Unit Based ChampionsUnit Based ChampionsInfection PreventionInfection Prevention

eBug ByteseBug Bytes

October 2012

Superbugs Ride Air Currents Superbugs Ride Air Currents Around Hospital UnitsAround Hospital Units

University of Leeds research showed that coughing, sneezing or simply shaking the bed linens can send superbugs into flight, allowing them to contaminate recently cleaned surfaces. PhD student Marco-Felipe King used a biological aerosol chamber, one of a handful in the world, to replicate conditions in one- and two-bedded hospital rooms. He released tiny aerosol droplets containing Staphyloccus aureus from a heated mannequin simulating the heat emitted by a human body. He placed open petri dishes where other patients’ beds, bedside tables, chairs and washbasins might be and then checked where the bacteria landed and grew.

The results confirmed that contamination can spread to surfaces across a ward. “The level of contamination immediately around the patient’s bed was high but you would expect that. Hospitals keep beds clean and disinfect the tables and surfaces next to beds,” says Dr. Cath Noakes, from the University’s School of Civil Engineering, who supervised the work. “However, we also captured significant quantities of bacteria right across the room, up to 3.5 meters away and especially along the route of the airflows in the room.” Reference: M.F. King, C.J. Noakes, P.A. Sleigh, M.A. Camargo-Valero. Bioaerosol Deposition in Single and Two-Bed Hospital Rooms: A Numerical and Experimental Study. Building and Environment. 2012

Effect of Nonpayment for Effect of Nonpayment for Preventable Infections in U.S. Preventable Infections in U.S. HospitalsHospitals

Using a quasi-experimental design with interrupted time series with comparison series, we examined changes in trends of two health care–associated infections that were targeted by the CMS policy (CLABSI and CAUTI as compared with an outcome that was not targeted by the policy (VAP). Hospitals participating in the NHSN and reporting data on at least one health care–associated infection before the onset of the policy were eligible to participate. Data from January 2006 through March 2011 were included.

A total of 398 hospitals contributed 14,817 to 28,339 hospital unit–months, depending on the type of infection. We observed decreasing secular trends for both targeted and nontargeted infections long before the policy was implemented. There were no significant changes in quarterly rates of CLABSI, CAUTI, or VAP after the policy implementation. Our findings did not differ for hospitals in states without mandatory reporting, nor did it differ according to the quartile of percentage of Medicare admissions or hospital size, type of ownership, or teaching status.

Reference: N Engl J Med 2012; 367:1428-1437 October 11, 2012

Study finds credit cards Study finds credit cards contaminatedcontaminated

New results from a scientific study for Global Handwashing Day reveal that one in 10 bank cards (10%) and one in seven notes (14%) were found to be contaminated with fecal organisms. The nationwide study carried out by researchers from the London School of Hygiene & Tropical Medicine and Queen Mary, University of London investigated levels of bacterial contamination on the hands, credit cards and currency of various sample sizes in East and West London, Birmingham and Liverpool to raise awareness of Global Handwashing Day. The research highlights the importance of handwashing with soap before eating and after using the toilet.

The research also revealed that over a quarter of hands sampled (26%) showed traces of fecal contamination including bacteria such as E. coli. More significantly, out of the samples taken, 11% of hands, 8% of cards and 6% of notes showed gross contamination - where the levels of bacteria detected were equal to that you would expect to find in a dirty toilet bowl.

http://www.lshtm.ac.uk/newsevents/news/2012/dirty_money.html

Hospital food Hospital food contaminated with C. diffcontaminated with C. diff

Oct. 19, 2012 -- A new report suggests that hospital food is frequently contaminated with the dangerous diarrhea bug Clostridium difficile (C. diff). Houston researchers found that about one-fourth of nearly 100 hospital food samples they tested were positive for C. diff. Among the worst culprits: turkey, chicken, and egg products, vegetables and fruits, and desserts. Almost all were cooked. C. diff has been recovered from pigs, cows, and chickens, and the bug has been found in retail meat and salad greens. It's only one hospital. And no cases of human infection were linked to the food. But together with past research, the findings suggest that contaminated food may be an important route of spread of C. diff in hospitals, says researcher Hoonmo Koo, MD, an infectious diseases specialist at Baylor College of Medicine in Houston, Texas.

Moreover, the temperatures at which hospital foods are cooked may be too low to kill the bug, he says. An infectious diseases expert not involved with the research says the major C. diff strains that contaminate food are different from the ones responsible for human disease.

IDSA meeting – October 19, 2012

Study Shows Universal Study Shows Universal Decolonization of ICU Patients Decolonization of ICU Patients Reduces Bloodstream Reduces Bloodstream Infections by 44 PercentInfections by 44 Percent

The REDUCE MRSA study proved convincingly that universal decolonization is the best practice to prevent infection from MRSA and other antibiotic-resistant bacteria in high risk ICU patients. The study, which involved nearly 75,000 patients and more than 280,000 patient days in 74 adult ICUs located in 16 states, compared the results of three approaches in ICUs:

- Screen all patients and isolate MRSA carriers - Targeted decolonization after screening - Universal decolonization

Investigators found that using universal decolonization reduced the number of patients harboring MRSA by 37 percent. All bloodstream infections decreased by 44 percent. The researchers noted that this trial took place in HCA facilities, mostly in community hospitals, rather than academic institutions and was conducted by hospital personnel rather than specially trained research staff. Therefore, unlike some clinical studies, these results are likely to be applicable to nearly all U.S. hospitals.

Source: Presented at IDWeek 2012

Study Examines Microorganism Study Examines Microorganism Kill in the Presence of Blood on Kill in the Presence of Blood on Surgical InstrumentsSurgical Instruments

U.S. concern over compounders U.S. concern over compounders predates outbreak of predates outbreak of meningitismeningitis

A year before people began dying of meningitis caused by a tainted drug from a compounding pharmacy in Massachusetts, the Food and Drug Administration worried that compounders across the country might be selling another substandard drug, one possibly made with unapproved Chinese ingredients. But when the FDA began seeking samples to test, the trade group representing compounding pharmacists went on the offensive. Instead of encouraging members to help the agency determine if the injectable drug, used to reduce the risk of premature birth, was substandard, the group tutored pharmacists on how to sidestep requests. In Texas, a hub of compounding pharmacies, random tests by the state's pharmacy board over the last several years found that as many as one in four compounded drugs was either too weak or too strong.

The FDA said on Friday that investigators did not believe that original ingredients used by the Massachusetts pharmacy, the New England Compounding Center in Framingham, were the source of the crisis unfolding in 16 states, where at least 297 people have contracted meningitis and 23 have died.