Isis Lamphier, MPH, CIC, is an infection preventionist at Moffitt Cancer Center in Tampa, FL.

The Centers for Disease Control and Prevention urged consumers to stop using EzriCare Artificial Tears immediately.

The Centers for Disease Control and Prevention (CDC) issued a statement recently,

 urging the immediate discontinuation of the use of EzriCare Artificial Tears until epidemiological investigation and laboratory analyses are complete.

EzriCare Artificial Tears are eye drops containing 1% Carboxymethylcellulose Sodium designed to relieve eye irritation and dryness. According to the CDC, these lubricant eye drops are preservative-free. These eye drops are dispensed in multidose bottles.

The CDC has linked these eye drops to a "multistate cluster of Verona Integron‐mediated Metallo‐β‐lactamase (VIM)‐ and Guiana‐Extended Spectrum‐β‐Lactamase (GES) producing carbapenem‐resistant Pseudomonas aeruginosa (VIM‐GES‐CRPA) associated with multiple different types of infections, including eye infections." In addition to demonstrating carbapenem resistance, isolates in this cluster have shown resistance to ceftazidime and cefepime.

The CDC reported 10 patient cases had eye involvement with one case of permanent vision loss. There has also been one death reported. 

"This investigation unfortunately reiterates the significance of ensuring that all ophthalmic andoptometric devices are cleaned, disinfected, and sterilized in accordance with the manufacturer’s instructions for use, based on the intended use of the device," Katharine Hoffman, MPH, CIC, NCMA, LSSGB, infection prevention community health program manager at JPS Health Network in Fort Worth, Texas.

It is crucial that with any contact with non-intact skin, mucous membranes, or normally sterile tissue, that there is strict adherence to Spaulding Classification and evidence-based guidelines. The reprocessing of reusable medical devices must be achieved in a linear manner to best support both patient and staff safety. A breach or omission in reprocessing could increase the risk of an outbreak and could be further complicated by antimicrobial resistant organisms such as Carbapenem‐Resistant Pseudomonas aeruginosa (CRPA). Additionally, standard precautions to include effective hand hygiene also supports high-quality, safe patient care through further mitigating the risk of cross-contamination by breaking the chain of infection."


The cluster identified by the CDC, in partnership with state and local health departments, contains 56 isolates from 50 case-patients from 11 states (CA, CO, CT, FL, NJ, NM, NY, NV, TX, UT, and WA). The date of specimen collection is from May to December 2022, and isolates came from the corneum, sputum or bronchial wash, urine, other nonsterile sources, blood, and rectal swabs.

Patient outcomes in this cluster have included permanent vision loss resulting from ocular infection, hospitalization, and the death of one patient with a bloodstream infection.

Exposures were reviewed for each patient, and the majority of patients used artificial tears. The most common brand reported among patients in the cluster was EzriCare Artificial Tears.

Individuals who use this product should follow the CDC’s recommendation and discontinue current usage. Contact your health department’s healthcare-associated infections contact for submitting isolates.

For users of lubricating eye drops, it is always recommended to avoid touching the tip of the container to any surface- including the user’s eyelids or lashes. Always wash your hand before and after the use of eye drops. It is also recommended to follow the provided instructions for use and storage. 

 states to never share eye drops, whether prescription or over the counter. Sharing eye drops increases your risk of infections, primarily eye infections. If you have questions regarding instructions for eye drops, always ask your doctor.

Articles

EzriCare Artificial Tears have been linked to a multistate cluster of VIM‐GES‐CRPA associated with multiple different types of infections, including eye infections, permanent vision loss, hospitalizations, and 1 death.  

Updated: Multistate Cluster of Carbapenem-Resistant Pseudomonas aeruginosa Linked to Use of Artificial Tears

KEVIN KAVANAGH, MD, is the founder of the patient advocacy group Health Watch USA

Vaccines and Related Biological Products Advisory Committee 

 was a pivotal meeting that discussed and laid out a new direction for SARS-CoV-2 vaccine development and deployment. The committee addressed and discussed 3 out of the 4 recommendations that were proposed in an 

® article regarding future directions for vaccine development. The most important was the recommendation that the initial vaccine exposure should be to a bivalent vaccine. In addition, there was a discussion of creating a schedule for periodic vaccine reformulation and the need for entirely new vaccines which have a longer duration and higher rates of protection.


The call for reformulation of SARS-CoV-2 vaccines was to “harmonize” the vaccine’s composition which would make supply, administration, and patient education simpler. All of this is true and very important, but there was very little discussion regarding immune imprinting. This topic was briefly 

 , who discussed strategies to maximize SARS-CoV-2 vaccines for new emerging strains. One of the strategies was to search for “potential approaches which may better overcome immune imprinting.” When asked to 

 period, she replied that we know there is a benefit to including an Omicron (BA.5) component in the vaccine for the prevention of infections from sub-lineages of Omicron, but that “we know the history” and referenced influenza, “where there is much more extensive year-to-year data of where there may be potential of some immune imprinting and how do you best overcome that?” They will be looking at all of that data “to better understand how much of a hurdle (immune imprinting) may or may not be for SARS-CoV-2.”



In addition, concerns for immune imprinting were raised regarding 

animal research presented at the Sept. 1, 2022, CDC ACIP meeting

. All animals were vaccinated with the original SARS-CoV-2 strain. A group was then given a monovalent BA4/5 booster. This group had a robust and one of the largest recorded responses to the original viral strain. In addition, 

booster efficacy data from several other studies

 have shown what some would describe as a less-than-the-expected advantage of the bivalent booster over the original booster.

Immune imprinting has recently been discussed in a comprehensive 

 entitled: “How your first brush with COVID warps your immunity.” This phenomenon was first observed with the Seasonal Flu and an ominous warning given by evolutionary biologist Katie Gostic, PhD “We saw this remarkably clear pattern that you seem to be much more susceptible, at least to severe infection, if you had been imprinted in childhood to a mismatched subtype.” Kate Gostic also stated, "you are better off having some immunity no matter what it is.” 

In individuals without a previous infection, the better match the original vaccination has to the current viral strain, the better the immunological response will match to future infecting pathogens and the less impact any potential imprinting will have.



The severity of COVID & hospitalization rates were also brought into question. One committee member presented 

data and the reporting methodology used by the State of Massachusetts

. He felt that CDC-reported hospitalization rates may be 3 times as high as actual rates. It should be stressed that under the strict definition used by Massachusetts, only severe pulmonary manifestations of COVID-19 where 

dexamethasone was administered are counted

. The metric used for counting COVID-19 hospitalizations affects estimates of not only the severity of COVID-19 but also estimates of vaccine effectiveness. Lower hospitalization rates will cause the severity of COVID-19 to fall and vaccine effectiveness to rise.

However, I feel the contention that the CDC is overcounting rates of hospitalizations by a factor of 3 is feeding into the narrative of COVID-19 minimizers. This is the old fringe talking point of “hospitalized because of, not with COVID.” Focusing on severe pulmonary hospitalizations also denies the reality that SARS-CoV-2 affects every organ of the body and ignores the fact that there is an increase in SARS-CoV-2 hospitalizations from 

, and infectious diseases due to post-COVID 

.

In addition, none of these metrics will capture few, if any, stealth hospitalizations and deaths due to a plethora of delayed systemic organ damage (cardiac strokes, etc.) which occurs with SARS-CoV-2. These delayed manifestations can 

almost double the death count of acute COVID-19

 and can occur in COVID-19-negative patients.



Other discussion topics included reducing the number of vaccine doses to one except for those who were immunologically naive and high-risk. As stated by 

 the “Major issue is, the concept was that if you had COVID-19 or had been vaccinated previously, you would just need one dose versus others who might have multiple doses.” If adopted in the future, this would significantly recognize natural immunity. I must stress no one is recommending getting an infection to prevent an infection with this dangerous virus.

Finally, the committee appeared to want more data before recommending a boosting schedule. Many members stressed that such a schedule would have to be flexible depending on how high-risk a patient is. In other words, those over 65, immunosuppressed or obese may need a booster more frequently, such as every 5 to 6 months, as opposed to young, healthy individuals.

A schedule for periodically updating the formulation of the vaccine was also discussed. Possibly yearly unless an important variant arises sooner. The time needed to reformulate and bring a new vaccine to market 

.

The next step will be to send the vaccine reformulating recommendations to next month’s CDC meeting for final approval. Until then, recommendations for vaccination have not officially changed.



The FDA's Vaccines and Related Biological Products Advisory Committee laid out a simpler direction for SARS-CoV-2 development and deployment. 

FDA VRBPAC Meeting:  Bivalent Vaccines, Natural Immunity, Imprinting and COVID-19 Hospitalization Rates

’s) wide-ranging coverage of the infection prevention and control world. Everything from interviews with known opinion leaders to the news that infection preventionists and other health care professionals can use on their jobs.

Bird Flu Warning: Its Spreading, Mutating, and Infecting

Kevin Kavanagh, MD, examines the current bird flu outbreak and the possible dangers it holds for humans.

ICT's Product Locator: January/February 2023

Infection Control Today's® Product Locator is a monthly column highlighting some of the latest advanced technology in the infection prevention field.

Bug of the Month helps educate readers about existing and emerging pathogens of clinical importance in health care facilities today.

Hot Topics in IPC: January 25, 2023, COVID-19, CDC Shake-Up, and Bird Flu

Saskia v. Popescu, PhD, MPH, MA, CIC, discusses the latest in COVID-19, a CDC shake-up, and the bird flu.

EzriCare Artificial Tears have been linked to a multistate cluster of VIM‐GES‐CRPA associated with multiple different types of infections, including eye infections, permanent vision loss, hospitalizations, and 1 death.

Take 5 minutes to catch up on Infection Control Today®’s highlights for the week ending January 27, 2023.


Weekly Rounds: Bird Flu Warning, Product Locator, Bug of the Month, and More

Tori Whitacre Martonicz is the editor of 

.  She has been a writer and editor for over 30 years, and she has an MA and BA in English Composition/Literature from the University of Akron in Akron, OH. She lives in Ohio with her husband; son; 2 tiny dogs, Selena Brigid Sophia and Doctor Danger Dog; and a big black cat, Freya. She loves reading, writing, gardening, and spending time with her loved ones.

), National Home Infusion Association (NHIA) reached out to 

to the topic. The article and interview titled “

Home Infusion Therapy: Limited Study Shows Lack of Formal Infection-Surveillance Training

,” discussed the issues that Home-infusion therapy (HIT) staff have with lack of surveillance, education, and barriers to training in central line-associated bloodstream infection (CLABSI) surveillance. 

This interview was with Sara Keller, MD, MSHP, MPH, with Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, and lead author of this 

, “The Need to Expand the Infection Prevention Workforce in Home Infusion Therapy” published in the 

American Journal of Infection Control. This study is part of a broader study on CLABSI surveillance.

To further understand NHIA’s thoughts on the interview and accompanying article, 

 spoke to Connie Sullivan, BSPharm, CEO of NHIA.

When asked about her concerns with the study, Sullivan said that the “limited study is not representative of the home infusion industry and misrepresents the industry based on the data.”

 that she was concerned that the study's results were skewed because it was limited. “I think that if you talk to a field nurse, and this is one of the things that we don't know who she spoke to, specifically in these organizations. It's hard to address the lack of training specifically for those individuals because we don't know if this is a field nurse [who] also has some additional responsibilities of looking at the quality improvement data this, a pharmacist is this someone who exclusively works in the quality improvement arm and, their whole job is just to aggregate data and report back on what their infection rates are. Without having any transparency into what questions she asked, I think that's also something we [NHIA] wanted to know; she described these as semi-structured interviews. I think that again, looking at the methodology that she used for the study, not only is it just qualitative, she's snowball sampling, which is “Hey, do you know anyone else I can talk to?” We're all very prone to bias.”

Sullivan did note things that NHIA and Keller agreed on. “It's much harder to confirm a cloud see in the home setting. You're not always going to be able to get a culture. You're not always going to be able to send a patient in. So our definition reflex, our environment, and that is, again, where we keep emphasizing, if you're looking for the same exact thing you do in a hospital and home infusion, you are likely not going to find it just because the environment demands different approaches, different understanding. We feel like a preventative approach is a much more effective approach. Not to say surveillance wouldn't be a great thing and should be done. But we do feel like it is done. It's done differently. 

Sullivan continued: "These are not large providers, and in a lot of cases, these are smaller, pharmacy-based operations. They don't always have the resources to have dedicated people just to do these types of things. Most of these people are going to have other responsibilities in the organization, but they're required by their accreditation or conversations to monitor for catheter infections. And they do.”  

Nation Home Infusion Association addresses the media's coverage of the recent limited home infusion therapy study from Johns Hopkins University School of Medicine. 

NHIA Addresses Recent Home Infusion Therapy Study

SASKIA V. POPESCU, PHD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in biodefense from George Mason University where her research focused on the role of infection prevention in facilitating global health security efforts. She is certified in infection control and has worked in both pediatric and adult acute care facilities.

Hot Topics in infection control and prevention.

The good news – COVID-19 cases continue to decline across the United States. The last 2 weeks have 

 a 30% decline in cases, with the daily average hovering around 45,000. Test positivity is also down, sitting at 12%, and across the board, other metrics like hospitalizations and even deaths have dropped. Most US states and territories are reporting double-digit drops in cases, except for a few: Illinois is showing a 76% increase in cases, Kentucky has a 49% increase, the US. Virgin Islands is up 187%, and Alaska is up 38%.

While we mostly feel confident in reporting that this winter season showed a much milder COVID-19 surge than previous winters, those cases, hospitalizations, and deaths were still avoidable and devastating. Consider a recent 

 that only 41% of US adults with impaired immune systems have received 4 doses of the mRNA vaccines. Even worse, less than 1% received the recommended 5 doses that was a part of guidance released in August 2022. The authors reported that “Participants 65 years and older were more likely to receive at least four vaccine doses than younger patients (hazard ratio [HR], 3.95 vs 2.52, respectively). Those least likely to receive at least four doses were Black versus White adults (HR, 0.77), patients who previously had COVID-19 vs never-infected participants (HR, 0.71), and those receiving high-dose corticosteroids versus patients not taking these medications (HR, 0.88).” These findings underscore the importance of a tailored and agile approach to COVID-19 vaccines and interventions. This might come to head with a 

 that is being proposed by the US Food and Drug Administration (FDA). The agency is reportedly considering a new strategy for the national COVID-19 vaccine approach, which would adopting an annual update of the vaccine, similar to that of influenza shots. While the goal is to simplify the COVID-19 vaccine approach and move away from individuals having to remember how many shots they had and the time in between, many worry that this change could oversimplify the process and run the risk of reducing production capacity to respond to emerging strains.

We knew that changes to the Centers for Disease Control and Prevention (CDC) were imminent. Director Rochelle Walensky, MD, has reiterated failures of the agency during the COVID-19 pandemic and a need for a review and overhaul. This week it was released that several changes would occur, from merging of offices to a new reporting structure. Most of the CDC is now reportedly set to report to the Immediate Office of the Director, away from what was called a “Community of Practice structure.” It was 

 “The Center for Surveillance, Epidemiology and Laboratory Services and the Center for State, Tribal, Local and Territorial Support will be combined into a new agency entity called the National Center for State, Tribal, Local and Territorial Public Health Infrastructure and Workforce. The Center for Preparedness and Response will now be renamed the Office of Readiness and Response.” Even better, several new offices are being created to address health equity, public health data, surveillance, and technology. In efforts to modernize its approach to data and centralize leadership, the goal is to improve speed and efficiency. No agency is perfect, and the truth is that public health is difficult, often thankless work, that is often chronically underfunded. The CDC, like any agency, has been imperfect, and there were many times we found ourselves frustrated by their choices, communication strategies, and approach to this pandemic. Hopefully, these changes will lead to a more robust and agile agency that can effectively address health threats.

A bird flu outbreak spreading in mink in a farm is causing concern – 

Saskia v. Popescu, PhD, MPH, MA, CIC, discusses the latest in COVID-19, a CDC shake-up, and the bird flu.


Heather Saunders is an experienced and motivated registered nurse with a master’s degree in public health and a certification in infection control. Striving for excellence in the prevention and control of infectious disease, Heather believes in using innovative and strategic leadership methods to achieve program goals.

Heather first discovered her love for infection control (and chai tea) during a short-term assignment in Nairobi, Kenya, where she worked to improve maternal and child health through the prevention of infectious diseases. After spending the first 6 years of her nursing career in busy emergency departments, Heather transitioned away from the bedside to join the work at the Johns Hopkins Hospital as an infection control epidemiologist. Following the completion of her master's degree in public health, Heather became the infection prevention and control nurse consultant for the State of Maryland, assisting healthcare facilities in their response to healthcare-associated infections. Currently, Heather is employed with Johns Hopkins University Division of Infectious Diseases as a research nurse program manager, using her expertise to guide research in the prevention and control of infections in healthcare settings. Additionally, Heather is the owner of Broad Street Prevention, where she serves as an infection prevention consultant.

During her off hours, Heather enjoys writing, reading, hiking, and spending time with her friends and family. She is the proud author of the blog, All the Lessons We Learn, where she gives a lyrical accounting of all the beautiful, painful, and transcendent lessons that we learn on this journey we call life.

https://www.facebook.com/thelessonswelearn/

Bug of the Month helps educate readers about existing and emerging pathogens of clinical importance in healthcare facilities today. Each column explores the Bug of the Month's etiology, the infections it can cause, the modes of transmission, and ways to fight its spread. The pathogen profiles will span bacterial, viral, fungal and parasitic species. We encourage you to use Bug of the Month as a teaching tool to help educate healthcare personnel and start a dialogue about microbiology-related imperatives.

Bug of the Month helps educate readers about existing and emerging pathogens of clinical importance in health care facilities today. 

Bug of the Month: Wasting Away

The launderable and reusable Soteria Bed Barrier from Trinity Guardion, Inc, protects beds and mattresses from patient soiling, helping to reduce contamination during use. Designed for acute and long-term care beds and stretchers, it fits securely over the mattress and bed deck and attaches to the bed frame without disrupting performance during patient care.

Trinity Guardion has received FDA 510(k) clearance in a new product code (QTV) for its innovative Soteria, a level 3 barrier per the Association for the Advancement of Medical Instrumentation (AAMI) Standard PB70. The Soteria proprietary surface formulation allows for laundering that meets AAMI TIR 12: 2020 acceptance criteria for high-level disinfection plus spore removal (99.9999%) using a rigorous commercial health care laundry method.

“Advances in the cleaning of high-touch surfaces like
mattresses have become a fundamental necessity,” infectious disease physician Ardis Hoven, MD, a Trinity Guardion board member and former president of the American Medical Association told 

. “The Soteria Bed Barrier helps protect the mattress and bed deck from patient soiling and will become an essential contributor in a culture of safety.”

Neuster Health’s PMSSteripack autoclavable biohazard bags are ideal for processing of biohazardous materials that require autoclaving before disposal. These bags provide safe handling and an efficient solution for biohazard waste needs.

Neuster Health is one of few manufacturers worldwide that produce polypropylene biohazard bags, whereas most other biohazard bags marketed as “autoclavable” are made from polyethylene plastic, which becomes brittle after autoclave and easily breaks. Polypropylene allows the PMSSteripack bags to maintain structural integrity even after the ultrahigh temperatures of an autoclave (up to
300 0F). They are designed to resist punctures, tears, and leaks.

The PMSSteripack biohazard bags come in various colors, and the optional steam sterilization indicator can be printed. They are all imprinted with the universal biohazard symbol, comply with international standards, and are manufactured under validated production processes.

CensisAI2 Productivity interactive platform

With sterile processing departments (SPDs) under increased pressure to deliver more sterile trays to operating rooms in less time, Censis—a leader and founder in surgical asset management technology—focused solely on improving perioperative efficiency with its CensisAI2 Productivity platform. It provides real-time access into day-to-day operations so sterile processing and perioperative leaders can quickly gain insights to streamline processes and make data-driven decisions.

“Sterile processing leaders everywhere are facing a challenging environment and are being asked to always do more with less,” said Censis Chief Technology Officer Barry Phetteplace told 

. “CensisAI2 Productivity gives them complete visibility into everything the department does and insights that empower them to eliminate wasted effort and increase throughput.”

The CensisAI2 Productivity interactive platform provides visibility into all aspects of SPD operations to identify problems. It allows easy comparisons of tech-to-tech, shift-to-shift, and site-to-site data to drive process refinements and enterprise-wide standards, encourage best practices, improve staff training, and inspire continuous improvement.

The PureSteel Ergonomic WorkStation is engineered to enhance worker ergonomics, packing efficiency, organization, inspection, and sterilization outcomes in a comprehensive table solution.

Each prep-and-pack table is built to meet the needs of its department, with customizable length, depth, height, and more. With integrated back-wall pegboards to organize and manage accessories and power, the PureSteel Ergonomic WorkStation keeps tools at an ideal height for staff. Built-in tabletop lights allow sterile processing staff to closely inspect wrapping materials and instrumentation. Built-in counters that can be pulled out or collapsed provide an additional, optional workspace for larger sets, and a full range of pegboard accessories afford ready-to-integrate assembly tables. Storage, footrests, shelves, and more complete each Ergonomic WorkStation.

As one sterile processing manager said to PureSteel, the tabletop light “solves issues. Holes in the filter or drape are a problem, so the light is a time-saver and a frustration saver. We can have faith that the drape will be in good shape.”

TBJ Endoscopy Sinks are designed for sterile processing departments, specifically endoscopy departments, to help them meet industry guidelines for the precleaning of flexible, immersible endoscopes. Double- and triple-bowl units provide users ample space for soaking, flushing, and rinsing of endoscopes, whereas single-bowl units provide a space-saving option. All sinks from TBJ, Inc, can be equipped with a wide variety of options, including an integrated Scope Buddy Plus Flushing aid, LED lighting, push-button height adjustment, water temperature monitoring, and storage bins and baskets. Because all sinks are made to order, they can be customized to a facility’s specific needs.

The TBJ Model 30-48-1B-AH SPCS is a single-sink design measuring 28 × 16 × 10.5 in. It has a deck-mounted hot/cold-water faucet with wrist blade handles centered on the bowl. The sink includes an electric hydraulic lift system that allows the sink height to be adjusted from 32 to 40 in high via a rocker switch control that can be added to the base unit.

The sinks are made of heavy-duty stainless steel and have adjustable leveling feet, seamless heliarc-welded construction, and a 4-in backsplash extending the length of the sink top. The sinks have hospital-grade, chrome-plated brass faucets and fixtures and crumb cup drain stoppers. Bowl sizes and overall dimensions can also be customized.

Anytime a medical instrument is reprocessed, patient cross-contamination is a risk, even with the most advanced reprocessing. One way to solve this problem is with single-use medical instruments.

aScope Duodeno is a single-use and fully disposable duodenoscope for endoscopic retrograde cholangiopancreatography procedures. Because it is sterile straight from the pack, the aScope Duodeno eliminates any chance of cross-contamination and the need for repair or reprocessing while providing more timely access to duodenoscopes in an emergency. The single-use aScope Duodeno delivers the performance of conventional duodenoscopes without the hassle that comes with them.

The aScope Duodeno has received FDA 510(k) clearance and breakthrough device designation.

ICT's Product Locator: January/February 2023 

Avian flu has caused the culling of over 60 million birds.

As many of us remain focused on COVID-19 and its immunosuppressive augmentation of other infectious diseases, mother nature is not sitting still. I was again reminded of this fact when I attempted to purchase a dozen eggs for over $6. The average price in the United States was 

 a cost of over $7. This consumer price gouge is not the grocery store's fault, the COVID-19 bailout, or even our bloated federal deficit. It is the result of mother nature and the H5N1 bird flu pandemic.
 
Along with RSV, SARS-CoV-2, and Seasonal influenza, the bird flu is spreading rapidly in the United States at epidemic proportions. 

, 60 million birds have been infected or killed (culled) in 47 states. So far, this has 

 in 2015, when 50.1 million birds died in 21 states. The number of states affected has more than doubled.
 
Bird flu has rarely affected humans; when it does, it is from directly handling birds. The virus rarely spreads from human to human. The concern is that when it infects humans, according to the Centers for Disease Control and Prevention (CDC), there is an approximately. From 2003 to 2006, H5N1 

But the one thing we have all learned from COVID-19 is that when RNA viruses spread rapidly, they mutate. This is what appears to have happened with H5N1. A new strain that is “highly pathogenic” has emerged and 

 had to be euthanized after they caught the virus. This outbreak was described as the most significant foreign animal outbreak in US history and raises fears that the virus has mutated to promote the infection of mammals. A capability that could have profound consequences for the mammalian species, homo sapiens.
 
Unfortunately, this outbreak appears not to be a single occurrence. In Spain, 

a highly pathogenic H5N1 virus has infected the mink population

. As of early October 2022, 52,000 minks were placed in cages, and the expected overall mortality of 0.2% to 0.4% rose to a mortality rate of 4%. Samples from the minks that died revealed the H5N1 virus. This virus was also found in 27 birds in the province and a neighboring province. The authors report that mink-to-mink transmission has occurred.
 
The virus which affected the mink population was a 

, having the “uncommon mutation (T271A) in the PB2 gene.” 

 have observed, “that amino acid 271A of PB2 plays a key role in virus acquisition of the mutation at position 226 of HA that confers human receptor recognition.” In other words, the strain which infected the mink population may be one step away from being able to spread in humans efficiently.
 
There have also been several gain-of-function laboratory experiments which, as dangerous as these experiments are, have shown the potential for the avian flu virus to take on characteristics of seasonal influenza. In 2006,  

 viruses (avian flu and human influenza) and infected ferrets, but the infection failed to spread. But research reported in 2010 by Dr. Yoshihiro Kawaoka from the University of Wisconsin produced a 

highly pathogenic hybrid with the pandemic ability of H1N1

 “the new findings raise concerns that H5N1 and pandemic H1N1 viruses could reassort in individuals exposed to both viruses and generate an influenza strain that is both highly virulent and contagious.” The 

published research in the Proceedings of the National Academy of Sciences

 also stressed the importance of monitoring the emergence of avian flu viruses with mutations in the PB2 segment.
 
“…that the human virus PB2 segment functions in the background of an avian H5N1 virus, enhancing its virulence. Our findings highlight the importance of surveillance programs to monitor the emergence of human H5 reassortant viruses, especially those containing a PB2 segment of human origin.”

I’m starting to experience dé·jà Vu. Gain-of-Function experiments performed on a hazardous virus, viral spread from birds to mammals, spread between mammals, and mutations beginning to arise, which may be the first step in conferring the ability to transmit in humans.
 
I do not want to go through this again, especially since our current pandemic is not under control. We need to aggressively contain the spread of bird flu and increase our genomic surveillance for this disease. This is not a certainty since our 

 at a time when mutations are flourishing, and the dangers of long COVID are becoming more ominous.


Bird Flu Warning: Its Spreading, Mutating, and Infecting Mammals

Preventing Infections in Cancer Patients at Home

Information for health care workers and patients to protect patients from infections.

Routine Change of Surgical Gloves/Instruments Significantly Lowers SSIs

A study clearly shows that surgical site infections (SSIs) can be reduced by changing surgical gloves and instruments before the closing abdominal wound closure.

Moderna: Vaccine Shown Effective Against RSV in Older Adults in Phase III Trial

Moderna announced encouraging news about its RSV mRNA-1345 vaccine and plans to submit for regulatory approval in the first half of 2023.

Considerations for Extended Spectrum Beta-Lactamase (ESBL)-Producers in Nursing Homes

Information for infection preventionists to manage ESBL-producers even while fighting against COVID-19.

Home Infusion Therapy: Study Shows Significant Lack of Formal Infection-Surveillance Training

New study shows home infusion therapy staff have significant barriers to infection-surveillance training, and this could be leading to higher infection rates.

Take 5 minutes to catch up on Infection Control Today®’s highlights for the week ending January 20, 2023.

Weekly Rounds: ESBL-Producers, Home Infusion Therapy, Lowering SSIs, and More

Because patients with cancer or receiving cancer treatments are at an increased risk for infections, health care workers should assure that their patients know how to protect themselves.

Cancer and chemotherapy can weaken patients' immune systems and reduce the number of white blood cells. Also, chemotherapy can kill healthy white blood cells while targeting cancer cells. Neutropenia is a common side effect after receiving chemotherapy that causes a decrease in the number of white cells, called 

. While neutropenia cannot be prevented, patients can take steps to reduce their risk of getting an infection while their white blood cell count is low.

Health care providers should make sure their patients know these guidelines to protect against infectious diseases while their immune systems are low. 

: Patients should wash their hands often with soap and warm water. They should carry alcohol-based hand sanitizer to clean their hands while they are out. Moments for performing hand hygiene include before eating or handling food products, after using the bathroom, after visiting a public place or touching an item touched by others, after taking out the trash, and after touching animals. Hand hygiene is the number one way to prevent the spread of infections, according to the Centers for Disease Control and Prevention (CDC).

: Patients are encouraged to receive their flu shot every fall. It is also recommended that household members of patients with cancer also receive the flu shot. Cancer patients should always consult with their physician before receiving any vaccine.

 and discuss foods that should be avoided with the health care team. Before handling food products, patients should wash their hands. They should also ensure that all meat or poultry products are cooked thoroughly before eating. 

The US Department of Agriculture (USDA) recommends that individuals read food packaging before cooking

. Not all frozen foods are fully cooked or ready to eat; some can come partially cooked. In a study conducted by the USDA, 22% of participants preparing frozen foods were unaware if the products were raw or fully cooked despite reading the product instructions. A food thermometer can also ensure that cooked meat and poultry have reached their safe internal temperature. Cancer patients should also follow best-by-dates and expiration dates present on the packaging. These dates are printed to ensure the quality of foods, and it is imperative that patients only consume fresh, unexpired foods. It is also a recommendation for cancer patients to avoid foods linked to outbreaks.

: Cooked or ready-to-eat foods should be placed on upper shelves while raw foods are on lower shelves to avoid leaking or dripping. While at the grocery store, it is recommended that non-perishable items are gathered first. Deli items, dairy, and eggs should be collected last for items to maintain the appropriate temperature while in the shopping cart. When selecting foods, check for proper refrigeration- the items are cold to the touch, the odors are fresh and mild, and the packaging is tightly sealed and free of tear. Groceries should be taken home immediately and stored in the refrigerator or freezer.

Avoid anyone with a fever, influenza, or other infections

. Cancer patients and survivors are at an increased risk of developing influenza complications. Consider asking friends and family to wash their hands when visiting. Care teams could also recommend that patients stay home or wear masks during respiratory virus season.

 with warm water and mild soap. If they have a PICC (peripherally inserted central catheter) line or dressing- maintain the area dry.

 several times a day with a soft, clean toothbrush. Chemotherapy drugs can cause sores in the mouth and throat; therefore, oral hygiene is strongly recommended to prevent sores from becoming infected. All dentures, bridges, and retainers should be cleaned daily as well.

Avoid keeping fresh flowers and live plants in their bedroom

Plants and flowers and their water in vases and pots can harbor harmful fungal spores and bacteria

. These fungal spores and bacteria can place cancer patients at a higher risk for infection. Cancer patients should discuss with their care team if they can garden. If they can, garden gloves and hand hygiene is recommended. The skin is the first line of defense and should be protected during gardening.

 such as food, drink cups, utensils, and other personal items.

Discuss with their care team any travel plans.

 Care teams need to know if patients are traveling, especially since there may be times when flying is not recommended, such as after surgery, when platelets are low, etc. Doctors and nurses will also inform patients if there are any vaccines they may need for traveling purposes.

: if they feel well, clean the home with disinfectants to kill germs on high-touch surfaces such as telephones and doorknobs. Also, they should try to keep their house dust free. 

Dust can contain thousands of fungal and bacterial organisms

: protect skin from contact with pet bodily waste, if possible, have someone else change litter pans, wash hands after handling pets, avoid being scratched or bitten by pets, and stop pets from licking any open cuts, wounds, or catheters. Also, pets must remain clean and are taken to the veterinarian for regular check-ups and vaccinations. Pets are beneficial in providing companionship and reducing stress and anxiety, but cancer patients need to protect themselves from the germs carried by pets.

Care for catheters, ports, and other medical devices

. Patients should always follow their care team’s instructions and keep their devices clean and dry. Before touching or caring for their devices such as a Foley, port, or PICC ensure that hands are clean and perform hand hygiene. Monitor all insertion sites for redness, swelling, soreness, or drainage and notify physicians timely and appropriately.

Information for health care workers and patients to protect patients from infections. 
