Publication of the April 2013 HAI Quarterly Report (2012 HAI Annual Summary)

The April 2013 HAI Quarterly report for healthcare providers and healthcare consumers will be published today on the NC DPH website at http://epi.publichealth.nc.gov/cd/hai/figures.html. These reports include hospital-level and state-level estimates of select HAIs from January-December 2012 and serves as the 2012 HAI Annual Summary for NC.

Novel Influenza A(H7N9) in China - Update April 15

According to the the European Center for Disease Control and Prevention 


As of 15 April 2013, 60  sixty cases of human infection with influenza A(H7N9) have been reported from six provinces in eastern China with a combined population of about 330 million. Onset of disease has been between 19 February and 9 April 2013 in: Shanghai (24), Jiangsu (16), Zhejiang (15), Anhui (2), Henan (2)and Beijing (1). The date of disease onset is currently unknown for five patients. Most cases have developed severe respiratory disease and only three cases are reported to have mild clinical course. Thirteen patients died (case-fatality ratio=21%). The median age is 65 years with a range between 4 and 87 years; 17 of them are females.

More than 1000 close contacts of the confirmed cases are being closely monitored. There are reports of a small family cluster of disease around the first patient, but this has not been confirmed by laboratory data.

The source and mode of transmission have not been confirmed. The outbreak is caused by a reassortant avian influenza virus with low pathogenicity for birds, hence it does not cause the signal 'die-offs' in poultry associated with highly pathogenic strains of avian influenza viruses. Genetic analyses of the isolates have shown changes which suggest that the H7N9 virus may have greater ability to infect mammalian species, including humans, than most other avian influenza viruses. Pathogenicity for humans appears to be high and higher age appears to be a risk factor for disease.
 
The most likely scenario is that of A(H7N9) spreading undetected in poultry populations and occasionally infecting humans who have close contact with poultry or poultry products but this will have to be validated as further data become available.

The Chinese health authorities are responding to this public health event by enhanced surveillance, epidemiological and laboratory investigation and contact tracing. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus. The authorities reported to the World Organisation for Animal Health (OIE) that A(H7N9) was detected in samples from pigeons and chickens and in environmental specimens from three markets in Shanghai. These markets have been closed and the live poultry were culled.

No vaccine is currently available for this subtype of the influenza virus. Preliminary test results suggest that the virus is susceptible to the neuraminidase inhibitors (oseltamivir and zanamivir).

At this time, there is no evidence of on-going human-to-human transmission. More sporadic cases are expected to be reported. The risk of disease spread to outside of China is considered low, although individual cases coming from China cannot be ruled out.

The CDC also release a HAN alert yesterday regarding the current situation as well as interim recommendations for case definitions, testing, infection control and treatment.

ICR: New Collaboration, New Format

The Statewide Program for Infection Control and Epidemiology and the NC Division of Public Health are embarking on a new communication collaboration. Going forward, Infection Control Report will continue to offer up applicable nuggets of knowledge from UNC infection prevention experts and to highlight relevant literature, news, and programming. Added to Infection Control Report will be brief summaries of NC Division

of Public Health reports, NHSN tips, tricks, hints, and lessons learned, NHSN success stories, and information relevant to long term care facilities. All of this will be packaged in a user friendly format for easy access and utilization.

A new format 

Easy access and utilization for our users is important to us. With an increasing number of Infection Control Report (ICR) contributors, we are publishing ICR as a website in a blog format. Welcome to the new Infection Control Report!

 

Partnership in Prevention Award

The U.S. Department of Health and Human Services (HHS) has partnered with the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) to create the Partnership in Prevention Award.

The award will highlight the work of a hospital that achieved sustainable improvements based on the concepts of the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination. The award winner will be announced during International Infection Prevention Week (October 20-26, 2013).
This is an opportunity to recognize the outstanding efforts of multidisciplinary teams that have improved clinical practice and patient safety through the utilization of evidence-based guidelines, achieved and maintained superior prevention results, and advanced best practices.

Nominations for the award will be accepted through July 1, 2013. Eligibility criteria and application instructions [PDF 130 KB].

We invite you to nominate your team.  If you have any questions about the awards, please email the Partnership in Prevention Award team at awards@apic.org.

CDC Releases NHSN Annual Report

The Centers for Disease Control and Prevention yesterday released its annual report summarizing device-associated data reported to the agency’s National Healthcare Safety Network in 2011. Among the improvements in quality, the report cites a 41% reduction in central line-associated bloodstream infections since 2008, up from 32% in 2010; a 17% reduction in surgical site infections since 2008, up from 7% in 2010; and a 7% reduction in catheter-associated urinary tract infections since 2009. The report was published in the American Journal of Infection Control (AJIC). The data, which were collected by participating hospitals from January through December 2011 and reported to CDC by Aug. 1, 2012, are used for the 2011 National and State Healthcare-associated Infections Standardized Infection Ratio Report.

Influenza Immunization at UNC Health Care: Impact of Implementing a Program where Continued Employee is Conditional on Receipt of Vaccine

by David Weber, M.D., M.P.H.

Each year approximately 10% to 20% of Americans develop viral influenza leading to thousands of deaths.  The risk of severe illness and death is increased in persons who are very young, older, have comorbid conditions (e.g., obesity, diabetes, renal failure, cardiac disease), or are immunocompromised (e.g., HIV-infected, solid organ transplant, cancer).  High coverage rates of influenza vaccine among healthcare personnel have been demonstrated to reduce the risk of acquisition of influenza by patients.  For these reasons, the Centers for Disease Control and Prevention (CDC) and many professional organizations (e.g., SHEA, APIC) have recommended that all healthcare personnel, unless they have a medical contra-indication receive influenza vaccine.  Furthermore, The Joint Commission (TJC) and CMS require that healthcare facilities track influenza vaccine coverage by healthcare personnel.  Many interventions have been demonstrated to improve uptake of the vaccine including the following:  providing vaccine at no cost to healthcare personnel, providing vaccine at convenient times and locations, strong support by senior administration, use of mobile carts, and rewards for taking vaccine.  By using ALL these interventions healthcare facilities can often achieve immunization coverage of 70% to 80%.  However, published papers have demonstrated that to exceed these levels, influenza immunization must be a condition of employment.

UNC Health Care made receipt of influenza immunization a condition of employment (or accreditation for professional staff) for the 2012-2013 influenza season.  We did accept religious objections and medical contra-indications are valid reasons for not receiving vaccine.  Of 9,533 employees at UNC Health Care, 9,529 were compliant with our policy (99.9%) and the other 4 were terminated.  Overall, 9,002 employees (94.4%) were vaccinated, 116 (1.2%) had medical contra-indications, and 370 (3.88%) were granted a religious exemption; 1,048 employees provided documentation of receipt of influenza vaccine by their own medical provider.  Our experience at UNC Health Care demonstrates that receipt of influenza vaccine can successfully be made a condition of employment.  Influenza vaccine protects our employees and our patients and healthcare facilities should comply with CDC and TJC recommendations for use. 

Also of interest, at UNC Health Care we allow our healthcare personnel to choose among inactivated influenza vaccine (IIV) which is given as an intra-muscular injection (IM), attenuated inhaled influenza vaccine, and inactivated intradermal influenza vaccine.  Our personnel made the following choices (numbers are an approximate):  inactivated IM vaccine, 8600, attenuated inhaled vaccine, 460, and inactivated intradermal vaccine, 580.