Transcript Unit Based Champions Infection Prevention eBug Bytes

Unit Based Champions
Infection Prevention
eBug Bytes
December 2012
Investigators Conduct MetaAnalysis of Antimicrobial CVCs
Antimicrobial catheters have been utilized to reduce risk of catheter
colonization and infection. Researchers sought to determine if there is
a greater than expected risk of microorganism-specific colonization
associated with the use of antimicrobial central venous catheters
(CVCs). The researchers performed a meta-analysis of 21
randomized, controlled trials comparing the incidence of specific
bacterial and fungal species colonizing antimicrobial CVCs and
standard CVCs in hospitalized patients. The proportion of minocyclinerifampin colonized CVCs that were colonized with Candida species was
greater than the proportion associated with standard colonized CVCs.
In comparison, the proportion of colonized chlorhexidine-silver
sulfadiazine CVCs specifically colonized with Acinetobacter species or
diphtheroids was less than the proportion of similarly colonized
standard CVCs. No such differences were found with CVCs colonized
with staphylococci.
Reference: Novikov A, et al. Impact of catheter antimicrobial coating on species-specific
risk of catheter colonization: a meta-analysis. Antimicrobial Resistance and Infection
Control 2012, 1:40 doi:10.1186/2047-2994-1-40
Flesh-Eating Fungus Responsible for
Five Deaths in Wake of Massive Tornado
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A fast growing, flesh-eating fungus killed 5 people following a massive
tornado that devastated Joplin, Mo., according to the Centers for Disease
Control and Prevention (CDC). Health officials should be aware of
infections caused by the fungus Apophysomyces, according to the studies,
which tracked 13 people infected by the pathogen during the Class EF-5
tornado -- the most powerful category -- whose 200-plus mph winds
plowed through Joplin on May 22, 2011, initially killing 160 and injuring
more than 1,000.
The common fungus -- which lives in soil, wood or water -- usually has no
effect on people. But once it is introduced deep into the body through a
blunt trauma puncture wound, it can grow quickly if the proper medical
response is not immediate, the studies said. Five of the 13 people infected
through injuries suffered during the Joplin tornado died within two weeks.
Dr. Benjamin Park, chief of the Epidemiology Team at the CDC's Mycotic
Diseases Branch, said the victims were infected when their injuries from
the tornado were contaminated with debris from the storm, including
gravel, wood and soil, as well as the aerosolized fungus.
Sources: New England Journal of Medicine, 2012; 367 (23): 2194
'Sticky' Stomach Flu Virus Stands Up to
Typical Restaurant Dishwashing Measures
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Restaurant dishes and silverware may be an overlooked place where people
can catch stomach viruses. Norovirus is the leading cause of epidemic
gastroenteritis and the major cause of foodborne illness worldwide,
responsible for at least 50% of all gastroenteritis outbreaks in the United
States.
To carry out the experiment, the research team infused cream cheese and
reduced fat milk -- two foods that are known for being difficult to clean off - with murine norovirus (MNV-1), Escherichia coli (E. coli K-12) or Listeria
innocua (L. innocua). The scientists then applied the dairy products to
stainless steel utensils, ceramic plates and glassware, and put the tableware
through a variety of chlorine and quaternary ammonium compound (QAC)based sanitary protocols delivered via a commercial dishwasher or hand
washing. The team found that while both the commercial dishwasher and
manual washing reduced bacterial loads of E. coli K-12 and L. innocua
enough to meet safety standards, neither technique was able to significantly
reduce the presence of MNV-1. Reference: Lizanel Feliciano, Jianrong Li, Jaesung Lee, Melvin
A. Pascall. Efficacies of Sodium Hypochlorite and Quaternary Ammonium Sanitizers for Reduction of
Norovirus and Selected Bacteria during Ware-Washing Operations.
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PLoS ONE, 2012; 7 (12):
Surgeon infected 5 patients at
Cedars-Sinai, hospital reports
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Cedars-Sinai Medical Center, LA said Friday that a heart surgeon
unwittingly infected five patients during valve replacement surgeries, due
to tiny tears in his latex surgical glove, earlier this year. The infections
caused four of the patients to need a second operation, officials said.
The infections occurred after the tears in the latex surgical gloves
routinely worn by the doctor allowed bacteria from a skin inflammation
on his hand to pass into the patients' hearts, according to the hospital. The
patients survived the second operations and are still recovering, hospital
officials said. Hospital officials called it a "very unusual occurrence"
probably caused by an unfortunate confluence of events: the nature of the
surgery, the microscopic rips in the gloves and the surgeon's skin
condition.Valve replacement requires the surgeon to use thick sutures
and tie more than 100 knots, which can cause extra stress on the gloves.
The infections raise questions about what health conditions should
prevent a surgeon from operating and how to get the best protection
from surgical gloves. Surgeons with open sores or known infections aren't
supposed to operate, but there is no national standard on what to do if
they have skin inflammation
FDA to Hold Public Hearing on
Antiseptic Patient Preoperative
Skin Preparation Products
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The Food and Drug Administration (FDA) is holding a public hearing Dec.
12-13, 2012 to obtain input on how to address microbial contamination of
patient preoperative skin preparation drug products. Currently, patient
preoperative skin preparations are not required to be sterile. Bacteria can
contaminate these products at the time of manufacture or during product
use. Contaminated patient preoperative skin preparations have been
associated with clinical infections and adverse outcomes. At this public
hearing, the FDA is interested in obtaining public comment about certain
scientific and product use issues related to patient preoperative skin
preparations.
Patient preoperative skin preparations are over-the-counter (OTC)
topical antiseptic drug products used to reduce the number of bacteria
on the skin prior to medical procedures or injections. Although they are
marketed predominantly to healthcare facilities, the use of these products
extends beyond the healthcare facility setting. For example, consumers
with medical conditions requiring regular injections (e.g., of insulin or
heparin) may use these products at home.
Bed Bugs Not Repelled by Commercial
Ultrasonic Frequency Devices
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According to an article in the Journal of Economic Entomology,
commercial devices that produce ultrasound frequencies are NOT
promising tools for repelling bed bugs. In "Efficacy of Commercially
Available Ultrasonic Pest Repellent Devices to Affect Behavior of Bed
Bugs (Hemiptera: Cimicidae)," authors K. M.Yturralde and R. W.
Hofstetter report the results of their tests of four commercially available
electronic pest repellent devices designed to repel insect and mammalian
pests by using sound. The devices, which were purchased online, were
used according to manufacturers' instructions. A sound arena was created
for each ultrasonic device, in addition to a control arena which featured
no sound. However, the authors found that there were no significant
differences in the number of bed bugs observed in the control (no sound)
and sound arenas, and that bed bugs were neither deterred nor attracted
to the arena with the sound device.
Bed bugs are commonly exposed to frequencies made by their host
species (humans) and by appliances and machines found in homes.
Therefore, it may be possible that bed bugs also would exploit sounds
made by their human hosts, such as breathing or snoring.
Vaccine rule is said to hurt
health efforts
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Representatives from governments around the world will meet in
Geneva next month in a session convened by the United Nations
Environmental Program to prepare a global treaty to reduce health
hazards by banning certain products and processes that release mercury
into the environment. But a proposal that the ban include thimerosal,
which has been used since the 1930s to prevent bacterial and fungal
contamination in multidose vials of vaccines, has drawn strong criticism
from pediatricians.
In the United States, thimerosal has not been used in children's vaccines
since the early 2000s after the Food and Drug Administration and public
health groups came under pressure from advocacy groups that believed
there was an association between the compound and autism in children.
Since then, however, there has been a lot of research, and the evidence is
overwhelming that thimerosal is not harmful. Science clearly documented
no hazards from thimerosal in vaccines. The preservative plays a critical
role in distribution of vaccine to the global community.
Source: NY Times Dec 17 2012
Beagle sniffs out
bacterial infection
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A 2-year-old beagle in the Netherlands has been trained to sniff out
Clostridium difficile, a skill that could help doctors catch the deadly infection
days before laboratory tests. Clostridium difficile infections often occur in
people who are already taking antibiotics, causing symptoms that range from
mild diarrhea to severe inflammation of the colon. And to make matters
worse, the bug is particularly adept at spreading through hospitals,
uncontrolled by the usual surface cleansers.
The clever canine, called Cliff, correctly identified 50 stool samples
containing the bacterium, which kills 14,000 Americans each year, according
to the U.S. Centers for Disease Control and Prevention. Cliff also identified
47 of 50 stool samples that were Clostridium difficile-free (he couldn't make
up his mind about the last three).
Laboratory tests for Clostridium difficile - dubbed C. diff - can take up to 48
hours. But Cliff gives his answer immediately by sitting or lying down. Stool
from patients with the C. diff has a characteristic smell, often likened to
horse manure, which Cliff learned to identify over two months of training.
Now he can smell the bug even without the stool, correctly identifying 25 of
30 patients with the infection and 265 of 270 without
Hospital super-bug strains
traced back to US, Canada
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Researchers have now shown that the gastrointestinal illness that spread to
various hospitals across the world was caused by two different but related
strains of Clostridium difficile. One of the strains originated in the U.S. while
the other came from Canada. The outbreak occurred between 2002 and
2006 in hospitals across UK, U.S.A., Canada and Europe. Researchers were
able to determine the source as well as track its spread across the countries.
"We found that this outbreak came from two separate epidemic strains or
lineages of C. difficile, FQR1 and FQR2, both emerging from North America
over a very short period and rapidly spread between hospitals around the
world.” C. difficile produces highly resistant spores. These spores help the
organism survive harsh conditions and spread to other geographical areas.
The strains of C. difficile infection linked with the outbreak had developed
resistance to a commonly used drug, fluoroquinolone. It was an effective
treatment for C. difficile infection but these strains acquired resistance to this
frontline antibiotic. It is now virtually useless against this organism, but
resistance seems to have been a major factor in the continued evolution and
persistence of these strains in hospitals and clinical settings.
Source: Nature Genetics