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January 2012

CDC Clinical Reminder: Insulin Pens Must CDC Clinical Reminder: Insulin Pens Must

Never Be Used for More than One PersonNever Be Used for More than One Person Insulin pens containing multiple doses of insulin are meant for use on a single person only, and should never be used for more than one person, even when the needle is changed.

Insulin pens should be clearly labeled with the person’s name or other identifying information to ensure that the correct pen is used only on the correct individual.

Hospitals and other facilities should review their policies and educate their staff regarding safe use of insulin pens and similar devices.

If reuse is identified, exposed persons should be promptly notified and offered appropriate follow-up including bloodborne pathogen testing.

These recommendations apply to any setting where insulin pens are used, including assisted living or residential care facilities, skilled nursing facilities, clinics, health fairs, shelters, detention facilities, senior centers, schools, and camps as well as licensed healthcare facilities. Use of insulin pens for more than one person, like other forms of syringe reuse imposes unacceptable risks and should be considered a 'never event'.

References : Sonoki K, Yoshinari M, Iwase M, Tashiro K, Iino K, Wakisaka M, Fujishima M. Regurgitation of blood into insulin cartridges in the pen-like injectors. Diabetes Care. 2001;24(3):603-4.

Researchers analyzed more than 5,100 patients in a heart surgery registry. Patients, average age 64, were treated at nine U.S. academic medical centers and one Canadian center. The median time to major infection was 14 days after heart surgeries. Forty-three percent of all major infections occurred after hospital discharge. In this study, which excluded patients who were infected before surgery, researchers found 761 infections: 300 were classified as major infections (occurring in 6 percent of patients) and 461 were minor (in 8.1 percent of patients). Of the major infections:

Pneumonia, infection of the lungs, occurred in 2.4 percent of all patients.

C. difficile colitis, an intestinal infection, occurred in 1.0 percent. Bloodstream infections occurred in 1.1 percent. Deep-incision surgical site infections occurred in 0.5 percent. Minor infections included urinary tract and superficial incision site

infections. References: Presented at the American Heart Association's

Scientific Sessions 2011

Pneumonia Most Common Pneumonia Most Common Infection After Heart SurgeryInfection After Heart Surgery

'Brain-Eating' 'Brain-Eating' amoeba kills second amoeba kills second neti pot userneti pot user

Louisiana state health officials are warning patients about potential dangers of using tap water in the sinus-irrigating neti pot after two patients died of Naegleria fowleri infection. N. fowleri is known as a "brain-eating" amoeba because it can enter a patient's nose, infect the brain, and cause primary amebic meningoencephalitis (PAM), a brain-tissue destroying condition. The first Louisiana patient died of neti pot-induced infection in June. An additional two patients died of N. fowleri infection in August after swimming in warm, fresh water.

Patients that irrigate their noses with a neti pot should use distilled, sterile, or previously boiled water

Symptoms of PAM include headache, fever, nausea, vomiting, and stiff neck, and may take one to seven days to start. Later symptoms include confusion, lack of attention to environment, loss of balance, seizures, hallucinations, and, in one to 12 days after infection, death.

Source: MedPage Today - December 29, 2011

The Centers for Disease Control and Prevention (CDC) have identified two novel flu infections, including an H1N1 variant previously not

reported in humans and a novel H3N2 variant identified in 11 patients. The novel H1N1 virus is a triple-reassortant that has acquired the M gene of the 2009 H1N1 virus and has sickened an adult in Wisconsin who had occupational contact with swine

From August 17 to December 23, 2011, CDC received reports of 12 human infections with influenza A (H3N2)v viruses that have the matrix (M) gene from the influenza A (H1N1) virus (formerly called swine-origin influenza A [H3N2] and pandemic influenza A [H1N1] 2009 viruses, respectively. The 12 cases occurred in five states (Indiana, Iowa, Maine, Pennsylvania, and West Virginia), and 11 were in children. Six of the 12 patients had no identified recent exposure to swine. Three of the 12 patients were hospitalized, and all have recovered fully.

A case in an adult male in Indiana with occupational exposure to swine was among the 12, and two children in West Virginia who regularly attended the same day care accounted for the latest cases. This report describes those cases and swine influenza virus (SIV) surveillance being conducted by the U.S. Department of Agriculture (USDA). MMWR: December 23, 2011

CDC reports two novel flu infectionsCDC reports two novel flu infections

Microbial Communities on Skin Microbial Communities on Skin Affect Humans' Attractiveness to Affect Humans' Attractiveness to MosquitoesMosquitoes

The microbes on your skin determine how attractive you are to mosquitoes, which may have important implications for malaria transmission and prevention. Without bacteria, human sweat is odorless to the human nose, so the microbial communities on the skin play a key role in producing each individual's specific body odor.

The researchers conducted their experiments with the Anopheles gambiae sensu stricto mosquito, which plays an important role in malaria transmission. They found that individuals with a higher abundance but lower diversity of bacteria on their skin were more attractive to this particular mosquito. They speculate individuals with more diverse skin microbiota may host a selective group of bacteria that emits compounds to interfere with the normal attraction of mosquitoes to their human hosts, making these individuals less attractive, and therefore lower risk to contracting malaria. This finding may lead to the development of personalized methods for malaria prevention.

Reference: Verhulst NO, Qiu YT, Beijleveld H, Maliepaard C, Knights D, et al. (2011) Composition of Human Skin Microbiota Affects Attractiveness to Malaria Mosquitoes. PLoS ONE 6(12): e28991. doi:10.1371/journal.pone.0028991

Over-reliance on gloves leads to Over-reliance on gloves leads to poor worker hand hygienepoor worker hand hygiene

Stone and his colleagues observed more than 7,000 patient contacts in 56 ICUs and geriatric care units in 15 hospitals. They found that proper hand hygiene compliance rates were “disappointingly” low, at 47.7% — a statistic, experts contend, that contributes to the costs associated with healthcare-associated infections.

Proper hand hygiene protocol includes changing gloves and washing one's hands. Hands can be contaminated by “back spray” when gloves are removed after contact with bodily fluid, researchers said.

Some germs can get through latex gloves, investigators note. Stone and his team suggested that more studies are needed to determine behavioral reasons behind poor hand hygiene habits.

The study, “The Dirty Hand in the Latex Glove: A Study of Hand-Hygiene Compliance When Gloves Are Worn,” was published in the December issue of Infection Control and Hospital Epidemiology.From the January 2012 Issue of McKnight's Long Term Care News

Temporary central venous catheter Temporary central venous catheter utilization patterns in a large tertiary utilization patterns in a large tertiary care centercare center Intravenous literature: Tejedor, S., Tong, D., Stein, J., Payne, C.,

Dressler, D., Xue, W. and Steinberg, J.P. (2012) Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “idle central venous catheter”. Infection Control & Hospital Epidemiology. 33(1), p.50-7.

Abstract:Objectives: Although central venous catheter (CVC) dwell time is a major risk factor for catheter-related bloodstream infections (CR-BSIs), few studies reveal how often CVCs are retained when not needed (“idle”). We describe use patterns for temporary CVCs, including peripherally inserted central catheters (PICCs), on non-ICU wards.

Design: A retrospective observational study. Setting: A 579-bed acute care, academic tertiary care facility.

See next slide for results and conclusions

Temporary central venous catheter Temporary central venous catheter utilization patterns in a large tertiary utilization patterns in a large tertiary care centercare center Methods: A retrospective observational study of a random sample of patients on hospital wards who have a temporary, nonimplanted CVC, with a focus on on daily ward CVC justification. A uniform definition of idle CVC-days was used.

Results: We analyzed 89 patients with 146 CVCs (56% of which were PICCs); of 1,433 ward CVC-days, 361 (25.2%) were idle. At least 1 idle day was observed for 63% of patients. Patients had a mean of 4.1 idle days and a mean of 3.4 days with both a CVC and a peripheral intravenous catheter (PIV). After adjusting for ward length of stay, mean CVC dwell time was 14.4 days for patients with PICCs versus 9.0 days for patients with non-PICC temporary CVCs (other CVCs; [Formula: see text]). Patients with a PICC had 5.4 days in which they also had a PIV, compared with 10 days in other CVC patients ([Formula: see text]). Patients with PICCs had more days in which the only justification for the CVC was intravenous administration of antimicrobial agents (8.5 vs 1.6 days; [Formula: see text]).

Conclusions: Significant proportions of ward CVC-days were unjustified. Reducing “idle CVC-days” and facilitating the appropriate use of PIVs may reduce CVC-days and CR-BSI risk.

Legionnaires' Disease Outbreak Linked to Hospital's Decorative Fountain

Environmental testing within the hospital detected notable amounts of Legionella in samples collected from the “water wall” decorative fountain located in the hospital’s main lobby.

The investigation revealed that all eight patients had spent time in the main lobby where the fountain is located. This, along with the proximity of each patient’s onset of illness and the degree of Legionella contamination in the fountain strongly support the conclusion that the decorative fountain was the source of the outbreak. Hospital officials quickly shut down the fountain when it was first suspected as a source, and notified staff and approximately 4,000 potentially exposed patients and visitors. Prior to the investigation, the decorative fountain underwent routine cleaning and maintenance. Since this investigation, many healthcare facilities in Wisconsin shut down or removed decorative fountains in their facilities, while others enhanced their regular testing protocols to reduce the risk of Legionnaires’ disease, the researchers report.

Reference: Haupt TE, et al. An outbreak of Legionnaires disease associated with a decorative water wall fountain in a hospital. Infection Control and Hospital Epidemiology. 33:2. February 2012.