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 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.  

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

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.


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

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

ICT's Product Locator: January/February 2023 

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

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.


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

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

’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.

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. 


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.

Could changing gloves and instruments prevent SSIs?

Because surgical site infections (SSIs) remain the most common complication of surgery globally and affect patients in both low- and middle-income countries, investigators continue to find ways of reducing SSIs anywhere they can. One of the main issues is that SSI causes widely vary and few interventions work well or at all.

However, authors of a new study published in 

explain that a simple routine change of surgical gloves and instruments can prevent 1 in 8 SSIs from striking. One specific surgery that often has an SSI associated with it is abdominal surgery.

“SSIs are one of the major health challenges for surgery today. The simple and cost-effective intervention of clean gloves and instruments for wound closure is appropriate for implementation across the world and can mark an important step towards the future minimizing of SSIs and so improve patient outcomes,”

 Dion Morton, MD, MBchB, FRCS (Eng), OBE, Barling Chair of Surgery, The University of Birmingham told 

Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomized trial in seven low-income and middle-income countries,”

A total of 13,301 patients were recruited for the trial (ChEETAh, a multicentre, cluster randomized trial), which took place between June 2020 and March 2022 across a total of 7 hospitals, both large hospitals with advanced perioperative services to small, rural hospitals with as few as 20 beds. These hospitals are in Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa. Morton and his colleagues found that a routine change of gloves and instruments before abdominal wound closure reduced SSIs rates by 13% at 30 days post-surgery compared with the trial control group. This reduction in SSI was seen across the trial.

Of the 13,301 participants, 11,825 (88.9%) were adults and 1476 (11.1%) were children. Gender balance was 54.8% female participants and 45.2% male.

The paper concludes that, “this trial showed a robust benefit to routinely changing gloves and instruments before abdominal wound closure. We suggest that it should be widely implemented into surgical practice around the world.”

Weaknesses of the study noted in the study include “small imbalances in patient characteristics across groups, which are inevitable in a clustered design, particularly with such a broad and heterogenous hospital network.” Also, the investigators note that selection bias and residual bias could exist. Also, some clusters included fewer patients than the investigators anticipated because of low volume or the site opening towards the end of the trial. And the investigators did not collect data around single or double gloving.

This recommendation despite the World Health Organization not making recommendations for changing gloves and instruments before wound closure because of lack of evidence.

, a medical solutions company, donated sterile Biogel surgical gloves to participating sites to help support this study.

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 made an announcement about its mRNA-based vaccine.

 its investigational, mRNA-based vaccine proved effective in protecting against the respiratory syncytial virus (RSV) in older adults with no safety concerns.

 that attacks the lungs and breathing passageways. Currently, there is no targeted treatment or vaccine for children or adults, but there are several in trials. Older adults are at high risk of severe disease progression due to a natural age-related decline in immunity. RSV is responsible for an estimated 420,000 hospitalizations and 29,000 deaths in industrialized nations.

“It is exciting to see the possibility of adding RSV to the list of vaccine-preventable diseases for older adults,” Shannon Simmons, DHSc, MPH, CIC, a system infection preventionist for CHRISTUS Health in Irving, TX, told 

. “The reported efficacy of the Moderna investigational mRNA vaccine targeting RSV in older adults has the ability to provide protection for a segment of the population that is increasingly vulnerable but often disregarded. We saw firsthand how older adults were disproportionately impacted by COVID-19, so it’s extremely important that all older adults consider the advantages of a vaccine aimed at preventing lower respiratory disease."

The data evaluated the efficiency of Moderna’s RSV vaccine, mRNA-1345, in protecting older adults. The investigators created 2 groups of 64 cases: one group had 2 or more symptoms, and the other had 3 or more symptoms of RSV-associated lower respiratory tract disease (RSV-LRTD).

The investigators identified no safety concerns with the vaccine, which was well tolerated. The most common adverse reactions noted were injection site pain, myalgia, arthralgia, fatigue, and headache.

For this Moderna trial, the group of 2 or more symptoms met the endpoint first and showed that the vaccine was 83.7% effective. The group with 3 or more symptoms then met the endpoint and showed that the vaccine was 82.4% effective.

This trial, called the ConquerRSV trial, was a randomized, double-blind, placebo-controlled study, and it evaluated mRNA-1345 in approximately 37,000 adults aged 60 years or older in 22 countries, including the US.

The interim analysis was based on 64 cases of RSV-LRTD with 2 or more symptoms. The placebo group had 55 cases, and the mRNA-1345 group had 9. There were 20 cases of RSV-LRTD with 3 or more symptoms. The placebo group contained 17 cases, and the mRNA-1345 group had 3 cases.

Because of these encouraging results of preventing severe lower respiratory disease due to RSV in the older population, Moderna intends to submit for regulatory approval in the first half of 2023. The data will be submitted to a peer-reviewed publication and presented at an upcoming scientific meeting.

The mRNA-1345 vaccine is being tested in an ongoing Phase 1 trial in pediatric populations, and the clinical trial is fully enrolled.

 encouraging data on an RSV vaccine for pregnant persons. In October 2022, 

 that its RSV vaccine trial demonstrated promising results for older adults.

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

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

Karen M. Jones, MPH, RN, CIC, FAPIC, has been an acute care infection preventionist since 2009 and has conducted infection prevention research at hospitals and nursing homes. She has 15 years’ experience as an emergency department nurse in Chicago and Detroit, and her interests are translational research and the mentorship of nursing home infection preventionists.

As the COVID-19 pandemic was challenging public health and infection preventionists, multidrug-resistant organisms (MDROs) lurked quietly in the background. Although not as well-known as methicillin-resistant 

(VRE) or as feared as Candida auris, extended spectrum beta-lactamase (ESBL)-producing 

 have been identified by the Centers for Disease Control & Prevention (CDC) as a serious risk to public health. Infection preventionists (IPs) in nursing homes must thus gain a better understanding of how to manage this additional threat.

ESBL-producing Enterobacterales (ESBL-Es) received an unfortunate honorable mention in the 2022 CDC special report 

COVID-19: US Impact on Antimicrobial Resistance

. From 2019 to 2020, the US saw a 32% increase in these infections in hospitalized patients.

 In 2017, there were 197,00 new ESBL cases, which was a 53% rise from 2012.

 Also identified as rapidly spreading through nursing homes were ESBL-producing 

Because the health care continuum involves patient movement between acute care, short-stay rehab, long-term care, and other facilities, it is critical that infection preventionists in nursing homes be aware of this MDRO.

An ESBL is an enzyme produced by certain strains of gram-negative bacteria that protects bacteria from many commonly prescribed antibiotics, which is great news for bacteria but bad news for the patient, clinical treatment options, and public health overall. First identified in Greece in the early 1960s, ESBLs have been expanding their families and geographic reach ever since. The first case in the US was reported in 1988.

 ESBLs continue to strengthen in antibiotic resistance and require treatments other than standard antibiotic regimens.

. Exposure to health care, including hospitals or nursing homes, places individuals at greater risk for developing an ESBL. But even without such exposure, ESBLs have been identified in otherwise healthy people, often manifesting as urinary tract infections.

 ESBLs are resistant to cephalosporins and penicillin, with carbapenems left as one of the only effective treatments. Although these intravenous antibiotics are often the best treatment, they require venous catheters and often a longer stay. If bacteria become resistant to this last-option drug class, even fewer options will be available.

Because nursing homes provide long-term care as well as short-stay rehabilitation, they are affected by various factors. Most of their residents are aged over 65 and have multiple comorbidities that impact their immune system, skin, and mucous membranes. In addition, the atypical infection symptoms seen in them may delay infection identification. Creating a home-like environment is essential for individuals who will spend weeks, months, or even the remainder of their lives at the facility. With more shared residential areas than other settings, nursing homes find it difficult to contain infections. Private rooms, especially in older facilities, are far less common than shared rooms, which may be designed to accommodate up to 4 residents. More than half of them will receive an antibiotic over the course of a given year. Of those, 40% to 75% do not meet the clinical criteria for appropriateness of use or are prescribed an incorrect dose or length of treatment.

As with all MDROs, prevention and containment of ESBLs begins with good hygiene. ESBLs are primarily spread by direct contact with infected body fluids, including those found on surfaces and equipment. Just as hand hygiene is essential in health care workers, residents should also be encouraged to wash their hands, especially after using the bathroom and before meals, as ESBLs live and travel in the gastrointestinal tract. A study at the University of Michigan revealed that residents’ hands are often contaminated with MDROs.

Proper cleaning and disinfection, with periodic audits and feedback, will help build adherence to your prevention program. Obtain buy-in from those individuals doing the work by making infection prevention “everyone’s business” and include others who may be interested to collect data and provide reports to peers. Keep everyone in the prevention program involved and aware that environmental services are far more than merely janitorial, and that infection prevention relies on all the dedicated individuals doing this work. They must understand their role in infection prevention, stay up to date on best practices, and have a voice in the decisions made by Quality Assurance & Performance Improvement (QAPI) and the institution’s antimicrobial stewardship program.

The CDC’s Project Firstline offers virtual learning with interactive resources, educational modules, printed materials, and training toolkits improve infection prevention and control beyond hospitals into nursing homes, and other long-term care facilities.

 These materials are a great way to educate the staff and keep them up to date.

Transmission-based isolation precautions for ESBLs may differ between nursing homes and other health care facilities. Stay connected with and follow recommendations from your health department to stay abreast of current trends.

 Enhanced Barrier Precautions (EBP) offer direction on how to handle MDRO infection and colonization. If CDC contact precautions don’t apply to a resident with an ESBL per the facility’s protocol, CDC guidelines list them as an “epidemiologically important MDRO,” for which EBP is recommended. The EBP strategy was designed with input from a CDC Healthcare Infection Control Practices Advisory Committee expert group in 2019 and updated in 2022. Besides MDRO infection and colonization for residents when contact precautions don’t otherwise apply, EBP is recommended to be followed with residents who have indwelling medical devices or wounds during “high-contact resident care activities.”

 Because EBP does not require a private room or exclude residents from activities, it may be the ideal option.

The prompt and accurate sharing of information during care transitions or resident transfers is an essential component of infection prevention and resident safety. When residents are moved between nursing homes, acute care, outpatient clinics, and home care, infection and colonization status information should be prioritized. Have there been times when information about residents coming to your facility has not been provided directly to the clinical staff? Does a physician's office always communicate lab or clinical findings after the resident returns to your facility? On the flip side, can hospital emergency department staff easily discern whether a resident is being treated for an infection or has a history of MDRO colonization? Developing working relationships between the staff responsible for transfers and IPs can bridge the communication gap. Not only is the sharing of infection information best practice, but it can also alert you to current practices and challenges at nearby facilities.

Nursing homes are one of several health care settings that must have antibiotic stewardship programs in place. A 2015 study by Daneman et al found a great deal of variability among 600 nursing homes with respect to antibiotic prescribing and the high antibiotic use associated with increased individual-level risk, even among residents who did not receive antibiotics. Nonrecipients are at an increased risk simply by being at that facility.

 Recognizing where the facility stands in terms of antibiotic prescribing, zeroing in on opportunities for improvement, and engaging a multidisciplinary team to address problems create a safer environment for everyone. The CDC’s 

Core Elements of Antibiotic Stewardship for Nursing Homes

 is a comprehensive toolkit for institutions starting from scratch or looking for materials to address a specific issue related to antibiotic stewardship.

COVID-19: U.S. impact on antimicrobial resistance, special report 2022.Centers for Disease Control and Prevention. June 2022. Accessed Nov 21, 2022. 

https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf

Castanheira M, Simner PJ, Bradford PA. Extended-spectrum β-lactamases: an update on their characteristics, epidemiology and detection. JAC Antimicrob Resist. 2021;3(3):dlab092. doi:10.1093/jacamr/dlab092

ESBL-producing Enterobacterales in healthcare settings. Centers for Disease Control and Prevention. Updated Nov 22, 2019. Accessed Nov 21, 2022. 

https://www.cdc.gov/hai/organisms/ESBL.html

Ghafourian, S., Sadeghifard, N., Soheili, S., & Sekawi, Z. Extended spectrum beta-lactamases: Definition, classification, and epidemiology. Curr Issues Mol Bio. 2015;17:11-22.

Antibiotic resistance threats in the United States, 2019.Centers for Disease Control and Prevention. Reviewed December 2019. Accessed Nov 21, 2022. 

https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf

Montoya A, Cassone M, Mody L. Infections in Nursing Homes: Epidemiology and Prevention Programs. Clin Geriatr Med. 2016 Aug;32(3):585-607. doi:10.1016/j.cger.2016.02.004. PMID: 27394025.

Core elements of antibiotic stewardship for nursing homes. Centers for Disease Control and Prevention. Reviewed Aug 20, 2021.Accessed Nov 15, 2022. 

https://www.cdc.gov/antibiotic-use/core-elements/nursing-homes.html

Cao J, Min L, Lansing B, Foxman B, Mody L. Multidrug-resistant organisms on patients’ hands: a missed opportunity. JAMA Intern Med. 2016;176(5):705-706. doi:10.1001/jamainternmed.2016.0142

Project Firstline.Centers for Disease Control and Prevention. Updated July 20, 2022. Accessed November 15, 2022. 

https://www.cdc.gov/infectioncontrol/projectfirstline/index.html

Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings.Updated May 2022. Accessed November 15, 2022. 

https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html

Implementation of personal protective equipment (PPE) use in nursing homes to prevent spread of multidrug-resistant organisms (MDROs). Centers for Disease Control and Prevention. Updated July 12, 2022. Accessed November 15, 2022.

https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

Daneman N, Bronskill SE, Gruneir A, et al. Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual residents. JAMA Intern Med. 2015;175(8):1331-1339. doi:10.1001/jamainternmed.2015.2770

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