News Scan for May 12, 2022

High-path avian flu in Minnesota fox
Hospital C difficile intervention

Avian flu infects Minnesota fox kit; more poultry outbreaks in 4 states

The Minnesota Department of Natural Resources (DNR) yesterday announced that a wild fox in Anoka County near Minneapolis has tested positive for highly pathogenic avian flu, which follows similar detections in Canadian foxes that marked the first known wild mammal infections in North America.

Like the two Ontario foxes, the Minnesota fox was a kit. The DNR, which routinely responds to reports of sick wildlife, said it added avian influenza to routine screening for foxes that exhibit neurologic symptoms.

The strain has been previously found in a few mammals in Europe and Japan and in two people, one from the United Kingdom and one from Colorado, raising concerns about the zoonotic potential of the virus.
May 11 Minnesota DNR press release
May 6 CIDRAP News scan

In other high-path avian flu developments, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported six more outbreaks in poultry in four states, all involving backyard flocks.

In the West, Washington reported three outbreaks, two in Clallam County near Seattle and one in Pierce County near Tacoma. Utah reported an outbreak in Cache County in the north, and Idaho reported another in Ada County near Boise.

Elsewhere, the virus struck backyard birds in Minnesota's Chisago County, which is northeast of Minneapolis.
USDA APHIS poultry avian flu page


Team effort linked to significant C diff reductions at community hospital

A quality-improvement program led by an interprofessional team was associated with significant and sustained reductions in hospital-onset Clostridioides difficile infection (HO-CDI) at a community hospital, researchers reported today in the American Journal of Infection Control.

The program, implemented at a 410-bed community hospital in the southeastern United States from 2015 to 2020, was led by a team that included nurses, a physician champion, a hospital epidemiologist, an infection preventionist, a clinical microbiologist, and an antimicrobial stewardship pharmacist.

The team and program were created in response to HO-CDI rates at the hospital that were continuously above the national benchmark set by the Centers for Disease Control and Prevention. Interventions to reduce HO-CDI rates included diagnostic stewardship (a C difficile testing algorithm named the "diarrhea decision tree"), enhanced environmental cleaning, antimicrobial stewardship, and education and accountability.

Prior to implementation of the program the HO-CDI incidence rate at the hospital was 12.91 per 10,000 patient-days. After the first year of implementation, HO-CDI incidence fell to 4.72/10,000 patient-days, a 63% reduction. After three years, HO-CDI incidence fell to 2.8/10,000 patient-days, a 77% reduction from the baseline. The standardized infection ratio saw a sustained decrease, falling from 1.11 in 2015 to 0.43 in 2020—below the national benchmark of 0.51.  

The intervention also resulted in increased C difficile testing for appropriate patients within the first 3 days of hospital admission and decreased use of fluoroquinolones.

"Our project showed that interprofessional collaboration and continuous improvement can profoundly impact HO-CDI incidence, and sustain reductions over years," Cherith Walter, MSN, RN, first author on the study, said in a press release from the Association for Professionals in Infection Control (APIC), which publishes the journal. "We hope our findings will help other healthcare teams struggling with this incredibly challenging healthcare-associated infection to improve patient safety and reduce associated costs."
May 12 Am J Infect Control abstract
May 12 APIC press release

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