Infection control practices not adequately implemented at many U.S. hospital ICUs, study finds — ScienceDaily

Infection control practices not adequately implemented at many U.S. hospital ICUs, study finds — ScienceDaily.

Date:  January 29, 2014
Source:  Elsevier
Summary:  U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, according to a study.

From the news article

U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, according to a study in the February issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

…

“Establishing policies does not ensure clinician adherence at the bedside,” state the authors. “Previous studies have found that an extremely high rate of clinician adherence to infection prevention policies is needed to lead to a decrease in healthcare-associated infections. Unfortunately, the hospitals that monitored clinician adherence reported relatively low rates of adherence.”

The survey also assessed structure and resources of infection prevention and control programs, evaluating characteristics such as staffing, use of electronic surveillance systems, and proportion of infection preventionists with certification.

Healthcare-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a healthcare setting. Many of these infections occur in the ICU setting and are associated with an invasive device such as central line, ventilator, or indwelling urinary catheter. At any given time, about 1 in every 20 inpatients has an infection related to hospital care. The estimated annual costs associated with HAIs in the U.S. are up to $33 billion.

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Patients Can Emit Small, Influenza-Containing Particles Into the Air During Routine Care

From the 31 January 2013 article at KevinMD.com

[The]majority of influenza virus in the air samples analyzed was found in small particles during non-aerosol-generating activities up to a 6-foot distance from the patient’s head..

Vaccination of health providers remains a fundamental and key part of protecting them from influenza

 

A new study suggests that patients with influenza can emit small virus-containing particles into the surrounding air during routine patient care, potentially exposing health care providers to influenza. Published in The Journal of Infectious Diseases, the findings raise the possibility that current influenza infection control recommendations may not always be adequate to protect providers from influenza during routine patient care in hospitals…

…

The current belief is that influenza virus is spread primarily by large particles traveling up to a maximum of 3 to 6 feet from an infected person. Recommended precautions for health providers focus on preventing transmission by large droplets and following special instructions during aerosol-generating procedures. In this study, Dr. Bischoff and his team discovered that the majority of influenza virus in the air samples analyzed was found in small particles during non-aerosol-generating activities up to a 6-foot distance from the patient’s head, and that concentrations of virus decreased with distance. The study addressed only the presence of influenza-containing particles near patients during routine care, not the actual transmission of influenza infection to others.

Fitted respirators are currently required for health care providers during aerosol-generating procedures with patients. During routine, non-aerosol-generating patient care, the current precautions recommend that providers wear a non-fitted face mask. Based on their findings, Dr. Bischoff and investigators are concerned that providers may still be exposed to infectious dosages of influenza virus up to 6 feet from patients with small wide-spreading particles potentially exceeding the current suggested exposure zones.

These findings suggest that current infection control recommendations may need to be reevaluated, the study authors concluded. The detection of “super-emitters” raises concerns about how individuals with high viral load may impact the spread of influenza, they noted. “Our study offers new evidence of the natural emission of influenza and may provide a better understanding of how to best protect health care providers during routine care activities,” the study authors wrote. However, studies of influenza virus transmission will be necessary before the role of super-emitters can be firmly established, they noted…

Whatever protective equipment or infection control practices are used for preventing influenza transmission, vaccination of health providers remains a fundamental and key part of protecting them from influenza, noted Dr. William Schaffner, professor medicine and chair of the department of preventive medicine at Vanderbilt University School of Medicine in Nashville, Tenn., who was not involved with the study. “Influenza vaccination, although not perfect, is the best tool we have to protect health care workers — and their patients — from influenza illness.

 

Related articles

• Health care providers may be at greater risk of flu exposure (eurekalert.org)
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Hydrogen Peroxide Vapor Enhances Hospital Disinfection of Superbugs

From the 30 December 2012 article at ScienceDaily

Infection control experts at The Johns Hopkins Hospital have found that a combination of robot-like devices that disperse a bleaching agent into the air and then detoxify the disinfecting chemical are highly effective at killing and preventing the spread of multiple-drug-resistant bacteria, or so-called hospital superbugs.

…

In the study, the Johns Hopkins team placed the devices in single hospital rooms after routine cleaning to disperse a thin film of the bleaching hydrogen peroxide across all exposed hospital equipment surfaces, as well as on room floors and walls. Results showed that the enhanced cleaning reduced by 64 percent the number of patients who later became contaminated with any of the most common drug-resistant organisms. Moreover, researchers found that protection from infection was conferred on patients regardless of whether the previous room occupant was infected with drug-resistant bacteria or not.

“Hydrogen peroxide vapor, as spread around patients’ rooms by these devices, represents a major technological advance in preventing the spread of dangerous bacteria inside hospitals and, especially, from one patient occupant to the next, even though sick patients were never in the same room at the same time,” says infectious disease specialist and study senior investigator Trish Perl, M.D., M.Sc.

Of special note, researchers say, was that enhanced cleaning with the vapor reduced by 80 percent a patient’s chances of becoming colonized by a particularly aggressive and hard-to-treat bacterium, vancomycin-resistant enterococci (VRE)…

 

Read the entire article here

 

The Dirtiest Places In The Office

From the 24 May 2012 Medical News Today article

If you think the restroom is the place you are most likely to pick up germs at the office, perhaps you should think again, because new findings from the US suggest the dirtiest places in the office are in break rooms and kitchens, with sink and microwave door handles topping the list of germ “hot spots”…

..
An ATP **count of 300 or more means the surface has a high level of contamination and there is a high risk of illness transmission. When they analyzed the samples, the researchers found ATP counts of 300 and higher on:

• 75% of break room sink faucet (tap) handles,
• 48% of microwave door handles,
• 27% of keyboards,
• 26% of refrigerator door handles,
• 23% of water fountain buttons, and
• 21% of vending machine buttons.

**ATP  (adenosine triphosphate) is the universal energy molecule found in all animal, plant, bacteria, yeast and mold cells. Large amounts are present in food and organic residues, which when left on a surface can harbor and grow bacteria.

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Fighting Bacteria’s Strength in Numbers

Example of signaling between bacteria. Salmonella enteritidis uses acyl-homoserine lactone for Quorum sensing (Photo credit: Wikipedia)

From the 18 May 2012 article at Science Daily

Scientists at The University of Nottingham have opened the way for more accurate research into new ways to fight dangerous bacterial infections by proving a long-held theory about how bacteria communicate with each other.

Researchers in the University’s School of Molecular Medical Sciences have shown for the first time that the effectiveness of the bacteria’s communication method, a process called ‘quorum sensing’, directly depends on the density of the bacterial population. This work will help inform wider research into how to stop bacteria talking to each other with the aim of switching off their toxin production.

As some pathogenic organisms are increasingly resistant to traditional antibiotics, medical researchers around the world, including scientists at The University of Nottingham, are trying to find other ways of fighting infection. This new work involves using ‘quorum quenching’ compounds which interfere with bacterial signalling and disrupt their social lives.

Quorum sensing (QS) is the process by which bacteria communicate and co-operate using signal molecules which control, among other things, the production of toxins. QS is therefore an important factor in a number of bacterial species that cause serious infection in humans includingPseudomonas aeruginosa, a leading cause of death among cystic fibrosis sufferers, and MRSA which is a huge clinical problem in hospitals….

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For Rapid Response To Health-Care-Associated Infections, Collaboration Needed, Survey Reveals

From the 10 March 2012 Medical News Today article

he U.S. Department of Health and Human Services (HHS) estimates that about one in every 20 patients develops an infection each year related to their hospital care. The key to preventing an outbreak of potentially deadly healthcare-associated infections (HAIs) – such as methicillin-resistant Staphylococcus aureus (MRSA) or C. difficile – is identifying them before affected individuals can pose a transmission risk.

But, according to a survey released by the Association for Professionals in Infection Control and Epidemiology (APIC) and the American Society for Microbiology (ASM), the typical turnaround time for laboratory test results may not be meeting expectations. Greater collaboration between labs and infection preventionists may hold the key to addressing the gap – and to more effective management of some HAIs.

Most (51 percent) of the infection preventionists (IPs) surveyed indicated that they need results for MRSA screening tests within 12 hours to initiate the necessary precautions; however, MRSA cultures – a traditional method for screening – typically take 24 to 48 hours to complete.

The survey identified two factors that could be addressed to help resolve the discrepancy and reduce HAIs: the need for increased communication between IPs and lab professionals, and the lack of tools and resources for training and educating all healthcare personnel. …

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How bacteria behind serious childhood disease evolve to evade vaccines (& related article about bad immunity genes)

Vaccines (Photo credit: www78)

How bacteria behind serious childhood disease evolve to evade vaccines

From the 29 January 2012 Science Daily article

 Genetics has provided surprising insights into why vaccines used in both the UK and US to combat serious childhood infections can eventually fail. The study, recently published in Nature Genetics, which investigates how bacteria change their disguise to evade the vaccines, has implications for how future vaccines can be made more effective…

…

n spite of the success of the vaccine programmes, some pneumococcal strains managed to continue to cause disease by camouflaging themselves from the vaccine. In research funded by the Wellcome Trust, scientists at the University of Oxford and at the Centers for Disease Control and Prevention in Atlanta studied what happened after the introduction of this vaccine in the US. They used the latest genomic techniques combined with epidemiology to understand how different serotypes of the pneumococcus bacteria evolve to replace those targeted by the initial vaccine.

The researchers found bacteria that had evaded the vaccine by swapping the region of the genome responsible for making the polysaccharide coating with the same region from a different serotype, not targeted by the vaccine. This effectively disguised the bacteria, making it invisible to the vaccine….

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Why bad immunity genes survive -Utah study implicates arms race between genes and germs

		IMAGE: This electron microscope image shows yellow particles of a mouse leukemia virus named Friend virus emerging or “budding ” out of an infected white blood cell known as a T-cell. By… Click here for more information.

SALT LAKE CITY, Feb. 6, 2012 – University of Utah biologists found new evidence why mice, people and other vertebrate animals carry thousands of varieties of genes to make immune-system proteins named MHCs – even though some of those genes make us susceptible to infections and to autoimmune diseases.

“Major histocompatibility complex” (MHC) proteins are found on the surface of most cells in vertebrate animals. They distinguish self from foreign, and trigger an immune response against foreign invaders. MHCs recognize invading germs, reject or accept transplanted organs and play a role in helping us smell compatible mates.

“This study explains why there are so many versions of the MHC genes, and why the ones that cause susceptibility to diseases are being maintained and not eliminated,” says biology Professor Wayne Potts. “They are involved in a never-ending arms race that causes them, at any point in time, to be good against some infections but bad against other infections and autoimmune diseases.”

By allowing a disease virus to evolve rapidly in mice, the study produced new experimental evidence for the arms race between genes and germs – known technically as “antagonistic coevolution.” The findings will be published online the week of Feb. 6, 2012, in the journal Proceedings of the National Academy of Sciences.

Potts, the senior author, ran the study with first author and former doctoral student Jason Kubinak, now a postdoctoral fellow in pathology. Other co-authors were biology doctoral student James Ruff, biology undergraduate C. Whitney Hyzer and Patricia Slev, a clinical assistant professor of pathology. The research was funded by the National Science Foundation and the National Institute of Allergy and Infectious Diseases.

Futuristic Therapy: Steering Microrobots Through Blood Vessels For Disease Treatment

From the 20 December 2011 Space Daily article

Microscopic-scale medical robots represent a promising new type of therapeutic technology. As envisioned, the microbots, which are less than one millimeter in size, might someday be able totravel throughout the human bloodstream to deliver drugs to specific targets or seek out and destroy tumors, blood clots, and infections that can’t be easily accessed in other ways.

One challenge in the deployment of microbots, however, is developing a system to accurately “drive” them and maneuver them through the complex and convoluted circulatory system, to a chosen destination….

…Article: “Magnetic Navigation Systems for the Precise Helical and Translational Motions of a Microrobot in Human Blood Vessels” is part of the Proceedings of the 56th Annual Conference on Magnetism and Magnetic Materials, to be published in the Journal of Applied Physics in April. Authors: Seungmun Jeon, Gunhee Jang, Hyunchul Choi, Sukho Park, and Jongoh Park.

 

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Probiotics reduce infections for patients in intensive care, study finds

 Probiotics reduce infections for patients in intensive care, study finds

From the Science Daily article of Thu Dec 1, 2011

Traumatic brain injury is associated with a profound suppression of the patient’s ability to fight infection. At the same time the patient also often suffers hyper-inflammation, due to the brain releasing glucocorticoids. New research shows that including probiotics with nutrients, supplied via the patient’s feeding tube, increased interferon levels, reduced the number of infections, and even reduced the amount of time patients spent in intensive care.