Becker's Clinical Quality & Infection Control

is typically spread through body fluids of an infected person being transmitted into a noninfected person, which in healthcare settings is often through contaminated needles, syringes or other sharps. The HBV vaccine is highly effective, mostly when administered to chil- dren, as 95 percent develop protective antibodies. That protection percentage drops to 90 percent at age 40 and 75 percent for people age 65 and above. Hepatitis C Unlike HAV and HBV, there is no vaccine against HCV. While main- ly transmitted through intravenous drug use in the community, the healthcare setting sees HCV transmission through contaminated sy- ringes, needles or sharps, infected blood transfusions and sometimes even organ transplants that have not undergone adequate HCV screen- ing. The U.S. implemented blood screening for HCV in 1992, before which blood transfusion was one of the major causes of infection transmission. Now, the risk is approximately 1 in 2 million units trans- ferred. The majority of people diagnosed with HCV, 75 to 85 percent, will develop a chronic infection. In late 2013, the U.S. Food and Drug Administration approved two separate drugs for Hepatitis C treatment, Sovaldi and Olysio. Human Immunodeficiency Virus The HIV virus damages T cells that are vital in helping the body fight off diseases, leaving those infected at risk of many types of infections. Although HIV transmission in hospitals is rare, it is possible to be spread to patients via improper infection control procedures, such as sterilization and disinfection. HIV is transferred through bodily fluids, so healthcare personnel should take caution as they would with other bloodborne pathogens. Influenza The influenza virus is a common one, but novel strains — strains not before seen in humans — and variant strains often emerge. The H1N1 strain, or swine flu, was one of the most recent deadly variants of the influenza A virus. The virus' ability to adapt into new strains causes researchers to have to update flu vaccines annually to reflect current influenza trends. While people often come down with the flu, in some severe cases it can lead to death. Klebsiella pneumoniae In the healthcare setting, Klebsiella bacteria, most often the pneumoniae species, cause urinary tract infections, wound infections, upper respira- tory tract infections, osteomyelitis and even meningitis. The risk of in- fection heightens if a patient requires invasive medical devices, urinary catheters, ventilators and antibiotics. The Klebsiella genus has started developing antimicrobial resistance, causing treatment for such strains to be more limited. K. pneumoniae cannot be transmitted through the air, rather mainly through contact with an infected person. These bacteria are another that are normally found in the body but have the potential to cause infection. They cause approximately eight percent of HAIs in the U.S. and occur more frequently in premature infants and in the neonatal intensive care unit. Methicillin-resisitent Staphylococcus aureus MRSA is an often-talked about HAI, often because its severe antimicrobial resistance makes it difficult to treat. Vancomycin has been used as treat- ment for MRSA, but now even vancomycin-resistant strains are emerg- ing. MRSA infections generally appear on the skin, but they can spread to organs and into the bloodstream, causing sepsis, pneumonia and surgi- cal site infections. The bacteria are spread through direct contact, usually through an open wound or contaminated hands. Proper hand hygiene is considered the best defense against MRSA transmission. Although MRSA remains a clinical threat to patients, studies report rates of the bacteria are declining. The CDC reported a 54 percent decline in life-threatening MRSA infections from 2005 to 2011. Current research is examining the effect copper-infused hospital materials may have on eliminating MRSA, as copper alloys have demonstrated a 99.9 percent kill rate. Morganella morganii This bacteria is one of the less common HAIs, accounting for approxi- mately 1 percent of nonsocomial infections, most often encountered in post-operative settings. It is associated with urinary tract infections, sepsis, pneumonia, inflammation of the eye and musculoskeletal infec- tions. Although the M. morganii is naturally resistant to certain penicil- lins, it is still treatable with other antibiotics. Mycobacterium abscessus M. abscessus is a distant relative to the bacteria that cause tuberculosis and leprosy. Found in water, soil and dust, the bacteria are known to contaminate medication and medical devices. Most M. abscessus infec- tions are of the skin or soft tissue under the skin, although it also can cause lung infections in people with chronic lung diseases. Transmission of the bacteria rarely occurs person to person, rather it is more com- monly transferred via infected equipment or material in invasive medical procedures or when contaminated substances are injected into a patient. Some reports estimate it takes fewer than 20 norovirus particles to cause an infection. C. diff, norovirus, E. coli. — these are some of the better- known bacteria and viruses responsible for HAIs, yet many others exist that providers should be aware of as they work to eradicate infections from their organizations. 23

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