonorrhea, are becoming less effective at treating
the disease. If this trend continues, cephalosporin-resistant gonorrhea could
emerge in the U.S., like it has in Japan, France, and Spain. To help delay the
emergence of this new super bug, the CDC made changes to guidelines for
gonorrhea treatment. An injectable cephalosporin called ceftriaxone
combined with an oral antibiotic is now the preferred treatment.
Gonorrhea is the second most commonly reported infectious disease in the
United States. In 2011, more than 300,000 cases of gonorrhea were
reported. An estimated 20 million people are diagnosed each year in the
U.S. Treating these infections cost the U.S. healthcare system nearly $16
billion in direct medical costs. According to the CDC, the numbers reflect
an ongoing, severe STI epidemic.
http://abcnews.go.com/blogs/health/2013/02/14/cdc-warns-of-super-gonorrhea/
Cancer survivor catches fire at
hospital: Is hand sanitizer to blame?
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An 11-year-old cancer survivor is now facing another recovery after she
reportedly erupted in flames while at Doernbecher Children's Hospital in
Portland, OR.
In an incident unrelated to her cancer, Ireland Lane had hit her hit her head
at school and passed out, according to The Oregonian. She was receiving care
at the hospital when the front of her t-shirt burst into flames. As a result of
her third-degree burns across her chest, arms and ear lobes, she will need
multiple skin grafts and burn treatments. She is scheduled to receive her
second skin graft on her 12th birthday on Thursday. Ireland's father
explained that his daughter had painted a wooden box for nurses and used
the hand sanitizer to clean the table she had placed on the bed. He said that
his daughter had also been playing in the bed, which could have caused static
electricity. While it may seem strange, The Oregonian reported that similar
cases happened in 1998, when a patient was burned in an operating room
fire due to an alcohol-based antiseptic, and in 2002, in a case where a
nurse's hand antiseptic burst into flames from a charge of static electricity.
Olean General Hospital confirms 13
cases of hepatitis, deny it's related to
reuse of insulin pens
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Olean General Hospital officials confirm 12 people have tested positive for
Hepatitis C and one person Hepatitis B after the hospital sent notices to
more than 1,900 patients who received insulin shots from insulin pens
over the past three years.
Last month, the VA office of the Inspector General announced it's looking
into possible reuse of insulin pens at the VA Medical Center in Buffalo.
More than 700 veterans potentially could have been exposed to infectious
diseases between October 2010 and November 2012.
Freshman Congressman Chris Collins, a member of the Veterans Affairs
Committee called for the investigation. "We're still quite hopeful that no
one was infected, but the fact 13 individuals did test positive for HepatitisC at the Olean (hospital) does reinforce why it's so important for these
veterans to get the tests done," said Collins, (R).
Olean General Hospital officials insist the chances are remote the 13 cases
are related to insulin pen reuse. Still, they're encouraging all patients
contacted to get tested.
Insulin Pens Sharing Practices
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Buffalo, NY – Authorities report that more than 700 patients admitted to
The Veterans Affairs Western New York Healthcare System over a twoyear period, may have been exposed to blood-borne infectious diseases.
Blood-borne diseases included Human immunodeficiency virus (HIV) and
hepatitis B and C. In this situation, multi-dose injectable insulin pens
indented for single person use, were instead used to treat multiple
patients. The hospital’s storage of insulin could have also been
contaminated through needle flow back. The reuse of insulin pens is akin
to the reuse of other syringes, potentially spreading pernicious diseases
from one unsuspecting patient to another.
The Buffalo hospital began using insulin pens in October 2010. An
inspection in November 2012 led to the discovery that the pens had
likely been used on more than one patient.
Read more at http://www.inquisitr.com/482313/hospital-patientspotentially-exposed-to-blood-borne-infectious-diseases-through-reusedinsulin-pens/#kksf7JC8LtMRu0ww.99