Becker's Clinical Quality & Infection Control

14 INFECTION CONTROL & PATIENT SAFETY Experts Reveal New Information on Heater-Cooler- Related Infections: 7 Things to Know By Heather Punke A t the Society of oracic Surgeons 53rd Annual Meeting in January, cardiothoracic surgeons and experts in perfusion and infectious diseases presented "Heater-Cooler-Inducted Infections: Practices, Protocols and Mitigation Strategies," which contained the most up-to-date information available. Heater-cooler devices are used during some heart surgeries, and a specific brand of such devices — Stöckert 3T heater-cooler devices — have been implicated by the CDC in causing nontuberculous my- cobacterium infections in patients. e Food and Drug Administra- tion and the CDC have released guidance for what healthcare organi- zations should do if they used that brand of device. Here are seven things to know about what new information related to these infections was given at the STS 53rd Annual Meeting. 1. e experts said infections are linked to heater-coolers from five different manufacturers, not just one, but 89 percent of the infections are linked to one manufacturer. 2. e Medical Device Report database collects reports from manu- facturers, importers and user facilities as well as from physicians and patients. e database currently has 339 reports of NTM infections related to heater-coolers that happened between January 2010 and August 2016. 3. NTM infections have a latency period of up to 72 months, and symptoms tend to start about 17 months from surgery, according to Neil Fishman, MD, an infectious disease expert with the University of Pennsylvania Perelman School of Medicine in Philadelphia. 4. e risk of infection increases with length of exposure to the bacte- ria, which is aerosolized from the devices. 5. Overall mortality from NTM infections is greater than 50 percent, according to Dr. Fishman. Treatment isn't yet standardized, with some clinicians treating for nine months, while some extend it to a year or 18 months. 6. Kenneth G. Shann, director of perfusion services at Boston-based Massachusetts General Hospital, suggested using a checklist when cleaning heater-cooler devices, documenting the cleanings and record- ing serial numbers of heater-cooler devices used during procedures. 7. "is is a device problem, not a surgical problem," Dr. Fishman em- phasized. n FDA: Serious Allergic Reactions Associated With Chlorhexidine Gluconate By Anuja Vaidya T he FDA issued a safety announcement Feb. 2 regarding serious allergic reactions reported with the use of skin antiseptic products containing chlorhexidine gluconate. These reactions are rare, but reports have increased over the last few years. Chlorhexidine gluconate is found in a number of over-the- counter products used to clean and prepare the skin before sur- gery and injections. Between January 1969 and June 2015, the FDA received reports of 43 cases of anaphylaxis with the use of chlorhexidine gluconate products worldwide. More than half of the 43 cases were reported after 2010. The FDA issued a pub- lic health notice regarding the use of chlorhexidine gluconate products in 1998. The latest safety announcement requests that manufacturers of chlorhexidine gluconate-based antiseptics add a warning about the risk of allergic reaction to the Drug Facts labels. Additionally, the FDA noted healthcare professionals should "al- ways ask patients if they have ever had an allergic reaction to any antiseptic before recommending or prescribing a chlorhexidine gluconate product." n CDC Revises Guidance on Controlling C. auris in Hospitals By Heather Punke C andida auris is an emerging, multidrug-re- sistant yeast that is poised to spread quickly through healthcare settings if not contained. The CDC originally issued recommen- dations for hospitals to prevent C. auris infections in June 2016, and updated the recommendations in February. The new recommendations include tips for how to treat invasive C. auris infections and what infection control measures to use for patients who have an in- fection or are colonized with C. auris. According to the U.S. Environmental Protection Agency, one of the main changes in the new CDC rec- ommendations is to clean rooms of patients with C. auris daily and post-discharge with an EPA-regis- tered disinfectant that is effective against Clostridi- um difficile. Previously, the CDC recommended us- ing disinfectants effective against fungi. n

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