Unit Based Champions Infection Prevention eBug Bytes

1. Unit Based ChampionsInfection PreventioneBug Bytes June 2012

2. Sepsis Outbreak at LA County Dialysis Center Prompts Public Health Investigation • The County of Los Angeles Department of Public Health became aware of the situation when a hospital in southern California reported an outbreak of sepsis tied to one dialysis center. During the course of their investigation, they discovered that all of the cases used the same type of dialyzer with a removable component – an O-ring header. These three patients were the only ones in the facility to use this type of dialyzer. In response to this outbreak, the facility decided to discontinue use of multi-use dialyzers with O-ring headers. • If multi-use dialyzers with removable headers and O-rings are used, processes to ensure proper disinfection must be in place • Contaminated O-rings have been previously implicated in dialysis-associated infection outbreaks. This report underscores the need for adequate infection prevention training in dialysis settings, as well as the critical partnership between public health departments and infection preventionists in hospitals and outpatient settings. • Source: APIC Poster Presentation #9-136 – Outbreak investigation at a dialysis center associated with a multi-use dialyzer with removable headers and O-rings, Los Angeles County.

3. Researcher Identifies the Most Contaminated Surfaces in Hotel Rooms • Researchers from Purdue University and the University of South Carolina sampled a variety of surfaces from hotel rooms in Texas, Indiana and South Carolina. They tested the levels of total aerobic bacteria and coliform (fecal) bacterial contamination on each of the surfaces. • While some of the most contaminated samples, including the toilet and the bathroom sink, they also found high levels of bacterial contamination on the TV remote and the bedside lamp switch. Most concerning, some of highest levels of contamination were found in items from the housekeepers' carts, including sponges and mops which pose a risk for cross-contamination of rooms. Surfaces with the lowest contamination included the headboard on the bed, curtain rods and the bathroom door handle. This preliminary study was limited by the sample size, which included only three rooms in each state and 19 surfaces within each hotel room, but hopes that it is just the beginning of a body of research that could offer a scientific basis to hotel housekeeping. • This research was presented as part of the 2012 General Meeting of the American Society for Microbiology held June 16-19, 2012 in San Francisco.

4. Community-Acquired MRSA Cases On the Rise in New York City, Study Suggests • During the study period 3,579 people were admitted to New York City hospitals with CA-MRSA. The rate of CA-MRSA increased from 113 people in 1997, a rate of about 1.5 cases per 100,000 people, to 875 admissions in 2006, a rate of 5.3 per 100,000. Overall, about 20 percent of all MRSA hospitalizations over the study period were community acquired. When compared with other hospitalizations in the study period, researchers noted that men, children, people with diabetes, people with HIV, and the homeless were more likely to be hospitalized with CA-MRSA than the general population. Residents of the Bronx also had substantially higher rates of CA-MRSA hospitalization than those of other New York City boroughs, likely impacted by a lack of access to primary care health services. The authors speculated at the increased risk associated with these demographics and co-morbidities. Skin infections and sores are common among people with HIV and diabetes and could open the door to MRSA infection. • Source: Amanda M. Farr, Brandon Aden, Don Weiss, Denis Nash, and Melissa A. Marx. Trends in Hospitalization for Community-Associated Methicillin-Resistant Staphylococcus aureus in New York City, 1997–2006: Data from New York State’s Statewide Planning and Research Cooperative System. Infection Control and Hospital Epidemiology, 33:7 (July 2012)

5. Officials investigate hepatitis C outbreak in N.H. – 10 cases • Nine patients and one hospital employee in New Hampshire have now been linked to an outbreak of hepatitis C at Exeter Hospital, NH • The hospital first announced the outbreak on May 31, after four people had been diagnosed with the same strain of the virus. The only apparent connection between those diagnoses is the hospital’s cardiac catheterization laboratory, prompting hospital officials to contact all 651 of the people that have been treated in the lab since August 2011. State health officials are examining all possible causes for the outbreak and the transmission of the disease within the lab. • Hepatitis C is a viral infection transmitted by blood. It causes inflammation of the liver that can lead to chronic health issues. It is passed from person to person through contact with an infected person's blood. While the official cause of the hepatitis C outbreak at Exeter Hospital has not been pinned down, officials say the most likely hypothesis is that a worker associated with the hospital’s cardiac catheterization lab used equipment as part of a drug habit and then reused them with patients to hide their misuse. • Source: Nashua Telegraph – June 17 2012

6. Hospital re-trains staff after contaminated instruments were used • Doctors and employees at Venice Regional Medical Center, in Venice, FL, have been going through "re-education" following state inspectors' discovery that contaminated surgical instruments were used at least twice in early March and that patients were not informed. • The investigative report said a surgical tool used for inserting a screw in a broken bone was not properly prepared before being sent to be sterilized, containing "biomatter" from a previous patient that should have been removed. When contamination is discovered, the surgery is typically halted and the room and equipment de-contaminated, according to the records. The unnamed surgeon in one of the cases told AHCA reviewers that the patient was 87 and bleeding heavily, and he was afraid it would be too dangerous to put the procedure on hold for 30 to 45 minutes. By law, patients must be notified of "adverse incidents." The unidentified physician told inspectors that "he was waiting for risk management to tell him whether he should tell the patient about the incident.“ The other patient apparently found out about the problem through an anonymous call from one of the hospital employees, the record shows. • Source: Herald Tribune

7. Dissecting the Dirty Instruments Issue in Healthcare Facilities • Processes- The complexity of surgical instrument design - many hard to reach areas which make cleaning challenging and difficult. - Manufacturers' instructions are not consistent, not easily obtained and are hard to read. - Some complex instrumentation cannot be disassembled for cleaning and inspection.- Loaner instrumentation is frequently brought in without consideration for in-servicing SPD staff on the recommended cleaning and sterilization.- Loaner instrumentation, in many instances, does not arrive in sufficient time for adequate processing prior to use.- Failure of facilities to consult with the sterile processing manager regarding potential purchases of instruments and devices to determine if the facility can comply with the IFUs (instructions for use).- Lack of sufficient instrument inventory – forces quick turnaround (taking short cuts) and immediate use sterilization. • Source: Article in Infection Control Today May 21 2012