Salmonella Outbreak Sickens Patients at Multiple PA Healthcare Facilities

An outbreak of Salmonella Javiana has sickened more than 30 patients at four healthcare facilities in southeast Pennsylvania, according to U.S. Food and Drug Administration (FDA) report.

Evidence points to a mix of fruit as the source of the outbreak. This mix — called "Fruit Luau" — has been recalled by its producer, Tailor Cut Produce of New Jersey.

As the FDA notes, the recalled products — which were distributed in Pennsylvania, New Jersey, New York and Delaware between Nov. 15 and Dec. 1, 2019 — may have been distributed to nursing homes, schools, hospitals and other facilities that cater to vulnerable populations.

Salmonella can cause fever, diarrhea, nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections, endocarditis and arthritis.

The FDA is still investigating the outbreak in collaboration with the Pennsylvania Department of Health. The FDA has not yet identified the four healthcare facilities confirmed as involved.

Study: Healthcare Workers Contaminated With Respiratory Viruses Following Care

The results of a new study indicate that the skin, clothing and personal protective equipment (PPE) of healthcare workers are frequently contaminated with respiratory viruses following the delivery of care to patients with acute viral infections.

The study, published in the Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA), examined the skin, clothing and/or PPE of 59 such workers in an acute-care academic hospital.

Viruses were detected on:

• 31% of glove samples

• 21% of gown samples

• 12% of face mask samples

• 21% of bare hand samples

• 11% of scrub samples

• 7% of face samples

Researchers also found positive correlation between virus concentrations on stethoscopes and gowns with the number of torso contacts and virus concentrations on face masks with the number of face mask and patient contacts.

In their conclusion, researchers call for renewed focus on hand hygiene and use of PPE as well as consideration of modifying self-contact behaviors.

CDC: Medical Device-Associated HAIs More Likely to Be Antibiotic Resistant

A new report from the Centers for Disease Control and Prevention (CDC) indicates that healthcare-associated infections (HAIs) linked to medical device use are more likely to be antibiotic resistant than surgical site infections (SSIs).

The report, from the CDC's National Healthcare Safety Network (NHSN), was published in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA).

Researchers analyzed data on patients at least 18 years of age from more than 5,600 facilities — most of which were general acute-care hospitals with fewer than 200 beds — gathered from 2015 to 2017. The devices studied were those used for a limited time, such as central lines, ventilators and urinary catheters, as opposed to implants.

Among the key findings, as noted in a SHEA news release: 48% of tested Staphylococcus aureus isolated from device-associated infections were methicillin resistant (MRSA) compared to 41% among those isolated from surgical site infections and 82% of tested device-associated Enterococcus faecium bacteria were resistant to vancomycin (VRE) compared to 55% percent among SSIs. 

Other noteworthy findings from this report and a companion report on pediatric HAIs include the following:

• Escherichia coli, Staphylococcus aureus and Klebsiella spp were the three most frequently reported pathogens associated with adult HAIs.

• Staphylococcus aureus, Escherichia coli and coagulase-negative staphylococci were the three most commonly reported pathogens associated with pediatric HAIs. 

• Pathogens from long-term acute care hospitals are more likely to be antibiotic resistant than those acquired in general acute-care hospitals.

• HAIs in adult healthcare settings are likely to be more resistant than those in pediatrics settings.

In the SHEA release, CDC epidemiologist and lead author Lindsey Weiner-Lastinger said, "These data show that the threat of exposure to bacteria that are resistant to antibiotics extends across the nation. The data also serve as an urgent call for healthcare facilities and public health agencies to intensify their efforts to prevent the emergence and spread of antimicrobial resistance."

Cardiac Implantable Electronic Device Infection Significantly Increases Mortality Risk, Study Shows

The results of a study presented at the recent American Heart Association Scientific Sessions indicate that patients with a cardiac implantable electronic device (CIED) who experience a "major" infection face a significant risk of mortality and impaired quality of life.

As Cardiac Rhythm News (CRN) reports, major infection was defined as "… resulting in CIED system removal, an invasive CIED procedure, treatment with long-term suppressive antibiotic therapy with infection recurrence after discontinuation of antibiotic therapy, or resulting in death."

The study, which involved nearly 7,000 patients, found that a major infection was associated with a threefold risk of mortality at one year and impaired quality of life through six months.

The study was presented by Dr. Bruce Wilkoff of Cleveland Clinic. CRN quotes him as concluding, "This large, prospective analysis corroborates and extends understanding of the impact of CIED infections as seen in real-world datasets. CIED infections severely impact mortality, quality of life, healthcare utilization and cost in the U.S. healthcare system."

CIEDs include "… pacemakers for bradyarrhythmia treatment, implantable cardioverter defibrillators for tachyarrhythmia management and cardiac resynchronization therapy devices for systolic dysfunction with conduction delays, according to the Anesthesia Patient Safety Foundation.

CDC Updates Core Elements of Hospital Antibiotic Stewardship Programs

The Centers for Disease Control and Prevention (CDC) has updated its "core elements" of hospital antibiotic stewardship programs.

First released in 2014, the core elements are intended to be an adaptable framework that any hospital can use to guide its efforts to develop and implement antibiotic stewardship programs and help improve antibiotic prescribing. The core elements are comprised of seven structural and procedural components CDC has determined is associated with successful antibiotic stewardship programs: hospital leadership commitment, accountability, pharmacy expertise (formerly "drug expertise"), action, tracking, reporting and education.

CDC said its updates "reflect both lessons learned from five years of experience as well as new evidence from the field of antibiotic stewardship."

Major updates include the following:

• Hospital leadership commitment: Dedicate necessary human, financial and information technology resources. This includes hospital leadership better ensuring that antibiotic stewardship programs leadership has dedicated time and resources to operate the program effectively, along with ensuring that program leadership has regularly scheduled opportunities to report stewardship activities, resources and outcomes to hospital leadership.

• Accountability: Appoint a leader or co-leaders, such as a physician and pharmacist, responsible for program management and outcomes.

• Pharmacy expertise: Appoint a pharmacist, ideally as the co-leader of the stewardship program, to lead implementation efforts to improve antibiotic use.

• Action: Implement interventions, such as prospective audit and feedback or preauthorization, to improve antibiotic use. The update includes other examples of interventions, such as facility-specific treatment recommendations. The update also emphasizes the importance of actions focused on the most common indications for hospital antibiotic use (i.e., lower respiratory tract infection (e.g., community-acquired pneumonia), urinary tract infection and skin and soft tissue infection). A category of nursing-based actions was added in the update.

• Tracking: Monitor antibiotic prescribing, impact of interventions and other important outcomes like Clostridium difficile infection and resistance patterns.

• Reporting: Regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses and hospital leadership.

• Education: Educate prescribers, pharmacists and nurses about adverse reactions from antibiotics, antibiotic resistance and optimal prescribing. The update notes that case-based education through prospective audit and feedback and preauthorization are effective methods to provide education on antibiotic use. The update also suggests engaging nurses in patient education efforts.

As CDC notes, U.S. hospitals have made considerable progress implementing the core elements. In 2018, 85% of acute care hospitals reported having all seven of the core elements in place, compared to only 41% in 2014.

For more information about the update, download "The Core Elements of Hospital Antibiotic Stewardship Programs: 2019" and watch a CDC-produced video discussing what's new in the core elements.