2004 Infection Control Year in Review By Kelly M. Pyrek It was a busy year for public healthofficials, infectious diseases physicians, infection control practitioners, andanyone else concerned about the genesis and transmission of life-threateningpathogens. Heres a look at some of the most interesting and notable events,trends, discoveries and guidelines-related announcements of 2004. For more than1,000 other infection control-related news items published this year on ICTsWeb site, go to www.infectioncontroltoday.com. January New British Study Says Nurses Wash Their Hands More Often ThanDoctors 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 consultingroom of each member of a primary-care hospital. The soap dispensers were allfilled to the same level on the same day at the start of the study. Over oneyear, the amount of soap used and the number of consultations for each member ofthe team were recorded to calculate the ratio of handwashes to patients seen.Nursing staff showed greater attention to personal hygiene than doctors. Thebest-performing nurse washed her hands at least twice as often as thebest-performing doctor. February APIC Appoints Kathy L. Warye as Executive Director The Association for Professionals in Infection Control andEpidemiology (APIC) announced the appointment of Kathy L. Warye as theorganizations executive director. Warye has more than two decades ofnon-profit experience and has held key positions in the management ofhigh-profile organizations in the Washington, D.C. area. Previously, Waryeserved as senior vice president of education and government programs for theAssociation for the Advancement of Medical Instrumentation (AAMI). APIC is arepository of considerable infection control expertise, and one of my primarygoals is to ensure that we continue to effectively leverage this resource tobenefit healthcare professionals and the public, she said. Scientists Identify a Human Antibody That Blocks SARS VirusInfection An antibody plucked from a library of human antibodiesblocked infection by the SARS virus in laboratory tests, scientists atDana-Farber Cancer Institute reported. This discovery could expedite thedevelopment 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 antibodyneutralized SARS infection in a laboratory setting by blocking the virus fromentering cultured cells. The experiments are continuing in animal models ofSARS, and the researchers are discussing future trials in humans. April Polio Victory Remembered on 50th Anniversary of Salk VaccineField Trials Fifty years ago, thousands of parents drove their school-agechildren to designated sites across the country for immunizations of anexperimental vaccine that they hoped would stop, once and for all, the ragingpolio epidemic that was leaving young Americans paralyzed and sometimes dead.Organized and funded by the March of Dimes, this was the largest voluntaryclinical trial ever undertaken. One year later, the Salk vaccine was declaredsafe, potent and effective. Within only a few years, polio rates in theUnited States had dropped dramatically. Polio has since been eliminated from theWestern Hemisphere and the World Health Organization hopes polio will beeliminated from the world by 2005. New Drug-resistant Strain of Salmonella is Identified Researchers from Taiwan reported the identification of a newform of drug-resistant salmonella bacterium in TheLancet. Salmonella entericaserotype choleraesuis usually causes infections thatrequire antimicrobial treatment. Multidrug-resistant strains have been identified, but theantimicrobial ceftriaxone has been effective against them so far. Professor JTOu, from the Chang Gung University College of Medicine in Taoyuan, Taiwan,isolated a strain of Salmonella enterica serotype choleraesuis that wasresistant to all antimicrobials commonly used to treat salmonellosis, includingceftriaxone and ciprofloxacin. The bacterium came from a 58-year-old man withsepsis who subsequently died. CDC Issues New Guidelines for Preventing Healthcare-Associated Pneumonia The CDC and the Healthcare Infection Control PracticesAdvisory Committee (HICPAC) released new recommendations regardinghealthcare-associated pneumonia. The guidelines update, expand, and replace thepreviously published CDC Guideline for Prevention of Nosocomial Pneumonia. The new guidelines were designed to reduce the incidence ofpneumonia and other severe, acute lower respiratory tract infections in allsettings where healthcare is provided. Brookdale University Hospital and Medical Center ReceivesIndustry Honors for Long-Term Infection Control Study Brookdale University Hospital and Medical Center gainednational honors for a long-term study showing promise in reducing the incidenceof bloodstream infections. The study, conducted over a three-year period,outlined Brookdales efforts to reduce central venous catheter (CVC)-relatedbloodstream infections by implementing the CDC and HICPAC recommendations. June Research Shows Promise for Development of Human SARSImmunization Research published in The Lancet providedevidence for the effectiveness of experimental SARS immunization in animalstudies. Although further research is required, these preliminary results showedthe potential for the development of human SARS immunization. Alexander Bukreyevfrom the U.S. National Institutes of Health and colleagues immunizedeight African green monkeys, four with a single dose of an intranasal vaccinederived from an experimental pediatric parainfluenza vaccine, the other fourwith a control. All monkeys were deliberately infected with SARS coronavirusone month after immunization. The monkeys given the SARS vaccine had antibodiesto the SARS coronavirus in their blood indicating an immune response tovaccination; none of these monkeys had evidence of viral shedding. Bycontrast, all four monkeys in the control group had evidence of viral sheddingbetween five and eight days after infection with the SARS coronavirus. New Jersey Mandates Certification of Central ServiceProfessionals The International Association of Healthcare Central ServiceMateriel Management (IAHCSMM) reported that New Jersey officially became thefirst state to mandate certification of central service professionals. The lawwas approved by the New Jersey Healthcare Advisory Board on June 17, 2004. Under the new law, existing CS technicians will have fiveyears to become certified, and new hires will have three years. Those in theambulatory care setting will have two years to complete the requirement. The lawstipulates that sterile processing managers must become certified immediately.It took three years, but it has finally been made official, said AnthonyT. Monaco, coordinator for New Jerseys Department of Health and SeniorServices. This law will help legitimize the profession by recognizing thecritical role CS professionals play in patient care and ensuring that theseindividuals 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 BritishJournal of Ophthalmology. The finding suggests thattear analysis could not only be an effective means of diagnosing the infection,but also an unrecognized source of its spread, if appropriate preventivemeasures are not taken, the authors said. Tear samples were swabbed from thetear ducts of 36 patients in Singapore with suspected SARS over 12 days in April2003. Most of those thought to have the infection were healthcare workers,including nurses. Eight of these patients subsequently turned out to haveprobable SARS. Russian Researcher Dies After Contact With Ebola Virus A researcher in a Siberian virology laboratory died afterpricking herself with a syringe containing Ebola virus. Most outbreaks haveoccurred in Africa, far from the Siberian lab where the senior technician wasexperimenting on guinea pigs when the accident happened on May 5, 2004. She diedseveral weeks later. The state-owned vector research center at Novosibirsk,located in Siberia, conducts research into deadly diseases such as SARS andanthrax. Along with the CDC, the laboratory is one of only two placeswith official stockpiles of smallpox, which killed around 300 million people inthe last century. After the accident, the woman was hospitalized in a wardspecially equipped to contain virulent diseases. Anyone who came into contactwith her was put under observation for three weeks. Clash of the Guidelines: HICPAC and SHEA Debate the Standardof Care Attendees of the 31st annual meeting of APIC were treated to alively discussion of the Healthcare Infection Control Practices AdvisoryCommittee (HICPAC) and Society for Healthcare Epidemiology of America (SHEA)guidelines by William Jarvis, MD and William Scheckler, MD, in the first-everScience to Practice session, sponsored by 3M Health Care. The topic wasHICPAC/SHEA: Conflicting Guidelines ... What is the Standard of Care? During this symposium held on June 9, 2004, revisions to theHICPAC Guideline to Prevent Transmission of Infectious Agents inHealthcare Settings were reviewed, and the differences between this documentand the SHEA Guideline for Preventing Nosocomial Transmission of Multi-drugResistant Strains of Staphylococcus aureus and Enterococcus were debated.3M Health Care provided about 300 members of the audience with a wirelesstransmitter device capable of registering individuals votes after thedebate between Jarvis and Scheckler. When asked if they agreed with the conceptsput forth by the SHEA guidelines, 26 percent of those with transmitters agreed;28 percent disagreed, and 46 percent were undecided. When asked if they agreedwith the concepts put forth by the HICPAC guidelines, 28 percent of those withtransmitters agreed, 17 percent disagreed, and 55 percent were undecided. Whenasked if they thought either guidelines were valid, 51 percent of those withtransmitters agreed, 22 percent disagreed, and 27 percent had no opinion. Scope Scare at New York Hospital The New York Times broke the storythat North Shore University Hospital in Manhasset, N.Y., may have exposedpatients to HIV and hepatitis virus because instruments used for routineendoscopies might not have been properly disinfected. The story, originallypublished on June 16, 2004, reported that hospital officials discovered a 12-daystretch beginning April 28 during which there was no record of employees havingtested disinfectant used to clean the scopes. Letters were sent out to the 177patients 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 forthe North Shore-Long Island Jewish Health System said, The letter wasundoubtedly unsettling. But were trying to ease those concerns by raisingwhat is a miniscule likelihood that any of these infections could betransmitted. This is the first time its ever happened at this hospital. July National Time Out Day Celebrates Adoption of First UniversalProtocol to Prevent Errors in U.S. Operating Rooms For the first time, nurses, surgeons and accredited hospitalsthroughout the country were required to adopt a common set of operating roomprocedures in an effort to eliminate the alarming number of deaths and injuriesdue to wrong-site, wrong-procedure, and wrong-person surgeries. Six nationalhealthcare organizations and associations, led by the Association ofperiOperative Registered Nurses (AORN), joined together to promote the adoptionof the Joint Commission on Accreditation of Healthcare OrganizationsUniversal Protocol for preventing wrong-site surgery errors in U.S. operatingrooms. To promote the new requirements, surgeons, perioperativenurses, anesthesiologists and other members of the healthcare team declared June23, 2004 as National Time Out Day. On July 1, 2004, all JCAHO-accreditedhospitals, ambulatory care and office-based surgery facilities were required totake a time out before a surgery began. Illinois Governor Signs Bill Allowing HIV-Infected Individualsto Donate Organs Illinois became the first state in the country to allow organdonations by people who are HIV positive when Gov. Rod R. Blagojevich signedHouse Bill 3857. The new law, sponsored by state Rep. Larry McKeon (D-Chicago), allows the organs of an HIV-positivedonor 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 fromHIV-positive donors, Illinois is the first to make it legal. Mystery Infection Kills Teenager Recovering From a Bone MarrowTransplant Public-health officials at the Health Protection Agency in theUK investigated the death of a 14- year-old boy who contracted a mysteryinfection while he was recovering from a bone marrow transplant at ahospital. Five other young recipients of bone marrow were in the ICU followingthe development of similar respiratory symptoms. Three of the patients were described as seriously ill, whiletwo patients showed improvement. A section of the high-dependency bone marrowunit was closed. Officials considered the possibility that the patients were thevictims of a combination of several deadly pathogens, instead of one microscopicculprit. 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. Apreliminary count by the CDC identified more than 11,000 cases last year in theU.S., up from 9,771 in 2002. This number, which the CDC admits is almostcertainly an underestimate, is the highest recorded in three decades. Most people assume whooping cough has gone the way of polioand the measles, says Jeanne Pfeiffer, RN, MPH, CIC, president of APIC. Butthere are up to 50 million cases of whooping cough worldwide each year and morethan 350,000 deaths associated with it. With minimal effort in the UnitedStates, we can greatly reduce the chances of our children contracting pertussis. CDC Confirms First Reported Cases of Rabies TransmissionThrough Solid Organ Transplantation The CDC confirmed the first reported cases of rabiestransmission through solid organ transplantation. Confirmation came from laboratory testing of autopsy specimensafter the deaths of three persons who had received organ transplants from the samedonor. The organ donor, an Arkansas resident, had undergone routinedonor eligibility screening and testing, but rabies testing is not part of theroutine screening process. Lungs, kidneys, and liver were recovered and latertransplanted on May 4, 2004 into four recipients, one of whom (the lungtransplant patient) died during transplant surgery. No other organs or tissueswere recovered from the donor. Infectious Disease Experts Issue Report Stressing the Need toImprove Low Influenza Vaccination Rates Among HCWs The National Foundation for Infectious Diseases (NFID) issueda comprehensive report stressing the importance of annual influenza vaccinationamong HCWs and urged healthcare institutions to help facilitate annual employeeinfluenza immunization programs. The report was issued in response to dismalinfluenza immunization rates among HCWs, despite longstanding recommendationsfrom the CDC. Alarmingly, only 36 percent of U.S. HCWs are immunized againstinfluenza each year, which means the majority of HCWs remain unprotected and mayreport to work when they have influenza and can easily spread the virus topatients, said William Schaffner, MD, NFID board member, and professor andchair of the department of preventive medicine at Vanderbilt University Schoolof Medicine. The report, Improving Influenza Vaccination Rates in Health CareWorkers: Strategies to Increase Protection for Workers and Patients,provided details about the overall impact of influenza among HCWs and sharesdata regarding the lack of knowledge among HCWs about influenza immunization andits impact on patient safety. Surveys Finds Americans are Concerned About Hospital-BasedMedical and Surgical Errors Hospital-based medication, surgical and diagnostic errors areof concern to most Americans, according to the results of a Harris poll of 2,847U.S. adults conducted online. Three in five Americans were extremelyconcerned (39 percent) or very concerned (24 percent) abouthospital-based medication errors, such as receiving the wrong medication or thewrong dose, and 55 percent are concerned about hospital-based surgical errorsthat might include incorrect amputations or mistaken patient identities. MRSA Contamination Can Be Reduced by Using Copper Alloys forSurfaces in Healthcare Facilities In a study co-funded by the International Copper Associationand Copper Development Association Inc., Bill Keevil, head of the environmentalhealthcare unit in the University of Southamptons School of BiologicalSciences, and Dr. Jonathan Noyce examined the survival rates ofmethicillin-resistant Staphylococcus aureus onstainless steel, the most commonly used metal in healthcare facilities, and onselected copper alloys. They found that at room temperature, MRSA was able topersist and remain viable in dried deposits on stainless steel for periods up to72 hours. For copper alloys containing 55 percent, 80 percent, and 99 percentcopper, significant reductions in viability were achieved after 4.5 hours, 3hours, and 1.5 hours, respectively. Yellow brass rendered the bacteriacompletely inviable after 270 minutes, while the high-copper alloy took only 90minutes. Our results strongly indicate that use of the copper metals in suchapplications as door knobs, push plates, fittings, fixtures and work surfaceswould considerably mitigate MRSA in hospitals and reduce the risk ofcross-contamination between staff and patients in critical care areas, saidKeevil. August New York Hospitals Take Aim at Surgical Infections New York hospitals were expected to take a leading role inadopting new national guidelines that address the prevention of surgery-relatedinfections. The guidelines, which represent unprecedented consensus among20 of the nations largest surgical, medical and hospital associations, arethe result of a year-long effort by these groups to identify best practices forpreventing surgical site infections. We believe this consensus statement willlead to greater clarity for health professionals on proper antibiotic use, andwill help in our quality improvement efforts, said Charles E. Stimler, MD,MPH, medical officer for IPRO. We will leverage this consensus as we continueto work with the New York Surgical Infection Prevention Collaborative and thestates hospitals to save lives and reduce unnecessary hospitalizations.Stimler and the IPRO quality improvement team are leading the Collaborative aspart of Medicares National Surgical Infection Prevention (SIP) Project, anongoing, three-year-old initiative co-sponsored by CMS and the CDC. The SIPProjects goal is to reduce the occurrence of post-operative infection byimproving 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 RespiratoryProtection Standard. The revision added a new quantitative fit-testing procedureto assist workers and employers in the proper fit and selection of respirators. Selecting the proper respirator is a vital step inprotecting a user against potential over-exposures and adverse health effects,said OSHA administrator John Henshaw. The additional fit-testing protocolwill help employers and employees to select the right respirator based on theconditions in their workplaces. The new fit-testing protocol, referred to as the ControlledNegative Pressure (CNP) REDON protocol, requires three different test exercisesfollowed by two re-donnings of the respirator. Lassa Fever Claims Life of New Jersey Man The New Jersey Department of Health reported that a38-year-old Mercer County man died from an acute viral disease called Lassafever, a condition that is rare in the U.S., but endemic to West Africa. The manhad traveled to Liberia, where he stayed for several months, before returning tothe 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. Lassafever is an acute viral disease that is endemic in portions of West Africa. Thedisease is animalborne and is transmitted to humans through contact with urineor droppings of infected rodents; it can also be transmitted from person-to-person through blood or bodily fluid that penetrates the skin, through mucousmembrane or through sexual contact. Overall, death is rare in patients whocontract Lassa fever, with only 1 percent of all cases resulting in death.However, between 15 percent to 20 percent of patients hospitalized with Lassafever 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 SecuringMedical Catheters fact sheet. The revised OSHA document now requires allhealthcare facilities to conduct annual reviews of their catheter-securementprocesses to ensure the institution is using the safest system possible in orderto reduce or eliminate needlesticks. The document emphasized, In this review,employers must include the input of non-managerial employees responsible fordirect patient care who are potentially exposed to injuries from contaminatedsharps in the identification, evaluation, and selection of effective engineeringand work practice controls. Clostridium difficile Death PutsHospitals in Ontario on Notice The death of a patient at Southlake Regional Health Centre inNewmarket 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 thepotential 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 beensignificantly corrected and no additional resources have been dedicated tohospital cleaning. During the SARS crisis, the organism lived on an unwashedsurface in a hospital for 30 days, before spreading to a patient who thentransferred to another facility. Fifteen years of cuts to hospital cleaningbudgets have left many institutions unable to eliminate virulent organisms like Cdifficile. And these cuts are compounded by multiple patient transfersbetween institutions and the huge numbers of part-time hospital staff, forced towork 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 whodied aboard a ship sailing to the Galveston area, according to Dr. Mark Guidryof the Galveston County Health Authority. The man, who was returning from a tripto West Africa, had symptoms suggestive of Lassa fever and malaria. Guidry said malaria is common in many developing countries andtravelers who visit these areas risk getting malaria. About 1,200 cases ofmalaria are diagnosed in the U.S. each year. Cases are typically among travelersand immigrants returning from malaria-risk areas, many from sub-Saharan Africaand the Indian subcontinent. Indiana, Oregon State Health Officials Report WNV Detected inBlood Donations State health officials reported that routine screening by theAmerican Red Cross detected West Nile virus in blood donated by a LaGrangeCounty resident. The individual developed no symptoms of West Nile infection,and the blood was not put into circulation. A Jackson County blood donor was thesecond person in Oregon to test positive for West Nile virus, according topublic health and American Red Cross officials. It does not in any waysignify there is a risk of acquiring West Nile from giving blood. We continue toadvise 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 thesupply. WHO Official Warns of a Growing Global Threat From AvianInfluenza The World Health Organization (WHO) warned that greaterefforts will be needed if the world is to head off the threat of an avianinfluenza pandemic springing from the presence of the avian influenza H5N1 virusin poultry in Asia. Unless intensive efforts are made, a pandemic is verylikely to occur, said Shigeru Omi, MD, WHOs regional director for theWestern Pacific. Omi cited four reasons for concern: the H5N1 virus causingavian influenza among poultry in Asia is circulating more widely than initiallybelieved; the cyclical history of previous influenza outbreaks means a pandemic is due;virtually nobody would be immune to a new human influenza virus that resultedfrom outbreaks in poultry; and the increased global movement of people and goodsmeans 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 beginningof this year, there have been 39 confirmed human cases in the region, 28 of whomdied. October 2004 HHS Awards $232 Million in Biodefense Contracts For VaccineDevelopment HHS Secretary Tommy G. Thompson announced four new contractstotaling more than $232 million to fund development of new vaccines againstthree potential agents of bioterrorism: smallpox, plague and tularemia. TheNIAID will administer the contracts. We are moving as quickly as possible todevelop new vaccines to ensure that our nation is protected against an array ofpotential bioterror agents, Thompson said. IDSA Urges Senate to Spur Anti-Infective Development The Infectious Diseases Society of America (IDSA) saidCongress should act soon to introduce and enact legislation to spur thedevelopment 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 theU.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) and theSenate Judiciary Committee. The new legislation would build on The ProjectBioshield Act, which was signed into law July 21, 2004, the same day thatIDSA issued a major report, Bad Bugs, No Drugs: As Antibiotic DiscoverStagnates ... A Public Health Crisis Brews. IDSA hopes to convince Senateleaders to extend the scope of Bioshield II beyond bioterrorism to removefinancial disincentives in all areas of infectious diseases research anddevelopment, particularly for antibiotics to treat drug-resistant infections. There is an inextricably linked, synergistic relationshipbetween research and development efforts needed to protect against bothnaturally occurring infections and bioterrorism agents, said John G.Bartlett, MD, chief of the division of infectious diseases at the Johns HopkinsUniversity School of Medicine and chair of IDSAs Task Force on AntimicrobialAvailability. As such, we believe this approach makes perfect sense. Nurses Petition Federal Court to Stop Virginia Mason MedicalCenters Mandatory Flu Vaccination Policy The Washington State Nurses Association (WSNA), representingmore than 600 registered nurses at Virginia Mason Medical Center (VMMC), filed apetition Oct. 1 in Federal Court seeking an injunction to stop theimplementation of the hospitals policy requiring mandatory flu vaccinationfor all RNs. The association says this unilaterally implemented policy violatesthe terms and the very purpose of the collective bargaining agreement betweenWSNA and VMMC. The WSNA did not oppose the flu vaccination; however, it did oppose any healthcare facility threatening tofire people if they did not submit to the mandatory vaccination, especially inthe absence of a declared public health emergency and a recommendation for mandatory vaccination by the CDC.
