Severe Staph Infections Linked to Unsafe Use of Single-Dose/Single-Use Vials

With certain drugs in short supply, some health care professionals may be tempted to use singledose/single-use medication vials for more than one patient, a practice that goes against US CDC’s 2007 Standard Precautions. New outbreak reports provide a frightening reminder of these critical recommendations: medications labeled “single-use” or “singledose” must be used for one—and only one—patient.

US CDC reported in the July 13 issue of MMWR that 10 patients in Arizona and Delaware contracted severe methicillin-susceptible Staphylococcus aureus (staph) or methicillin-resistant S. aureus (MRSA) infections at outpatient facilities where practitioners reused medication from single-dose/single-use medication vials for multiple patients.

In Arizona, three patients contracted invasive MRSA infections following injections from the same singledose/single-use vial at an outpatient pain management clinic. Patients were treated for acute mediastinitis, bacterial meningitis, epidural abscess and sepsis. A fourth patient who received an injection from the same vial was found dead at home six days after treatment at the clinic. Cause of death was reported as multiple drug overdose; however invasive MRSA could not be ruled out.

Seven patients in Delaware were diagnosed with severe staph infections after receiving joint injections at the same outpatient orthopedic practice. Staff at the clinic had recently started to use singledose/single-use vials for multiple patients after their supply of a smaller vial size (which they had previously dedicated for single-patient use), was disrupted as part of a national shortage. Two staff members who were responsible for preparing injections were found to be colonized with S. aureus, and one was an identical match to the strain that infected the seven patients.

Since 2007, the year that injection safety was included as part of Standard Precautions, there have been at least 20 outbreaks associated with the use of single-dose or single-use medication vials for more than one patient. Medication in single-dose/single-use vials is typically preservative-free, which makes it unsafe to use for more than one patient.

It is every provider’s responsibility to protect their patients. Refresh your knowledge of safe injection practices at the website, download the Healthcare Provider Toolkit, including an injection safety checklist and follow the campaign on Twitter and Facebook. Every patient deserves the protection of safe injections.

Tobacco prevention

The Cancer Action Network of the American Cancer Society recently released a report, Staying Well: Real Stories from the Prevention and Public Health Fund. The report includes a feature on the Maine Tobacco HelpLine and the Partnership for a Tobacco-Free Maine on pages 20-21.
Young tobacco prevention activists from Maine and throughout the United States are participating in a youth leadership training in Washington, DC, this week and meeting with members of Congress to urge them to support strong policies to reduce tobacco use.

In particular, the youth are calling attention to the marketing of cheap, sweet-flavored cigars that appeal to kids. Nearly 30 youth from across the country are participating in the training, which is organized by the Campaign for Tobacco-Free Kids and includes skill-building workshops on leadership, advocacy and communications.

In Maine, tobacco use kills 2,200 residents and costs the state $602 million in health care bills each year, and 15.2 percent of high school students smoke cigarettes.

For more information, visit http://www.tobaccofreekids.org/

Food safety

One confirmed case in Maine is included in a multistate outbreak of Salmonella Enteritidis infections linked to ground beef. A second suspected case is undergoing testing.


Consumers should check their refrigerators and freezers for recalled products and not eat them; retailers and food service operators should not serve them.

Salmonella Enteriditis causes abdominal pain, diarrhea, cramps, and fevers. It usually lasts 3-10 days.

One in six Americans will get sick from food poisoning this year alone. FoodSafety.gov has a number of helpful at-a-glance food safety charts available as well as other food safety information.
If you’ll be grilling outdoors this summer, check out this video from the Grill Sergeants with safety guidelines for safe grilling.

Pertussis (whooping cough) update 7/26/12

Pertussis is endemic in the United States. Although cyclical in nature, a gradual and sustained increase has been observed in the United States after reaching historic lows in the 1970s. In 2010, 27,550 pertussis cases were reported. Year-to-date case counts from 2012 have surpassed those from the previous 5 years for the same period.


To date, 300 cases of pertussis have been reported in Maine this calendar year, compared with 75 cases at the same time last year. The majority of cases have been in Cumberland, Somerset, and Penobscot counties, with most cases in children ages 7 to 19. Weekly pertussis updates are available on the Maine CDC website (http://www.mainepublichealth.gov/), updated every Thursday. This week's update is available at: http://go.usa.gov/fMC

US CDC recently issued a MMWR about the pertussis epidemic in Washington state, which suggests early waning of immunity from acellular pertussis vaccines.

For more information, visit http://go.usa.gov/dCO

HIV updates

The XIX Annual International AIDS Conference is currently underway in Washington, D.C., and several recent developments have occurred in the fight against HIV/AIDS:


Home Testing

The US Food and Drug Administration (FDA) approved the first over-the-counter home-use rapid HIV test on July 3. The OraQuick In-Home HIV Test is designed to allow individuals to collect an oral fluid sample and obtain test results within 20 to 40 minutes.


A positive result with this test does not mean that an individual is definitely infected with HIV, but rather that additional testing should be done in a medical setting to confirm the test result. Similarly, a negative test result does not mean that an individual is definitely not infected with HIV, particularly when exposure may have been within the previous three months. The test has the potential to identify large numbers of previously undiagnosed HIV infections especially if used by those unlikely to use standard screening methods.


Pre-Exposure Prophylaxis

On July 16, FDA approved Truvada (a fixed dose combination of two antiretrovirals used to treat HIV) to reduce the risk of HIV infection in uninfected individuals who are at high risk of HIV infection and who may engage in sexual activity with HIV-infected partners. Truvada is to be used for pre-exposure prophylaxis (PrEP) in combination with safer sex practices to prevent sexually-acquired HIV infection in adults at high risk. Truvada is the first drug approved for this indication.

Truvada for PrEP is meant to be used as part of a comprehensive HIV prevention plan that includes risk reduction counseling consistent and correct condom use, regular HIV testing, and screening for and treatment of other sexually-transmitted infections. Truvada is not a substitute for safer sex practices. As part of PrEP, HIV-uninfected individuals who are at high risk will need to take Truvada daily to lower their chances of becoming infected with HIV should they be exposed to the virus.

For more information about PrEP, visit http://www.cdc.gov/hiv/prep/


Prevention with Positives

Earlier this week, US CDC launched the first ever Prevention with Positives website to help address the prevention needs of people living with HIV/AIDS.

Trends in HIV-related Risk Behaviors Among High School Students

An early release MMWR article “Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011” describes the analysis of data from the biennial national Youth Risk Behavior Survey (YRBS) with results that suggest that progress in reducing some HIV-related risk behaviors among high school students overall and in certain populations stalled in the past decade. The article suggests that renewed educational efforts and other risk reduction interventions are warranted to reduce the number of young persons who become infected with HIV.


Maine Reports

Maine's May 2012 HIV/STD update and 2011 HIV/STD Surveillance Report are now both posted on the Maine CDC website.