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NEWS FEATURES
Researchers at Washington University School of Medicine have identified
the formation of biofilms in the bladder of mice that were infected with
high titers of uropathogenic strains of Escherichia coli (UPCE).
Treatment
of urinary tract infections (UTI's) costs around $1.6 billion in the U.S.
annually. The majority of the UTI's (70 to 95%) are caused by invasion of
UPEC from enteric flora. Sexual intercourse and urinary catheterization
are the most clearly defined predisposing risk factors. Initial bacterial
colonization events activate host inflammatory responses and shedding of
the bladder epithelium, which is normally inert and only turns over every
6 to 12 months. Bladder epithelial cells respond to the invading bacteria
by recognizing the bacterial lipopolysaccharides on receptor cells which
results in a strong neutrophil influx into the bladder. Despite this
robust inflammatory response and epithelial exfoliation, UPEC are often
able to maintain high titers in the bladder for several days. This occurs
through a bacterial mechanism invading into the superficial cells to evade
these innate defenses. Continued bacterial replication inside superficial
cells leads to high bacterial titers in the bladder wall, which creates a
bacterial reservoir that can persist undetected for several months without
bacteria shedding in the urine. These bacteria are completely resistant
to 3 and 10 day courses of antibiotics. This may be the source for
recurrent cystitis and asymptomatic bacteriuria seen in a large portion of
women with UTI's. To study the bacteria effects of clinically isolated
UPEC versus a laboratory E. coli strain, researchers studied acute
UTI's
initiated in mice which lack an intact immune response. Over 24 hours the
numbers of bacteria increased nearly 2 orders of magnitude in the UPEC and
decreased in numbers with the laboratory strain. Previously unrecognized
were observations by electron microscopy of numerous, large profusions or
pods on the surfaces of the UPEC infected bladders. This was a rare event
in the mice infected with the laboratory E. coli strain. Video
microscopy
revealed that the disorganized intracellular bacteria formed over time
into a biolfilm-like (polysaccharide-rich matrix surrounded by a
protective shell of uroplakin) bulging pods on the bladder surface. This
discovery may lead to better understanding and treatment of recurrent
UTI's in and out of the hospital setting.
(Science 2003;310:105-107)
BIOTERRORISM AGENTS II WALL CHART
A Bioterrorism Agents II wall chart, developed by the North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) is now available. SPICE developed a Bioterrorism Agents wall chart in 2001 that included information about smallpox, anthrax, plague, and botulism. In 2002, SPICE produced the Chemical Terrorism Agents wall chart. Now SPICE has developed Bioterrorism Agents II wall chart that includes additional agents that the Centers for Disease Control and Prevention cites in its listing of the most likely bioterrorism agents. The chart includes common presenting signs/symptoms, communicability, decontamination methods, recommended isolation precautions, prophylaxis for exposed persons, and therapy. Diseases included are the following: pneumonic tularemia, viral hemorrhagic fevers (filovirus, arenavirus, junin and machupo). We also include critical notification numbers in the event of a suspected case or cases.
The chart is online at www.unc.edu/depts/spice/bioterrorism.html
In November the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced revised standards to help prevent healthcare-associated infections. The revised standards retain many of the infection control elements in the current standards but increase the expectations of the infection control program and organization leadership. The Centers for Disease Control and Prevention (CDC) estimates that two million individuals acquire an infection each year while being treated in hospitals for other illnesses or injuries, and that 90,000 people die as a result.
The revised standards focus on the development and implementation of plans to prevent and control infections with the following expectations listed by JCAHO in its news release:
The requirements for ambulatory care, behavioral healthcare, home care,
hospital, laboratory and long-term care organizations will take effect
January 2005. For more information see the JCAHO web site.
http://www.jcaho.org/news+room/news+release+archives/ic_standards.htm
Q: When reading the CDC website, what are the definitions for sporadic, local, regional, and widespread influenza activity? http://www.cdc.gov/ncidod/diseases/flu/weekly.htm
A.: The definitions are listed below:
No Activity: No laboratory-confirmed cases of influenza and no reported increase in the number of cases of influenza-like illness.
Sporadic: Outbreaks of influenza or increases in influenza-like illness cases and recent laboratory-confirmed influenza in a single region of the state.
Local: Outbreaks of influenza or increases in influenza-like illness cases and recent laboratory-confirmed influenza in a single region of the state.
Regional: Outbreaks of influenza or increases in influenza-like illness and recent laboratory confirmed influenza in at least 2 but less than half the regions of the state.
Widespread: Outbreaks of influenza or increases in illness-like illness cases and recent laboratory-confirmed influenza in at least half the regions of the state.
COMPLETE ENVIRONMENTAL INFECTION CONTROL GUIDELINE AVAILABLE
The CDC/HICPAC Guideline for Environmental Infection Control in
Health-Care Facilities, 2003 was published in the MMWR June 6, 2003. The
full guideline, including the scientific background, recommendations,
appendices, and full reference list, is now available online.
http://www.cdc.gov/ncidod/hip/enviro/Enviro_guide_03.pdf
CDC GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE SETTINGS -
2003
Guidelines for Infection Control in Dental Health-Care Settings - 2003 was
published December 19, 2003 in the Morbidity and Mortality Weekly Report
(Vol. 52/No. RR-17).
The complete MMWR is available in Adobe Acrobat format.
http://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf
The guidelines and appendices are online in html format at
OSHA PROVIDES BULLETIN ABOUT PROTECTING WORKERS AGAINST MOLD
EXPOSURE
OSHA has published a new safety and health information bulletin to provide
employers and workers with essential information on how to prevent,
control and remove mold in buildings. Geared specifically for those
responsible for building maintenance, the bulletin offers recommendations
on preventing mold growth, proper use of personal protective equipment,
and safe cleanup methods. The bulletin in online at
http://www.osha.gov/dts/shib/shib101003.html
REVISED RECORDKEEPING FORMS AVAILABLE ONLINE
Beginning January 1, 2004, employers must use OSHA's revised Form 300 (Log
of Work-Related Injuries and Illnesses). The revised form includes various
changes, including the addition of an occupational hearing loss column and
more clear-cut formulas for calculating incidence rates. While there is no
separate column for work-related injuries associated with ergonomic
factors, employers must still record those injuries in either the injury
or "all other illness" columns.
http://www.osha.gov/recordkeeping/new-osha300form1-1-04.pdf.
FDA CLEARS TWO WEST NILE VIRUS DIAGNOSTIC TESTS
On October 22, 2003, the Food and Drug Administration (FDA) approved two
more tests for use as an aid in the clinical laboratory diagnosis of West
Nile Virus infection. The two tests, the West Nile Virus IgM Capture ELISA
and the West Nile Virus ELISA IgG, are serological assays made by Focus
Technologies in Cypress, California.
http://www.fda.gov/cdrh/oivd/news.html#headline6
FDA CLEARS LAB CULTURE TEST FOR ANTHRAX
December 9, 2003. The Food and Drug Administration (FDA) cleared a test
kit for clinical laboratories to use with culture testing to help
distinguish the organism that causes anthrax disease, Bacillus
anthracis,
from similar organisms. The Redline Alert test is manufactured by
Tetracore, Inc., of Gaithersburg, Md.
UNIVERSAL PROTOCOL TO PREVENT WRONG SITE, WRONG PROCEDURE, AND WRONG
PATIENT SURGERIES
December 2, 2003. The nation's medical, nursing, and healthcare
leadership associations and organizations joined the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) in a new nationwide
effort to eliminate wrong site, wrong procedure, and wrong patient
surgeries. Such occurrences are widely viewed as entirely preventable.
More than 40 organizations have now endorsed a new Universal Protocol™ to
standardize pre-surgery procedures for verifying the correct patient, the
correct procedure, and the correct surgical site. The Universal Protocol
will officially become effective on July 1, 2004.
Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong
Person Surgery
http://www.jcaho.org/accredited+organizations/patient+safety/universal+protocol/universal+protocol.pdf
Guidelines for Implementing the Universal Protocol
http://www.jcaho.org/accredited+organizations/patient+safety/universal+protocol/up+guidelines.pdf
"Infection Control in Long-Term Care Facilities" will be held in Chapel Hill March 22-24, 2004.
"Infection Control Part I: Clinical Surveillance of Healthcare-Associated Infections" will be held in Chapel Hill May 3-7, 2004.
"Infection Control Part II: The ICP as an Environmentalist" will be held in Chapel Hill in the fall of 2004.
To subscribe to the Report of the Month, send email to
spice@unc.edu
Report of the Month is also available on the home page of the Statewide Program for Infection Control and Epidemiology at http://www.unc.edu/depts/spice/
The Statewide Program for Infection Control Program and Epidemiology (SPICE) is funded by the General Assembly of North Carolina to serve the State. The SPICE is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Copyright 2003 North Carolina Statewide Program for Infection Control and Epidemiology
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