Good hygiene practice and a strong Infection Control program are only half the battle against antibiotic resistant infections. Improper use of antibiotics is only increasing the speed by which bacteria develop resistance, something that science has been aware of for years. It might therefore be surprising to find out that many doctors still prescribe antibiotics in cases where there is little to no point in doing so. To this end, Harvard Vanguard Medical Associates has launched an antibiotics awareness campaign. “Eighty percent of adults with acute bronchitis should not be placed on antibiotics, yet many are given a prescription,” says Ben Kruskal, pediatrician and director of infection control at Harvard Vanguard Medical Associates. “Acute bronchitis is almost always the result of a viral infection. Antibiotics are used to kill bacteria, not viruses.”

As a result, Harvard Vanguard Medical Associates has launched a campaign to reduce the inappropriate use of antibiotics by sharing research findings to educate clinicians and change patient perceptions. “There is no benefit from using antibiotics to treat a viral infection like bronchitis,” Kruskal said. “Antibiotics will give you all of the side effects and none of the relief that a patient might hope for from the medication.”

Additionally, antibiotic overuse can lead to antibiotic resistance which has been deemed one of the world’s most pressing public health problems. Kruskal explains that every time you take a drug for a bacterial infection or bug that you do not have, you kill off harmless bacteria and encourage the growth of drug-resistant strains. In the past, this has been viewed as a tradeoff between the individual hope for benefit and the harm to society, but a number of recent studies have demonstrated that even for an individual, recent antibiotic use increases the risk of a resistant infection.

Copyright © 2010 Weymouth News

Americans are six times more at risk of contracting antibiotic resistant staph infections from their community than their British counterparts, according to a recent U.S. government study.

Researchers working with the U.S. Centers for Disease Control and Prevention (CDC) found that the rate of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) was much higher in U.S. communities than in U.K. communities, despite the fact that the rate of hospital-acquired infections linked to MRSA were about the same. The CDC announced its findings in a report published in the medical journal Clinical Infectious Diseases.

MRSA resists a number of antibiotic treatments and is often referred to as the “superbug”. It was first detected in the U.K. several years before there were any known U.S. cases.

Researchers conducting population-based surveillance found that the rate of community-acquired MRSA BSIs was 6.3 times higher in the U.S. than the U.K. There were 22 cases for every 100,000 people in the U.S., compared to 3.5 for every 100,000 in the U.K. Hospital-acquired MRSA infections were about even, the researchers reported.

MRSA infections have accounted for more than 60 percent of hospital staph infections in the U.S. in recent years. The CDC reports that about 126,000 hospital MRSA infections occur each year, resulting in about 5,000 deaths. But some researchers suggest that the overall number of deaths from MRSA in the U.S. is closer to 20,000 annually once community-acquired MRSA infections are factored into the equation.

In recent years, there has been an increasing number of hospital infection lawsuits filed throughout the United States, as experts believe that most of these potentially life-threatening infections that develop in hospitals and medical centers can be prevented if steps are taken by the facility and staff.

Courtesy WTSP.com

Tampa, Florida – On the first floor of UCH’s Pepin Hospital, a bright blue light illuminated an otherwise dark hallway.

Through the glass of a patient room, UCH’s newest weapon in its battle against bacteria and germs churned out the blue light and an invisible wave length that seems more science fiction than cleaning agent.

“We treat the entire room, all the exposed surfaces with a very high intensity electromagnetic field that disrupts the genetic material in a pathogen,” explained Mark Statham, with the machine’s creator, Infection Prevention Technologies.

UCH’s director of Infection Control, Jacqueline Whitaker says she came across the machine in her search for a more effective way to prevent hospital infections and is confident she’s found it in IPT’s portable room sterilization machine. Over the summer, UCH ran tests of the machine on 30 patient rooms.

Staff first cleaned the rooms using traditional cleaning methods with chemicals and then took cultures of the room. Then, they placed the sterilization machine, which resembles an over-sized bug zapper, and let it run for ten minutes.The cultures of the room after it was cleaned with chemicals showed the growth of bacteria colonies.

It was a different story after the room was treated with the machine.

“It effectively eliminated any organism that can potentially cause disease in the next patient that wold go in that room,” said Whitaker. The machine will play an important role in the hospital’s efforts to fight hospital infections. “We’re always looking to see how we can effectively kill these organisms if a patient brings them into the hospital, so we don’t transmit them to the next patient,” said Whitaker.

Whitaker says UCH’s hospital infection rate is less than 1%. “Actually it averages about 0.4% and that’s an excellent rate for our hospital, but we want it to be zero,” she said.

The machine didn’t come cheap, with a price tag of about $100,000, but Whitaker says the costs outweighs the potential costs if someone gets sick. “That’s a significant amount of money, but each infection, whether it’s a blood stream infection of a surgical site infection can cost you anywhere from $25,000 to $40,000,” said Whitaker.

Whitaker says they plan to use the machine in patient rooms when they are discharged and in the surgical rooms in addition to regular cleaning disinfection.

© WTSP.com

The Royal Bolton hospital have successfully managed to eradicate MRSA with no new cases for 116 days. In addition, just 24 people contracted C diff between April and September; a major turnaround from 2007/8 when the trust came under fire when MRSA infections reached 31 and infection rates of C diff were in the 20-30 cases a month range. What does the trust attribute to such a reversal of fortune?

“We have made infection control everybody’s business which is one of the reasons we are doing so well” said Maria Sinfield, head of clinical practice and deputy director of nursing. “I am delighted with the reduction, it’s fantastic, but we are not complacent and the work carries on. We have a whole range of work going on around this area and every case of MRSA and C diff is scrutinised. Now we want to expand it to look at other infections.”

All training within the hospital now includes information on infection prevention. Hand-washing is also promoted across the hospital and every patient who has invasive devices, such as such as intravenous drips and feeding tubes, as they are at higher risk, are closely monitored. Every case of MRSA and Clostridium difficile is examined so lessons can be learned.

The same approach will now be used to deal with MSSA and E.Coli.

“A lot of things we are already doing around MRSA and C diff do impact on the other infections” Ms Sinfield added. “But there might be more we are able to do, so we will closely monitor these other conditions.”

Becker’s ASC Review carries an interview with Dr. Ralph Gambardella, an orthopedic surgeon and president of Kerlan-Jobe Surgery Center in Los Angeles. His center succumbed to two infections in three months but took quick and decisive action, meeting with the board and coming up with new protocols to implement that were hoped to reduce rates of infection. These turned out to be very successful and Dr. Gambardella has noted 5 key aspects of these procedures that have led to reduced infection rates:

1. Patients scrub before surgery. The surgery focused on improved doctor/patient communication, most importantly, ordering patients to scrub themselves in the lead-up to their surgery. “One of the things shown to definitely lower the risk of skin microbes is trying to have patients wash a day or two before their surgery with scrub,” Dr. Gambardella noted.

2. Surgeons scrub before surgery. As well as the standard skin prep in the operating theatre, emphasis has been placed on doctors to scrub immediately before entering the theatre, thus acting as a second line of defense.

3. Limit and monitor traffic flow. The flow of people in and out of the surgical centre was recognised as a point of key significance. More emphasis was placed on the nurse manager to control movements in and out of the centre, down to monitoring supply vendors as they traveled through the facilities, to ensure infection control policies were adhered to.

4. Go above and beyond in disinfecting the facility. It goes without saying that equipment such as surgical instruments and counter-tops are disinfected between use. However, Dr. Gambardella does not believe this goes far enough and ensured that his surgery paid attention to other potential sources of infection including air vents and lights. Dr. Gambardella says even the furniture in the waiting area is wiped down more regularly to reduce the incidence of infection.

5. Time antibiotic administration carefully. Lastly, doctors were made to be much more accountable for administration of antibiotics to ensure that patients received doses within the crucial 1 hour window following an incision, after which patients are at risk of being administered less effective antibiotics. In addition, it is checked to make sure that patients are not cold before administration as hypothermia can be a major factor in reduced immune response.

Australian schools are a distribution centre for bacteria and viruses, an infection control conference has heard, and yet school toilets were not required to contain soap.

Those which do usually contain easily vandalised soap dispensers or adopt the “soap in a stocking” approach which creates another focal point for bacteria, said Perth-based businessman and hand hygiene campaigner Keith Gregory.

“In defence of the education department, and health department, the main factor we have had at schools is vandalism,” Mr Gregory told AAP on Thursday.

“It is very, very hard to maintain any current (hand hygiene) system within a school toilet, especially using liquid soaps as they get broken and smashed.

“That’s why it becomes so important to start really having a good look at alternative measures for hand hygiene in schools.”

Mr Gregory was a speaker at the annual Australian Infection Control Conference underway in Perth this week.

He is also founder of Soapstream, a start-up Australian company which has designed a vandal and tamper proof metal device that can be retrofitted to existing taps and which contains a pellet of soap.

Mr Gregory said once fitted, the device would allow one student to hygienically wash their hands twice daily, for a year, for soap costs totalling less than one dollar.

It was a two-pronged approach, he also said, as schools installing the devices should also roll out an aligned education campaign that included an online computer game for kids to play with a theme of “respecting the washroom”.

Principals now decide, on a school by school basis, what soap option was offered in the toilets and this was “not audited, and there’s no rule he has to have anything”.

Mr Gregory also points to a US study which found when students switched to regular and hygienic hand washing, sick days for stomach upsets more than halved (down 51 per cent) while those for respiratory tract infections declined by a quarter (24 per cent).

“You could almost call a school a distribution centre for any viral infection that is going around,” Mr Gregory said.

“… We talk about, in school environments, having no peanuts because of allergies and yet one of the most simple things we can provide to children for their safety, and overall wellbeing, is soap and water in the toilets.

“This is something we need to do in the community, this is a change we need to make.”

© AAP

You might have thought that glove use would go ‘hand in hand’ with lowered infection rates. However, a new report suggests that the contrary may actually be the case. A large, U.K. based research study of nurses, physicians, and other health care personnel, showed that they were consistently less likely to disinfect or clean their hands before and after gloved patient contacts than ungloved ones. Most concerning of all, this was particularly true for the high-risk contacts involving body fluids or aseptic techniques.

“Compliance is worse when gloves are worn,” Dr. Sheldon P. Stone reported at the annual European Congress of Clinical Microbiology and Infectious Diseases. ”What I wonder is whether we’ve demonstrated the iron fist of infection in the vinyl glove–in other words, a health care worker whose hands appear clean but aren’t really.”

The Feedback Intervention Trial (FIT) involved 249 hours of structured observation of patient-caregiver interactions on 56 ICUs and geriatric and general medical wards in 20 English and Welsh hospitals. In all, 7,578 patient contacts during a 6-week period were scored via a validated hand hygiene observation tool.

World Health Organization guidelines recommend changing gloves between patient contacts and disinfecting the hands before and after each use of gloves to prevent iatrogenic transmission of pathogens between patients. Yet in FIT, healthcare workers followed this practice in conjunction with only 41% of gloved contacts. They were significantly more likely to clean their hands with soap or an alcohol hand rub before and after ungloved contacts, which they did 50% of the time, said Dr. Stone of University College London.

Other key FIT findings included:

• Gloves were used in only 26% of patient contacts.
• Gloves were worn in 79% of high-risk contacts, when WHO guidelines recommend routine use of gloves. But gloves were also worn in 17% of low-risk contacts, when they’re not indicated. Thus, gloves weren’t worn about 20% of the time they should have been and were worn nearly 20% of the time they shouldn’t have been, Dr. Stone said.
• WHO hand hygiene recommendations were followed in only 44% of gloved high-risk contacts, compared with 59% of ungloved high-risk contacts. That means good hand hygiene was 44% less likely to occur in high-risk situations when gloves were worn than when they weren’t worn.

As to the reason why healthcare workers are more cavalier with their hand hygiene when wearing gloves, several recent studies by other investigators indicate that many believe gloves are a good substitute for hand hygiene, or think of gloves chiefly as a means of protecting themselves from a patient’s pathogens and vice versa. They’re not considering contaminated gloves as a potential vector of transmission, Dr. Stone said.

The FIT findings suggest that interventions aimed at ensuring appropriate hand hygiene compliance before and after glove use could have a major effect on the spread of infection.

NHS trusts must publish figures on various Hospital Acquired Infections (HAI’s) as part of new health policies coming into effect in January 2011. The policies are designed to help the public make “informed choices” about where to go for treatment.

On Tuesday, Andrew Lansley, the health secretary, said in his speech to the Conservative party conference that patients need more information about the quality of services at different hospitals before they make decisions about their health. The published information will include numbers on incidence of infections such as MSSA (a relation of MRSA) and E.Coli will be included in the future.

Hospital trusts are already obliged to publish their rates of MRSA, and the bug Clostridium difficile but recording of other infections is only done on a voluntary basis. The voluntary figures show a 37% rise in the number of E.Coli cases since 2005, experts fear that the real figure is much higher as those with the worst records are the least likely to declare them.

MRSA infection rates are now falling, but rates of MSSA have risen since 2000, with more than 7,000 cases last year. MSSA is much more easily treatable than MRSA if caught early enough, however, both are equally deadly if prompt care is not given.

An MP report last year found that hospitals had been focusing almost exclusively on MRSA and C.Diff infections, leaving other infections, which account for up to 80% of all hospital infections, to go mostly unchecked. The report warned that it was therefore impossible to judge how many deaths were being caused by HAI’s.

First responders to emergency situations are not only essential to increasing survival chances for victims, but also often have to place themselves in situations of increased risk in order to provide assistance. There has to be few more intimidating jobs than being a first responder in the middle of a potentially lethal pandemic. However, new research suggests that given such a situation, more than 50% of essential response staff may be either unable or unwilling to work.

The study, reported online in the October issue of the Journal of Occupational and Environmental Medicine, involved more than 1,100 workers recruited from six essential work groups, all located in the New York metropolitan area, included hospital employees, police and fire department personnel, emergency medical services workers, public health workers, and correctional facility officers.

The results of the study indicated that although 80% of workers would be fit for work, only 65% would be willing. As such, a combined total of less than half of the key workers would be both willing and able to report to duty. According to the lead author, Dr. Robyn Gershon, professor of clinical sociomedical sciences and associate dean for research resources at Columbia University’s Mailman School of Public Health, and faculty affiliate at Columbia University’s National Center for Disaster Preparedness, “these data indicate that non-illness related shortfalls among essential workers could be substantial.”

In anonymously conducted surveys, when questioned about their willingness to work during a pandemic, the percentage willing ranged from a high of 74% (public health workers) to a low of 56% (correctional workers). The researchers found that motivation to work during a serious pandemic was associated with workplace safety measures and trust in the employer’s ability to protect workers from harm. Workers were also more willing to report to duty if their employer provided them with respirators and pandemic vaccine and had an established pandemic plan. Willingness was also tied to past experience; essential workers who had responded to a previous disaster were significantly more willing to report during a pandemic.

Reasons for non-ability/availability were mostly down to personal obligations, referred to as ‘dilemmas of loyalty’, where otherwise healthy essential workers might stay at home to care for sick family members or their children (if schools are closed). Gershon believes that organisational policies and programs that help workers meet their personal obligations will increase workers’ ability to work: “Even something as simple as ensuring that workers can communicate with their families while they are on duty, can have a big impact on both ability and willingness.”

Only a small proportion of the workers (9%) were aware of their organisation’s pandemic plans, and only 15% had ever received pandemic influenza training at work. As Gershon notes, “the study findings suggest that these preparedness steps are important in building worker trust. Workers who trust that their employers can protect them during a communicable disease outbreak will be significantly more likely to come to work and perform their jobs– jobs that are vital to the safety, security and well-being of the entire community.”

To help ensure adequate staffing levels, employers should focus preparedness efforts on worker protection and the development of policies that facilitate the attendance of healthy workers. The authors suggest a number of relatively straightforward strategies that employers can take to support employees’ response during pandemic outbreaks. These include:

- Prepare a plan to quickly and easily vaccinate essential workers and their families, so that when a vaccine is available it can be readily distributed.

- Discuss respiratory protection needs with public health officials. They can provide guidance on the need, feasibility, and use of these safety devices.

Becker’s Orthopedic and Spine Review have published what should be a very useful article for any healthcare worker in charge of Infection Control measures: 6 Best Practices for Implementing an Effective Infection Control Program. The advice comes from Denise Kesler, director of Athens (Ga.) Orthopedic Ambulatory Surgery Center, who presents examples of Infection Control policies and measures that have been tried and tested in real world scenarios.

Here’s an example:

Monitor physicians and staff members. Denise Kesler, director of Athens (Ga.) Orthopedic Ambulatory Surgery Center, says the facility established a monitoring policy where staff members in each department, such as the OR, are selected to secretly monitor their co-workers compliance to hand hygiene protocols.

“It’s done anonymously, so no one knows they’re being watched,” she says. “The monitor tallies up hand washing incidences on a monthly and quarterly basis, and that data is then delivered at a staff meeting. It makes the staff more aware, and compliance has improved greatly since we implemented this.”

Other examples include regularly wiping equipment down, placing hand sanitisers throughout the facility, installing a washer steriliser, training and testing for competency in infection control and incorporating infection-fighting materials.

For more information you can read the rest of the article here.