Unit Based ChampionsUnit Based ChampionsInfection PreventionInfection Prevention

eBug ByteseBug BytesFebruary 2013

Single-Patient Rolls of Medical Single-Patient Rolls of Medical Tapes Reduce Cross-Tapes Reduce Cross-Contamination RiskContamination Risk

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 Nearly 2,000 patients at Olean General Hospital may have been contaminated Hospital may have been contaminated by reused insulin pensby reused insulin pensOlean 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 in-services 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/united-states/130124/olean-general-hospital-reused-insulin-pens

Transmission of Hepatitis CTransmission of Hepatitis C 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.

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.

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 New whooping cough strain in US raises questions US raises questions

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 Outbreak of Carbapenem-Resistant Klebsiella pneumoniaeKlebsiella pneumoniae Producing Producing New New Delhi 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 NDM-producing 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.

SalmonellaSalmonella Bredeney Infections Bredeney Infections Linked Linked to a Brand of Peanut Butterto a Brand of Peanut Butter

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.

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).

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-CDC warns of super-gonorrheagonorrhea

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 Cancer survivor catches fire at hospital: Is hand sanitizer to hospital: Is hand sanitizer to blame?blame?

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 Olean General Hospital confirms 13 cases of hepatitis, deny it's related cases of hepatitis, deny it's related to to reuse of insulin pensreuse of insulin pens

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 Hepatitis-C 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 PracticesInsulin Pens Sharing Practices Buffalo, NY – Authorities report that more than 700 patients

admitted to The Veterans Affairs Western New York Healthcare System over a two-year 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-patients-potentially-exposed-to-blood-borne-infectious-diseases-through-reused-insulin-pens/#kksf7JC8LtMRu0ww.99