Biofilm Formation Hampers Removal of Dangerous Bacteria from Hospital Surfaces

MedicalResearch.com Interview with:
Christine Greene, Ph.D. and Chuanwu Xi, Ph.D.
School of Public Health, Department of Environmental Health Sciences
University of Michigan

Medical Research: What is the background for this study?

Response: Healthcare-associated infections (HAIs) are a serious problem globally.  Acinetobacter baumannii, a gram-negative opportunistic pathogen, was mostly unheard of 10-15 years ago, but is now a clinically significant pathogen in hospitals.  A. baumannii causes a variety of infections ranging from urinary tract infections to bacteremia and patients who are at high risk of A. baumannii infection are those who are critically ill, who have indwelling catheters or patients with long hospital says.  Once infected, the risk of mortality is high – up to 26% for in-hospital patients and as much as 43% for those in the ICU.  The mortality rate is high largely due to the rapid ability for this pathogen to develop antibiotic resistance.  Despite patient isolation, we still see hospital outbreaks because A. baumannii survives very well in the environment and it is resistant to most biocides, detergents, dehydration, and UV radiation.  A. baumannii is also a known biofilm former.  Biofilms serve to protect the microorganism.  In the open environment, biofilms protect from desiccation and other harsh environmental insults such as biocides, thereby promoting persistence in the open environment.  In the human body, biofilms protect against the immune system, provide an additional layer of protection from antibiotics and contribute to reoccurring infections in the patient.

This research characterizes the fitness (desiccation tolerance) trade-offs imposed on A. baumannii isolated from clinical and environmental settings.  This investigation compares isolates of A. baumannii from both environments on the basis of multidrug resistance, biofilms and desiccation tolerance.  We looked to see if either MDR or biofilm formation increased fitness (ability to tolerate desiccation) or impose a fitness cost depending on environmental conditions.

Medical Research: What are the main findings?

Response: We provide evidence of variation in desiccation tolerance between clinical and environmental isolates of similar phenotypes and show a trend of increased desiccation tolerance for high biofilm forming clinical isolates with additional tolerance when the ability to form biofilms is coupled with the multidrug resistance.  By contrast, biofilm formation had a significant impact on desiccation tolerance for environmental isolates.

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Feeding Tubes Linked To Resistant Organisms In Nursing Home Patients

MedicalResearch.com Interview with:

Leonard Mermel, DO, ScM, AM (Hon), FSHEA, FIDSA, FACP Professor of Medicine, Warren Alpert Medical School of Brown University Medical Director, Dept. of Epidemiology & Infection Control, Rhode Island Hospital

Dr. Leonard Mermel

Leonard Mermel, DO, ScM, AM (Hon), FSHEA, FIDSA, FACP 
Professor of Medicine, Warren Alpert Medical School of Brown University
Medical Director, Dept. of Epidemiology & Infection Control, Rhode Island Hospital
Adjunct Clinical Professor, University of Rhode Island College of Pharmacy 

Medical Research: What is the background for this study? What are the main findings?

Dr. Mermel:  There is increasing concern in the US and abroad regarding multi-drug resistant organisms (MDROs), particularly bacteria resistant to carbapenem antibiotics.  Concern has been raised about MDRO colonization in high-risk populations, such as nursing home patients and transmission between nursing home and acute care hospitals.  Little data exists concerning the incidence of GI tract colonization of such pathogens in nursing home patients at the time of acute care hospitalization.  We used rectal swabs on 500 hospital admissions from nursing homes to assess carriage of bacteria resistant to carbapenem antibiotics.  We found carbapenem-resistant or carbapenemase-producing gram-negative bacteria in 23 of the 500 (4.6%) hospital admissions from nursing homes, which included 7 carbapenemase-producing CRE bacteria (1.4%).  The latter bacteria produce an enzyme that breaks down the carbapenem antibiotic and the resistance genes are located on mobile genetic elements.  We also found that use of gastrostomy tubes was associated with fecal carriage of gram-negative bacteria with detectable carbapenem resistance.

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Most Nurses Skip Some Infection Control Measures

MedicalResearch.com Interview with:

Donna Powers, DNP, RN Kransoff Quality Management Institute North Shore Long Island Jewish Health System New York, NY

Dr. Donna Powers

Donna Powers, DNP, RN
Kransoff Quality Management Institute
North Shore Long Island Jewish Health System
New York, NY 

Medical Research: What is the background for this study? What are the main findings?

Dr. Powers: Despite widely published, accessible guidelines on infection control and negative health consequences of noncompliance with the guidelines, significant issues remain around the use of Standard Precautions to protect nurses  from bloodborne infectious diseases.

Only 17.4% of ambulatory nurses reported compliance with all nine standards. The nurses represented medicine, cardiology, dialysis, oncology, pre – surgical testing, radiation and urology practices. Compliance rates varied considerably and were highest for wearing gloves (92%) when exposure of hands to bodily fluids was anticipated, however only 63% reported washing hands after glove removal.  68% provided nursing care considering all patients as potentially contagious. Overall, the ambulatory care nurses chose to implement some behaviors and not others, and this behavior puts them at risk for acquiring a bloodborne infection.”

The study also found knowledge of HCV was variable. Although HCV is not efficiently transmitted by sexual activity, more than one in four nurses (26 %) believed that sexual transmission is a common way that HCV is spread.  14 percent believed incorrectly that most people with HCV will die prematurely because of the infection, 12 percent did not know that HCV antibodies can be present without an infection, and 11 percent did not know there are multiple HCV genotypes.

A statistically significant relationship was found between compliance and perception of susceptibility to HCV illness (P = .05) and between compliance and perception of barriers to use of Standard precautions (P=.005).

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Antibiotic Induced Depletion of Bile Acids Facilitates Growth of C. diff

Casey M. Theriot, Ph.D. Assistant Professor Infectious Disease College of Veterinary Medicine Department of Population Health and Pathobiology North Carolina State University Raleigh, NC 27607

Dr. Casey Theriot

MedicalResearch.com Interview with:
Casey M. Theriot, Ph.D.
Assistant Professor Infectious Disease
College of Veterinary Medicine
Department of Population Health and Pathobiology
North Carolina State University
Raleigh, NC 27607

Medical Research: What is the background for this study? What are the main findings?

Dr. Theriot: This study is an extension of the work we did in 2014 in our Nature Communications paper (Theriot et al. Antibiotic-induced shifts in the mouse gut microbiome and metabolome increase susceptibility to Clostridium difficile infection, 2014). We really wanted to know how different antibiotics that varied in their mechanism of action altered the gut microbiota in different ways and also in turn how this altered the bile acids present in the small and large intestine of mice. Primary bile acids are made by the host and are further converted to secondary bile acids by members of the microbiota in the large intestine. We know from previous work that secondary bile acids can inhibit the growth of C. difficile, but no one has looked in depth at the bile acid makeup in the actual gut before in the context of C. difficile. In this study we show that specific antibiotics that significantly alter the large intestinal gut microbiota and deplete all secondary bile acids allow for C. difficile to grow without any inhibition. We also showed that C. difficile spores are always germinating in the small intestine, which means in order to prevent this pathogen from colonizing the gut, we will have to target the growth of the pathogen. Moving forward the focus will be on trying to repopulate the gut with bacteria that are capable of restoring the secondary bile acid pools in order to inhibit C. difficile.

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Post Discharge Phone Call Improves Infection Detection Rate

Muhammad A. Halwani, MSc, PhD Faculty of Medicine, Al Baha University Al Baha, Saudi Arabia.

Dr. Halwani

MedicalResearch.com Interview with:
Muhammad A. Halwani, MSc, PhD
Faculty of Medicine, Al Baha University
Al Baha, Saudi Arabia. 

Medical Research: What is the background for this study? What are the main findings?

Response: The study idea was based on examining the current rate of post cesarean section infections that were detected in the hospital at the time. It was hypothesized that the detected infections were actually less than the real number identified. Therefore, we challenged the traditional surveillance method that was applied in the hospital with a new enhanced methodology which is telephone follow-ups for patients who under go C-section operations.

Our main finding proved that this new applied method was able to detect more cases than the traditional one. Using phone calls as a gold standard, the sensitivity of the standard methodology to capture SSI after cesarean increased to 73.3% with the new methodology identifying an extra five cases. These patients represented 26.3% (5 of 19) of all the patients who developed SSI. In other words, for every 100 C-section procedures there were 2.6% missed cases which the new method was able to detect. The duration of the calls ranged from 1 to 5 minutes and were well received by the patients.

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The ‘Wiperator’ Tests Ability of Disinfecting Wipes To Decontaminate Infected Surfaces

Prof. Jean-Yves Maillard Professor of Pharmaceutical Microbiology College of Biomedical and Life Sciences Cardiff School of Pharmacy and Pharmaceutical Sciences Cardiff University Cardiff United Kingdom

Prof. Maillard

MedicalResearch.com Interview with:
Prof. Jean-Yves Maillard

Professor of Pharmaceutical Microbiology
College of Biomedical and Life Sciences
Cardiff School of Pharmacy and Pharmaceutical Sciences
Cardiff University
Cardiff United Kingdom

Medical Research: What is the background for this study? What are the main findings?

Prof. Maillard: Environmental surfaces in healthcare and other settings become contaminated with a variety of infectious agents which may survive long enough to infect susceptible hosts, either directly or through secondary vehicles such as hands. Therefore, routine decontamination of environmental surfaces, in particular those that are frequently touched, is crucial to reduce the risk of infections. Such decontamination is often performed by wiping the target surface with disinfectant-soaked or pre-wetted wipes. However, the label claims of wipes marketed for this purpose are often based upon testing that does not reflect their field use, where contact times are frequently no more than a few seconds with wide variations in the pressure applied during wiping. In addition, wipes impregnated with a disinfectant or detergent can potentially transfer microbial contaminants to a wider area, when the same wipe is used on multiple surfaces.

A device called the ‘Wiperator’ was invented to address these issues. It can be used to test wipes with predetermined pressures, wiping times and number of wiping strokes, using a standardized rotary action. It can not only assess the decontaminating efficiency of the test wipe, but also its ability to transfer the acquired contamination to clean surfaces. The test procedure developed using the device is now a standard (E2967) of ASTM International, a highly-respected standards-setting organization.

The Wiperator was used in a multi-laboratory collaborative to test commercially-available wipes for their ability to decontaminate metal disks that had been experimentally-contaminated with vegetative bacteria representing healthcare-associated pathogens. The used wipes were subsequently tested for their potential to transfer viable bacteria to clean surfaces. The contact time for wiping and transfer was 10 seconds. Only one of the wipes tested reduced the contamination to an undetectable level while not transferring any viable bacteria to a clean surface. All others left behind detectable levels of contamination on the wiped disks and transferred the contamination to clean surfaces.

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ID Badges and Lanyards Appear To Have Low Risk of Viral Spread In Hospitals

Daryl R. Cheng, MBBS Monash Children's Hospital Victoria, AustraliaMedicalResearch.com Interview with:
Daryl R. Cheng, MBBS

Monash Children’s Hospital
Victoria, Australia

 

Medical Research: What is the background for this study? What are the main findings?
Response: Inanimate objects worn and used by health care workers (HCW), such as neckties and stethoscopes,  have been shown to be reservoirs for potential pathogens. Of particular concern in the pediatric setting are identity (ID) badges and lanyards.

Many pediatric health care workers use them not only for
identification but also as a distraction tool during examination or procedures. Children have an increased tendency to place these items in their mouth as health care workers lean over to examine or care for them, therefore completing the chain of transmission for a potential nosocomial infection.

Whilst previous studies have demonstrated that ID badges and lanyards worn by health care workers may harbor pathogenic bacteria , there is paucity of comparative data suggesting that ID badges may be similarly contaminated with viral pathogens.

However, given the higher incidence of viral infections in pediatrics up to 50% of preterm infants screened during their hospital stay y had viruses detected in  their nasopharynx, further evaluation of the viral burden and potential for nosocomial transmission of  prevalent viruses are of both clinical and economic significance.

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High-Performance Work Practices Can Reduce Central Line Infections

Ann Scheck McAlearney, Sc.D., M.S. Professor, Family Medicine Vice Chair for Research, Department of Family Medicine College of Medicine Ohio State University Columbus, OhioMedicalResearch.com Interview with:
Ann Scheck McAlearney, Sc.D., M.S.
Professor, Family Medicine
Vice Chair for Research, Department of Family Medicine
College of Medicine Ohio State University
Columbus, Ohio

MedicalResearch: What is the background for this study? What are the main findings?

Dr. McAlearney: In this study, we sought to explore the potential role high-performance work practices (HPWPs) may play in explaining differences in the success of central line-associated blood stream infection (CLABSI) reduction efforts involving otherwise similar organizations and approaches. We analyzed data from 194 key informant interviews across eight hospitals participating in the federally funded ‘‘On the CUSP: Stop BSI’’ initiative. We found evidence that at sites more successful at reducing central line-associated blood stream infection, HPWPs facilitated the adoption and consistent application of practices known to prevent CLABSIs; these HPWPs were virtually absent at lower performing sites.

In this paper we present examples of management practices and illustrative quotes categorized into four HPWP subsystems:
(a) staff engagement,
(b) staff acquisition/development,
c) frontline empowerment, and
(d) leadership alignment/development. Continue reading

Antibiotic Impregnated Catheters Can Reduce Central Line-Associated Bloodstream Infection

Stephanie Bonne, MD, FACS Assistant Professor Trauma, Acute, and Critical Care Surgery Washington University in St. LouisMedicalResearch.com Interview with:
Stephanie Bonne, MD, FACS
Assistant Professor
Trauma, Acute, and Critical Care Surgery
Washington University in St. Louis

Medical Research: What is the background for this study? What are the main findings?

Response: We had previously implemented education programs in our ICU in an attempt to decrease our Central Line-Associated Bloodstream Infection (CLABSI) rate.  We were, however, unable to come to zero.  We were looking for innovative ways to lower our CLABSI rate, and the use of Clorhexidine/Silver Sulfadiazine catheters was unable to move our CLABSI rate.  We decided to try Minocycline/Rifampin catheters, and monitor our Central Line-Associated Bloodstream Infection rate.

Medical Research: What should clinicians and patients take away from your report?

Response: The use of Minocycline/Rifampin impregnated catheters can lower Central Line-Associated Bloodstream Infection rate, particularly in ICUs who have been unable to reach a Central Line-Associated Bloodstream Infection rate of zero with other measures.

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Non-Toxic Spores May Prevent C. difficile infection

Dale N. Gerding, MD Research Physician, Edward Hines, Jr., VA Hospital Professor, Department of Medicine of Loyola University Chicago Stritch School of MedicineMedicalResearch.com Interview with:
Dale N. Gerding, MD
Research Physician, Edward Hines, Jr., VA Hospital
Professor, Department of Medicine of Loyola University Chicago Stritch School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Gerding: Naturally occurring strains of C. difficile lack the genes for production of the toxins that cause C. difficile infection (CDI) and are known as non-toxigenic C. difficile (NTCD). These strains when ingested by patients whose normal microbiota is disrupted by antibiotic treatment will harmlessly colonize the colon and remain in the gut for weeks to months. Specific strains of NTCD found in patients were shown to colonize the gut and prevent C. difficile infection when challenged with toxigenic C. difficile strains in animal models. One such NTCD strain, NTCD-M3, was shown to be safe and well tolerated in human volunteer trials and was used in the present study to determine if it would prevent recurrence of C. difficile infection in patients who had just completed treatment with vancomycin or metronidazole of either their first CDI episode or first recurrence of
C. difficile infection. 168 patients were randomized to receive by mouth in a liquid form, either 10,000 spores/day of NTCD-M3 for 7 days, 10 million spores/day for 7 days, 10 million spores/day for 14 days, or an identical placebo for 14 days.  Primary outcome was safety, and secondary outcomes were the percent who colonized the gut with NTCD-M3 in the time period from end of treatment to week 6, and the rate of recurrent CDI in the patients at week 6. The results showed that NTCD-M3 was safe and well tolerated, and colonized the gut of 69% of patients who received it. The C. difficile infection recurrence rate was 30% in the placebo patients and 11% in patients who received any of the NTCD-M3 doses (P<.006). The best dose tested was 10 million spores/day for 7 days which resulted in a recurrence rate of only 5% (p<.01 vs placebo). Colonization of the gut was not permanent, but lasted a maximum of 22 weeks. The summary conclusion is that NTCD-M3 is safe, colonized the gut, and when it colonized the gut, reduced recurrence of C. difficile infection to 2% (p<.001 vs patients who were not colonized).

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Antibacterial Gloves May Reduce Cross Contamination In ICU Setting

Ojan Assadian, M.D., DTMH Professor for Skin Integrity and Infection Prevention Institute for Skin Integrity and Infection Prevention School of Human & Health Sciences University of Huddersfield Queensgate, Huddersfield UKMedicalResearch.com Interview with:
Ojan Assadian, M.D., DTMH
Professor for Skin Integrity and Infection Prevention
Institute for Skin Integrity and Infection Prevention
School of Human & Health Sciences
University of Huddersfield
Queensgate, Huddersfield UK

MedicalResearch: What is the background for this study? What are the main findings?

Prof. Assadian: Although medical gloves serve as an important mechanical barrier to prevent healthcare workers’ hands from getting contaminated with potentially pathogenic microorganisms, their inappropriate and incorrect use may support microbial transmission, eventually resulting in indirect horizontal cross-contamination of other patients.

We conducted a clinical study designed to determine the efficacy of a newly developed synthetic antibacterial nitrile medical glove coated with an antiseptic, polyhexamethylen-biguanid hydrochloride (PHMB), on its external surface, and compared this antibacterial glove to an identical non-antibacterial glove in reducing surface contamination after common patient care measures in an intensive care unit.

We found significantly lower numbers of bacteria on surfaces after performing typical clinical activities such as intravenous fluid handling, oral toilet, or physiotherapy, if touched with antibacterial gloves.

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Antimicrobial Chlorhexidine Baths Did Not Reduce Hospital Infections

Michael Noto, MD, PhD Pulmonary and Critical Care Medicine Vanderbilt University Medical CenterMedicalResearch.com Interview with:
Michael Noto, MD, PhD

Pulmonary and Critical Care Medicine
Vanderbilt University Medical Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Noto: Health care-associated infections are the most common complication for hospitalized patients and several studies have suggested that bathing critically ill patients with the antimicrobial chlorhexidine reduces health care-associated infections.  In the largest study of chlorhexidine bathing to date, however, we were unable to demonstrate a reduction in infections.

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Medicare Initiative Reduced Hospital-Acquired Infections

Teresa Waters PhD Professor and Chair, Preventive Medicine University of Tennessee Health Science Center Memphis TNMedicalResearch.com Interview with:
Teresa Waters PhD

Professor and Chair, Preventive Medicine
University of Tennessee Health Science Center
Memphis TN

Medical Research: What is the background for this study? What are the main findings?

Dr. Waters: On October 1, 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy penalizing hospitals for eight complications of hospital care, also known as never events. Under the HACs Initiative, hospitals could no longer justify a higher level Medicare MS-DRG when caring for a patient who developed 1 of the 8 never events. This Initiative was one in a series of CMS payment reforms intended to increase emphasis on value-based purchasing.

We found that Medicare’s nonpayment policy was associated with significant improvements in the time trends for central line associated blood stream infections (CLABSIs) and catheter associated urinary tract infections(CAUTIs). For these outcomes, our data from the National Database of Nursing Quality Indicators showed that introduction of the Medicare policy was associated with an 11% reduction in the rate of change in central line associated blood stream infections and a 10% reduction in the rate of change in CAUTIs. We did not find any relationship between introduction of the policy and significant changes in injurious falls or hospital acquired pressure ulcers (two other important never events covered by the policy). We hypothesized that the Hospital-Acquired Conditions Initiative may have a great effect for conditions where there is strong evidence that better hospital processes yield better outcomes or where processes are more conducive to standardization.

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Hospital Acquired C. diff Infections Increase Both Length of Stay and Mortality

MedicalResearch.com Interview with:
Esther van Kleef
London School of Hygiene and Tropical Medicine,
London, UK

Medical Research: What are the main findings of the study?

Response:  Existing evidence reveals a wide variation in estimated excess length of hospital stay (LoS) associated with healthcare-acquired C. difficile infection (HA-CDI), ranging from 2.8 to 16.1 days. Few studies considered the time-dependent nature of healthcare-acquired C. difficile (i.e. patients that spent a longer time in hospital have an increased risk of infection), and none have considered the impact of severity of healthcare-acquired C. difficile on expected delayed discharge. Using a method that adjusted for this so-called time-dependent bias, we found that compared to non-infected patients, the excess length of stay of severe patients (defined by increased white blood cell count, serum creatinine, or temperature, or presence of colitis) was on average, twice (11.6 days; 95% CI: 3.6-19.6) that of non-severe cases (5.3 days; 95% CI: 1.1-9.5). However, severely infected patients did not have a higher daily risk of in-hospital death than non-severe patients. Overall, we estimated that healthcare-acquired C. difficile prolonged hospital stay with an average of ~7 days (95% CI: 3.5-10.9) and increased in-hospital daily death rate with 75% (Hazard Ratio (HR): 1.75; 95% CI: 1. 16 – 2.62).

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Perioperative Bundles Can Reduce Surgical Site Infections

Christopher Mantyh, M.D. Associate Professor of Surgery Chief of Colorectal Surgery NSQIP Surgical Champion Duke University Medical CenterMedicalResearch.com Interview with:
Christopher Mantyh, M.D.
Associate Professor of Surgery
Chief of Colorectal Surgery
NSQIP Surgical Champion
Duke University Medical Center

Medical Research: What are the main findings of the study? 

Dr. Mantyh: Specific perioperative bundles can drastically reduce surgical site infections in colorectal surgery patients.
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Hospital Acquired Infections: Still Room for Improvement

MedicalResearch.com Interview with:
Shelley S. Magill, M.D., Ph.D.
From the Centers for Disease Control and Prevention
Emory University School of Medicine
Atlanta, Georgia

MedicalResearch.com: What are the main findings of the study?

Dr. Magill: The results of this survey show that healthcare-associated infections continue to be a threat to patient safety in U.S. acute care hospitals. Among the more than 11,000 patients included in the survey, approximately 4% (or 1 in 25) had at least one healthcare-associated infection at the time of the survey. We used these results to develop national estimates of healthcare-associated infections. We estimated that in 2011, there were approximately 721,800 healthcare-associated infections in U.S. acute care hospitals. The most common types of infections were surgical site infections (SSIs), pneumonias, and gastrointestinal infections.
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Decreasing Bacterial Contamination from Surgical Gloves, Gowns

William G Ward, Sr. MD Chair of Orthopaedic Surgery, Chief of Musculoskeletal Service Line - Guthrie Clinic One Guthrie Square Sayre, Pennsylvania 18840 (Professor Emeritus - Wake Forest University Dept of Orthopaedic Surgery)MedicalResearch.com Interview with:
William G Ward, Sr. MD
Chair of Orthopaedic Surgery, Chief of Musculoskeletal Service Line – Guthrie Clinic
Sayre, Pennsylvania 18840
(Professor Emeritus – Wake Forest University Dept of Orthopaedic Surgery)

MedicalResearch.com: What are the main findings of this study?

Dr. Ward: The main findings of the study include:

  1. The use of disposable spun-lace “paper” gowns was associated with a dramatic decrease in the likelihood of culture-detected bacterial contamination on the surgeon’s gloved hand and gown sleeve.
  2. For a double-gloved surgeon, changing the outer glove just prior to implant handling should decrease bacterial contamination from the surgeon by about 50%.
  3. Bacteria suspended in saline solution transgressed the material of standard reusable scrub attire in 96% (26/27) of tested gowns and in 0% (0/27) of spun-lace disposable “paper” gowns. Continue reading

Hospital Infection Control Adherence Variable

Patricia W. Stone, PhD, FAAN Columbia University School of Nursing New York, NY 10032.MedicalResearch.com Interview with:
Patricia W. Stone, PhD, FAAN
Columbia University School of Nursing
New York, NY 10032.


MedicalResearch.com: What are the main findings of the study?

Dr. Stone: Our study found variation in the presence of infection control policies directed at central-line bloodstream infections, ventilator-associated pneumonia and catheter-associated urinary tract infections. Even when present, the policies were adhered to only about half of the time.
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Neonatal Intensive Care Unit and Vancomycin-resistant Enterococcus outbreak

MedicalResearch.com Interview with:
Elias Iosifidis, MD, PhD
Pediatric Infectious Disease Fellow
Aristotle University of Thessaloniki
Hippokration Hospital
Thessaloniki, Greece

MedicalResearch.com: What are the main findings of the study?

Dr. Iosifidis: A large outbreak of VRE colonization was found in neonates hospitalized in an intensive care unit (Neonatal Intensive Care Unit, NICU) after the implementation of an active surveillance program. Both high incidence of VRE colonization (or “colonization pressure”) and antibiotic use promoted VRE spread according to the results of the case control study. No proven sources of VRE were found (in local hospital or even in local livestock). A multifaceted management was implemented and included enhanced infection control measures, active surveillance cultures, cohorting of colonized patients, daily audits and optimization of antibiotic therapy. Although the outbreak had a biphasic pattern (monoclonal first wave followed by a polyclonal second wave) strict adherence to the aforementioned bundle of actions was proved essential for reducing VRE colonized cases. During the study period no new VRE infection occurred in neonates.

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How Hospital Infections Spread from One Hospital to Another

MedicalResearch.com Interview with:

Bruce Y. Lee, MD MBA Associate Professor of International Health Director of Operations Research International Vaccine Access Center (IVAC) Johns Hopkins Bloomberg School of Public Health 855 N. Wolfe Street Suite 600 Baltimore, MD 21205Bruce Y. Lee, MD MBA
Associate Professor of International Health
Director of Operations Research
International Vaccine Access Center (IVAC)
Johns Hopkins Bloomberg School of Public Health
855 N. Wolfe Street Suite 600
Baltimore, MD 21205

MedicalResearch.com: What are the main findings of the study?

Dr. Lee: Vancomycin resistant enterococci (VRE) is every hospital’s problem.  A VRE outbreak in one hospital, even if the hospital is relatively small or distant, can readily spread to other hospitals in a region because patients leaving one hospital often will go to other hospitals either directly or after an intervening stay at home.  These patients can then carry VRE with them to other hospitals.  Therefore, as long a single hospital has a problem with VRE or any other healthcare associated infection, all other hospitals are at risk.  Conquering VRE then requires cooperation among hospitals.
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Decreasing Infections after Surgery: Bundling Decolonization and Prophylaxis

Marin L. Schweizer Ph.D.  Assistant Professor University of Iowa Carver College of Medicine, Iowa City, IA, USAMedicalResearch.com Interview with:
Marin L. Schweizer Ph.D.

Assistant Professor
University of Iowa Carver College of Medicine
Iowa City, IA, USA

MedicalResearch.com: What are the main findings of the study?

Dr. Schweizer: A clinical bundle that includes nasally screening cardiac and orthopedic surgery patients for S. aureus (both methicillin-resistant S. aureus and methicillin-susceptible S. aureus), decolonizing carriers, and changing antibiotic prophylaxis for MRSA carriers, can significantly reduce the number of gram-positive surgical site infections, S. aureus surgical site infections and MRSA surgical site infections.
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Inexpensive Infection Control Reduces Hospital Mortality and Costs

 

Thursday, Sept. 8, 2011

CHAPEL HILL, N.C. – At any given time, one of every 20 hospital patients has a hospital-acquired infection, according to the U.S. Department of Health and Human Services.
This leads to an estimated 99,000 deaths in the U.S. each year and up to $33 billion in preventable health care costs.

Now a new study by University of North Carolina at Chapel Hill researchers finds that adopting an inexpensive set of infection control measures could potentially save many thousands of lives and billions of dollars. The study appears in the September 2011 issue of Health Affairs.

“These two initiatives, targeting ventilator associated pneumonias and central line associated bloodstream infections, involved simple steps that lead to dramatic reductions in not only the targeted infections, but also mortality and costs,” said Bradford D. Harris, MD, who led the study while serving as an associate professor of anesthesiology and pediatrics in the UNC School of Medicine. He is now a medical officer at the U.S. Food and Drug Administration in Washington.

The study was conducted in the Pediatric Intensive Care Unit at North Carolina Children’s Hospital, which is one of the five University of North Carolina Hospitals. The study tested three interventions aimed at preventing and reducing hospital acquired infections.

The first intervention was strict enforcement of standard hand hygiene practices on the unit. All health care workers are expected to wash their hands with soap and running water or an alcohol-based rub on entering and leaving a patient’s room, before putting on and after removing gloves, and before and after any task that involves touching potentially contaminated surfaces or body fluids.

The second intervention was implementing a bundle of measures aimed at preventing ventilator-associated pneumonia. Examples included elevating the head of the patient’s bed while the patient is receiving breathing assistance from a ventilator, giving the patient daily breaks from sedation and then — while the patient was unsedated — assessing whether or not the patient is ready to come off the ventilator, and providing daily oral care (teeth brushing, mouth washes, etc.) with a long-lasting antiseptic.

The final intervention was ensuring compliance with guidelines for the use and maintenance of central-line catheters. Examples included using sponges impregnated with an antiseptic, using catheters impregnated with antibiotics whenever possible, and performing two assessments per day of whether patients with central-line catheters still needed them.

Results of the study showed that patients admitted after these interventions were fully implemented got out of the hospital an average of two days earlier, their hospital stay cost about $12,000 less and the number of patient deaths were reduced by two percentage points.

The costs for implementing these measures were modest. Examples include roughly $21 a day for oral care kits and about 60 cents a day for antiseptic patches and hand sanitizers. But adoption of the three interventions collectively could save this single hospital unit an estimated $12 million a year, the study found. If replicated nationwide, these measures potentially could save thousands of lives and billions of dollars each year.

The study concluded that measures such as these have the potential to save both lives and money and will improve the care of all patients.

UNC co-authors of the study are Cherissa Hanson, MD; Claudia Christy, Tina Adams, Andrew Banks and Tina Schade Willis, MD. Matthew Maciejewski, PhD, an associate professor at Duke University School of Medicine who holds adjunct professor appointments at UNC, is also a co-author.

BI C. difficile strain found common in Chicago hospitals

An outbreak strain of Clostridium difficile, a bacterium that causes diarrhea and sometimes life-threatening inflammation of the colon, is common in Chicago-area acute care hospitals, an investigation published in the September issue of Infection Control and Hospital Epidemiology suggests.

In response to Illinois Department of Public Health reports of rising rates of C. difficile infection as a hospital discharge diagnosis, the Chicago and Cook County health departments surveyed 25 Chicago-area hospitals over one month in 2009. They identified 263 total cases of C. difficile illness. Of 129 C. difficile isolates cultured from these patients, 61 percent were the outbreak C. difficile strain known as BI/NAP1.

The BI strain, which is known to cause more serious illness, is usually associated with large acute outbreaks of C. difficile. However this investigation suggests that BI is endemic in the Chicago area and patients could be at risk for severe disease even in the absence of a large acute outbreak.

“Our findings highlight the need for effective interventions aimed at reducing the risk of C. difficile infection,” said Stephanie Black, MD with the Chicago Department of Public Health and the investigation’s lead author.

The investigation suggests that the transfer of patients from one facility to another has helped to spread the BI strain. Dr. Black and her team found that half of the patients with the BI strain were transferred from one healthcare facility to another. “Inter-facility transfer of recently infected patients is a plausible mechanism for the spread of the BI group and may explain in part how BI became the dominant [strain] in this region,” the authors write.

C. difficile is most common in elderly patients and those receiving treatment with antibiotics. It is considered to be one of the most important health care-related infections in the U.S.

The Society for Healthcare Epidemiology of America recommends that patients take the following steps to reduce the spread of C. difficile:

  • Make sure that all doctors, nurses, and other healthcare providers clean their hands with soap and water.
  • Only take antibiotics as prescribed by your doctor.
  • Be sure to clean your own hands often, especially after using the bathroom and before eating.
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Stephanie R. Black, Kingsley N. Weaver, Roderick C. Jones, Kathleen A. Ritger, Laurica A. Petrella, Susan P. Sambol, Michael Vernon, Stephanie Burton, Sylvia Garcia-Houchins, Stephen G. Weber, Mary Alice Lavin, Dale Gerding, Stuart Johnson, Susan I. Gerber, “Clostridium difficile Outbreak Strain BI Is Highly Endemic in Chicago Area Hospitals.” Infection Control and Hospital Epidemiology 32:9 (September 2011)