Infection Prevention eBug Bytes June 2015. New strategies for stopping spread of Staph and MRSA Staphylococcus aureus -- better known as Staph -- is a.

Infection PreventioneBug Bytes

June 2015

New strategies for stopping spread of Staph and MRSA

• Staphylococcus aureus -- better known as Staph -- is a common inhabitant of the human nose, and people who carry it are at increased risk for dangerous Staph infections.

• However, it may be possible to exclude these unwelcome guests using other more benign bacteria, according to a new study led by scientists representing the Translational Genomics Research Institute (TGen), the Statens Serum Institut, and Milken Institute School of Public Health (SPH) at the George Washington University.

• The study, published in the AAAS journal Science Advances, suggests that a person's environment is more important than their genes in determining the bacteria that inhabit their noses. The study also suggests that some common nasal bacteria may prevent Staph colonization. The multi-center research team looked at data taken from 46 identical twins and 43 fraternal twins in the Danish Twin Registry, one of the oldest registries of twins in the world. It showed that there is no genetically inherent cause for specific bacteria in the nasal microbiome. The so-called nasal microbiome is the collection of microbes living deep within the nasal cavity. This research might ultimately lead to interventions that could route Staph from the nose and thus prevent dangerous infections, including those caused by antibiotic resistant Staph, the authors say. Studies suggest drug-resistant Staph infections kill more than 18,000 people in the United States every year. The researchers also looked for possible gender differences and found that contrary to past studies there is no difference between men and woman in the likelihood of nasal colonization by Staph.

• Source: Liu C et al. Staphylococcus aureus and the ecology of the nasal microbiome. Science Advances, 2015; 1 (5)

Toothbrush contamination in communal bathrooms

• Data confirms that there is transmission of fecal coliforms in communal bathrooms can serve as a vector for transmission of potentially pathogenic organisms. Enteric bacteria are a family of bacteria, Enterobacteriaceae, they are known to be normal flora found in the gut. Pseudomonas group of bacteria are gram-negative aerobic rods commonly found in soil, water, plants and animals. They are part of the normal flora of the gut and also on the skin of humans.

• All toothbrushes were collected from participants using communal bathrooms, with an average of 9.4 occupants per bathroom. Regardless of the storage method, at least 60% of the toothbrushes were contamination with fecal coliforms. There were no differences seen with the effectiveness of the decontamination methods between cold water, hot water or rinsing with mouthwash and 100% of toothbrushes regularly rinsed with mouthwash had growth on MacConkey agar indicating fecal contamination (n=2). Fecal coliforms were seen on 54.85% of toothbrushes, which has been seen in previous studies. There is an 80% chance that the fecal coliforms seen on the toothbrushes came from another person using the same bathroom.

• Source: American Society for Microbiology. "Toothbrush contamination in communal bathrooms." ScienceDaily. ScienceDaily, 2 June 2015

MERS Virus’s Path: One Man, Many South Korean Hospitals

• At first, doctors thought the 68-year-old man might have simple pneumonia. He coughed and wheezed his way through four hospitals before officials figured out, nine days later, that he had something far more serious and contagious. Along the way the man infected dozens who then became potential carriers themselves and infected dozens more and counting. The original diagnosis that missed what became South Korea’s first case of Middle East respiratory syndrome, or MERS, was possibly caused by incomplete information from the patient about his travels. And the WHO acknowledged that MERS was not an easy virus to identify early because its symptoms are similar to other respiratory infections, like a common cold. But it was especially problematic in South Korea because of peculiarities in the hospital system. Patients jostle, cajole and name-drop to get referrals to the biggest hospitals, which they believe attract the best doctors. Family members and outside caregivers commingle with the sick in crowded emergency wards. They often stay with the patients in their rooms and do much of the nursing work — wiping sweat, emptying bedpans, changing sheets and exposing themselves to infections. As of Tuesday – June 8th, the South Korean authorities had confirmed at least 95 MERS cases and were monitoring more than 2,500 people under quarantine for symptoms. At least seven patients have died. There has been no sign of a panic among the wider public. But fears of the virus have led to the closings of nearly 2,000 kindergartens and schools and the cancellation of concerts and religious and social gatherings. Sales of face masks and hand sanitizer have soared. http://www.nytimes.com/2015/06/09/world/asia/mers-viruss-path-one-man-many-south-korean-hospitals.html?&_r=1

Researchers Map Where Hospital Pathogens Are Lurking

• In a new approach to reducing the scourge of hospital-acquired infections, a team of scientists has been testing thousands of microbe samples from a Chicago hospital to learn how a medical building might make patients sicker. Data from the three-year Hospital Microbiome Project are still being analyzed. So far the team has found factors including ventilation and humidity, and design features such as furnishings and fixtures, affect the kinds of bacteria people encounter inside a hospital in ways that impact their health. The scientists aim one day to slow the rise of antibiotic-resistant bacteria in hospital settings by manipulating conditions from room to room to keep pathogens in check.

• A person typically sheds some 37 million bacteria every hour into the surrounding air or onto surfaces touched. Every building appears to have its own unique microbiome, depending on how it is built and operated, who uses it and what they do there. In hospitals, for example, the air that many patients breathe, recycled through heating and air-conditioning systems, concentrates human-related bacteria and potential pathogens, compared with patient rooms with open windows where outdoor air can circulate. Other recent studies discovered that moisture-loving bacteria living in showerheads include distinct populations of potential pathogens quite different from microbes on shower curtains a few feet away. Drug-resistant staph germs can live for up to a week on some common furniture fabrics. Strep germs can survive for months on a dry surface. Typically, people came in and out of each room 100 times a day, trailing invisible plumes of bacteria, the researchers found. Some room surfaces had thousands of types of bacteria; others had only a few hundred. Within hours of arrival of a new patient, however, his or her personal collection of microbes spread throughout the room, mingling with microbes already present and making the microbiome of each room unique. Researchers hope the project will inspire a new generation of infection-control practices. Dr. Green, of the University of Oregon, believes the technology will begin showing up in hospitals within five years.

• Source: http://fpn.advisen.com/?resource_id=2378153821162460763#top

Health officials tracing path of woman with rare TB

• Health officials are trying to track down people who may have been in contact with a woman with a rare and deadly form of hard-to-treat tuberculosis.

• The woman has an extremely drug-resistant form of the disease, which is impervious to most TB drugs. Three to four cases are reported each year in the United States, on average.

• Health officials in Illinois are working with the Centers for Disease Control and Prevention to find people with whom the woman may have had prolonged direct contact, in close quarters, CDC spokesman Tom Skinner said.

• TB is not as easily spread as diseases like the flu or measles. But it is a dangerous illness, especially for people with weakened immune systems, and health officials are taking the situation seriously, Skinner said. In April, the woman traveled from India to the United States, arriving at Chicago's O'Hare International Airport. She spent time in Missouri, Tennessee and Illinois before growing sick and being admitted to an isolation unit at a suburban Chicago hospital. She is now being cared for at a National Institutes of Health hospital in Bethesda, MD, where she is in stable condition. The CDC did not release other details.

• Source: http://abcnews.go.com/Health/wireStory/health-officials-tracing-path-woman-rare-tb-31624273

CDC updates guidelines for prevention and control of MERS-CoV in light of new outbreak• The recommendations were informed by evidence-based infection prevention and control

guidelines CDC published previously in July 2014. Among the guidelines, the CDC recommends minimizing the chance of exposure by:•Taking steps to ensure all persons with symptoms of a respiratory infection adhere to hygiene and cough etiquette, as well as hand hygiene.•Designating waiting area spaces for patients who may have symptoms of respiratory infection away from other patients.•Ensuring quick triage and isolation of patients who may have MERS-CoV.•Properly training and demonstrating how to use personal protective equipment, such as gloves, gowns, and respiratory and eye protection.

• According to the CDC, the Republic of Korea has been investigating an outbreak of MERS since May. It is the largest outbreak of MERS outside the Arabian Peninsula. Only two patients in the United States have tested positive for the MERS-CoV infection - both in May 2014 - while more than 500 have tested negative. CDC has provided information for travelers and is working with health departments, hospitals and other partners to prepare for this. To stay up to date on the situation, visit the CDC's MERS home page. www.cdc.gov

Measles Transmission in an International Airport at a Domestic Terminal Gate — April–May 2014

• On April 22, 2014, the Minnesota Department of Health notified CDC of a case of measles in a child aged 19 months who had documentation of receiving 1 dose of measles, mumps, and rubella vaccine at age 12 months. The child's illness was clinically compatible with measles, which was confirmed by polymerase chain reaction and immunoglobulin M serology at the Minnesota Department of Health Public Health Laboratory. The child was febrile and developed a rash on April 17 while on an international flight from India to the United States before taking a connecting flight from Chicago to Minneapolis. Persons with measles are infectious from 4 days before to 4 days after rash onset. Therefore, travelers were exposed on both the international and domestic flights. CDC's Division of Global Migration and Quarantine was contacted and provided information on potentially exposed persons to relevant health departments for follow-up. No documented transmission was reported as a result of the two flight exposures.

• On May 5, the Massachusetts Department of Public Health contacted the Minnesota Department of Health to report a case of measles in a Minnesota resident aged 46 years with unknown vaccination status, who was traveling in Massachusetts for business when a rash was observed. The case was confirmed by polymerase chain reaction and immunoglobulin M serology at the Massachusetts Department of Public Health Laboratory. This person had no known exposures or international travel, and did not fly on the same aircraft as the child from Minnesota on April 17. However, investigation revealed that both patients had traveled through a Chicago airport and used the same gate for their respective flights. Measles is a highly communicable disease, and infectious droplets can remain suspended in the air for up to 2 hours after an infected person leaves the area. MMWR June 26, 2015 / 64(24);679

Financial Penalties Reduce Hospital-Acquired Infections

• After Medicare's Hospital-Acquired Conditions Payment Policy came into effect, infections, such as central-line-associated bloodstream infections, decreased in hospitals with low operating margins. In fact, it was in the hospitals with the least amount of money at their disposal that the improvement in infection rates was best. In the first year of the policy, there was a 3% decline in bloodstream infections per quarter, according to new research. However, although the policy ended reimbursement for infections that were acquired in the hospital, infection rates in American hospitals as a whole were unchanged. "In previous work, we found no impact of the policy on rates of targeted hospital-acquired infections reported to the NHSN, but we were worried that the policy might have unintended consequences, particularly in hospitals that were already resource-constrained," investigator Grace Lee, MD, from Boston Children's Hospital and Harvard Medical School, told Medscape Medical News.. According to the research the pair presented at the APIC 2015 Annual Meeting in Nashville, Tennessee, resource-constrained hospitals actually reduced their infection rates after the policy was implemented.

• Source: Medscape Medical News – June 30 2015

IPs spend more time in collecting and reporting hospital infection data than protecting patients

• Collecting and reporting hospital infection data to federal health agencies takes more than 5 hours each day, at the expense of time needed to ensure that frontline healthcare personnel are adhering to basic infection prevention practices such as hand hygiene, according to a recent case study, to be presented on Saturday, June 27 at the 42nd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC). Infection preventionists (IPs) play a critical role in the effort to eliminate healthcare-associated infections (HAIs), which strike one in 25 U.S. hospital patients. But many IPs, especially those in community hospitals, feel burdened by the time necessary to comply with the Centers for Medicare & Medicaid Services (CMS) reporting requirements--so much so that one IP decided to find out just how much time it takes. The answer: five hours and eight minutes a day of IP time, based on a five-day work week. That leaves little time to observe practices, go on rounds, lead safety drills, or answer questions about how to keep patients safe. IPs at Robert Wood Johnson University Hospital Somerset tabulated the amount of time necessary to review lab data and complete reports for bloodstream infections, urinary tract infections, surgical site infections, MRSA infections, and Clostridium difficile infections to the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN). IPs at hospitals across the country are responsible for analyzing lab reports and reporting infection data to the NHSN database, which is used for Medicare payment determination by CMS. Source: Association for Professionals in Infection Control Conference – abstract presentations.