Unit Based Champions Infection Prevention eBug Bytes

1. Unit Based ChampionsInfection PreventioneBug Bytes November 2012

2. Multistate Outbreak of Salmonella Serotype Bovismorbificans Infections Associated with Hummus and Tahini - 2011 • 22 patients with exposure information, 20 (91%) reported eating at a restaurant in the DC metropolitan area. Among 15 patients asked about Mediterranean-style restaurant exposure, 14 (93%) indicated that they had eaten at a Mediterranean-style restaurant in the DC area, including six restaurants in DC and two in northern Virginia. Nine (69%) of 13 patients reported eating at restaurants A, B, or C, and three of eight reported eating at DC restaurants, before symptom onset. Sixteen (84%) of 19 patients reported eating Mediterranean-style food; 10 (67%) of 15 patients reported eating hummus. Other commonly reported foods eaten were lettuce (11 of 14; 79%), chicken (11 of 15; 73%), tomato (11 of 15; 73%), and cucumber (nine of 11; 82%). On May 30, 2012, trac eback by FDA suggested that tahini (sesame seed paste) used in hummus was a plausible source for Salmonella infections. The trace back revealed tahini used at the different restaurants in the DC area came from a common foreign manufacturer from Lebanon associated with recent Salmonella outbreaks in Canada. FDA issued a mandate that all products imported from this manufacturer undergo Salmonella testingbefore entry into the US. MMWR: November 23, 2012 / 61(46);944-947

3. Hospital cleaning protocol ineffective against A. Baumannii Current hospital cleaning protocol may be inadequate to rid patient rooms of multidrug-resistant (MDR) Acinetobacter baumannii, according to a study in the December issue of the American Journal of Infection Control APIC). A team of researchers from the University of Maryland collected 487 cultures from 32 hospital rooms occupied by just-discharged patients with a known history of MDR A. baumannii both before and after terminal cleaning of the rooms. Over half of the rooms positive for the A. baumannii bacteria prior to cleaning remained contaminated after terminal cleaning had occurred. Fifteen rooms (46.9 percent) and 41 sites (n=268, 15.3 percent) tested positive for MDR A. baumannii before cleaning. Post-cleaning, eight rooms (25 percent) and 12 sites (n=219, 5.5 percent) still tested positive for the pathogen. Sites with post-cleaning contamination included the floor (12.5 percent), call button (10 percent), door handle (9.4 percent) bedside table (7.4 percent), and supply cart (3.8 percent). “The effect of terminal cleaning on environmental contamination rates of multidrug-resistant Acinetobacter Baumannii” by Paula Strassle, Kerri A. Thom, J. Kristie Johnson, Surbhi Leekha, Matthew Lissauer, Jingkun Zhu and Anthony D. Harris appears in the American Journal of Infection Control, Volume 40, Issue 10 (December 2012

4. Flu season arrives early, and could be bad Flu season arrived early this year. according to the U.S. Centers for Disease Control and Prevention, it's shaping up to be a bad one. CDC director Dr. Thomas Frieden announced today that Tennessee, Mississippi, Alabama, Louisiana and Texas have reported enough seasonal flu cases to officially mark the beginning of the flu season. "We're seeing the beginning of the uptick start at least a month before we'd generally see it," Frieden said, explaining that flu rates typically start to rise in early January. Missouri and Georgia are also well on their way to meeting the critical threshold number of cases. And as the season progresses, the infection is expected to spread across the nation. "It looks like it's shaping up to be a bad flu season," Frieden said, explaining that the predominant flu subtype being passed around - H3N2 - is known to cause more severe illness. H3N2 was the predominant subtype in 2003-2004, the last time the flu season arrived this early. But there's some good news: It appears the circulating strains are "a great match" for this year's vaccine, according to Frieden.

5. No vaccination, no job, some hospitals say: It's civil rights versus health of patients As hospitals in recent years have stepped up their efforts to persuade the public to get annual flu vaccinations, their employees haven't always heeded the call. But federal health authorities believe that hospital workers who are anywhere near patients should be vaccinated for their welfare, as well as patients'. And with the government dangling the carrot of Medicare reimbursement money, hospital administrators are wielding the stick. The list of staff affected by these policies is broad. It includes not only doctors and nurses and others directly involved in patient care but also housekeeping and maintenance workers. The Joint Commission, the top healthcare accreditation agency in the nation, this year enacted a plan to have hospitals train and educate their staffs about the benefits of flu vaccines. Although it is not demanding mandatory vaccinations, the commission is requiring hospitals to show they are progressing toward 90 percent compliance by 2020.

6. College Students Report Low Flu Vaccination Rate In a study, believed to be the first multi-university study to assess seasonal flu vaccine coverage, a total of 4,090 college students participated in a confidential, web-based survey in late October and November 2009 regarding whether they had received a flu shot. Overall, 20 percent of the students reported they had been vaccinated during a year in which significant media attention focused on both seasonal and H1N1 flu. The seasonal vaccine coverage varied across the eight universities from 14 percent to 30 percent, which was considerably less than half of the U.S. Department of Health and Human Services' 2020 Healthy People goal of 80 percent coverage for healthy persons 18 to 64 years of age. In addition, the researchers found that students more often reported receiving the vaccine from a private physician or clinic rather than from student health services, even though it was available free of charge. Co-authors of the study are Jill Blocker, MS, Edward Ip, PhD, Timothy Peters, MD and Mark Wolfson, PhD, of Wake Forest Baptist.

7. AAMI Offers Webinar on Updates to ST79 Steam Sterilization Standard • The Association for the Advancement of Medical Instrumentation (AAMI) will host a webinar that discusses the recent amendments and updates to AAMI's landmark recommended practice for hospital steam sterilization, ANSI/AAMI ST79, Comprehensive guide to steam sterilization and sterility assurance in healthcare facilities. • This webinar will be held on Tuesday, Jan. 15, 2013, from 12 p.m. to 1:30 p.m. ET. The speaker is Martha L. Young, BS, MS, CSPDT, of Martha L. Young, LLC. • The most recent amendment replaces the term "flash sterilization" with "immediate use steam sterilization" to better reflect current practice; provides guidance to sterile processing professionals on the different ways that chemical indicators may be classified; and adds, deletes, or updates definitions to reflect changes elsewhere in the document. The amendment also provides updates to the design considerations section, updates recommendations in the personnel considerations section, updates the section on handling, collection, and transportation of contaminated items, and updates the section on cleaning and other decontamination processes.

8. Former Exeter Hospital Employee Indicted in Connection With Hepatitis C Outbreak David M. Kwiatkowski, 33, a former employee of Exeter Hospital, has been indicted for his alleged role in causing the hepatitis C outbreak that infected patients in New Hampshire as well as other states.Kwiatkowski has been charged with seven counts of tampering with a consumer product and seven counts of obtaining controlled substances by fraud. The charges relate to suspected thefts of the controlled substance fentanyl, a powerful anesthetic used in various medical procedures. In addition to stealing fentanyl and depriving patients in his care of the intended analgesic effect of the drug, Kwiatkowski allegedly caused over 30 individuals in New Hampshire and elsewhere to become infected with hepatitis C, a bloodborne virus that can cause serious damage to the liver. According to the indictment, Kwiatkowski was employed for several years as a healthcare worker in Michigan. Beginning in 2007, he became a traveling health care technician, employed in various states, including New York, Pennsylvania, Maryland, Arizona, Kansas, Georgia and New Hampshire.

9. Studies Prove Copper Kills Bacteria, Provides Viable Solution to the Problem of HAIs • Preliminary results of a Department of Defense (DoD) study have shown that Antimicrobial Copper reduces HAIs by 41 percent through continuously killing bacteria on touch surfaces, such as IV poles and bedrails. This same study demonstrated that copper reduces the bacteria in intensive care units (ICUs) by 83 percent. After rigorous testing, copper alloys have been registered with the Environmental Protection Agency (EPA) to kill greater than 99.9 percent of Staph and E. coli, as well as the superbugs MRSA, VRE and others. However, only 16 percent of U.S. adults polled in the Harris survey are aware of the proven power of antimicrobial copper to kill bacteria.“Antimicrobial copper healthcare equipment offers patients an added line of protection when they visit a healthcare facility for treatment,” says Dr. Archelle Georgiou, a physician who has practiced as a clinician and corporate managed care executive for nearly two decades. “Utilizing antimicrobial copper touch surfaces in simple ways such as on handrails, overbed trays and IV poles could go a long way to reducing the huge burden HAIs place on the healthcare system and the patients who need treatment.”

10. CDC Offers Tips for Safe Holiday Meal Preparation • Safe Thawing: Thawing turkeys must be kept at a safe temperature. The "danger zone" is between 40 and 140°F — the temperature range where foodborne bacteria multiply rapidly. While frozen, a turkey is safe indefinitely, but as soon as it begins to thaw, bacteria that may have been present before freezing can begin to grow again, if it is in the "danger zone." There are three safe ways to thaw food: in the refrigerator, in cold water, and in a microwave oven. • Safe Preparation: Bacteria present on raw poultry can contaminate your hands, utensils, and work surfaces as you prepare the turkey. If these areas are not cleaned thoroughly before working with other foods, bacteria from the raw poultry can then be transferred to other foods. After working with raw poultry, always wash your hands, utensils, and work surfaces before they touch other foods. • Safe Stuffing: For optimal safety and uniform doneness, cook the stuffing outside the turkey in a casserole dish. However, if you place stuffing inside the turkey, do so just before cooking, and use a food thermometer. Make sure the center of the stuffing reaches a safe minimum internal temperature of 165°F. Bacteria can survive in stuffing that has not reached 165°F, possibly resulting in foodborne illness. Follow the FSIS' steps to safely prepare, cook, remove, and refrigerate stuffing; Spanish language instructions are available. • Safe Cooking: Set the oven temperature no lower than 325°F and be sure the turkey is completely thawed. Place turkey breast-side up on a flat wire rack in a shallow roasting pan 2 to 2-1/2 inches deep. Check the internal temperature at the center of the stuffing and meaty portion of the breast, thigh, and wing joint using a food thermometer. Cooking times will vary. The food thermometer must reach a safe minimum internal temperature of 165°F. Let the turkey stand 20 minutes before removing all stuffing from the cavity and carving the meat.