File - Working Toward Zero HAIs

Unit Based
eBug Bytes
June 2013
• Globally, from September 2012 to date, WHO has been informed of a total of
53 laboratory-confirmed cases of infection with Middle East respiratory
syndrome coronavirus (MERS-CoV), including 30 deaths.
• WHO has received reports of laboratory-confirmed cases originating in the
following countries in the Middle East to date: Jordan, Qatar, Saudi Arabia, and
the United Arab Emirates (UAE). France, Germany, Italy, Tunisia and the United
Kingdom also reported laboratory-confirmed cases; they were either
transferred there for care of the disease or returned from the Middle East and
subsequently became ill. In France, Italy, Tunisia and the United Kingdom,
there has been limited local transmission among patients who had not been to
the Middle East but had been in close contact with the laboratory-confirmed
or probable cases.
• Healthcare facilities are reminded of the importance of systematic
implementation of infection prevention and control. Healthcare facilities that
provide care for patients suspected or confirmed with MERS-CoV infection
should take appropriate measures to decrease the risk of transmission of the
virus to other patients, healthcare workers and visitors.
MERS-CoV is Easily
Transmitted in Healthcare
• An investigative team of infectious disease experts who traveled to Saudi Arabia
during an outbreak of the Middle East respiratory syndrome coronavirus (MERSCoV) reports that the virus poses a serious risk to hospitals because it is easily
transmitted in healthcare settings. The team, from Johns Hopkins and elsewhere,
investigated the spread of MERS-CoV in four local Saudi hospitals in May, and
concluded that it is even more deadly than the related coronavirus responsible
for the severe acute respiratory syndrome (SARS) outbreak in Toronto hospitals in
2003. The same team investigated that event, as well. Initially, 23 people in Saudi
Arabia were infected with MERS at the time of the investigation, and 11 had died
of the SARS-like virus. Saudi health officials now put the death toll at 32, with
another 49 infected.
• The experts, whose report on the outbreak is to be published in The New
England Journal of Medicine online June 19, say that MERS is not only easily
transmitted from patient to patient, but also from the transfer of sick patients to
other hospitals.
Quebec hospital wants 1,000 patients to
come in for HIV, hepatitis test due to
equipment may not have been sterilized
• In mid-April hospital staff discovered a leak in one of its linear endoscopes, an
instrument used to help diagnose cancer or gastroenterological malformations.
Once tests were performed on the instrument, it was discovered hospital staff
had not been properly disinfecting it for the past eight years.
• During that period - from June 14, 2005, until May 1, 2013 - nearly 1,000 patients
at Hôtel Dieu came into contact with that endoscope. The hospital has a record
of each of those patients, and it is hoping that all will respond to an invitation to
be tested for HIV as well as hepatitis B and C.
• The hospital said it is launching an inquiry into how the problem occurred and
who might have been responsible.
• Hospital authorities said 70 percent of the affected patients are from the Quebec
City area, and 30 percent are from other regions of the province
Multistate investigation of suspected
infections following steroid injections
• CDC is aware of reports of suspected infections among persons who
received either 80mg/mL or 40mg/mL of preservative-free
methylprednisolone acetate (MPA) produced by the Main Street Family
Pharmacy in Newbern, Tennessee. As of June 3rd, CDC is aware of 24
reported cases from four states -Arkansas, Florida, Illinois, North Carolina.
The majority of these persons developed skin and soft tissue infections of
unclear etiology following intramuscular injection of this product. Additional
clinical information is being gathered.
• To date, no reports of meningitis or other life-threatening infections have
been reported. All products labeled as sterile have been voluntarily recalled
by the pharmacy. CDC is not aware of infections among persons who
received products other than preservative-free MPA in the above
formulation from this pharmacy. State and local health departments are
working with CDC and FDA to evaluate this situation
Flu Vaccines Aimed at Younger Populations
Could Break Annual Transmission Cycle
• The key point: If you don't catch the flu, you can't die from it.
• Centers for Disease Control and Prevention, researchers agree that almost
everyone over the age of six months should get the flu vaccine, unless they
were allergic to the shot or had other reasons not to take it. But in the US, only
about one-third of the population actually gets a flu vaccine each year. Historic
efforts have been focused on people at higher risk of death and severe disease
-- often the elderly, and those with chronic illness, weakened immune systems,
health care workers or others. With existing patterns of vaccine usage, the
problem is enormous. Seasonal influenza in the U.S. results each year in an
average of 36,000 deaths, more than 200,000 hospitalizations, an $87 billion
economic burden, and millions of hours of lost time at school and work -- not
to mention feeling sick and miserable. Vaccinating children could prevent a
great deal of illness and save many lives at all ages. More aggressive
educational campaigns to reach young adults would also be helpful.
Martial L. Ndeffo Mbah, Jan Medlock, Lauren Ancel Meyers, Alison P. Galvani, Jeffrey P.
Townsend. Optimal targeting of seasonal influenza vaccination toward younger ages is
robust to parameter uncertainty. Vaccine, 2013; DOI: 10.1016/j.vaccine.2013.04.052
NH report criticizes hospital in
Hepatitis C outbreak
• Exeter Hospital ignored employee concerns about a medical technician
accused of infecting patients with hepatitis C, had an unreliable system for
documenting their complaints and told at least one not to file a report.
Kwiatkowski, a former medical technician who has been jailed since his arrest
in July 2012, is accused of stealing painkiller syringes from the hospital's
cardiac catheterization lab and replacing them with saline tainted with his
blood. He has pleaded not guilty to 14 federal drug charges and is scheduled
to go to trial in January.
• Thirty-two Exeter Hospital patients have been diagnosed with the strain of
hepatitis C that Kwiatkowski carries, along with an additional person who
contracted the liver-destroying disease from one of them. In other states
where Kwiatkowski worked, there have been seven confirmed cases in
Maryland, six in Kansas and one in Pennsylvania. As outlined in earlier court
documents, Kwiatkowski's co-workers raised concerns that he sometimes
showed up for work with blood-shot eyes, was seen sweating profusely and
foaming at the mouth and sometimes slurred his speech. But the hospital did
not follow its own policy and re-test him for drugs, the report states.
Chemical in antibacterial soaps
may harm nursing babies
• A mother's prolonged use of antibacterial soaps containing the chemical
triclocarban may harm nursing babies, according to a recent study from the
University of Tennessee, Knoxville. The study, which was conducted on rats,
showed that exposure to the compound may reduce the survival rates of
babies. The results were presented in June month at the Endocrine Society's
95th Annual Meeting and Expo in San Francisco.
• Triclocarban, a bactericide, is found primarily in antibacterial bar soaps. The
researchers noted that they were not condemning the use of antibacterial
soaps. During research, pregnant rats fed with triclocarban through food had
similar blood concentrations compared to human blood concentrations after a
15-minute shower using antibacterial soap.
• The study found that triclocarban did not affect the post-birth survival rate of
baby rats exposed to the compound in the womb. But baby rats nursed by
mothers that were exposed to the compound did not survive beyond the sixth
day after birth.
Loyola Fights Healthcare
Acquired Infections with Xenex
Loyola University Health System is the first academic medical center in Illinois to
take disinfection to futuristic levels. Nicknamed “Ralph” by the housekeeping
staff at Gottlieb Memorial Hospital and “little Joe” at Loyola University Medical
Center, 3-foot upright cylindrical robots provide the finishing touches to room
sanitation. A rotating telescopic head emits germicidal ultraviolet (UV) rays for
15 minutes in closed, unoccupied rooms to systematically kill germs.
According to studies, the disinfection robots eliminate Clostridium difficile (C.
diff) in less than 4 minutes and Methicillin-resistant Staphylococcus Aureus
(MRSA) in less than 2 minutes. “The robots are used for further disinfection in
the operating suites and patient rooms including isolation, burn and transplant,”
says Alex Tomich, DNP, RN, CIC, manager of infection prevention and control at
Loyola. “Loyola takes very seriously its responsibility to protect patients, visitors
and our hospital staff from infections and we are early adopters of proven
technology as well as best practices.”
The hospital housekeeping staff cleans the rooms and then uses the robots for
additional sterilization. The pulsed UV light destroys viruses, bacteria and
bacterial spores without human contact or use of chemicals
Occupationally Acquired Salmonella
Infection in a Phlebotomist —
Minnesota, January 2013
MMWR, June 28 , 2013 / 62(25);525-525
On January 25, 2013, the Minnesota Department of Health (MDH) was notified of two
clinical cases of Salmonella I 4,12:i:1,2 infection with isolates that had indistinguishable
pulsed-field gel electrophoresis (PFGE) patterns. Illness onset dates were January 3 and
January 9, 2013. Patients A and B were hospitalized at the same hospital during January 12–
15 for dehydration. Investigations indicated that these cases were part of a multistate
outbreak associated with frozen mice purchased to feed snakes. On January 25, the MDH
Public Health Laboratory isolated Salmonella I 4,12:i:1,2 with an indistinguishable PFGE
pattern from a third Minnesota resident, patient C. Patient C denied contact with frozen
feeder mice or snakes, but was employed as a phlebotomist at the hospital where the two
infected patients were hospitalized. Protocol at the hospital requires that each phlebotomist
use a hand-held sample tracking device to scan the identification band of each patient from
whom blood is drawn. Accessing these records, the infection prevention specialist at the
hospital found that patient C drew blood from patient A on January 13 and from patients A
and B on January 14, which was 3 days before onset of patient C's symptoms on January 17.
Patient C reported use of gloves while drawing blood. In the absence of specific evidence for
any other risk factor for Salmonella I 4,12:i:1,2 infection and considering the temporal
relationship between exposure and symptom onset, occupational person-to-person contact
with patients A or B likely was the source of patient C's infection. Salmonella transmission
from infected patients to health-care workers, although rare, has been reported .
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