Infection Prevention eBug Bytes April 2014

1. Infection PreventioneBug BytesApril 2014

2. Scientists are discovering a surprising number of microbes living on cash • In the first comprehensive study of the DNA on dollar bills, researchers at New York University's Dirty Money Project found that currency is a medium of exchange for hundreds of different kinds of bacteria as bank notes pass from hand to hand. • By analyzing genetic material on $1 bills, the NYU researchers identified 3,000 types of bacteria in all—many times more than in previous studies that examined samples under a microscope. Even so, they could identify only about 20% of the non-human DNA they found because so many microorganisms haven't yet been cataloged in genetic data banks. Their unpublished research offers a glimpse into the international problem of dirty money. From rupees to euros, paper money is one of the most frequently passed items in the world. Hygienists have long worried that it could become a source of contagion. To make cash more durable, countries from Canada to the Kingdom of Bhutan are printing bank notes on sheets of flexible plastic polymer film, with implications for the microbiology of money. • The bacteria found in a study of DNA on money included Staphylococcus aureus, Escherichia coli, Helicobacter pylori and Corynebacterium diphtheriae. A chart in an earlier version of this article misspelled the bacteria as Staphyloccus aureus, Eschera coli, Heliobacter pylori and Coroynebactrium diptheriae.

3. Using video surveillance to measure peoples' hand washing habits • The study was carried out using video cameras installed in the washing areas outside latrines of four public schools in the sprawling Kibera slum of Nairobi, Kenya. Parents and administrators gave permission for the study, and teachers were informed in advance. A new study finds that video surveillance can provide insights into hand washing behavior. When another person is present, for example, hand washing rates increase 23 percent. Both methods of observation found the hand cleaning rate after toileting was higher among girls -- a 4 percent difference, according to video surveillance, and a 3 percent difference, according to in-person observation. Both video observation and in-person observation demonstrated longer hand cleaning times for hand washing with soap as compared to rubbing with sanitizer. Students at schools equipped with soap and water, instead of sanitizer, were 1.3 times more likely to wash their hands during simultaneous video surveillance and in-persono bservation when compared with periods of in-person observation alone. Overall, when students were alone at a hand cleaning station, hand cleaning rates averaged 48 percent, compared to 71 percent when at least one other student was present. Hand cleaning rates showed an overall trend of increasing as the number of other people present at hand cleaning stations increased. Amy J. Pickering, Annalise G. Blum, Robert F. Breiman, Pavani K. Ram, Jennifer Davis. Video Surveillance Captures Student Hand Hygiene Behavior, Reactivity to Observation, and Peer Influence in Kenyan Primary Schools. PLoS ONE, 2014; 9 (3): e92571

4. Overuse of blood transfusions increases infection risk • Blood transfusions are one of the most common procedures patients receive in the hospital but the more red blood cells they receive, the greater their risk of infection, says a new study led by the University of Michigan Heath System and VA Ann Arbor Healthcare System. Elderly patients undergoing hip or knee surgeries were most susceptible, with a 30 percent lower risk of infection when fewer transfusions were used. Overall, for every 38 hospitalized patients considered for a red blood cell transfusion (RBC), one patient would be spared a serious infection if fewer transfusions were used. • Transfusions are often used for anemia or during surgery to make up for blood loss. The authors evaluated all health care-associated infections that were reported after receiving donor blood in the randomized trials. These included serious infections such as pneumonia, bloodstream infections and wound infections. This is most likely due to the patient’s immune system reacting to donor blood (known as transfusion-associated immunomodulation or TRIM).  Transfusions may benefit patients with severe anemia or blood loss; however, for patients with higher red blood cell levels, the risks may outweigh the benefits.  • Reference: “Healthcare-associated infection after red blood cell transfusion: A systematic review and meta-analysis,” JAMA, doi: 10:1001/jama.2014.2726

5. State: RI Hospital botched possible measles case • State health officials have ordered Rhode Island Hospital to retrain its emergency department staff on infection control after they botched the handling of a potential measles case. • The state Health Department investigated the Feb. 28 incident and found that hospital staff violated infection control policies when they allowed a patient with measles symptoms to sit in a public waiting area for more than two hours. Health officials say the patient was wearing a mask, but should have confined in a private room under hospital policy. Tests later showed the person did not have measles, which is highly contagious. • Health Director Michael Fine says the hospital won't be fined for the incident. • Hospital officials say they take patient safety seriously and will re-educate staff about the hospital's comprehensive infection control policies.

6. CDC remains concerned about C.diff but hospitals using UV room disinfection system are reporting fewer infections • According to the CDC, approximately one in 25 U.S. patients contract at least one infection during the course of their hospital care and every day, more than more than 200 Americans with healthcare-associated infections (HAIs) will die during their hospital stay. The CDC's HAI Progress Report showed minimal decreases for both hospital-onset Clostridium difficile (C.diff) infections and hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections. A study published in the American Journal of Infection Control (August 2013) reported that Cooley Dickinson Hospital (an affiliate of Massachusetts General Hospital) experienced a 53 percent decrease in the rate of hospital-acquired C.diff infections after implementing the Xenex system. A study published in Journal of Infection Prevention in 2013 reported that Cone Health experienced a 56 percent reduction in its rate of hospital acquired MRSA infections after implementing an infection prevention program that included Xenex's room disinfection system. • http://www.xenex.com/article/cdc-remains-concerned-c-diff-hospitals-using-xenex-uv-room-disinfection-system-reporting-fewer-infections/

7. Peer reviewed article puts the focus on infections from conventional endoscopes Reprocessing conventional flexible endoscopes is "time consuming, labor intensive, expensive and, most importantly, susceptible to failure." Due to "limited surveillance, limited reporting, and lack of immediate clinical symptoms of patients," experts agree that cross-contamination is significantly under-reported. Infections "resulting from scope contamination breaks the trust between patients and doctors and places a financial burden on healthcare institutions." Research shows that using EndoSheath Technology and its simplified cleaning and disinfection procedure offers "a vast improvement over current decontamination procedures." EndoSheath Technology eliminates "unreliable and cumbersome reprocessing" of conventional endoscopes by condensing the protocol into just a few steps, and "reduces reprocessing time by up to 31 minutes." Due to its design, EndoSheath Technology is "more cost effective, reduces repair costs, and decreases investment in multiple scopes that are out of operation while being cleaned." BMJ 2014;348:g2047

8. Newly identified C. difficile strain highly virulent Researchers from Monash University in Australia have found that the RT244 Clostridium difficile strain, which was associated with severe disease and a high mortality rate, has significant pathogenic potential. They found that the patients with the RT244 strain had more severe disease, renal impairment and hypoalbuminemia compared with non-RT244 patients. These patients also were more likely to die: They had a 30-day mortality of 42% and four of the five deaths were attributed to CDI. There were no deaths among patients with non-RT244 strains. Patients with the RT244 strain were 13 times more likely to die compared with those with non-RT244 strains. “The overall clinical significance of RT244 cannot be clearly determined at present,” the researchers wrote in Clinical Infectious Diseases. “At our laboratory, C. difficile RT244 has spontaneously declined and the epidemiological data available to us provided no clear evidence for the source of the strain, how it disseminated in our community or why its incidence has declined. Further studies are required to answer these questions, and to better understand the virulence of the strain, and its potential to become endemic and to cause further outbreaks.” http://www.healio.com/infectious-disease/gastrointestinal-infections/news/online/%7Baded8e63-618e-4300-a1ad-f8402cbfd011%7D/newly-identified-c-difficile-strain-highly-virulent

9. SoClean CPAP sanitizing machine uses activated oxygen to eliminate any mold, bacteria, and viruses • A study conducted by Dr. Sandra Horowitz of Brigham Women's Hospital concluded that CPAP masks are a source of microbial contamination. Researchers reported that a variety of bacteria were found inside CPAP masks, even the pathogen Staph aureus. •  CPAP equipment, should be cleaned daily but is often neglected either resulting in someone not using their CPAP machine or possibly contracting an illness from a germ-ridden environment because the user allowed bacteria and fungus to compound inside. Most users hand wash their equipment with soap and water, but many others simply forget. •  The SoClean 2 destroys 99.9% of mold, bacteria, and viruses it comes in contact with-without chemicals, soap or water with a seven minute procedure and two hour wait time. It is FDA registered and independent lab test info is available.  Mike Schmidt, President of BRS. "The CPAP cleaning chore with the SoClean 2; encourages users to maintain clean and sanitized CPAP equipment to help keep them healthier and living longer as well.“ • http://www.betterrestsolutions.com/soclean/

10. Epidemic of Mumps among Vaccinated Persons, the Netherlands, 2009–2012 • Mumps is an acute illness caused by mumps virus (family Paramyxoviridae) and characterized by fever, swelling, and tenderness of >1 salivary gland, usually the parotid gland. Complications associated with mumps include orchitis (inflammation of the testes), meningitis, pancreatitis, and deafness. Mumps virus is spread in respiratory droplets, and the incubation period is 15–24 days (median 19). The Netherlands began mumps vaccination in 1987, using the measles, mumps, and rubella combination vaccine (MMR). The vaccine is administered in a 2-dose schedule at 14 months and 9 years of age. • During September 1, 2009–August 31, 2012, a total of 1,557 cases of mumps were reported in the Netherlands 1,254 (80.5%) of these were laboratory confirmed. Most case-patients were male (59%) and 18–25 years of age (67.9%). The average annual incidence per 100,000 population was 0.5 for the 0–3-year age group, 0.8 for the 4–14-year age group, 4.5 for the 13–17-year age group, 21.4 for the 18–25-year age group, and 0.9 for the >25-year age group. Of the 1,474 cases for which patient vaccination status was reported, 998 (67.7%) case-patients had received 2 doses of MMR; 157 (10.6%) had received 1 dose, and 242 (16.4%) were unvaccinated. A total of 31 patients (2.1% of 1,436 patients with known hospitalization status) were hospitalized. http://wwwnc.cdc.gov/eid/article/20/4/13-1681_article.htm

11. Deadly virus's spread raises alarms in Mideast • The United Arab Emirates over the weekend separately announced six confirmed cases of Middle East Respiratory Syndrome, or MERS, among paramedics there, one of whom died of the illness. The high number of cases among medical workers raised questions about how effective Arab Gulf governments have been in controlling the 1½-year-old outbreak. King Fahd General Hospital, the large public hospital in Jeddah that has been hardest hit by a spike in the city this month. • The hospital reopened its emergency room on Friday after shutting it briefly for what authorities said was disinfection measures against MERS. But patients were avoiding the hospital, and health workers were "very worried" after the MERS death of one colleague and sickness in another.   • About 50 of the overall cases have been in healthcare workers, a strong warning sign about measures being taken to control the outbreak. MERS-CoV does not spread easily from person-to-person, so these clusters suggest a breakdown in infection prevention and control. • http://online.wsj.com/news/article_email/SB10001424052702303887804579499831393801054-lMyQjAxMTA0MDEwMzExNDMyWj#printMode

12. Deadly H5N1 bird flu needs just 5 mutations to spread easily in people • It's a flu virus so deadly that scientists once halted research on the disease because governments feared it might be used by terrorists to stage a biological attack. H5N1 avian influenza has killed 60% of the 650 humans known to be infected since it was identified in Hong Kong 17 years ago, yet the "bird flu" virus has yet to evolve a means of spreading easily among people. • Now Dutch researchers have found that the virus needs only five favorable gene mutations to become transmissible through coughing or sneezing, like regular flu viruses. Researchers set out to determine the minimum number of mutations necessary for airborne infection. To do this, the researchers took a strain of the virus that had previously infected a human and altered its genes in the lab. Then they sprayed the altered version of the virus into a ferret's nose and placed the animal in a specially constructed cage with a second ferret who had not been exposed to the virus. The layout of the cages prevented direct contact between the animals, but allowed them to share airflow. When the healthy ferret developed flu symptoms researchers knew the virus had spread through the air. By exposing ferrets and human tissue samples to a variety of genetically altered viruses, study authors identified five key gene mutations. http://www.latimes.com/science/sciencenow/la-sci-sn-bird-flu-five-mutations-20140410,0,6818032.story