Unit Based Champions Infection Prevention eBug Bytes

1. Unit Based ChampionsInfection PreventioneBug Bytes April 2013

2. Boston hospital monitors 5 for possible hepatitis Doctors are monitoring five patients who may have been exposed to Hepatitis B when they were treated at Boston Medical Center. Hospital spokeswoman Jennifer Watson said Saturday that the hospital became aware that a small number of patients were potentially exposed to the hepatitis B virus and five patients are potentially at risk. WBZ reports that the hospital says the patients may have been exposed earlier this month through dialysis equipment that was not properly cleaned. The Massachusetts Department of Public Health says it’s investigating. Hepatitis B attacks the liver and can last a few weeks or become a long-term, life-threatening ailment. The virus is spread through bodily fluids such as blood. Symptoms include fever, fatigue, nausea and joint pain.

3. Western NY Infection Rates • * The overall surgical-site infection rate in upstate New York declined 7.9 percent, from 2.14 per 100 procedures in 2008 to 1.97 per 100 procedures in 2011. Statewide, the infection rate decreased 3.2 percent, from 2.17 infections per 100 procedures to 2.10 infections per 100 procedures.* Each year, surgical-site infection rates in upstate New York hospitals as a whole were lower, compared with statewide infection rates. The largest rate of decline - 32.9 percent - over the period examined for surgery-related infections occurred in Finger Lakes hospitals. The rate increased the most - 10.8 percent - in Central New York.* Central line-associated bloodstream infections decreased in all upstate regions, and the rate was lower as a whole upstate compared with the statewide rate. In upstate New York, the central-line infection rate dropped 45.9 percent, from 2.07 infections per 1,000 days to 1.12 per 1,000 days. It declined 42.4 percent statewide, from 2.38 infections per 1,000 days to 1.37 per 1,000 days. • Experts say that such simple steps as using checklists and ensuring employees, including doctors, wash their hands before touching a patient will lead to improvements..

4. Chinese told to change eating habits as H7N9 fatalities rise • China asked its citizens to avoid contact with live poultry as it tries to stem a H7N9 bird flu outbreak whose death toll rose to seven today, with a further 17 people infected in three eastern provinces and Shanghai. • Consumers should avoid markets where poultry are butchered as authorities increase monitoring for the new influenza strain, Feng Zijian, head of emergency response at the Chinese Center for Disease Control and Prevention, said in Beijing today. A vaccine is being prepared in case the virus starts spreading from human to human, health officials said. • "Consumers should no longer pursue the kind of eating habits where they buy fresh chickens that are butchered on the spot," Feng told reporters at a briefing held jointly with the World Health Organization. "Stalls and markets in cities where live poultry is being butchered need to be closely monitored as possible venues of infection.“ Shares in Shanghai and Taiwan fell on concern that infections may become more widespread, with airlines leading the slump after trading resumed today following a two-day holiday. The H7N9 infections tally rose to 24 after Chinese authorities reported three more cases today.

5. Green Valley Drugs announces voluntary nationwide recall of all lots of all sterile products compounded, repackaged, and distributed • Henderson, NV, Green Valley Drugs is voluntarily recalling All Lots of All Sterile products compounded, repackaged, and distributed by the pharmacy due to lack of sterility assurance and concerns associated with the quality control processes. A full list of the recalled products is attached to this press release and can be accessed at greenvalleymed.com. The recall of sterile products is conducted based on observations of clean room personnel and certain aseptic techniques. • Green Valley has received no reports of injury or illness associated with the use of our sterile products. In addition, we have received no indications of endotoxins or sterility issues from independent outside testing laboratories associated with any of the products subject to this recall. Out of an abundance of caution and in the interest of their patients, Green Valley Drugs has decided to voluntarily proceed with this recall process.

6. China bird-flu deaths rise to 13 as H7N9 virus spreads • Beijing confirmed that a 7-year-old girl has H7N9 avian influenza and Henan province reported its first two cases, opening a new front in the spread of the virus in the world's most populous nation. Shanghai said two people infected with the strain of bird flu died, taking the country's death toll to 13. The city also reported three fresh infections today while the eastern provinces of Jiangsu and Zhejiang also confirmed new cases, raising the national tally to 60 from 49 yesterday. The cases of the child in Beijing and two men in Henan widen the geographic spread of H7N9, adding impetus to the government's efforts to gauge the magnitude of the infection in poultry and wild birds. Live-poultry trading has been banned in some cities and the Ministry of Agriculture last week ordered local governments to collect tissue samples from birds at markets nationwide to contain the outbreak. The source of infections remains "under active investigation," he said. "We're still looking intensively for the reservoir of infection but the suspicion remains in birds, chicken, ducks and poultry.“ The first three cases of H7N9 in China were announced by the central government on March 31 and until yesterday all of those infected were in eastern China.

7. AACN Updates Patient Bathing Practices Protocolwww.aacn.org/practicealerts • Use prepackaged bathing products to reduce process variation. • Bathe patients daily using a disposable cloth that is prepackaged with a 2 percent solution of chlorhexidine gluconate (CHG). Use of CHG is associated with significant reductions in colonization of specific bacteria and infections with multidrug-resistant organisms. • Provide a daily bath for bed-bound patients to improve hygiene and promote comfort. More frequent baths may be performed upon patient request or to respond to patient needs. • Determine bath time based on patient preference and clinical stability, rather than organizational factors. • Use disposable basins and dispose of them after one use to reduce risk of bacterial contamination. • Avoid use of unfiltered tap water. Alternatives include prepackaged bathing products, sterile or distilled water or filtered water from faucets. • Use no-rinse pH balanced cleansers, which are superior to alkaline soaps that require wash-rinse cycles. • Apply emollients after each non-prepackaged bath to prevent dry skin. Prepackaged bathing products include skin emollients.

8. Mandatory glove wearing may reduce risk of hospital-acquired infections • Infection rates are reduced when physicians are required to wear gloves, according to a study published in the journal Pediatrics. Researchers examined the medical records of children admitted to the same hospital between 2002 and 2010; this hospital required physicians to wear gloves at any time while with patients during the season when the respiratory syncytial virus (RSV) was most rampant.IOver the course of the period studied, 686 hospital-acquired infections occurred among the patients. According to researchers, the risk of acquiring an infection was 25% lower during times when the hospital mandated that physicians wore gloves. Hospital-acquired infections were 37% lower in pediatric intensive care units, 38% lower in neonatal intensive care units, and 48% lower in the Pediatrics Bone Marrow Transplant Unit when mandatory gloving was in effect. The reduced risk due to glove wearing remained even after researchers accounted for long-term and season trends related to hospital-acquired infections. • Patient Safety Monitor Insider, April 24, 2013

9. H7N9 more lethal than SARS; 3 hospital staff show symptoms after H7N9 contact • The new H7N9 avian flu virus is more lethal than the strain of coronavirus that caused the global outbreak of severe acute respiratory syndrome in 2003 • Taiwan's Centers for Disease Control reported that China had 114 confirmed H7N9 cases, with 23 deaths as of Friday, which translated into a mortality rate of about 20 percent. The H7N9 strain of the flu was not known to infect people until March 31, when China reported its first cases of human infections of the virus. Before then, it was only found in birds. The first H7N9 case reported in Taiwan involved a 53-year-old man who fell ill with symptoms of fever and fatigue on April 12, three days after returning to Taiwan from Suzhou in Jiangsu Province, one of the H7N9-affected areas in China.Huang said the patient was transferred to National Taiwan University Hospital April 20 and has been treated in a negative pressure quarantine ward since. The patient is being given ECMO (extracorporeal membrane oxygenation) treatment and is in "serious but stable" condition, Huang added.

10. Hepatitis C screening for baby boomers • If you were born during 1945-1965, talk to your doctor about getting tested for hepatitis C. The word “hepatitis” means swelling of the liver. Hepatitis is most often caused by a virus. In the United States, the most common type of viral hepatitis is hepatitis C. Hepatitis C is primarily spread through contact with blood from an infected person. More than 15,000 Americans, most of them baby boomers, die each year from hepatitis C-related illness. Deaths related to hepatitis C have been on the rise and are expected to increase. Hepatitis C is a leading cause of liver cancer and the leading reason for liver transplants. Other serious health problems related to hepatitis C include: Liver damage. Cirrhosis, Liver failure. • People born during 1945 through 1965 are five times more likely than other adults to be infected. In fact, 75 percent of adults with hepatitis C were born in these years. People with hepatitis C often have no symptoms and can live for decades without feeling sick. As baby boomers grow older, there is a greater chance that they will develop life-threatening liver disease from hepatitis C. • Source: APIC