Tag Archives: HAI’s

Preventing Healthcare-Associated Infections (HAI’s) and the War On Superbugs

Many hospitals have made impressive strides in preventing health care-associated infections; some have seen a 70 percent reduction in the rate of bloodstream infections, thanks to safeguards such as checklists of steps to take before and during medical procedures and stepped-up hand-washing. But the problem continues to worsen. Now the White House has asked Congress for $1.2 billion to fund an effort to cut the rate of dangerous infections in half by 2020. The plan includes steps to prevent and slow the spread of infection, improve surveillance of resistant bugs, develop better diagnostic tests and new antibiotics and curb the misuse of currently available drugs – the main driver of drug resistance.

This is no fleeting crisis. Experts warn that the loss of antibiotics would roll back medical progress by 70 or 80 years. Without them, people could die of everyday dental abscesses and strep throat. Just inserting an IV could have lethal consequences. “Medical practice developed in a way that presumes the ability to treat infection in order to allow other things to be done like major surgery, cancer chemotherapy, transplants and joint replacement,” says James Johnson, senior associate director of the Infectious Disease Fellowship Program at the University of Minnesota in Minneapolis.

In terms of their power and importance, “almost nothing else in medicine comes close,” says Brad Spellberg, chief medical officer and professor of clinical medicine at the Los Angeles County and USC Medical Center. He is also the author of “Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them.”

The trouble is that “any time we use antibiotics, we’re contributing to their future ineffectiveness,” Johnson says. It’s natural for an organism to eventually become resistant to that drug. And too often, bowing to the demands of patients, doctors prescribe antibiotics when they’re not needed; the drugs aren’t effective against viral illnesses.

Another problem: Because it takes time to determine precisely which organism is the culprit, doctors frequently prescribe “broad spectrum” antibiotics that work against a wide range of bacteria when a more targeted drug would do. “The consequence,” Johnson says, is that “we’re using our last-reserve antibiotics with increasing frequency.” The CDC estimates that at least 50 percent of antibiotic use in humans is unnecessary or inappropriate.

At the same time, 80 percent of antibiotics in the U.S. are used in livestock feed to prevent or control infection and promote growth, which fuels outbreaks of drug-resistant organisms such as Salmonella, E. coli and Campylobacter that spread through the environment. The end result: “There are patients in hospitals in the U.S. today suffering and dying from infections for which doctors have no antibiotics to give,” says Arjun Srinivasan, associate director for Healthcare Associated Infection Prevention Programs for the CDC. “They are completely resistant to all therapies.” Experts agree that no single intervention will solve the problem – and are exploring a number of needed solutions:

Under the president’s plan, hospitals would establish antibiotic stewardship programs to focus doctors on “prescribing the right antibiotic at the right time at the right dose for the right duration,” says Ann McIntyre, clinical associate professor in internal medicine at Nova Southeastern University and director of the infectious diseases fellowship program at Palmetto General Hospital in Florida. Only about half of hospitals currently have such programs. But the Centers for Medicare and Medicaid Services is expected to make them a requirement for eligibility for reimbursements by 2017. Typically led by a multidisciplinary team – infectious disease doctors, pharmacists, microbiologists or epidemiologists and nurses – stewardship programs involve keeping careful control over how the drugs are dispensed. They include such strategies as frequently reviewing patients’ status to make sure they still need an antibiotic, and if so, reassessing the drug, dosage and type of delivery (switching from IV to oral antibiotics, for instance, eliminates a potential source of additional infection), and restricting the use of certain broad spectrum antibiotics until an antibiotic expert weighs in. “Physicians are used to practicing for the patient in the moment and not having to think about all patients globally,” says Neil Fishman, an infectious disease specialist and chief patient safety officer at the University of Pennsylvania Health System. That, he says, has to change.

 

To read article in its entirety click on the link below:

http://health.usnews.com/health-news/patient-advice/articles/2015/10/14/the-new-war-on-superbugs

 

“It Takes A Village” Re: Clostridium difficile (C.diff.) and Healthcare-Associated Infections, By Dr. Rosie D. Lyles, MD,MHA,MSc

“It Takes a Village”
By: Rosie D. Lyles, MD, MHA, MSc, Head of Clinical Affairs for Clorox Healthcare
September 21, 2015

With increasing rates of Clostridium difficile infections (CDI), C. difficile now rivals methicillin-resistance Staphylococcus aureus (MRSA) as the most common organism to cause healthcare-associated infections (HAIs) in the United States. (1) The prevalence of C. difficile infections has more than doubled in U.S. hospitals from 2000 to 2009 (2) and CDI is regarded as one of the serious, expensive, and potentially avoidable consequences of hospitalization. The cost of treating CDI in the hospital is $3427-$9960 (in 2012), and the cost of treating patients with recurrent CDI is $11,631, for a total cost of more than $1.2 billion annually in the United States. (3-4)

In June 2015, the White House spearheaded an executive call to action focused on implementing and improving antibiotic stewardship programs (ASPs) across the continuum of care (acute care facilities, outpatient clinics, doctors’ offices and long-term care facilities). The urgency around this issue stems from the increasing number of antibiotics prescribed, which subsequently breeds multi-drug resistant organisms (MDROs) like C. difficile. Unnecessary or excessive antibiotic use combined with poor infection control practices may increase the spread of C. difficile within a facility and across facilities when infected patients transfer, such as from a hospital to a nursing home. Increasing evidence suggests that contaminated surfaces in healthcare facilities play an important role in the transmission of several key pathogens including C. difficile, vancomycin – resistant enterococci (VRE), MRSA, Acinetobacter baumannii, and norovirus.

In order to reduce HAIs, all hands on deck are required to support a successful infection prevention strategy. In other words, “it takes a village.” Growing up, I remember hearing the phrase, “it takes a village to raise a child,” meaning there is a partnership within a community with several individuals playing a role in the maturation of a youth. Within a hospital, it’s a collaborative team across several departments that implements evidence-based protocols, continues to educate staff and patients, and maintains compliance of infection control strategies/approaches to reduce the risk of a broad range of infections, including CDI. From the C-suite (administrators and senior management) to direct healthcare providers (such as physicians, nurses, aides, and therapists) and environmental staff (EVS); everyone with direct or indirect contact with a patient’s care plays an essential role.

As a healthcare professional, it’s very important for hospitals to focus on the bigger picture when it comes to infection prevention strategy and control. Prioritizing infection control measures for just one or two pathogens of concern is insufficient. At the end of the day, one pathogen doesn’t trump another because patients don’t want an HAI from ANY pathogen! The horizontal approaches aim to reduce the risk of infections due to a broad array of pathogens through implementation of standardized practices that do not depend on patient-specific conditions:

• Proper hand hygiene
Hand hygiene practices in compliance with the Centers for Disease Control and Prevention (CDC) or World Health Organization (WHO) guidelines are a key component in preventing and controlling C. difficile, in addition to many other HAI-causing pathogens.
• Universal use of gloves or gloves and gowns
Donning the correct protective equipment minimizes contact with pathogens. It is also important to follow protocols for properly discarding this equipment.
• Universal decolonization (daily optimal bathing with chlorhexidine gluconate (CHG))
CHG bathing has been shown to decrease the bioburden of microorganisms on the patient, the environment, and the hands of healthcare personnel.
• Antimicrobial stewardship program
Ensuring every patient receives an antibiotic only when needed: the right agent, at the right dose, for the right duration.
• Evidence-based environmental cleaning and disinfection products
At a minimum, effective environmental cleaning involves using cleaners & disinfectants that are registered by the Environmental Protection Agency (EPA). Supplementing manual cleaning with new technology like ultraviolet (UV) light provides an extra layer of protection and the most comprehensive approach. UV has the highest-energy form that can inactivate dangerous and persistent pathogens by eradicating microorganism deoxyribonucleic acid (DNA) that may be left on surfaces, which can be missed with traditional cleaning. Finally, because C. difficile has been found in non-CDI patient rooms, using an EPA-registered sporicidal surface disinfectant to clean all patient rooms (daily and terminal) is great strategy to prevent the spread of the bacteria.

I had the pleasure of attending the CDC’s Environmental Hygiene for Ebola and Other Emerging Pathogens meeting on September 14, 2015, with attendees from academia, private industry, federal employees and health organizations, participated in a roundtable discussion on the research framework needed to determine the public health significance of non-critical environmental surface contamination and provide guidance to healthcare facilities about the methods to reduce the contamination of non-critical environmental surfaces reliably in order to improve patient safety. Every participant present at the meeting agreed that, due to the challenges/barriers that hospitals face with preventing HAIs (both from emerging pathogens and more common pathogens like C. difficile), it takes a village to successfully implement evidence-based protocols, continue to educate and maintain compliance with infection prevention protocols.

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About Rosie D. Lyles, MD, MHA, MSc, Head of Clinical Affairs for Clorox Healthcare

Rosie D. Lyles, MD, MHA, MSc is the Head of Clinical Affairs for the Clorox Professional Products Company where she serves as a research fellow and primary medical science liaison for the healthcare business, supporting all scientific research as well as clinical and product intervention design and development.
Dr. Lyles previously served as a physician researcher and study director for multiple epidemiologic research initiatives in the Division of Infectious Diseases at the Cook County Health and Hospitals System, investigating healthcare-associated infections with a particular focus on the epidemiology and prevention of multidrug-resistant organisms and infections in intensive care units and in long-term acute care hospitals. She has directed numerous clinical studies and interventions for the Centers for Disease Control and Prevention (CDC) and the Chicago Antimicrobial Resistance and Infection Prevention Epicenter.
During her nine years as a study director and physician researcher at Hektoen Institute for Medical Research, Dr. Lyles’ work included CDC Epicenters Prevention program studies on bloodstream infections, Clostridium difficile infections and case-control studies of community-acquired Methicillin-resistant Staphylococcus aureus (MRSA). She also performed surveillance studies of Klebsiella pneumoniae carbapenemase (KPC) positive patients, examining universal contact isolation and patient skin antisepsis protocols to identify ways to optimize standard infection control measures.
Dr. Lyles received her medical degree from St. Matthew’s University School of Medicine and holds a Master of Health Service Administration from St. Joseph College. She also recently completed a Master of Science in Clinical Research and Translational Sciences through the University of Illinois at Chicago. She is an active member of the Association of Professionals in Infection Control and Epidemiology, the Infectious Disease Society of America, the Society for Healthcare Epidemiology of America and has served as a peer reviewer for the National Institutes of Health, New England Journal of Medicine, and American Journal of Infection Control.
References:
1. Dubberke, ER, et al. Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol. 2014, V35:S48-S65
2. Tabak et al., Predicting the Risk for Hospital-onset Clostridium difficile Infection (HO-CDI) at the Time if Inpatient Admission: HO-CDI Risk Score. Infect Control Hosp Epidemiol. 2015, 36: 6; 695-701
3. Magill, SS. et al. “Multistate Point-Prevalence Survey of Health Care-Associated Infections.” The New England Journal of Medicine 370.13 (2014): 1198–1208.
4. Dubberke, ER, and Olsen, MA. “Burden of Clostridium Difficile on the Healthcare System.” Clinical infectious diseases 55 Suppl. 2 (2012): S88–92.
5. Septimus, E., et al. “Approaches for preventing Healthcare-associated Infections: Go Long or Go Wide?” Infect Control Hosp Epidemiol. 2014. 35: 7; 797-801

UV Room Disinfection: Scientific Evidence in Eliminating Healthcare-Associated Infections Worldwide

CdiffRadioPostC. diff. Spores and More  #CdiffRadio

Tuesday, April 21st: UV Room Disinfection: Scientific Evidence in Eliminating Healthcare Associated Infections Worldwide

Listen in at 11:00 a.m. Pacific , 2 pm Eastern time

http://www.voiceamerica.com/episode/84813/uv-room-disinfection-scientific-evidence-in-eliminating-healthcare-associated-infections-worldwide

Guests:  Dr. Mark Stibich, PhD, is Chief Scientific Officer & Co-founder, Xenex. and
Ms. Sarah Simmons, MPH CIC, is Science Director, Xenex

Dr. Stibich and Ms. Simmons will discuss UV Room Disinfection, how pulsed UV disinfection works, the pulsed Xenon UV (PX-UV) difference, and the effectiveness against endospores like
C. diff.
and bacillus strains and the scientific evidence in eliminating
Healthcare-Associated Infections worldwide.

Dr. Mark Stibich, PhD, Chief Scientific Officer & Co-founder, Xenex
Dr. Stibich is a founder of Xenex and, as its Chief Scientific Officer, he oversees scientific research, product development, facility assessments, and protocol design. He leads new technology development and is an inventor on multiple patents. Dr. Stibich meets frequently with infection prevention representatives at healthcare facilities, helping them understand and solve their infection control challenges while analyzing hospital results. Dr. Stibich holds a doctoral degree from the Johns Hopkins University School of Public Health, a Masters in Health Science, also from Johns Hopkins, and a bachelor’s degree from Yale University. He has conducted research in Russia, Tajikistan, Afghanistan, South Africa, Kenya, the United States and Brazil.

Ms. Sarah Simmons,  Science Director, Xenex
As an epidemiologist, Sarah Simmons works with customers to implement Xenex’s pulsed xenon UV light room disinfection technology in their facility, provide support for customers’ Infection Prevention departments, and evaluate their infection reduction results for publication in scientific journals. Sarah worked as an Infection Preventionist for five years in San Antonio, with a focus on infection prevention in critical care. She is a member of the San Antonio APIC chapter and has served on the board in numerous roles. Sarah is a Doctoral Candidate at the University of Texas School of Public Health, has a Masters of Public Health in Epidemiology and Biostatistics from the Texas A&M School of Rural Public Health, and a Bachelors degree in Biology from Texas A&M University.

 

Healthcare – Associated Infections (HAI’s) Patient Safety Addressed by Vice-President Joe Biden

Vice-President Joe Biden targets patient safety at hospitals

“Up until now, our health care system – in my humble opinion – hasn’t sufficiently linked quality … with safety,” the Vice President said.

"Up until now, our health care system -- in my humble opinion -- hasn't sufficiently linked quality … with safety," the Vice President said.

“Up until now, our health care system — in my humble opinion — hasn’t sufficiently linked quality … with safety,”  the Vice President said.

Hospitals need to focus more on reducing preventable errors and infections and the government must create more economic incentives to improve patient safety, Vice President Joe Biden said at a conference in Irvine, Calif. over the weekend.

“Up until now, our health care system – in my humble opinion – hasn’t sufficiently linked quality … with safety,” he said. “Not enough time has been focused on keeping bad things from happening.”

But Biden said the paradigm is starting to change. Hospitals are now penalized for unnecessary re-admissions and new technology alerts nurses of possible problems and reduces the reliance on handwritten doctors’ orders.

Gains have been made in improving hand hygiene and reducing central line infections, he said. And a recent government report by the Agency for Healthcare Research and Quality found that 1.3 million fewer hospital-acquired conditions occurred – and 50,000 fewer deaths – in 2013 compared to 2010.

“This is the time to double down on your commitment to patient safety,” he told the crowd of doctors, nurses, hospital executives and patient advocates. “We’ve gone from accepting the inevitable to showing what’s absolutely within our wheelhouse to be able to change.”

The conference was sponsored by the Patient Safety Movement, an organization aimed at reaching “zero preventable patient deaths by 2020.” There were panels on patient involvement, on lessons learned from Ebola and on measuring hospital efforts to improve safety.

Alicia Cole, who attended and spoke at the conference, has spent years recovering from multiple hospital-acquired infections. She went into a Burbank hospital in 2006 for a simple surgery to remove small fibroid and ended up with a staph infection, sepsis and flesh-eating disease.

“Instead of getting better I deteriorated,” Cole said. She has had numerous additional surgeries, had to stop working and still sees a doctor weekly. “My life completely changed.”

Jim Bialick, president of the Patient Safety Movement Foundation, said it’s critical to bring together patients, doctors and technology companies to create solutions. “Traditional methods aren’t working,” he said.

patientsafetymovement.org

Bialick said he appreciates the government’s renewed focus on the issue. For instance, its Partnership for Patients program is working with 3,700 hospitals across the nation to reduce preventable infections and re-admissions.

Much of the discussion at the conference focused on sepsis, a blood infection that costs the health care system more than $20 billion annually and has a mortality rate of up to 50 percent. Several hospitals, including UC San Francisco, have programs aimed at identifying victims early.

Chris Fee, associate professor of emergency medicine at UCSF, said reducing sepsis deaths is about recognizing symptoms in patients and getting treatment started as soon as possible. Technology can be key in alerting hospital staff of abnormal vital signs and lab tests he said.

www.sepsisalliance.org

“We have to remember that patients can be very ill and look quite well,” Fee said.

The UCSF project started as a pilot and has since expanded to the entire hospital. Fee said it is credited with reducing mortality from 18 percent in 2012 to 12 percent in 2014 and saving more than 100 lives.

To read the article in its entirety:

http://www.healthcarefinancenews.com/news/joe-biden-targets-patient-safety-hospitals

Healthcare Associated Infection (HAI) Patented UVC Lighting System Arcalux by Health Risk Management System (HRMS)

The Arcalux® HRMS is a ceiling mounted air disinfection system that doubles as a lighting fixture. The fluorescent HRMS01 uses about 110 watts of energy while the LED HRMS02 uses around 125 watts of energy. The installation process is easy, while maintenance of the lamp and filter are yearly and the ballast requires no tools.

Offering 24/7/365 protection against HAI – causing pathogens, this patented UVC lighting system works unobtrusively changing the air an average of four times an hour without ever disturbing a patient’s rest, quietly defending your staff and patients.

The CDC estimates that 2 million Healthcare-associated Infections (HAIs) cause or contribute to 99,000 deaths each year. With HAIs costing the US economy an estimated $45 billion annually, the HRMS is often more cost efficient than most stand-alone surface disinfection systems.

* In the news *

 AGT’s Health Risk Management System (HRMS) installed in Norwood Urgent Care Clinic in Massachusetts

State-of-the art urgent care facility built isolation room to provide enhanced patient treatment

South Bend, Indiana, December 2, 2014 – Norwood Urgent Care Clinic in Norwood, Massachusetts has taken the Health Risk Management System (HRMS) manufactured by American Green Technology ®  (AGT) and built a cutting edge isolation room for potential high risk patients. Unlike most traditional walk-in treatment centers, the Norwood facility has invested heavily in technology like on-site lab testing, cardiac monitoring, CT scan, X-Ray and ultrasound services in order to offer alternative healthcare options to consumers.

“Our goal at Norwood is to set a standard of excellence for urgent care clinics across the U.S.,” said Justin Mavromatis, Operations Director. “We feel the HRMS is an innovative product to add to our repertoire of healthcare technology.  Given the news reports of growing concerns over antibiotic resistant superbugs and the fact we are in the middle of flu season; providing unparalleled patient care is priority one.  We think using an HRMS in our isolation room can help accomplish that goal in urgent care clinics. Norwood Urgent Care will be the facility that is prepared for any medical condition that may arise.”

“Clinics like Norwood are the perfect application for the HRMS,” said Danny Bogar, CEO of AGT. “The HRMS is an environmental disinfection system that effectively purifies the air and reduces the concentration of dangerous surface pathogens like MRSA, influenza and C. difficile which combined kill over 70,000 people each year.”

Located just 25 miles from Boston, Norwood Urgent Care anticipates opening five additional centers surrounding the Greater Boston area in the near future.  To learn more log on to norwoodurgentcare.com.

The HRMS is distributed by Boston-based Improved Illumination who provides energy efficient lighting solutions to forward-thinking healthcare organizations including acute care hospitals, urgent care centers and skilled nursing facilities. 

About American Green Technology:American Green Technology® (AGT) is a company dedicated to developing innovative products to positively impact the health, economy and environment of global communities.  AGT’s Health Risk Management System (HRMS) is a patented UVC lighting product clinically proven to eliminate 99.7% of airborne pathogens that cause Healthcare-associated Infections (HAIs) in hospitals or wherever it is installed 

For more information please visit their website:

www.arcaluxhrms.com

 

 
AmericanGreenTechnology

hrms

Case Western Reserve University in Cleveland; Good Bacteria Helps Protect Against Harmful Effects of Antibiotics

Researchers from Case Western Reserve University in Cleveland have discovered that populating the gastrointestinal (GI) tracts of mice with Bacteroides species producing a specific enzyme helps protect the good commensal bacteria from the harmful effects of antibiotics. Their research is published ahead of print in Antimicrobial Agents and Chemotherapy.

Antibiotics are powerful weapons against pathogens, but most are relatively indiscriminate, killing the good bacteria  along with the bad. Thus, they may render patients vulnerable to invasion, particularly by virulent, antibiotic-resistant pathogens that frequently populate hospitals.

The novel aspect of the research is that the enzyme produced by these bacteria, beta-lactamase, is a major cause of antibiotic resistance  says first author, Usha Stiefel. Interestingly, the enzyme is not only protecting the bacteria that produce it but also the rest of the bacteria making up the intestinal microbiome.

In the study, the investigators established populations of beta-lactamase producing Bacteroides in some mice, but not others. They then gave all the mice ceftriaxone, a beta-lactam antibiotic, for three days and then oral doses of vancomycin-resistant enterococcus, or Clostridium difficile, both of which are virulent GI pathogens.

The mice that had been populated with Bacteroides maintained their diverse species of commensal gut bacteria, free of pathogens, while the control mice saw their commensals decimated by  antibiotics  enabling establishment of the pathogens.

“When patients in the hospital or nursing home setting receive antibiotics, it is doubly dangerous when they lose their native colonic bacteria, because healthcare settings are full of resistant or particularly  virulent bacteria,  and so patients are especially vulnerable to acquiring these bacteria within their intestinal tracts,” says Stiefel.

Since the Bacteroides, which comprise roughly one quarter of the intestinal microbiome, are absent elsewhere in the body, the investigators believe that the beta-lactamase will not interfere with treatment of infections in other organ systems, such as in the respiratory tract, or the blood, explains Stiefel.

“The results of our study are exciting because they show how it might be possible to take antibiotics without suffering from the loss of your colonic microbiome and then becoming colonized by virulent pathogens,” says Stiefel. For example, beta-lactamase enzymes could be given orally as drugs, to protect the  gut bacteria from systemic antibiotics. Alternatively, as with the mice, patients’ GI tracts might be populated with antibiotic-degrading  bacteria.

One weakness of the strategy is that while it could protect against acquiring a GI infection, C. difficile, for example, it could not be used to combat such an infection.

“The recognition of the importance of an intact and diverse microbiome has probably best been demonstrated by the successful treatment of Clostridium difficile colitis by fecal microbiota transplantation, or ‘stool transplant,'” says Stiefel.

“If you have an intact intestinal microbiome, you simply are going to be resistant to acquiring many types of infection.”

“If we can find ways to preserve the microbiome in hospitalized patients who are receiving antibiotics, we are on our way to preventing a large proportion of hospital-acquired infections,” says Stiefel.

More information: The manuscript can be found  online – The final version of the article

is scheduled for the August 2014 issue of Antimicrobial Agents and Chemotherapy.