Brazil's yellow fever outbreak tops 1,000 cases

A worrisome spike of more than 300 yellow fever cases in the past week has boosted Brazil's outbreak to 1,060 cases and 166 deaths, the country's health ministry said in an update yesterday.

Of the 1,060 cases, 215 are confirmed and 765 remain under investigation, while 80 previously suspected infections have been ruled out. Of the 166 fatalities, 70 have been confirmed. Cases have occurred in Minas Gerais, Espirito Santo, Sao Paulo, Bahia, and Tocantins states. Minas Gerais has been hit the hardest, with 903 suspected and 191 confirmed cases.

Brazil's Ministry of Health has now sent 9.9 million supplemental vaccine doses to five states: Minas Gerais (4.5 million), Espirito Santo (2.5 million), Sao Paulo (1.2 million), Bahia (900,000), and Rio de Janiero (850,000).
Feb 8 Brazilian Ministry of Health update

Study: Nurses can play a key role in nursing home stewardship efforts

A study yesterday in the American Journal of Infection Control indicates that an online course on infection control can help nurses become more knowledgeable and more aware of their role as antibiotic stewards in nursing homes.

The results are from a survey completed by 103 nurses before and after they took an online course comprising six 30-minute interactive modules on signs and symptoms of infection in older adults. The course was aimed at nurses working in infection control and long-term care settings. The surveys were designed to assess respondents' knowledge about the care of nursing home residents with infections and their attitudes and beliefs regarding antibiotic stewardship.

Matched surveys showed that after the respondents participated in the online course, the proportion of questions answered correctly on the 12-item knowledge assessment improved from 75% (9 out of 12 questions) to 86% (10.4 out of 12 questions). In addition, the results showed an increased agreement among the respondents that their awareness of a resident's baseline status, their assessment of that status, and their communication with residents, families, and providers could influence whether a resident receives antibiotics.

"Our results suggest that online education for RNs and LPNs about the principles of antimicrobial stewardship may be a viable component in multifaceted efforts to reduce inappropriate antibiotic use in the nursing home setting," the authors write.

According to the US Centers for Disease Control and Prevention (CDC), an estimated 70% of nursing home residents receive one or more courses of antibiotics during a year. In October 2016, the Centers for Medicare and Medicaid Services finalized a rule that will require nursing homes to have antibiotic stewardship program.
Feb 8 Am J Infect Control study

Lessons learned from stool-softener Burkholderia cepacia outbreak

Texas researchers who published findings this week from a 6-month investigation into a Burkholderia cepacia outbreak in critically ill kids at a Texas children's hospital said they initially suspected an environmental source, but the focus shifted to potentially contaminated products as soon as tests from yielded the same outbreak strain, according to their report in Infection Control and Hospital Epidemiology.

The outbreak began in February 2016 with a cluster of three infections in the hospital pediatric intensive care unit, with 24 illnesses reported overall. Seventeen children had clinical infections, and seven were colonized.

The outbreak had several unusual features, including that none of the children had cystic fibrosis, a group known to be especially vulnerable to B cepacia infections. Also, the outbreak involved a strain that had never been seen before, and, when the same strain was identified at an unrelated facility, strengthened suspicions that a contaminated product was involved.

In June 2016, tests revealed the outbreak strain in liquid docusate, a stool softener, from a compounding pharmacy, triggering a nationwide health provider alert from the CDC, tests by the Food and Drug Administration that confirmed the contamination findings, and a national recall of all liquid products made by PharmTech. As of Aug 10, 60 cases in eight states had been reported to the CDC.

The authors said the early focus on possible environmental contamination gave the hospital an opportunity to improve infection control practices at the facility: Officials increased the frequency of environment-of-care rounds and with limited exceptions moved to single-used ultrasound gel for procedures.

Lucila Marquez, MD, MPH, lead author of the study and infectious disease specialist at Texas Children's Hospital in Houston, said in an e-mailed press release from the Society for Healthcare Epidemiology of America, the publisher of the journal, "Using a multidisciplinary approach and by sharing information with other institutions, our detailed investigation stopped short a national outbreak of B. cepacia. This work also provided our team an opportunity to improve our infection prevention practices for the care of all patients."
Feb 7 Infect Control Hosp Epidemiol abstract