Unit Based ChampionsUnit Based ChampionsInfection PreventionInfection Prevention

eBug ByteseBug Bytes

December 2011

Researchers analyzed more than 5,100 patients in a heart surgery registry. Patients, average age 64, were treated at nine U.S. academic medical centers and one Canadian center. The median time to major infection was 14 days after heart surgeries. Forty-three percent of all major infections occurred after hospital discharge. In this study, which excluded patients who were infected before surgery, researchers found 761 infections: 300 were classified as major infections (occurring in 6 percent of patients) and 461 were minor (in 8.1 percent of patients). Of the major infections:

Pneumonia, infection of the lungs, occurred in 2.4 percent of all patients.

C. difficile colitis, an intestinal infection, occurred in 1.0 percent. Bloodstream infections occurred in 1.1 percent. Deep-incision surgical site infections occurred in 0.5 percent. Minor infections included urinary tract and superficial incision site

infections. References: Presented at the American Heart Association's

Scientific Sessions 2011

Pneumonia Most Common Infection After Heart Surgery

Three researchers from the Institute for Medical Microbiology and Hospital Epidemiology at Hannover Medical School in Hannover, Germany collected surveys from 85 medical students in their third year of study during a lecture class that all students must pass before bedside training and contact with patients commences. Students were given seven scenarios, of which five (“before contact to a patient,” “before preparation of intravenous fluids,” “after removal of gloves,” “after contact to the patient’s bed,” and “after contact to vomit”) were correct hand hygiene (HH) indications. Only 33 percent of the students correctly identified all five true indications, and only 21 percent correctly identified all true and false indications.

2 Out of 3 Medical Students Don't Know When to Wash Their Hands

Hospital-acquired infection with C. difficile was identified in 1,393 of 136 877 admissions to hospita. l The crude median length of stay in hospital was greater for patients with hospital-acquired C. difficile (34 d) than for those without C. difficile (8 d). Survival analysis showed that hospital-acquired infection with C. difficile increased the median length of stay in hospital by six days. In adjusted analyses, hospital-acquired C. difficile was significantly associated with time to discharge, modified by baseline risk of death and time to acquisition of C. difficile.

The researchers concluded that hospital-acquired infection with C. difficile significantly prolonged length of stay in hospital independent of baseline risk of death. Their research was published in the Canadian Medical Association Journal.

Reference: Forster AJ, Taljaard M, Oake N, Wilson K, Roth V and van Walrave C. The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital. CMAJ Dec. 5, 2011. doi: 10.1503/cmaj.110543

C. diff Infection Prolongs Hospital C. diff Infection Prolongs Hospital Length of StayLength of Stay

Patient Isolation Associated With Patient Isolation Associated With Hospital DeliriumHospital Delirium

A team of researchers led by Dr. Hannah Day of the University of Maryland School of Medicine examined two years of data from the university's 662-bed medical center. They found that patients who were placed on contact precautions at some point after admission to the hospital were 1.75 times more likely to develop delirium. However, patients on contact precautions starting at admission were no more likely to develop delirium. That finding, the researchers say, suggests that it may not be the precautions themselves causing delirium. "Patients in our study who were placed on contact precautions later in their hospitalization were generally sicker than those who were on contact precautions from the outset," said Dr. Day. "So it's possible that the underlying illness rather than the precautions themselves is responsible for the association with delirium."

Journal Reference: Hannah R. Day, Eli N. Perencevich, Anthony D. Harris, Ann L. Gruber-Baldini, Seth

S. Himelhoch, Clayton H. Brown, Emily Dotter, and Daniel J. Morgan. The Association between Contact Precautions and Delirium at a Tertiary Care Center. Infection Control and Hospital Epidemiology, 33:1 (January 2012)

Survival of Bacterial Pathogens on Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper and Bacterial Retrieval from Paper to HandsPaper to Hands

Samples of four bacterial pathogens (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus hirae) were prepared according to standard laboratory procedures. Sterile swatches of office paper were inoculated with the pathogens and bacterial survival was tested over seven days. To test the transmission of bacteria from one person's hands to paper and back to another person's hands, the fingertips of volunteers were inoculated with a nonpathogenic strain of E. coli; these volunteers then pressed the inoculum onto sterile paper swatches. Another group of volunteers whose hands had been moistened pressed their fingertips onto the contaminated paper swatches. Bacteria transferred to the moistened fingertips were cultivated according to standard laboratory procedures.

Results: The four tested organisms showed differences in length of survival depending on environmental room conditions, but were stable on paper for up to 72 hours and still cultivable after seven days. Test organisms were transferred to paper, survived on it, and were retransferred back to hands.

Conclusion: Paper can serve as a vehicle for cross-contamination of bacterial pathogens in medical settings if current recommendations on hand hygiene aren't meticulously followed.

Reference: AJN, American Journal of Nursing: December 2011 - Volume 111 - Issue 12 - pp 30-34

Microbial Contamination of Microbial Contamination of OJ in Bars and RestaurantsOJ in Bars and Restaurants

Around 40 percent of the fresh orange juice consumed in Spain is squeezed in bars and restaurants. According to a study conducted by researchers at the University of Valencia (UV) though, poor handling of the oranges and insufficient cleaning of the juicer equipment stimulates bacterial contamination.The team collected 190 batches of squeezed orange juice from different catering locations and analysed their microbiological content on the same day. The results reveal that 43 percent of the samples exceeded the enterobacteriaceae levels deemed acceptable by food regulations in Spain and Europe. Furthermore, 12 percent of samples exceeded mesophilic aerobic microorganism levels. According to the data published in the Food Control Journal, the presence of Staphylococcus aureus and the Salmonella species was found in 1percent and 0.5 percent of samples respectively.Isabel Sospedra, one of the authors of the study warns that "generally a percentage of oranges juice is consumed immediately after squeezing but, as in many cases, it is kept unprotected in stainless steel jugs."

Reference: I. Sospedra, J. Rubert, J.M. Soriano, J. Mañes. "Incidence of microorganisms from fresh orange juice processed by squeezing machines". Food Control 23 (1): 282-285,

2012.