10 of the Scariest Healthcare Infections and Threats

Venture out this Halloween and you will likely encounter some wonderfully scary costumes, from demons to vampires to ghosts and any number of tributes to iconic horror movie characters, such as Pennywise the Dancing Clown, Jason Vorhees, Freddy Krueger and Michael Myers.

But it's what you can't see that may be scariest of all: infection-causing organisms. In the spirit of Halloween, the team of Infection Control Consulting Services (ICCS) consultants share 10 of their scariest healthcare infections and threats.

1. Hepatitis A

Hep A is on our mind because of outbreaks flaring up across the United States. The good news is that hep A is uncommon and preventable by vaccine. The bad news is that hep A is highly contagious, can cause severe illness and there an estimated 1.4 million cases annually.

2. Hospital sinks next to toilets

Sinks should be located near toilets to help encourage proper hygiene, right? Perhaps not in hospitals. Research published earlier this year found that, in a medical intensive care unit of a large Wisconsin hospital, nearly nine out of 10 of the unit's patient sinks next to toilets tested positive for Klebsiella pneumoniae carbapenemase (KPC). KPC is a family of bacteria with high levels of resistance to antibiotics. Only about 22% of sink drains located closer to the entry door of the room tested positive for KPC.

3. Opened multi-dose vials left on anesthesia carts

Want to upset an infection preventionist? Leave a multi-dose vial opened, unlabeled and in an unsecured location. Unfortunately, ICCS team members witness this regularly during on-site visits (even once is too often), with anesthesia medication often the culprit.

When clinicians fail to follow safe injection practices, multi-dose vials are much more prone to contamination. We called attention to this — and other unsafe injection practices — in a 2018 Special Report.

4. Influenza

It's only fitting to include influenza on this list as we are officially into the 2019-2020 flu season. This fact hit home when the Centers for Disease Control and Prevention (CDC) recently reported the first pediatric influenza deaths of the season.

While getting an influenza vaccine does not ensure you won't get the flu, it's the single best preventative measure. If you still need the vaccine, don't wait much longer.

5. Measles

We hate to include measles on our list, but the times necessitate it. As the World Health Organization (WHO) notes, data indicates that during the first six months of 2019, there have been more measles cases reported worldwide than in any year since 2006. From Jan. 1 to July 31, 2019, 182 countries reported nearly 365,000 measles cases to the WHO. That's nearly tripling the number reported during the same time period in 2018.

In the United States, the news concerning measles isn't good. CDC reports that from Jan. 1 to Oct. 3, 2019, about 1,250 cases of measles have been confirmed in 31 states. This is the greatest number of cases reported in the United States since 1992. Of the reported cases, about 10% resulted in hospitalization, with about 5% reported having complications, including pneumonia and encephalitis.

Perhaps the worst part of all is that so many of these measles cases were preventable. The majority of the cases reported are among people not vaccinated against the viral infection.

6. Reuse of needles and syringes

While we think every item on this list is scary, this may be the scariest of all. Despite many years of stressing the importance of providers never reusing a needle or syringe, the practice remains a significant problem in the United States and worldwide. Both needle and syringe must be discarded upon use. This is the case regardless of whether you are using a single- or multi-dose vial. Any reuse of a needle or syringe can transmit disease. Providers should follow the CDC's "One and Only" Campaign, which advocates for one needle, one syringe, one time.

7. Dental unit waterlines not rinsed or flushed

We called attention to this issue in a 2016 Special Report and it remains problematic today, putting the health and wellbeing of dental patients of all ages at risk.

As we wrote in the report, "Dental waterlines are generally plastic in nature, and carry water to the hoses that rinse a patient's mouth. Dental waterlines are a challenge as bacteria grow biofilm which adheres to the plastic tubes and is very difficult to eradicate. Mycobacteria are not the only organisms that grow in dental water lines, and several studies have revealed issues with microbes and stagnant water."

8. Endoscopes testing positive for bacteria after cleaning and disinfection

When you hear "duodenoscope," do you think of endoscopic retrograde cholangiopancreatography (ERCP), the potentially life-saving procedure used to diagnose and treat problems in the pancreas and bile ducts, or do you think of infections?

Unfortunately, duodenoscopes have become synonymous with infections over the past several years. We drew attention to the challenges associated with the cleaning, disinfection and sterilization of duodenoscopes in a 2015 Special Report. Fast forward four years and we recently wrote that, "… despite efforts to improve the cleaning and reprocessing of duodenoscopes, decontamination remains a significant challenge, with scope-related infections continuing to harm many patients." That harm includes several deaths caused by bacteria transmitted from one patient to another, usually during ERCP.

9. Use of smartphones and tablets in an operating room

This is becoming an increasingly controversial issue as the reliance (and dare we say addiction?) on smart devices for personal and professional matters has grown. Should surgical team members be allowed to use their smart devices in the OR?

We're all for leveraging technology to improve the delivery of care, but not if it comes at the sacrifice of quality and safety. That's the dilemma of using smart devices in ORs. Think about where you use your smartphone. Rather, is there any place you won't use your smartphone? As we wrote in a blog last year, "… numerous studies have found that such devices are frequently contaminated and rarely cleaned and disinfected after handling." Unless a smart device is restricted to an OR, it is likely brought to dirty places within a facility (including restrooms) and outside it.

Without proper cleaning and disinfection of smart devices before they are brought into an OR, the likelihood of an infection increases. Proper hand hygiene before entering the OR is essential for patient safety, but the benefits of handwashing can quickly be undone by the handling of a dirty smart device.

10. Germs on airplanes

As a national firm, ICCS consultants fly around the country to visit clients, so we had to include airplane germs on the list. Few experiences may be worse for an infection preventionist then getting on a plane and hearing coughing and sneezing — especially during flu season. As we're trapped in the confined space, battling a continuous cold sweat, we hope to achieve the perfect blend of vitamin C, limited breathing and prayer to keep us healthy. Those hours between boarding and disembarking are quite scary, to say the least.

Think we're paranoid? Maybe a little. But a Today investigation found our infection fears justified. Warning: Reading the Today article may force you to reconsider any plans you have to fly.

Bonus: Spread of antibiotic-resistant E. coli superbugs

Perhaps "bonus" isn't the best word to describe this late addition to the list. New research published this month caught our attention — and made our skin crawl a bit. As we wrote in our blog, the study indicates that poor toilet hygiene is more likely to spread antibiotic-resistant E. coli than food. This came as a bit of surprise considering E. coli is generally associated with contaminated food. The takeaway: Avoid contaminated food, but also spend a little longer ensuring toilets and the spaces they occupy are as clean as possible.

Happy Halloween!

We hope you found this list and discussion informative and not too much of a damper on your Halloween. The holiday may be a good time for fun frights, but, when it comes to pesky organisms and infections, it's a scary world out there every day of the year. There's no "masking" this reality, so ensure infection prevention is high priority for your organization.

Did we omit your scariest infection or threat? Let us know on LinkedIn!

Request a Consultation

If your matter is urgent,
please call (215) 692-3485.