Middle East Respiratory Syndrome (MERS): An Update

novel coronavirus (CDC.gov)

by David Weber, MD, MPH

The Middle East Respiratory Syndrome (MERS) is a viral illness first reported in Saudi Arabia in 2012.  It is novel coronavirus (CDC.gov) caused by a coronavirus called MERS-CoV.  This virus is similar to the coronovirus that caused SARS.  As of 23 May 2014, there have been 635 laboratory confirmed cases of infection with MERS-CoV including 193 deaths (case fatality rate = 30.4%).  However, the mortality rate may be inflated by ascertainment bias (i.e., only sicker patients are being tested for MERS-CoV).

To date, all the cases have been linked to countries in the Arabian Peninsula occurring either in people who have recently returned from the Arabian Peninsula or had contact with an ill person who recently returned from the Arabian Peninsula (Table 1).

A Team Based Approach to Reducing Catheter-associated Urinary Tract Infections

by Lisa Teal, BSN, RN

Highlights of a poster presentation at the APIC Annual Conference, June 2014

Issue: Catheter-associated urinary tract infections (CAUTI), the most common healthcare-associated infection, lead to substantial morbidity and increased healthcare costs.  In 2011, at an 810-bed academic hospital, we set a 2-year hospital-wide quality goal of 5% CAUTI reduction each year from the previous year.  Achievement of the goal was tied to a hospital-wide employee financial incentive.  Unit-level Six-Sigma projects guided our multidisciplinary strategy to three focus areas for urinary catheters:  appropriate insertion indication, maintenance, and timely removal.

Highlights of NC Division of Public Health Healthcare-Associated Infections Prevention Program Activities for 2013

by Jennifer MacFarquhar, RN, MPH, CIC

The NC Division of Public Health HAI Program published its second annual statewide hospital-specific report in April 2014.  Key 2013 program accomplishments include the following:

1. Released the first public reports disclosing hospital-specific healthcare-associated infection rates in January 2013.  Public reports have been released quarterly since that time.

2. Convened two task forces targeting improved detection and prevention of carbapenem-resistant Enterobacteriaceae (CRE) infections.  These task forces created CRE infection prevention and laboratory guidance resources that have been disseminated statewide.

3. Worked to improve safe injection practices through the One & Only injection safety campaign.  In 2013, 10 injection safety educational sessions were held, with approximately 1,600 healthcare providers in attendance and over 2,600 campaign materials disseminated.  The NC One & Only Campaign also trained and equipped more than 20 healthcare professionals to provide safe injection education within their organizations or local communities.

New NC Division of Public Health Healthcare-Associated Infections Prevention Program Coordinator!

by Jennifer MacFarquhar, RN, MPH, CIC
 

Tammra Morrison

The NC Division of Public Health HAI Program is thrilled to welcome Tammra Morrison to the team as the new HAI Coordinator!  Tammra is a registered nurse with extensive experience in both healthcare and public health in a variety of positions including clinical staff nurse, nursing supervisor, communicable disease and clinical trials coordinator, and clinical nurse liaison.  Most recently, Tammra served as the Interim Director of Nursing at a local health department in North Carolina, providing direct oversight and program management for several sections including general communicable disease, immunizations, and preparedness.  

Regulatory Update - Infection Control Breaches Warrant Referral to Public Health Authorities

Note: The following regulatory updates are by Kirk Huslage, RN, BSN, MSPH, CIC

On May 30, 2014, CMS released a Survey and Certification Group memo reiterating the need for State Survey Agencies (SAs) or Accrediting Organizations (AOs) to report any identified breaches of generally accepted infection control standards as it relates to safe injection practices (see examples below) to the appropriate state public health authority (i.e., the State’s HAI Prevent Coordinator or Epidemiologist).

Regulatory Update – Inpatient Rehabilitation Facilities (IRF) Prospective Payment System proposed rules for FY 2015

CMS has proposed the following measures for inclusion in the IRF quality reporting program for FY 2017 payment determination with reporting to begin January 2015 through NHSN.  This rule covers both free-standing IRFs and Inpatient Rehabilitation units affiliated with acute care hospitals, including critical access hospitals (CAHs).

Regulatory Update - Hospital Inpatient Prospective Payment System (IPPS) proposed rules for FY 2015

The IPPS program includes infection related measures in several parts of the program:

• Hospital Acquired Conditions – Non-payment for certain secondary conditions when condition is acquired during hospitalization (includes several HAIs).

• Hospital Inpatient Quality Reporting Program (IQR) – Incentivized payment for reporting certain quality measures (including required NHSN reporting) to CMS so consumers make more informed decisions about their care.  Hospitals that do not participate in the IQR program receive a 2% reduction in payment.

• Hospital Value-based Purchasing (VBP) – Incentivized payment systems that rewards hospitals for the quality of care they provide based on a Total Performance Score in a performance period.   A hospital’s adjustment factor may be positive, negative or result in no change in the payment rate that would apply absent the VBP program.

Regulatory Update – Inpatient Psychiatric Facilities (IPF) Prospective Payment System proposed rules for FY 2015

CMS has proposed the following measures for inclusion in the IPF quality reporting program for FY 2017 payment determination with reporting to begin 2015-2016 Influenza season.  This rule covers both free standing inpatient psychiatric facilities and inpatient psychiatric units affiliated with acute care hospitals, including critical access hospitals (CAHs).

Selection of the Ideal Disinfectant

by William A. Rutala          

               Healthcare-associated infections (HAIs) remain an important source of morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths annually. A major source of nosocomial pathogens is thought to be the patient’s endogenous flora, but an estimated 20-40% of healthcare-associated infections have been attributed to cross-infection via the hands of healthcare personnel.  Contamination of the hands of healthcare personnel could in turn result from either direct patient contact or indirectly from touching contaminated environmental surfaces. Healthcare personnel have frequent contact with the environmental surfaces in patients’ rooms providing ample opportunity for contamination of gloves and/or hands.  Two recent studies demonstrated that contact with the environment was just as likely to contaminate the hands of healthcare workers as was direct contact with the patient.  Donskey has reviewed the scientific literature and found that improving surface cleaning and disinfection reduces healthcare-associated infections (Am J Infect Control 2013: 41:S12-S19).  Another recent paper showed that daily disinfection of surfaces (versus standard cleaning surfaces when visibly soiled) with a sporicidal disinfectant in rooms of patients with Clostridium  difficile and methicillin-resistant Staphylococcus aureus (MRSA) reduced acquisition of pathogens on gloved hands after contact with room surfaces.  While disinfectants are used to prevent transmission of pathogens from both noncritical and semicritical items, the purpose of this brief article is to assist the user in the selection of the optimal disinfectant for use with environmental surfaces and noncritical patient care items (devices that contact only intact skin such as stethoscopes).  The same characteristics for an ideal low-level disinfectant would be used for high-level disinfectants; however, the contact time would be longer and antimicrobial spectrum would be broader (e.g., may include C. difficile spores).  To date, the perfect product for healthcare disinfection has not been introduced; however, there is a wide array of disinfectants that offer a range of characteristics. 

Review of New and Current ACIP Recommendations

by David J. Weber, MD, MPH

The Centers for Disease Control and Prevention (CDC) has just released the 2014 vaccine schedules from the Advisory Committee on Immunization Practices (ACIP).  Changes in vaccine adult schedule (19 years or older) can be found in the MMWR 2014;63:1-2 { http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0203a2.htm?s_cid=mm63e0203a2_w} .  The schedule itself can be found at http://www.cdc.gov/vaccines/schedules/hcp/adult.html). 

Vaccines recommended for susceptible HCP include the following:

·         Mumps (2 doses):  MMR preferred (assume immune if born before 1957 except during an outbreak)

·         Measles (2 doses):  MMR preferred (assume immune if born before 1957 except during an outbreak)

·         Rubella (1 dose):  MMR preferred (indicated for all female HCP of childbearing potential)

·         Influenza (1 dose yearly)

·         Varicella (2 doses)

·         Tetanus toxoid, diphtheria toxoid, pertussis (1 dose of Tdap)

·         Hepatitis B (3 doses with quantitative anti-HBsAg titer 1-2 months after 3^rd dose):  Indicated for HCP who have potential exposure to blood or contaminated body fluids.

·         Meningococcal vaccine (1 dose; booster every 5 years if risk continues):  Indicated for lab personnel who spin cerebrospinal fluid.

New changes in the vaccine schedule relevant to HCP include:

·         Recombinant influenza vaccine (RIV) or inactivated influenza vaccine (IIV) can used among HCP with hives-only allergy to eggs.  RIV contains no egg protein and can be used among persons aged 18 to 49 years who have egg allergy of any severity.

·         A single dose of Tdap vaccine is recommended for HCP; a Td booster should be administered every 10 years thereafter.