Infection PreventioneBug Bytes

December 2015

Clostridium difficile

Harmful Bacteria Can Survive in Sandwich Crackers, Cookies for Months

• Researchers at the University of Georgia found that pathogens, like salmonella, can survive for at least six months in cookies and crackers. The recent study was prompted by an increased number of outbreaks of foodborne diseases linked to low-water-activity, or dry, foods. Researchers found that not only can harmful bacteria survive in dry foods, like cookie and cracker sandwiches, but they can also live for long periods of time. For the recent study, published in the Journal of Food Protection, researchers used five different serotypes of salmonella that had been isolated from foods involved in previous foodborne outbreaks.

• Focusing on cookie and cracker sandwiches, the researchers put the salmonella into four types of fillings found in cookies or crackers and placed them into storage. The researchers used cheese and peanut butter fillings for the cracker sandwiches and chocolate and vanilla fillings for the cookie sandwiches. These "are the kind that we find in grocery stores or vending machines," After storing, the UGA scientists determined how long salmonella was able to survive in each filling. There was survival in all types but salmonella survived longer in some types of the fillings than in others. The salmonella didn't survive as well in the cracker sandwiches as it did in the cookie sandwiches. In some cases, the pathogen was able to survive for at least to six months in the sandwiches. http://www. ncbi. nlm. nih. gov/ pubmed/ 26408131.

Drug-resistant bacteria carried by nursing home patients focus of study

• Miriam Hospital study found that a small percentage of nursing home patients carrying multi drug-resistant bacteria are admitted to hospitals without showing symptoms caused by the bacteria.

• The research, published in the American Journal of Infection Control, highlights the importance of hospital and nursing home infection control practices. Controlling the spread of such bacteria is paramount since infections caused by these microorganisms are associated with increased morbidity, mortality and cost. Mermel and colleagues documented patients admitted to Rhode Island Hospital and The Miriam Hospital from area nursing homes in 2012. They screened these patients for the presence of carbapenem-resistant Enterobacteriaceae (CRE) since there is little data in the medical literature regarding how prevalent these drug-resistant bacteria are among asymptomatic nursing home patients at the time of admission to hospitals.

• The researchers identified highly resistant bacteria in 23 of the 500 acute care hospital admissions from the nursing homes, seven of these were carbapenem-resistant Enterobacteriaceae. They found that the use of a feeding tube was associated with gastrointestinal carriage of these bacteria.

• Source: Screening of nursing home residents for colonization with carbapenem-resistant Enterobacteriaceae admitted to acute care hospitals: Incidence and risk factors. American Journal of Infection Control Dec (2015)

Rigid containers allowed bacterial contamination, while wrapped instrument trays tested had no detectable contamination• According to a new scientific study published in the December publication of the American Journal

of Infection Control, 87 percent of tested sterilized rigid containers - used in the sterilization of surgical instruments - allowed ingress of aerosolized bacteria under the test conditions used. This study calls into question the assumption that rigid containers, regardless of duration of use, can maintain the sterility of their contents post-sterilization. The two primary types of sterile packaging systems (SPS) include rigid containers and sterilization wrap. Rigid containers are reusable and come in a variety of materials (various metals, aluminum and polymers) and sizes, while single-use sterilization wrap is often composed of polypropylene. The study used a dynamic aerosol test method that allowed for air exchanges to occur in SPSs that may simulate normal air exchanges in hospital settings. The study found that: 1) Rigid containers, both used and unused, failed to maintain barrier performance under these test conditions: 87 percent (97 out of 111) of the rigid containers failed to maintain barrier performance, allowing ingress of the challenge microorganism. 2) Rigid containers with 5-9 years of use were significantly more likely to have bacterial ingress than unused rigid container. 3) Sterilization wraps provided no detectable ingress of bacteria: 100 percent (161 out of 161) of the wrapped trays using sterilization wrap maintained barrier performance, preventing any bacterial ingress and protecting sterility. Source: Sterility Maintenance Study: Dynamic Evaluation of Sterilized Rigid Containers and Wrapped Instrument Trays to Prevent Bacterial Ingress AJIC Dec 15

Nurse with TB may have exposed over 1,000 people, including 350 infants at Santa Clara Valley Medical Center

As many as 350 infants, 308 employees and 368 parents may have been exposed to tuberculosis after a San Jose, Calif-based Santa Clara Valley Medical Center maternity wing nurse was diagnosed with the disease, according to a news release from the hospital. "While it is very unlikely that infants who may have been exposed will come down with the disease, the consequences of infection in infants can be serious," the news release reads. "SCVMC will provide both diagnostic testing and preventative daily treatments of isoniazid, an antibiotic that kills tuberculosis and can successfully prevent infants from becoming ill. The 350 infants that may have been exposed will be monitored closely for signs of active tuberculosis. Moms and employees who may have been exposed will be screened and provided preventative treatment if needed.“ The hospital was notified mid-November that the nurse was suspected of having active tuberculosis, and the employee was placed on leave at that time.The patients the hospital is notifying of possible exposure are those who were in SCVMC's Mother & Infant Care Center between mid-August and mid-November of this year. The bacteria is contracted through the air, but only active strains are able to spread. Source: https://www.scvmc.org/newsroom/Pages/Tuberculosis-Exposure-Detected.aspx

Shingles isn't just nasty. It could kill you, too• Shingles isn't just a nasty and extremely painful experience. It can also cause strokes and

heart attacks. Researchers found elderly people who suffered a bout of the excruciating blisters were more than twice as likely to have a stroke in the first week after an attack started, and nearly twice as likely to have a heart attack. Shingles, also called herpes zoster, is a souvenir of childhood chicken pox infection. Both are caused by the same virus, although it's called varicella when it causes chicken pox. Like all herpes viruses, it stays in the body forever, moving along the nerves. Usually the immune system can control it after the first outbreak of chicken pox, but as people get older, or if they get cancer or another condition that depresses the immune system, it can erupt in a band of blisters. Unlike itchy chicken pox, shingles can cause months of pain after the blisters heal. Researchers from the London School of Hygiene and Tropical Medicine looked at the medical records of more than 67,000 U.S. Medicare patients who had shingles and suffered either a stroke or heart attack within a year afterwards. There are two possible causes, they said. The virus may be replicating inside the walls of the arteries, causing fatty buildups to break off and cause a stroke or heart attack. Or it might be the risks, the researchers said.

Wipes in the pipes: 'Flushable' wipes causing major plumbing problems• Holland, Mich. Don’t flush those wipes! Waste water officials are warning consumers that “flushable” wipes

aren’t so flushable. Tissues, paper towels and “flushable” wipes all remain intact to one degree or another and can clog up home drains and sewer lift stations, pumps and other areas down the line.

• Over the past five to 10 years, the Holland Board of Public Works has seen an increase in maintenance at its lift stations as a direct result of wipes “binding up” the works, according to Waste Water Treatment Plant Superintendent Joel Davenport. Three years ago, the municipal utility replaced its headworks facility at a cost of $5.3 million. The headworks sifts out large pieces of debris such as wipes. In the past two fiscal years, the headworks has removed about 450 tons (900,000 pounds) of material. Pumps partially plugged will continue to run, but are much less efficient, according to BPW documents. This requires them to run longer and increases the wear on the equipment. Toilet paper disperses after about 20 seconds, while wet wipes remained intact after 24 hours, according to a 2012 experiment by the Orange County California Sanitation District.

• “Flushable” has no legal definition, and the Federal Trade Commission does not regulate what products can carry the label. Both the wipes industry and utilities organizations are working to establish standards.

• Anything made of paper or cloth, the BPW terms “rags.” Paper towels, flushable wipes, even diapers and cloth towels are found in the sewer, Davenport said.

• “I don’t think most people realize toilet paper is designed so that as soon as you flush, it’s gone,” Davenport said. “The more durable it is when you use it, the harder it’s going to be to breakdown.”

Air travel and communicable diseases: Comprehensive federal plan needed for U.S. aviation system's preparedness

• A national aviation-preparedness plan would provide airports and airlines with an adaptable and scalable framework with which to align their individual plans-to help ensure that individual airport and airline plans work in accordance with one another. DOT and CDC officials agree that a national plan could add value. Such a plan would provide a mechanism for the public-health and aviation sectors to coordinate to more effectively prevent and control a communicable disease threat while minimizing unnecessary disruptions to the national aviation system.

• Employees at aviation services firms that GAO spoke with-including contract workers who clean aircraft-raised concerns about the availability of training and access to equipment to control exposure to communicable diseases. Some airports GAO reviewed developed additional mechanisms to ensure adequate training and preparation during the Ebola threat. A national aviation-preparedness plan could serve as the basis for testing communication mechanisms among responders to ensure those mechanisms are effective prior to a communicable disease outbreak as well as to provide the basis for ensuring that airport and airline staff receive appropriate training and equipment to reduce their risk of exposure to communicable diseases during an outbreak.

Our water pipes crawl with millions of bacteria

• Researchers from Lund University in Sweden have discovered that our drinking water is to a large extent purified by millions of "good bacteria" found in water pipes and purification plants. So far, the knowledge about them has been practically non-existent, but this new research is about to change that. A glass of clean drinking water actually contains ten million bacteria. But that is as it should be -- clean tap water always contains harmless bacteria. These bacteria and other microbes grow in the drinking water treatment plant and on the inside of our water pipes, which can be seen in the form of a thin, sticky coating -- a so-called biofilm. All surfaces from the raw water intake to the tap are covered in this biofilm. The diversity of species of bacteria in water pipes is huge, and that bacteria may play a larger role than previously thought. Among other things, the researchers suspect that a large part of water purification takes place in the pipes and not only in water purification plants. A previously completely unknown ecosystem has revealed itself to us. Formerly, you could hardly see any bacteria at all and now, thanks to techniques such as massive DNA sequencing and flow cytometry, we suddenly see eighty thousand bacteria per millilitre in drinking water. We suspect there are 'good' bacteria that help purify the water and keep it safe -- similar to what happens in our bodies. Our intestines are full of bacteria, and most the time when we are healthy, they help us digest our food and fight illness. Although the research was conducted in southern Sweden, bacteria and biofilms are found all over the world, in plumbing, taps and water pipes. This knowledge will be very useful for countries when updating and improving their water pipe systems. Source: Microbes and Environments 2015; 30 (1): 99

28 states ill-prepared for infectious disease outbreak

• The report graded states on 10 key indicators surrounding various types of outbreaks, including flu vaccination rates and vaccine requirements for schools, HIV/AIDS surveillance, climate change adaptation plans and E. coli testing rates.

• Five states — Delaware, Kentucky, Maine, New York and Virginia — tied for the high score of passing eight of the 10 indicators.

• But 28 states and the District of Columbia fared much worse. Below is a breakdown of their scores:

• Five out of 10: Arizona, Colorado, Connecticut, Georgia, Hawaii, Mississippi, Missouri, Montana, Pennsylvania, Rhode Island, Texas, Washington

• Four out of 10: Alabama, the District, Florida, Indiana, Louisiana, Nevada, South Carolina, South Dakota, Tennessee, Wyoming

• Three out of 10: Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon, Utah• "We need to reboot our approach so we support the health of every community by being

ready when new infectious threats emerge," said Paul Kuehnert, a RWJF director. Source: http://www.abqjournal.com/691445/news-around-the-region/whooping-cough-on-the-rise-in-san-juan-county.html

2 states report whooping cough outbreaks

• Areas of Minnesota and New Mexico are in the midst of pertussis, or whooping cough, outbreaks, according to their departments of public health. Minnesota public health officials reported to WCCO that there have been 36 confirmed cases in Olmsted County in the last six weeks. Olmsted County contains Rochester, where the Mayo Clinic is located. The number of cases jumps to 76 when confirmed, probable and suspected whooping cough cases are included. In New Mexico, officials have recorded seven confirmed and probable cases of the illness and 11 more suspected cases in San Juan County, according to the Albuquerque Journal. Whooping cough cases appear to be on the rise across the country, according to CDC data. In 2014, there were 32,971 confirmed cases of pertussis reported to the agency, a 15 percent increase from 2013. Last year, California experienced a major whooping cough outbreak, consisting of 9,935 cases reported in the state from Jan. 1 to Nov. 26. Officials from the state's department of public health blamed the epidemic on fewer people receiving the whooping cough vaccine. Pertussis can be a serious illness in babies, children, teens and adults, according to the CDC. The agency says the most effective way to prevent whooping cough is through vaccination.

Chipotle hit with another E. Coli outbreak• The Centers for Disease Control and Prevention (CDC) said Monday it is

investigating another recent E. coli outbreak linked to Chipotle.• Five people have been infected with a different, rare E. coli strain, health

officials said. All of them reported eating at the Mexican grill chain in the week before coming down with the illness in November. The cases were identified in Kansas, North Dakota and Oklahoma, the CDC said.

• It's unclear if the infections are related to the earlier outbreak, which has affected 53 people in nine states, health officials said. At least 43 of them had reported eating at Chipotle in the week leading up to their illness.

• Chipotle has increased its food safety measures, which include testing all local produce before it gets to the restaurants and testing the quality of ingredients throughout their shelf life.

• http://time.com/4157690/chipotle-ecoli-outbreak-cdc/

How a medical device maker kept U.S. hospitals in the dark about deadly infections

• The hunt for a deadly superbug that sickened 22 patients at a Dutch hospital began just before noon on a spring day in 2012. Inside a lab in the tiny hamlet of Zoeterwoude, a technician carefully peeled back the tip of a state-of-the art medical scope. Watching him intently was a small group of hospital officials and executives from Olympus Corp., the maker of the device. The Olympus technician found trouble right away. He spotted a brown, grimy film inside parts of the flexible, snake-like scope - parts that were supposed to be sealed. A rubber ring designed to keep bacteria out was cracked and worn. The same bacteria that had sickened the patients were found on the scope. An investigator hired by Olympus and the hospital concluded that the scope's design could allow blood and tissue to become trapped, spreading bacteria from one patient to another. In his report, he called on Olympus to conduct a worldwide investigation and recall all its scopes if similar problems turned up. Over the next three years, 21 people died and at least two dozen more became ill from infections related to scopes in Pittsburgh, Seattle and Los Angeles. An unknown number of other patients have been infected. The Food and Drug Administration has identified 10 outbreaks, seven of which involve Olympus scopes.

• After each outbreak, Olympus contended that its scopes did not cause the infections and blamed the hospitals for not cleaning them properly. The company treated each case as an isolated incident, not telling the U.S. hospitals that they weren't alone.

• Source: http://graphics.latimes.com/superbug-scope/

Costco E. coli outbreak appears to be over according to CDC

• An outbreak of E. coli linked to rotisserie chicken salad sold by warehouse club operator Costco Wholesale Corp appears to be over, the U.S. Centers for Disease Control (CDC) said on Tuesday. The most recent illness in this outbreak reported to CDC started on Nov. 3. The U.S. Food and Drug Administration conducted a trace back investigation to determine which ingredient was linked to the illnesses, but the probe could not identify a common source of contamination, the CDC said. Five of the 19 sickened people were hospitalized and two developed a type of kidney failure associated with the E. coli strain, STEC O157:H7. No deaths were reported and the infections occurred in Montana, Utah, Colorado, California, Missouri, Virginia and Washington, the CDC said. The Costco outbreak was initially traced to a celery-and-onion mix made by Taylor Farms Pacific Inc used in making the chicken salad. Taylor Farms, a major producer of fresh-cut vegetables and bagged salads, last month recalled more than 154,000 lots of numerous products from various grocery store chains in 17 states "out of an abundance of caution". Products were recalled from chains including Costco, Safeway, Starbucks Corp, Wal-Mart Stores Inc, and Target Corp. Source: http://news.yahoo.com/costco-e-coli-outbreak-appears-over-cdc-174159650--sector.html

• The most recent illness in this outbreak reported to CDC started on Nov. 3, the federal agency said.

• The U.S. Food and Drug Administration conducted a traceback investigation to determine which ingredient was linked to the illnesses, but the probe could not identify a common source of contamination, the CDC said. (http://1.usa.gov/1lI5Sgt)

• Five of the 19 sickened people were hospitalized and two developed a type of kidney failure associated with the E. coli strain, STEC O157:H7, the CDC said.

• No deaths were reported and the infections occurred in Montana, Utah, Colorado, California, Missouri, Virginia and Washington, the CDC said.

• The Costco incident is the latest E. coli outbreak where the source is unknown

CDC: Source of UPMC mold that killed 3 could not be found

• Pennsylvania Secretary of Health Karen Murphy issued a statement on the CDC preliminary report on an infection cluster found at the University of Pittsburgh Medical Center (UPMC). In September 2015, the Department of Health asked the CDC to investigate a cluster of four cases of mucormycosis, a rare infection caused by a group of environmental molds. The infections occurred over the course of a year among organ transplant recipients at the University of Pittsburgh Medical Center (UPMC). These infections are not spread person to person and are usually acquired through inhaling mold spores in the air. Transplant patients are at increased risk of infection because their immune systems have been suppressed or weakened. The on-site investigation conducted by the CDC in collaboration with the state Department of Health and Allegheny County Department of Health was completed on October 7. No additional infections were identified, and no single source has thus far been found to account for all four reported cases. Three of the four infected patients spent a significant amount of their hospitalizations in the same intensive care unit room. The room was known as a "negative pressure room," which is designed to draw air from outside the room into the room and may have exposed patients to mold spores that were present in the surrounding environment. Environmental testing of the room by the CDC team identified some common environmental molds but no mucormycetes. The unit in which the room was located had already been closed at the time of the investigation and was undergoing remediation to address any potential mold sources that limited the testing that could be performed. Source: http://www.prnewswire.com/news-releases/department-of-health-issues-statement-on-cdc-report-on-infection-cluster-at-university-of-pittsburgh-medical-center-300196343.html