September/October 2021 · Volume 12, Issue 87

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Antimicrobial Resistance (AR)   Healthcare-Associated Infection (HAI)
Virginia Department of Health (VDH)   United States (U.S.)
Centers for Disease Control & Prevention (CDC)

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• New Team Members
• COVID-19 Vaccine Update
• Burkholderia Outbreak
• Tuberculosis Program Updates
• IPC Assessments
• NHSN Updates
• Training & Education
  • Regional Containment Webinar, Safe Injection Practices, CE with Project Firstline
• Research
  • Candida auris, Antibiotic Stewardship
• Save the Dates

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News in Virginia

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Welcome New Team Members! We would like to welcome and introduce three new members to our Project Firstline team; Smrithi Chikkala, MBBS, Travis Bass, MA and Emily Varvil, MPH. The Virginia Project Firstline team works on infection prevention and control training and education for the frontline healthcare workforce. We're thankful to have such amazing talent join our HAI/AR Program!

COVID-19 Vaccination Updates

LTCF Survey: VDH is trying to better understand how much additional COVID-19 vaccine will be needed in long-term care facilities once ACIP and CDC guidelines for boosters and third doses are released.  These data are crucial to gather as they will help VDH plan accordingly based on the vaccine needs. Collecting these data will help VDH develop the best plan forward and enable VDH to successfully support LTCFs in ensuring they have access to COVID vaccines.  We ask that LTCF leadership please complete this survey by close of business on Friday, September 10th.

Vaccine Confidence: VDH has been working on an initiative to build vaccine confidence among LTCF staff. VDH developed a staff vaccine confidence toolkit that includes the following:

• A conversation guide and presentation slides to assist facilities with staff vaccine conversations. 
• Testimonials from various long-term care facility staff across the Commonwealth in hopes it would relate to staff, encourage those unvaccinated, and boost vaccine confidence. 
• Posters and factsheets that serve as educational material. The factsheets will soon be available in multiple languages.
• These are available for printing and shipping FREE of charge to facilities for your conference or break rooms. Submit your order using the REDCap form here by September 15, 2021.

Multistate Outbreak of Burkholderia cepacia Infections- Contaminated Ultrasound Gel. CDC is assisting the Food and Drug Administration (FDA) and several state and local health departments with an ongoing investigation of Burkholderia cepacia complex (Bcc) infections in healthcare facilities. Patients have developed Bcc infections after having undergone ultrasound-guided procedures in which MediChoice® M500812 ultrasound gel was used. All healthcare facilities have been ordered to destroy or return recalled products, and should immediately stop use and quarantine all lots of ultrasound gels distributed under a long list of brand names. On August 18, the FDA expanded the recall to include all gels and lotions produced from this manufacturer. CDC advises that healthcare facilities should always use single-use, sterile ultrasound gel packets for ultrasonography used in preparation for or during transcutaneous procedures. These procedures can include ultrasound-guided placement of peripheral or central lines, amniocentesis, paracentesis, endocavitary imaging, and intraoperative imaging. This also includes avoiding use of bottles of non sterile ultrasound gel for visualization prior to such procedures (e.g., vein marking, visualizing ascites).

Ultrasound procedures that are invasive (involve open skin or mucous membranes) should not utilize non-sterile gel, as that could allow the introduction of the contaminant into normally sterile body sites, including the bloodstream.  Only products that are single-use and sterile per the manufacturer should be used for invasive ultrasound procedures. Healthcare facilities should review ultrasound probe reprocessing practices to ensure proper cleaning and disinfection and to align with the manufacturer’s instructions.

Please notify your local health department if a cluster of Burkholderia cepacia complex infections is identified among patients with exposure to the recalled products. For more information, check out the CDC Bcc outbreak notifications page. 

VDH Tuberculosis (TB) Program Updates

• The VDH TB Program has released a 2020 Latent Tuberculosis Infection (LTBI) Fact Sheet to serve as a data resource on LTBI in Virginia, and provide a general overview of LTBI.
• Investigation continues of the multistate outbreak of TB associated with a suspected contaminated bone allograft material used in surgical procedures - VDH continues to work closely with the CDC, the hospital which received the contaminated material, and the local health department to ensure the continued care of the patients who received this product and to complete the contact investigation. No additional facilities in Virginia have been identified as recipients of this material. For more information, visit the CDC website. 
• Learn more about the new 4-month treatment regimen for drug-susceptible TB  - Considerations for the New Four-Month Rifapentine Moxifloxacin Regimen for Drug-Susceptible TB in the U.S.  - Tuesday, September 21, 2021, 2:00PM; Register here 

Request an Infection Prevention and Control Assessment. All Virginia acute and long-term acute care hospitals, long-term care facilities, outpatient clinics, and outpatient dialysis facilities are eligible to request a proactive onsite infection prevention and control assessment with VDH personnel.  Please visit our Infection Control Assessment and Response (ICAR) tools web page to learn more about the enrollment and assessment process.

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Pan-Resistant Candida auris in Healthcare Facilities. A recent MMWR publication reports clusters of pan-resistant and Echinocandin-resistant Candida auris in Texas and DC. Cases were identified in healthcare settings in both jurisdictions. The cases were not linked and had no known exposure to echinocandins, thus representing the first instance of transmission of pan-resistant C. auris in the U.S.

Rigorous Antibiotic Stewardship for Elderly Patients. Elderly hospitalized patients may benefit from rigorous antibiotic stewardship programs, a recent study found. Patients who received the antibiotic stewardship intervention were less likely to be readmitted to the hospital or experience mortality compared to those who did not receive the intervention, which was also cost-effective. The intervention included daily monitoring of patients on antibiotic therapy, reducing therapy duration, and discontinuing therapy as indicated. 

September is Sepsis Awareness Month.  Sepsis takes a life every 2 minutes. This September, take the T.I.M.E. to save lives. Learn more about T.I.M.E. in the Sepsis Alliance healthcare provider toolkit and by checking out the  Get Ahead of Sepsis CDC educational initiative. #SepsisAwareness #SAM2021

Global Handwashing Day: October 15, 2021. Over the past year and a half, the COVID-19 pandemic provided a reminder that simple acts such as handwashing is an effective way to stop the spread of germs. Global Handwashing Day highlights the importance of handwashing with soap and water at home, in the community, and around the world. This year’s theme, “Hand Hygiene for All,” seeks to raise awareness for making soap and water available globally. Seconds Save Lives - Clean Your Hands is WHO’s world hygiene campaign that provides multiple resources for everyone to access.

International Infection Prevention Week: October 17-23, 2021. Join the Infection Prevention and You campaign, part of APIC, in observing International Infection Prevention Week (IIPW). IIPW aims to shine a light on infection prevention and infection preventionists, who have been working hard in the fight against COVID-19 and keeping the world safe.   Make your intention Infection Prevention #IIPW

Respiratory Care Week: October 24-30, 2021. Join the American Association for Respiratory Care in recognizing the annual Respiratory Care Week this October. Respiratory therapists are critical partners in infection prevention and control, and the care they provide is critical for patients across many healthcare settings.