Transcript Slide 1

Unit Based Champions
Infection Prevention
eBug Bytes
November 2013
MERS-COV – More Cases
• The World Health Organization (WHO) has been informed of an additional four
laboratory-confirmed cases of infection with Middle East respiratory syndrome
coronavirus (MERS-CoV). These include the first laboratory-confirmed case from
Oman and three additional laboratory-confirmed cases from Saudi Arabia.
• The patient in Oman is a 68-year-old man from Al Dahkliya region who became ill
on Oct. 26, 2013 and was hospitalized on Oct. 28, 2013. Preliminary
epidemiological investigations revealed that he did not recently travel outside
the country. However, investigations are currently ongoing to determine what
exposures might be responsible for his infection. Of the three patients including
one death reported from the Eastern Region in Saudi Arabia, one is a woman and
two are men. The three patients, one of whom is a healthcare worker, had
underlying medical conditions. Their ages range from 49 to 83 years old. All three
patients reported having no contact with animals prior to their illness, while one
patient was reported to have been in contact with a previously laboratoryconfirmed case. Globally, from September 2012 to date, WHO has been
informed of a total of 149 laboratory-confirmed cases of infection with MERSCoV, including 63 deaths.
Location of Alcohol
Sanitizer in ICUs
• The introduction of alcohol-based handrub dispensers has had a positive influence
on compliance of healthcare workers with the recommended guidelines for hand
hygiene. However, establishing the best location for these dispensers remains a
problem. The workflow observations revealed that the activities of patient care
were most often at the entrance and near the computer at the right side of the test
room. Healthcare workers stated that the location of the dispenser should meet
several requirements. Measurements of the frequency of use showed that the
dispenser located near the computer, at the back of the room, was used less
frequently than the dispenser located near the sink and the dispenser located at
the entrance to the room. Workflow observations and the expressed preferences
of healthcare workers guide the choice for the location of alcohol-based handrub
dispensers and these choices may be optimized based on measurement of the
frequency of use of the dispensers.
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Reference: Boog MC, Erasmus V, de Graaf JM, van Beeck E, Melles M and van Beeck EF.
Assessing the optimal location for alcohol-based hand rub dispensers in a patient room in an
intensive care unit. BMC Infectious Diseases 2013, 13:510 doi:10.1186/1471-2334-13-510
MRSA on the decline
across VA hospitals
• The MRSA Prevention Initiative, implemented in 2007, resulted in
significant decreases in both the transmission (colonization with the
organism) of MRSA (17 percent for intensive care units [ICUs] and 21
percent for non-ICUs) and healthcare-associated infection (HAI) rates
within the hospitals (62 percent for ICUs, 45 percent for non-ICUs). In the
two-year period following the first wave of the initiative (data previously
published[i]), both MRSA transmissions and HAIs continued to decrease in
non-ICU settings (declining an additional 13.7 percent and 44.8 percent,
respectively), while holding steady in ICUs.
• The MRSA Prevention Initiative utilizes a bundled approach that includes
screening every patient for MRSA, use of gowns and gloves when caring for
patients colonized or infected with MRSA, hand hygiene, and an
institutional culture change focusing on individual responsibility for
infection control. It also created the new position of MRSA Prevention
Coordinator at each medical center.
Source: AJIC Nov 2013
FDA Seeks Changes to OTC
Antiseptics to Prevent Infection
• An ongoing evaluation of "infrequent but continuing" reports of infections resulting
from over-the-counter (OTC) antiseptic products used prior to surgery or injections
has prompted the US Food and Drug Administration (FDA) to request label and
packaging changes to enhance safety, the agency said yesterday.
• The FDA is requesting that manufacturers voluntarily package OTC antiseptics
indicated for preoperative or preinjection skin preparation in single-use containers
and to label their products as sterile or nonsterile.
• The FDA says infections tied to the use of contaminated topical antiseptics have
been reported in the medical literature and to the Centers for Disease Control and
Prevention (CDC) and to the FDA. Reported infections have ranged from localized
infections at injection sites to systemic infections that resulted in death. The FDA
says it has reviewed reports of 4 deaths, 5 cases of wound infection, 7 cases of
peritonitis, 10 cases of septic arthritis, 14 cases of indwelling catheters requiring
replacement, 16 cases of injection site infection, and 32 cases of bacteremia.
• Source: Medscape Nov 14 2013
Hospitals Try Yogurt to Prevent
Infections in Patients
• At Holy Redeemer Hospital in Meadowbrook, Pa., a worrisome trend
emerged in 2011: an uptick in cases of one of the most virulent hospital
infections, despite measures to battle the bug by scrubbing surfaces with
bleach and isolating affected patients. But the hospital was able to drive
down cases last year after adding a new weapon to its arsenal: probiotics,
the small organisms that help maintain the natural balance of bacteria in the
intestines. Contained in supplements and foods such as yogurt, probiotics
are of growing interest in health care for their potential in helping to treat a
number of conditions, including irritable bowel syndrome, tooth decay and
chronic fatigue syndrome. Now, Holy Redeemer and other hospitals are
experimenting with probiotics as a preventive measure for patients who are
on antibiotics. For all their infection-fighting power, antibiotics kill the good
bugs along with the bad in the intestine. The result is an imbalance in the gut
that can lead a bacterium known as Clostridium difficile—C. diff for short—to
colonize and produce a toxin that can cause diarrhea, dehydration and fever.
In severe cases, C. diff infections can lead to kidney failure, recurrent
infection and death. Source: Wall Street Journal, Nov 17 2013
FDA Warns of Infection Risk
With Topical Antiseptics
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The FDA has recommended that antiseptic products-- available as single- or multiple-use -be sold only as single-use preparations. In addition, the antiseptics should not be diluted
after opening and any leftover solution should be discarded. The FDA also has requested
that manufacturers voluntarily revise the product labels for topical antiseptics to indicate
whether the drug is manufactured as a sterile or nonsterile product. However, it cautioned
that even products manufactured as sterile can become contaminated during use and that
the term "nonsterile" does not mean the product contains harmful bacteria. The FDA said
it has reviewed reports of four deaths, five cases of wound infection, seven cases of
peritonitis, 10 cases of septic arthritis, 14 cases of indwelling catheters requiring
replacement, 16 cases of injection site infection, and 32 cases of bacteremia -- all
confirmed to have been caused by contaminated antiseptic products. The infectious
organisms implicated in the outbreaks included Bacillus cereus, Burkholderia cepacia,
Pseudomonas aeruginosa, Achromobacter xylosoxidans, Ralstonia pickettii, Serratia
marcescens, and Mycobacterium abscessus, the agency said. Commonly used products
contain isopropyl or ethyl alcohol, povidone iodine, poloxamer iodine, benzalkonium
chloride, benzethonium chloride, or chlorhexidine gluconate.
Source: http://www.fda.gov/Drugs/DrugSafety/ucm374711.htm