2004 Infection Control Year in Review

2004 Infection Control Year in Review

By Kelly M. Pyrek

It was a busy year for public health officials, infectious diseases physicians, infection control practitioners, and anyone else concerned about the genesis and transmission of life-threatening pathogens. Heres a look at some of the most interesting and notable events, trends, discoveries and guidelines-related announcements of 2004. For more than 1,000 other infection control-related news items published this year on ICTs Web site, go to www.infectioncontroltoday.com.

January

New British Study Says Nurses Wash Their Hands More Often Than Doctors

Nurses are more conscientious handwashers than doctors, reported a study in the British Medical Journal. Identical soap dispensers were installed next to the sinks in the consulting room of each member of a primary-care hospital. The soap dispensers were all filled to the same level on the same day at the start of the study. Over one year, the amount of soap used and the number of consultations for each member of the team were recorded to calculate the ratio of handwashes to patients seen. Nursing staff showed greater attention to personal hygiene than doctors. The best-performing nurse washed her hands at least twice as often as the best-performing doctor.

February

APIC Appoints Kathy L. Warye as Executive Director

The Association for Professionals in Infection Control and Epidemiology (APIC) announced the appointment of Kathy L. Warye as the organizations executive director. Warye has more than two decades of non-profit experience and has held key positions in the management of high-profile organizations in the Washington, D.C. area. Previously, Warye served as senior vice president of education and government programs for the Association for the Advancement of Medical Instrumentation (AAMI). APIC is a repository of considerable infection control expertise, and one of my primary goals is to ensure that we continue to effectively leverage this resource to benefit healthcare professionals and the public, she said.

Scientists Identify a Human Antibody That Blocks SARS Virus Infection

An antibody plucked from a library of human antibodies blocked infection by the SARS virus in laboratory tests, scientists at Dana-Farber Cancer Institute reported. This discovery could expedite the development of an antibody drug for the prevention or early treatment of SARS, which killed nearly 800 people in a global outbreak last year.

Researchers from Dana-Farber, Brigham and Womens Hospital, the CDC and Childrens Hospital Boston discovered that the antibody neutralized SARS infection in a laboratory setting by blocking the virus from entering cultured cells. The experiments are continuing in animal models of SARS, and the researchers are discussing future trials in humans.

April

Polio Victory Remembered on 50th Anniversary of Salk Vaccine Field Trials

Fifty years ago, thousands of parents drove their school-age children to designated sites across the country for immunizations of an experimental vaccine that they hoped would stop, once and for all, the raging polio epidemic that was leaving young Americans paralyzed and sometimes dead. Organized and funded by the March of Dimes, this was the largest voluntary clinical trial ever undertaken. One year later, the Salk vaccine was declared safe, potent and effective. Within only a few years, polio rates in the United States had dropped dramatically. Polio has since been eliminated from the Western Hemisphere and the World Health Organization hopes polio will be eliminated from the world by 2005.

New Drug-resistant Strain of Salmonella is Identified

Researchers from Taiwan reported the identification of a new form of drug-resistant salmonella bacterium in The Lancet. Salmonella enterica serotype choleraesuis usually causes infections that require antimicrobial treatment. Multidrug-resistant strains have been identified, but the antimicrobial ceftriaxone has been effective against them so far. Professor JT Ou, from the Chang Gung University College of Medicine in Taoyuan, Taiwan, isolated a strain of Salmonella enterica serotype choleraesuis that was resistant to all antimicrobials commonly used to treat salmonellosis, including ceftriaxone and ciprofloxacin. The bacterium came from a 58-year-old man with sepsis who subsequently died.

CDC Issues New Guidelines for Preventing Healthcare- Associated Pneumonia

The CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) released new recommendations regarding healthcare-associated pneumonia. The guidelines update, expand, and replace the previously published CDC Guideline for Prevention of Nosocomial Pneumonia. The new guidelines were designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in all settings where healthcare is provided.

Brookdale University Hospital and Medical Center Receives Industry Honors for Long-Term Infection Control Study

Brookdale University Hospital and Medical Center gained national honors for a long-term study showing promise in reducing the incidence of bloodstream infections. The study, conducted over a three-year period, outlined Brookdales efforts to reduce central venous catheter (CVC)-related bloodstream infections by implementing the CDC and HICPAC recommendations.

June

Research Shows Promise for Development of Human SARS Immunization

Research published in The Lancet provided evidence for the effectiveness of experimental SARS immunization in animal studies. Although further research is required, these preliminary results showed the potential for the development of human SARS immunization. Alexander Bukreyev from the U.S. National Institutes of Health and colleagues immunized eight African green monkeys, four with a single dose of an intranasal vaccine derived from an experimental pediatric parainfluenza vaccine, the other four with a control. All monkeys were deliberately infected with SARS coronavirus one month after immunization. The monkeys given the SARS vaccine had antibodies to the SARS coronavirus in their blood indicating an immune response to vaccination; none of these monkeys had evidence of viral shedding. By contrast, all four monkeys in the control group had evidence of viral shedding between five and eight days after infection with the SARS coronavirus.

New Jersey Mandates Certification of Central Service Professionals

The International Association of Healthcare Central Service Materiel Management (IAHCSMM) reported that New Jersey officially became the first state to mandate certification of central service professionals. The law was approved by the New Jersey Healthcare Advisory Board on June 17, 2004. Under the new law, existing CS technicians will have five years to become certified, and new hires will have three years. Those in the ambulatory care setting will have two years to complete the requirement. The law stipulates that sterile processing managers must become certified immediately. It took three years, but it has finally been made official, said Anthony T. Monaco, coordinator for New Jerseys Department of Health and Senior Services. This law will help legitimize the profession by recognizing the critical role CS professionals play in patient care and ensuring that these individuals obtain certification that will help them perform their jobs.

Researchers Report That SARS Has Been Found in Tears

SARS has been found in tears, revealed a small study in the British Journal of Ophthalmology. The finding suggests that tear analysis could not only be an effective means of diagnosing the infection, but also an unrecognized source of its spread, if appropriate preventive measures are not taken, the authors said. Tear samples were swabbed from the tear ducts of 36 patients in Singapore with suspected SARS over 12 days in April 2003. Most of those thought to have the infection were healthcare workers, including nurses. Eight of these patients subsequently turned out to have probable SARS.

Russian Researcher Dies After Contact With Ebola Virus

A researcher in a Siberian virology laboratory died after pricking herself with a syringe containing Ebola virus. Most outbreaks have occurred in Africa, far from the Siberian lab where the senior technician was experimenting on guinea pigs when the accident happened on May 5, 2004. She died several weeks later. The state-owned vector research center at Novosibirsk, located in Siberia, conducts research into deadly diseases such as SARS and anthrax. Along with the CDC, the laboratory is one of only two places with official stockpiles of smallpox, which killed around 300 million people in the last century. After the accident, the woman was hospitalized in a ward specially equipped to contain virulent diseases. Anyone who came into contact with her was put under observation for three weeks.

Clash of the Guidelines: HICPAC and SHEA Debate the Standard of Care

Attendees of the 31st annual meeting of APIC were treated to a lively discussion of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and Society for Healthcare Epidemiology of America (SHEA) guidelines by William Jarvis, MD and William Scheckler, MD, in the first-ever Science to Practice session, sponsored by 3M Health Care. The topic was HICPAC/SHEA: Conflicting Guidelines ... What is the Standard of Care? During this symposium held on June 9, 2004, revisions to the HICPAC Guideline to Prevent Transmission of Infectious Agents in Healthcare Settings were reviewed, and the differences between this document and the SHEA Guideline for Preventing Nosocomial Transmission of Multi-drug Resistant Strains of Staphylococcus aureus and Enterococcus were debated. 3M Health Care provided about 300 members of the audience with a wireless transmitter device capable of registering individuals votes after the debate between Jarvis and Scheckler. When asked if they agreed with the concepts put forth by the SHEA guidelines, 26 percent of those with transmitters agreed; 28 percent disagreed, and 46 percent were undecided. When asked if they agreed with the concepts put forth by the HICPAC guidelines, 28 percent of those with transmitters agreed, 17 percent disagreed, and 55 percent were undecided. When asked if they thought either guidelines were valid, 51 percent of those with transmitters agreed, 22 percent disagreed, and 27 percent had no opinion.

Scope Scare at New York Hospital

The New York Times broke the story that North Shore University Hospital in Manhasset, N.Y., may have exposed patients to HIV and hepatitis virus because instruments used for routine endoscopies might not have been properly disinfected. The story, originally published on June 16, 2004, reported that hospital officials discovered a 12-day stretch beginning April 28 during which there was no record of employees having tested disinfectant used to clean the scopes. Letters were sent out to the 177 patients who had undergone endoscopic procedures during that time period, recommending testing for hepatitis B, hepatitis C and HIV. According to the Times article, Terry Lynam, a spokesman for the North Shore-Long Island Jewish Health System said, The letter was undoubtedly unsettling. But were trying to ease those concerns by raising what is a miniscule likelihood that any of these infections could be transmitted. This is the first time its ever happened at this hospital.

July

National Time Out Day Celebrates Adoption of First Universal Protocol to Prevent Errors in U.S. Operating Rooms

For the first time, nurses, surgeons and accredited hospitals throughout the country were required to adopt a common set of operating room procedures in an effort to eliminate the alarming number of deaths and injuries due to wrong-site, wrong-procedure, and wrong-person surgeries. Six national healthcare organizations and associations, led by the Association of periOperative Registered Nurses (AORN), joined together to promote the adoption of the Joint Commission on Accreditation of Healthcare Organizations Universal Protocol for preventing wrong-site surgery errors in U.S. operating rooms. To promote the new requirements, surgeons, perioperative nurses, anesthesiologists and other members of the healthcare team declared June 23, 2004 as National Time Out Day. On July 1, 2004, all JCAHO-accredited hospitals, ambulatory care and office-based surgery facilities were required to take a time out before a surgery began.

Illinois Governor Signs Bill Allowing HIV-Infected Individuals to Donate Organs

Illinois became the first state in the country to allow organ donations by people who are HIV positive when Gov. Rod R. Blagojevich signed House Bill 3857. The new law, sponsored by state Rep. Larry McKeon (D-Chicago), allows the organs of an HIV-positive donor to be transplanted into others who are also infected with the disease. While there are other states that have begun to look into organ transplants from HIV-positive donors, Illinois is the first to make it legal.

Mystery Infection Kills Teenager Recovering From a Bone Marrow Transplant

Public-health officials at the Health Protection Agency in the UK investigated the death of a 14- year-old boy who contracted a mystery infection while he was recovering from a bone marrow transplant at a hospital. Five other young recipients of bone marrow were in the ICU following the development of similar respiratory symptoms. Three of the patients were described as seriously ill, while two patients showed improvement. A section of the high-dependency bone marrow unit was closed. Officials considered the possibility that the patients were the victims of a combination of several deadly pathogens, instead of one microscopic culprit. MRSA, TB and mumps were ruled out as possible infective agents.

Pertussis Cases on the Rise Nationally

The number of cases of pertussis were on the rise in 2004. A preliminary count by the CDC identified more than 11,000 cases last year in the U.S., up from 9,771 in 2002. This number, which the CDC admits is almost certainly an underestimate, is the highest recorded in three decades. Most people assume whooping cough has gone the way of polio and the measles, says Jeanne Pfeiffer, RN, MPH, CIC, president of APIC. But there are up to 50 million cases of whooping cough worldwide each year and more than 350,000 deaths associated with it. With minimal effort in the United States, we can greatly reduce the chances of our children contracting pertussis.

CDC Confirms First Reported Cases of Rabies Transmission Through Solid Organ Transplantation

The CDC confirmed the first reported cases of rabies transmission through solid organ transplantation. Confirmation came from laboratory testing of autopsy specimens after the deaths of three persons who had received organ transplants from the same donor. The organ donor, an Arkansas resident, had undergone routine donor eligibility screening and testing, but rabies testing is not part of the routine screening process. Lungs, kidneys, and liver were recovered and later transplanted on May 4, 2004 into four recipients, one of whom (the lung transplant patient) died during transplant surgery. No other organs or tissues were recovered from the donor.

Infectious Disease Experts Issue Report Stressing the Need to Improve Low Influenza Vaccination Rates Among HCWs

The National Foundation for Infectious Diseases (NFID) issued a comprehensive report stressing the importance of annual influenza vaccination among HCWs and urged healthcare institutions to help facilitate annual employee influenza immunization programs. The report was issued in response to dismal influenza immunization rates among HCWs, despite longstanding recommendations from the CDC. Alarmingly, only 36 percent of U.S. HCWs are immunized against influenza each year, which means the majority of HCWs remain unprotected and may report to work when they have influenza and can easily spread the virus to patients, said William Schaffner, MD, NFID board member, and professor and chair of the department of preventive medicine at Vanderbilt University School of Medicine. The report, Improving Influenza Vaccination Rates in Health Care Workers: Strategies to Increase Protection for Workers and Patients, provided details about the overall impact of influenza among HCWs and shares data regarding the lack of knowledge among HCWs about influenza immunization and its impact on patient safety.

Surveys Finds Americans are Concerned About Hospital-Based Medical and Surgical Errors

Hospital-based medication, surgical and diagnostic errors are of concern to most Americans, according to the results of a Harris poll of 2,847 U.S. adults conducted online. Three in five Americans were extremely concerned (39 percent) or very concerned (24 percent) about hospital-based medication errors, such as receiving the wrong medication or the wrong dose, and 55 percent are concerned about hospital-based surgical errors that might include incorrect amputations or mistaken patient identities.

MRSA Contamination Can Be Reduced by Using Copper Alloys for Surfaces in Healthcare Facilities

In a study co-funded by the International Copper Association and Copper Development Association Inc., Bill Keevil, head of the environmental healthcare unit in the University of Southamptons School of Biological Sciences, and Dr. Jonathan Noyce examined the survival rates of methicillin-resistant Staphylococcus aureus on stainless steel, the most commonly used metal in healthcare facilities, and on selected copper alloys. They found that at room temperature, MRSA was able to persist and remain viable in dried deposits on stainless steel for periods up to 72 hours. For copper alloys containing 55 percent, 80 percent, and 99 percent copper, significant reductions in viability were achieved after 4.5 hours, 3 hours, and 1.5 hours, respectively. Yellow brass rendered the bacteria completely inviable after 270 minutes, while the high-copper alloy took only 90 minutes. Our results strongly indicate that use of the copper metals in such applications as door knobs, push plates, fittings, fixtures and work surfaces would considerably mitigate MRSA in hospitals and reduce the risk of cross-contamination between staff and patients in critical care areas, said Keevil.

August

New York Hospitals Take Aim at Surgical Infections

New York hospitals were expected to take a leading role in adopting new national guidelines that address the prevention of surgery-related infections. The guidelines, which represent unprecedented consensus among 20 of the nations largest surgical, medical and hospital associations, are the result of a year-long effort by these groups to identify best practices for preventing surgical site infections. We believe this consensus statement will lead to greater clarity for health professionals on proper antibiotic use, and will help in our quality improvement efforts, said Charles E. Stimler, MD, MPH, medical officer for IPRO. We will leverage this consensus as we continue to work with the New York Surgical Infection Prevention Collaborative and the states hospitals to save lives and reduce unnecessary hospitalizations. Stimler and the IPRO quality improvement team are leading the Collaborative as part of Medicares National Surgical Infection Prevention (SIP) Project, an ongoing, three-year-old initiative co-sponsored by CMS and the CDC. The SIP Projects goal is to reduce the occurrence of post-operative infection by improving the selection and timing of preventive antibiotic administration.

OSHA Issues Final Rule on Respiratory Protection; Revised Standard Adds a New Fit-Testing Protocol

The Occupational Safety and Health Administration (OSHA) announced an addition to the approved fit-testing protocol in its Respiratory Protection Standard. The revision added a new quantitative fit-testing procedure to assist workers and employers in the proper fit and selection of respirators. Selecting the proper respirator is a vital step in protecting a user against potential over-exposures and adverse health effects, said OSHA administrator John Henshaw. The additional fit-testing protocol will help employers and employees to select the right respirator based on the conditions in their workplaces. The new fit-testing protocol, referred to as the Controlled Negative Pressure (CNP) REDON protocol, requires three different test exercises followed by two re-donnings of the respirator.

Lassa Fever Claims Life of New Jersey Man

The New Jersey Department of Health reported that a 38-year-old Mercer County man died from an acute viral disease called Lassa fever, a condition that is rare in the U.S., but endemic to West Africa. The man had traveled to Liberia, where he stayed for several months, before returning to the U.S. After arriving in New Jersey and spending several hours at his home, the man presented at the emergency department with symptoms of nausea, vomiting, headache, fever and myalgia. He was admitted and died four days later. Lassa fever is an acute viral disease that is endemic in portions of West Africa. The disease is animalborne and is transmitted to humans through contact with urine or droppings of infected rodents; it can also be transmitted from person- to-person through blood or bodily fluid that penetrates the skin, through mucous membrane or through sexual contact. Overall, death is rare in patients who contract Lassa fever, with only 1 percent of all cases resulting in death. However, between 15 percent to 20 percent of patients hospitalized with Lassa fever die. The last case in the U.S. was in 1989.

OSHA Issues Revised Document on Catheter Securement

OSHA posted to its Web site a revision to its online Securing Medical Catheters fact sheet. The revised OSHA document now requires all healthcare facilities to conduct annual reviews of their catheter-securement processes to ensure the institution is using the safest system possible in order to reduce or eliminate needlesticks. The document emphasized, In this review, employers must include the input of non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls.

Clostridium difficile Death Puts Hospitals in Ontario on Notice

The death of a patient at Southlake Regional Health Centre in Newmarket put Ontarios hospitals and long-term care facilities on high alert. Clostridium difficile, which is responsible for 79 deaths in Montreal and 10 in Calgary, has the potential to sweep through Ontarios hospital system, said Michael Hurley, president of CUPEs Ontario Council of Hospital Unions. The infection control system failures highlighted by SARS have not been significantly corrected and no additional resources have been dedicated to hospital cleaning. During the SARS crisis, the organism lived on an unwashed surface in a hospital for 30 days, before spreading to a patient who then transferred to another facility. Fifteen years of cuts to hospital cleaning budgets have left many institutions unable to eliminate virulent organisms like C difficile. And these cuts are compounded by multiple patient transfers between institutions and the huge numbers of part-time hospital staff, forced to work at multiple institutions to make a living.

September 2004

Sailors Death Attributed to Malaria

Malaria was the cause of death for a 36-yearold sailor who died aboard a ship sailing to the Galveston area, according to Dr. Mark Guidry of the Galveston County Health Authority. The man, who was returning from a trip to West Africa, had symptoms suggestive of Lassa fever and malaria. Guidry said malaria is common in many developing countries and travelers who visit these areas risk getting malaria. About 1,200 cases of malaria are diagnosed in the U.S. each year. Cases are typically among travelers and immigrants returning from malaria-risk areas, many from sub-Saharan Africa and the Indian subcontinent.

Indiana, Oregon State Health Officials Report WNV Detected in Blood Donations

State health officials reported that routine screening by the American Red Cross detected West Nile virus in blood donated by a LaGrange County resident. The individual developed no symptoms of West Nile infection, and the blood was not put into circulation. A Jackson County blood donor was the second person in Oregon to test positive for West Nile virus, according to public health and American Red Cross officials. It does not in any way signify there is a risk of acquiring West Nile from giving blood. We continue to advise people to give blood, as there is always a need for it, said Mel Kohn, MD, state epidemiologist. Any blood that tests positive is eliminated from the supply.

WHO Official Warns of a Growing Global Threat From Avian Influenza

The World Health Organization (WHO) warned that greater efforts will be needed if the world is to head off the threat of an avian influenza pandemic springing from the presence of the avian influenza H5N1 virus in poultry in Asia. Unless intensive efforts are made, a pandemic is very likely to occur, said Shigeru Omi, MD, WHOs regional director for the Western Pacific. Omi cited four reasons for concern: the H5N1 virus causing avian influenza among poultry in Asia is circulating more widely than initially believed; the cyclical history of previous influenza outbreaks means a pandemic is due; virtually nobody would be immune to a new human influenza virus that resulted from outbreaks in poultry; and the increased global movement of people and goods means the virus could spread far more quickly and extensively than in the past. Since the first reported outbreaks of avian influenza in Asia at the beginning of this year, there have been 39 confirmed human cases in the region, 28 of whom died.

October 2004

HHS Awards $232 Million in Biodefense Contracts For Vaccine Development

HHS Secretary Tommy G. Thompson announced four new contracts totaling more than $232 million to fund development of new vaccines against three potential agents of bioterrorism: smallpox, plague and tularemia. The NIAID will administer the contracts. We are moving as quickly as possible to develop new vaccines to ensure that our nation is protected against an array of potential bioterror agents, Thompson said.

IDSA Urges Senate to Spur Anti-Infective Development

The Infectious Diseases Society of America (IDSA) said Congress should act soon to introduce and enact legislation to spur the development of new medicines and diagnostics to treat infectious diseases, particularly new antibiotics that target drug-resistant infections. IDSA presented testimony before a unique joint hearing of the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) and the Senate Judiciary Committee. The new legislation would build on The Project Bioshield Act, which was signed into law July 21, 2004, the same day that IDSA issued a major report, Bad Bugs, No Drugs: As Antibiotic Discover Stagnates ... A Public Health Crisis Brews. IDSA hopes to convince Senate leaders to extend the scope of Bioshield II beyond bioterrorism to remove financial disincentives in all areas of infectious diseases research and development, particularly for antibiotics to treat drug-resistant infections.

There is an inextricably linked, synergistic relationship between research and development efforts needed to protect against both naturally occurring infections and bioterrorism agents, said John G. Bartlett, MD, chief of the division of infectious diseases at the Johns Hopkins University School of Medicine and chair of IDSAs Task Force on Antimicrobial Availability. As such, we believe this approach makes perfect sense.

Nurses Petition Federal Court to Stop Virginia Mason Medical Centers Mandatory Flu Vaccination Policy

The Washington State Nurses Association (WSNA), representing more than 600 registered nurses at Virginia Mason Medical Center (VMMC), filed a petition Oct. 1 in Federal Court seeking an injunction to stop the implementation of the hospitals policy requiring mandatory flu vaccination for all RNs. The association says this unilaterally implemented policy violates the terms and the very purpose of the collective bargaining agreement between WSNA and VMMC. The WSNA did not oppose the flu vaccination; however, it did oppose any healthcare facility threatening to fire people if they did not submit to the mandatory vaccination, especially in the absence of a declared public health emergency and a recommendation for mandatory vaccination by the CDC.

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