Effective infection prevention program can reduce HAIs

SUMMARYThe effective IPC/HE program must be multidisciplinary and include experts in both HE and infection prevention. Expertise is defined by sets of core competencies established by the Society for Healthcare Epidemiology of America for healthcare epidemiologists and by the Association for Professionals in Infection Control and Epidemiology for infection preventionists.

Program personnel must have authority delegated from institutional leadership to perform essential activities and implement change to reduce HAIs.

The number of personnel is determined not solely by the number of patients served by a given facility, but rather by the scope and complexity of program activities. The budget allocated for the program must support adequate numbers of personnel (infection preventionists and healthcare epidemiologists) to execute program activities. At present, many healthcare institutions are underresourced, with insufficient reimbursement for hospital epidemiology services and too few infection preventionists. This document provides an updated assessment of the resources and requirements for an effective IPC/HE program.

In 1996, the Society for Healthcare Epidemiology of America (SHEA) convened an expert consensus panel to provide a “best assessment of the needs for a healthy and effective hospital based infection control and epidemiology program.” The panel’s consensus report was approved by both SHEA and the Association for Professionals in Infection Control and Epidemiology (APIC) and published in 1998.

Nearly 2 decades later, transformative changes have taken place in healthcare and these changes have substantially increased the responsibilities and workload of infection prevention and control (IPC) programs. This evolution has included new challenges for IPC/healthcare epidemiology (hereafter referred to as IPC/HE) programs unheard of at the time of the original publication, including legislative mandates, public reporting, pay-for-performance, payment penalties, healthcare-associated infection (HAI) prevention collaboratives, bioterrorism (anthrax attacks), new and emerging pathogens (systemic acute respiratory distress syndrome, pandemic H1N1 influenza, Middle Eastern respiratory syndrome coronavirus, Ebola virus), Occupational Health and Safety Administration mandates, and the first National Action Plan to reduce HAIs. Concurrently, the rising frequencies of multidrug-resistant organisms (MDROs), unprecedented antimicrobial shortages, and a relative lack of new antimicrobials have further tested IPC strategies. Many of these challenges have necessitated increased education and training. In fact, there is ample evidence that a comprehensive IPC/HE program can reduce HAI, minimize the spread of MDROs, and address emerging infections and pathogens, ultimately keeping patients safer. Thus, the goals for IPC/HE programs noted in Table 1 remain relevant and have added urgency for implementation in a broader array of healthcare settings.

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© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved. Published online: 01 February 2016. Source: Website

Disinfecting vs. Cleaning: What's the Difference?

By Darrel Hicks Abstract: When educating the public, we often use words like clean, disinfect, and processed interchangeably. What is often overlooked is that to infection control practitioners, the differences are quite large.

Knowing the difference between these terms can mean the difference between life and death.

Main Article: In our world today, but especially in healthcare, there are few if any, tenets as impervious to overstatement as the importance of cleanliness. A facility might appear to be ‘clean’ and not be safe and disinfected. However, IF the facility is safe and disinfected, it is clean, too.

Improving sanitation (safe, clean and disinfected) and infection prevention can seem to be an expensive proposition, but for hospitals there’s nothing as unaffordable as ‘bad medicine.’ We’re not talking about dollars only. The cost of pain, suffering and death from healthcare acquired conditions has to be considered along with a damaged reputation in the community.

Gus Iverson writes, “Our ancestors in Mesopotamia were washing wounds with alcohol 4,000 years ago, but the real gravity of sanitation didn’t start to resonate until about 150 years ago, when the work of Louis Pasteur led surgeons towards new concepts like wearing gloves and disinfecting their instruments. Today, the mission is clear: to practice medicine in the cleanest environment possible.” Or, as Hippocrates quipped, “FIRST, DO NO HARM.”

Webster defines CLEAN (as an adjective)- free of soil, pollution and other undesirable materials. As a verb- make clean, remove dirt, marks or stains.

In recent years, there has been much discussion and debate surrounding the terms “environmental cleaning” and “environmental disinfection”; to many epidemiologists and microbiologists the terms seem to be interchangeable. “Clean hands” seem to have one definition while “clean environmental surfaces” seem to have different criteria.

Hands can be made clean and safe with potable water, soap, time, proper friction, rinsing with potable water and thorough drying. But, environmental surfaces are rendered “disinfected” by merely wiping the “proper” disinfectant on the hard non-porous surface and allowing the proper contact time (which may take re-wetting the surface six times to attain a 10-minute contact time).

I believe the goal of cleaning hands and environmental surfaces ought to be to break the chain of infection from hosts, to persons or commonly touched surfaces (fomites) and to other humans. Or, as I like to say, returning the commonly touched surface to its “fit for purpose” condition.

In order to make an environmental surface (especially, a frequently touched surface) fit for purpose, I believe the term “processing” should be adopted. Whether addressing the epidemiologist, microbiologist or the front-line Housekeeper, we all understand that environmental surfaces must be processed.

Processing Definition of “PROCESSING” –includes cleaning and disinfecting an item or area using a clean micro-denier cloth or flat mop, and an appropriate and facility-approved, EPA-registered disinfectant. We don’t clean operating rooms, we process them. We don’t clean a patient’s room, the Housekeeper processes the room.

This isn’t a matter of semantics but a realization that a new, more descriptive term must be adopted, understood and communicated to the person who must deliver a safe, clean and disinfected item or area (i.e., the Housekeeper or Cleaning Professional). The Housekeeper’s role must be a part of a multi-modal approach to infection prevention whether she works in a hospital, ambulatory surgery center, long-term care facility, office building, fitness center or an elementary school.

Cleaning Cleaning is not the same as disinfecting or sanitizing. Cleaning may and should occur before disinfecting or sanitizing surfaces. Cleaning is the removal of all foreign material from objects by using water and detergents, soaps, enzymes and the mechanical action of washing or scrubbing the object.

Disinfection/sterilization cannot be accomplished if soil removal is inadequate.

Witness the recent news about “dirty” duodenoscopes causing the death of 100 patients in the U.S.

If 98% of the micro-soil can be removed from an environmental surface with a clean micro-denier cloth and clean potable water, then it doesn’t matter what disinfectant you choose. If microbial pathogens are collected from a hard, non-porous surface, held in the micro-denier cloth and NOT released until laundered, then we change the conversation.

We need to stop looking at the wiping material, be it cotton or man-made fiber, as a cleaning cloth. Instead, it is merely a delivery system for the disinfectant. If the wiping material is binding the active ingredients in the disinfectant, does it matter whether or not the contact time (or dwell time) is observed? If the soil load on a surface is greater than the 5% mandated by EPA’s disinfectant registering protocols, is the efficacy of the disinfectant diminished?

Instead, we should be choosing the best, micro-denier wiper available to do a superior job of soil removal. The guiding principle is always to remove germs if possible rather than kill them, and then, when necessary use the least amount of the mildest chemical or disinfectant that will do the job; because stronger often means more toxic to humans.

In closing, simple cleaning of the environmental surfaces may be one of our key defenses in the future battle against infectious disease. With antibiotic-resistant organisms proliferating on surfaces for up to 56 or more days, the study of cleaning and measuring cleanliness is becoming all important.

Copyright © 2016 InfectionControl.Tips. All rights reserved. Used with permission. For more information, visit InfectionControl.tips


About E-Mist E-Mist helps healthcare organizations prevent and reduce HAIs. Founded on a legacy of electrostatic science and technology, the E-Mist Infection Control System and Process eliminates traditional disinfectant methods. The EM360 System is mobile, touchless, safer, cordless, and more cost-effective approach to environmental surface disinfection. E-Mist makes disinfection better, easier and more cost effective.

Disinfecting Athletic Facilities

According to the CDC, disinfecting athletic facilities is a critical step in preventing the spread of infectious and potentially deadly germs like MRSA.

At the professional level, the NFL.com reported, "Despite five surgeries to treat a serious staph infection, doctors may need to amputate the foot of New York Giants tight end Daniel Fells. The infection was caused by MRSA, a life-threatening antibiotic-resistant bacterial infection."

At the high school level, there are an increasing number of MRSA outbreaks occurring in locker rooms, gyms and on the field of play. For example, a study in the New England Journal of Medicine linked MRSA to abrasions caused by artificial turf. Three studies by the Texas State Department of Health found that the infection rate among football players was 16 times the national average. In 1974, MRSA infections accounted for 2% of the total number of staph infections, in 1995 it was 22%, and by 2004, it rose to 63%.

Training staff should ensure proper disinfection of equipment and surfaces.

Athletic facilities create a special risk for spreading infectious diseases such as Methicillin-resistant Staphylococcus aureus (MRSA) because of the potential for skin-to-skin and surface-to-skin contact among athletes.

Cleaning, Sanitizing, Disinfecting: The Differences

The U.S. Centers for Disease Control and Prevention (CDC) provides the following guidance on the difference between cleaning, sanitizing, and disinfecting:

Cleaning removes germs, dirt, and impurities from surfaces or objects. Cleaning works by using soap (or detergent) and water to physically remove germs from surfaces. This process does not necessarily kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.

Sanitizing lowers the number of germs on surfaces or objects to a safe level as judged by public health standards or requirements to lower the risk of spreading infection.

Disinfecting kills germs on surfaces or objects. Disinfecting works by using chemicals to kill germs on surfaces or objects. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.

Sanitizing and disinfecting require the use of EPA-registered pesticides or disinfecting/sanitizing water-based devices.

Shared equipment that comes into direct skin contact should be cleaned after each use and allowed to dry. Equipment, such as helmets and protective gear, should be cleaned according to the equipment manufacturers’ instructions to make sure the cleaner will not harm the item.

  • Athletic facilities such as locker rooms should always be kept clean whether or not MRSA infections have occurred among the athletes.
  • Review cleaning procedures and schedules with the janitorial/environmental service staff.
  • Cleaning procedures should focus on commonly touched surfaces and surfaces that come into direct contact with people's bare skin each day.
  • Cleaning with detergent-based cleaners or Environmental Protection Agency (EPA)-registered detergents/disinfectants will remove MRSA from surfaces.
  • Cleaners and disinfectants, including household chlorine bleach, can be irritating and exposure to these chemicals has been associated with health problems such as asthma and skin and eye irritation.
  • Take appropriate precautions described on the product's label instructions to reduce exposure. Wearing personal protective equipment such as gloves and eye protection may be indicated.
  • Follow the instruction labels on all cleaners and disinfectants, including household chlorine bleach, to make sure they are used safely and correctly.

Source: CDC Website

About E-Mist E-Mist is dedicated to infection prevention and control. The E-Mist Infection Control System and Process eliminates traditional disinfectant methods. The EM360 System is mobile, touchless, safer, cordless, and more cost-effective approach to environmental surface disinfection. E-Mist makes disinfection better, easier and more cost effective.

Electrostatic Technology for Surface Disinfection in Healthcare Facilities

Studies have shown that less than 50% of environmental surfaces in patient care rooms are properly cleaned and disinfected. Evidence strongly suggests that cross contamination of microorganisms from environmental surfaces is directly related to patient infections. High-touch surfaces such as bed rails, bed surfaces, tables, fluid poles, doorknobs, and supply carts have all been identified as having the greatest potential for transmission of pathogens. Current cleaning/disinfecting methods and procedures are critical to prevent the transmission of infectious diseases, yet, nearly 100,000 people will die this year directly attributable to HAIs. Electrostatically applied disinfectant may assist in the battle against preventable infections, improve patient experience, while increasing hospital revenues. Main Article:

One out of every 25 patients who are admitted to a hospital will contract a preventable healthcare-acquired infection (HAI). According to a 2002 study, approximately 1.7 million HAIs occur in U.S. acute care hospitals each year, resulting in 99,000 deaths at a total direct, indirect and non-medical social cost estimate of $96-147 billion per year.1,2 Study estimates did not include the more than 26,000 U.S. facilities such as ambulatory surgical centers, skilled nursing, long-term acute care, hospice, or dialysis centers. Obviously these HAI statistics are dated and may be vastly underestimated. In April 2016, the CDC approximated that the actual number of deaths from sepsis were as much as 140% higher than those recorded on death certificates, or as many as 381,000 deaths a year. Sepsis is just one subgroup of the infections.3 Healthcare-acquired infections continue to occur at alarming rates in U.S. hospitals and represent a significant cause of morbidity and mortality. HAIs have a devastating impact on people’s lives, the national economy, hospital reputations and financial sustainability.4

STUDIES HAVE INDICATED THAT INADEQUATE CLEANING AND DISINFECTING OF SURFACES IS WIDESPREAD

The physical environment is an important link in the chain of infection prevention and control. Contaminated environmental surfaces provide an important potential source for transmission of healthcare-associated pathogens.5 Cleaning and disinfecting of environmental surfaces in healthcare facilities is fundamental in healthcare facilities.6 The Centers for Disease Control and Prevention (CDC) Guidelines recommend that hospitals clean and disinfect all “high-touch surfaces.”7 High-touch surfaces include: bed rails, bed surfaces, supply carts, over-bed tables and intravenous pumps.8 Experts agree that monitoring terminal room cleaning and disinfecting practices in healthcare facilities is an important element of infection control programs.9 Still, studies have indicated that inadequate cleaning and disinfecting of surfaces is widespread with housekeeping wiping only 50% of surfaces targeted for cleaning.10,11,12

One way to break the chain of infection includes the use of innovative technology such as the application of EPA-registered disinfectants using electrostatic systems. As compared to traditional spray-and-wipe, fogging, and UV lighting, electrostatic disinfection application systems present a complementary and cost effective approach to healthcare facility environmental surface disinfection methods. Electrostatic spraying has been used in the agricultural and automobile industry for decades. In effect, a spray gun modified with an electrode charges the liquid particles, which are then guided to an oppositely charged target. Based on Coulomb’s law, an electrostatic disinfectant application system applies disinfectant more evenly to all surfaces. Coulomb’s law states that the magnitude of the electrostatic force of interaction between two point charges is directly proportional to the scalar multiplication of the square of the distance between them. The force is along the straight line joining them.13

Electrostatics is a proven technology in the agricultural and automotive industries. This technology is now being integrated into healthcare settings as a tool to break the chain of pathogen mobility.14 As an example, Creative Solutions in Healthcare owns and operates 46 skilled nursing and 13 assisted living facilities throughout the state of Texas. This top-50 ranked long-term care facility company uses electrostatic application technology in their efforts to prevent the transmission of dangerous pathogens. According to Gary Blake, President of Creative Solutions, this technology “has proven to be far more cost-effective than we ever dreamed possible. There’s a huge chemical cost savings, our employees are healthier – they’re staying at work, so our overtime is down in many markets during flu season. Our residents are returning home sooner from their rehab stays with us instead of going back into the hospital, and that’s gotten the attention of our managed-care insurance companies and even from Medicare.”

Most surface areas are neutral (uncharged) or negative. Electrostatic application for healthcare surface disinfection is a method of applying an EPA-registered disinfectant to a target surface area using electrostatic force of attraction. Using Coulomb’s law, these systems place a positive or negative charge on the chemical disinfectant as it leaves the spray nozzle.15,16 Because most surface areas are neutral or negative, a positively charged electrostatic spray application system optimizes adhesion and attraction (electromagnetic theory17). The dispersed droplets spread out more evenly and seek out the negative (-) or neutrally charged surface (neutral surfaces have the same number of protons as electrons – a neutral object can be polarized by a charged object and create attraction). The disinfectant is more targeted, provides more consistent coverage with less waste, and like two magnets, attracted to the oppositely charged surface with remarkable force.

PATHOGENS CAN SURVIVE ON SURFACES FOR MONTHS

Most common nosocomial pathogens can survive on surfaces for months18. These deadly bugs can become a continuous source of transmission. As such, regular, preventative surface disinfection is recommended. Wiping hard surfaces with contaminated cloths can contaminate hands, equipment, and other surfaces.19 Those involved in the prevention and control of infections require a balanced approach of cost and quality to improve outcomes. Existing healthcare disinfection methods including wipes, spray and wipe, fogging, and UV lighting all have their place in a multimodal IPC program, but may be ineffective or cost prohibitive for routine or comprehensive use. As environmental surface contamination and healthcare-acquired infections have become more defined, electrostatic disinfection application systems present a viable and cost effective tool in the environmental surface disinfection arsenal.

The battle against nosocomial pathogens is costly. This has become even more pronounced in light of the Hospital Value-Based Purchasing (VBP) Program. VBP rewards or penalizes hospitals based on degrees of care quality. Centers for Medicare & Medicaid Services (CMS) bases hospital performance on an approved set of measures and dimensions grouped into specific quality domains.20 For 2017, The CMS has created a new safety domain that primarily measures infection rates. Yet, most infection prevention and environmental surface teams continue to use antiquated or cost prohibitive disinfection methods including labor-intensive hand-wiping or UV lighting.

As presented, research studies have shown that environmental cleaning and disinfection play important roles in the prevention and control of healthcare-acquired infections. Though prevalent and widely used in other industries, electrostatic technology is now being adopted in the application of disinfectants. This new, innovative technology may assist in the battle against preventable infections, improve patient experience, while also increasing hospital revenues.

References:

  1. Klevens, Monina R., et al. (2002) Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals Center for Disease Control. Retrieved October 12, 2016, fromhttps://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf
  2. Marchetti, Albert. Rossiter, Richard. (2013) Economic burden of healthcare-associated infection in US acute care hospitals: societal perspective. Retrieved October 12, 2016 from http://www.tandfonline.com/doi/abs/10.3111/13696998.2013.842922?journalCode=ijme20&
  3. Epstein L, Dantes R, Magill S, Fiore A. (2016) Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes — United States, 1999–2014. MMWR Morb Mortal Wkly Rep 65:342–345.
  4. UMF Corporation. (2012) Doing Everything: Multimodal Intervention to Prevent Healthcare-Associated Infections. Retrieved October 12, 2016 fromhttp://perfectclean.com/pdf/WHITE_PAPER-MULTI-MODAL_INTERVENTION.pdf
  5. Donskey, C. J. (2013). Does improving surface cleaning and disinfection reduce health care-associated infections?. American journal of infection control, 41(5), S12-S19.
  6. Centers for Disease Control and Prevention. (2008) Guideline for Disinfection and Sterilization in Healthcare Facilities. Retrieved October 12, 2016 fromhttps://www.cdc.gov/hicpac/Disinfection_Sterilization/3_4surfaceDisinfection.html
  7. Centers for Disease Control and Prevention (CDC). (2003) Guidelines for Environmental Infection Control in Health Care Facilities, Centers for Disease Control and Prevention. Retrieved October 12, 2016 fromhttp://www.cdc.gov/hicpac/pdf/guidelines/eic_in_hcf_03.pdf
  8. Huslage, K., Rutala, W. A., & Weber, D. J. (2010). A quantitative approach to defining “high‐touch” surfaces in hospitals. Infection control and hospital epidemiology, 31(8), 850-853.
  9. Carling, P. C., Briggs, J. L., Perkins, J., & Highlander, D. (2006). Improved cleaning of patient rooms using a new targeting method. Clinical Infectious Diseases, 42(3), 385-388.
  10. Carling, P. C., Parry, M. M., Rupp, M. E., Po, J. L., Dick, B., & Von Beheren, S. (2008). Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infection Control & Hospital Epidemiology, 29(11), 1035-1041.
  11. Goodman, E. R., Piatt, R., Bass, R., Onderdonk, A. B., Yokoe, D. S., & Huang, S. S. (2008). Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infection Control & Hospital Epidemiology, 29(07), 593-599.
  12. Garrett, R. (2016) UV Light Disinfection And Other Alternative Methods. CleanLink. Retrieved October 12, 2016 from http://www.cleanlink.com/sm/article/UV-Light-Disinfection-And-Other-Alternative-Methods–19836
  13. Ida, Nathan, 2007, Engineering Electromagnetics, Springer, p. 126.
  14. E-Mist Innovations. (2016) Electrostatic Disinfection System. Retrieved October 12, 2016 from http://www.emist.com
  15. Bartlett, P.E. Goldhagen, and E.A. Phillips. (2016) Experimental Test of Coulomb’s Law. Oct. 12, 2016.https://www.princeton.edu/~romalis/PHYS312/Coulomb%20Ref/BartlettCoulomb.pdf
  16. Tang, K., & Smith, R. D. (2001). Physical/chemical separations in the break-up of highly charged droplets from electrosprays. Journal of the American Society for Mass Spectrometry, 12(3), 343-347.
  17. Maxwell, J.C., 1865, A dynamical theory of the electromagnetic field. Phil. Trans. R. Soc. Lond. 155, 459–512.
  18. Kramer, A., Schwebke, I., & Kampf, G. (2006). How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC infectious diseases, 6(1), 1.
  19. Hughes, R. (Ed.). (2008). Patient safety and quality: An evidence-based handbook for nurses (Vol. 3). Rockville MD: Agency for Healthcare Research and Quality. Chapter 41, Preventing Health Care-Associated Infections.
  20. Department of Health and Human Services. (2015) Hospital Value-Based Purchasing. Centers for Medicare & Medicaid Services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf

Copyright © 2016 InfectionControl.Tips. All rights reserved. Used with permission. For more information, visit InfectionControl.tips


Author: Joshua T. Robertson, President, E-Mist Innovations, Inc. Joshua is an entrepreneurial leader, experienced in growing organizations solving big issues within the healthcare space. Prior to joining E-Mist, Joshua launched National HME (NHME) in 2006. NHME partnered with over 500 hospice programs, served 500,000+ patients and created close to 500 jobs throughout the U.S. during his tenure at the company. In 2015, the company recapitalized and yielded a high rate of return for shareholders. Joshua also founded GrowCo Capital in 2014 that invests resources into entrepreneurial businesses and real estate projects throughout the United States. Joshua graduated from Texas Tech University receiving an Executive MBA and a double major in honors management and marketing. He is actively involved in GrowCo Capital, Project 4031, and founding President for the Rawls Raiders Alumni Network (Texas Tech Business School).

About E-Mist E-Mist helps healthcare organizations prevent and reduce HAIs. Founded on a legacy of electrostatic science and technology, the E-Mist Infection Control System and Process eliminates traditional disinfectant methods. The EM360 System is mobile, touchless, safer, cordless, and more cost-effective approach to environmental surface disinfection. E-Mist makes disinfection better, easier and more cost effective.

MRSA & Antibiotic Resistance: We’re on a collision course

By Rodney E. Rohde, PhD Abstract:

On any given day, approximately 1 in 25 inpatients in U.S. acute care hospitals has at least one healthcare–associated infection (HAI), adding up to about 722,000 infections in 2011. Pneumonia and surgical-site infection are the most common infection types, and Clostridium difficile is the most common pathogen. Practically, what this means is that over 200 patients will die the day you read this article and every day after that until the global community is able to address this healthcare crisis. If you do the simple math, you will realize that about 4% of hospitalized patients developed one or more HAIs due to the care received in the hospital, resulting in approximately 75,000 deaths. Imagine a jet airliner going down every day in this country and the American public accepting it without much notice. In reality, that is what is happening with HAIs. More Americans die every year from MRSA than from HIV/AIDS and H1N1 combined.

Main Article:

When I answered the phone at home one evening in late December 2007 and heard the voice of a worried woman, the genesis of an idea for my future research path began to take shape. She was concerned about her husband, she said. The retired couple from Utah had traveled over the holidays and the husband, a cancer patient, developed sores on his torso. They went to the emergency room, where a doctor diagnosed a staph infection and prescribed antibiotics. No laboratory tests were done. The man’s condition worsened, so when the couple returned home he went to his family doctor. After an examination and some laboratory tests, the doctor determined that the man had MRSA — methicillin-resistant Staphylococcus aureus — an infection that cannot be treated with most typical antibiotics.

MRSA became one of my primary areas of expertise after I became an assistant professor in Texas State’s Clinical Laboratory Science Program within the College of Health Professions back in 2002. I have since conducted numerous prevalence and incidence studies on MRSA in a variety of environments, including prisons, dormitories, recreation centers, physical therapy educational settings, and most recently in homes,1 as well as on nursing students and animals. In a sense, I am the classic clinical microbiologist and research scientist interested in documenting and discovering information about this dangerous microbe. However, it wasn’t until I started work on my PhD in 2006 that I revisited that “genesis of an idea” while receiving numerous “cold calls” and emails from concerned individuals who had been diagnosed with MRSA or had loved ones dealing with this deadly infection.

I remember it like yesterday – such a vivid reminder of the confusion, concern, and plight of these individuals dealing with such a difficult healthcare problem. The wife of the patient from Utah had some basic knowledge about MRSA from newspapers and other media coverage and she was very concerned about what had happened to her husband at the emergency room given his immunocompromised state because of the cancer. She just wanted to know why this had happened and whether she or anyone else they had been in contact with should be concerned about transmission.

IT IS VERY IMPORTANT TO HAVE A CULTURE DONE

I spent more than an hour on the phone explaining to her the difference between “regularStaph” and MRSA. I told her that it is very important to have a culture done so that a proper diagnosis and identification of MRSA can be made2. I also let her know that if the infection worsens, the patient might have to be admitted to a hospital and given strong antibiotics intravenously. I emphasized that it is always important to ask for a culture and antibiotic susceptibility test if her husband were to get another infection.

The man improved after being correctly diagnosed by his family physician. He received a combination of two powerful drugs and eventually recovered from the infection. To this day, that phone call remains a pivotal moment in my career. I realized that I needed to begin the process of understanding this disease from the perspective of those who had experienced it. I needed to begin delving deeper into the learning experiences of people who had lived through a MRSA infection in order to improve the practical management and outcomes of this disease. Simply put, I was becoming a more hybrid, translational researcher and it has become one of my primary passions.

“…SOMETIMES YOU DON’T EVEN KNOW WHICH QUESTIONS TO ASK….”

Often acquired in healthcare facilities or during healthcare procedures, the extremely high incidence of MRSA infections and the dangerously low levels of literacy regarding antibiotic resistance in the general public are on a collision course3. Traditional medical approaches to infection control and the conventional attitude healthcare practitioners adopt toward public education are no longer adequate to avoid this collision. In many cases, the patient simply does not know what to even ask of their healthcare providers. I documented this time and again through patient interviews. We must all learn to take an active role to be an advocate for patients who do not understand what antibiotic resistance means to their health – whether it’s in the healthcare facility or at home in the community. MRSA and other resistant organisms are not only in healthcare. Community facilities and locations can be major reservoirs of resistant organisms like MRSA. Recently, I and colleagues completed a study that documented prevalence rates of Staphylococcus aureus (15%) and MRSA (2%) in a physical therapy multi-use educational room.4 The lines have blurred between healthcare and community-associated MRSA. Education, for both healthcare providers and the general public, has become critical. Health literacy regarding antibiotic resistance, HAIs such as MRSA, and one’s responsibility in this perfect storm must be a priority for global public health.

For several decades now, the high incidence of HAI and the dangerously low levels of literacy regarding antibiotic resistance in the general public have been on a collision course. The “Perfect Storm” has arrived and is painfully evident in the numbers of illnesses and deaths due to HAI. Moreover, the general public seems to be more worried about headline diseases such as Ebola and Zika than the one right under their noses (or their hospital bed). While global outbreaks such as Zika are worthy of our most heroic public health efforts, in reality more United States citizens will die this year and every year from HAI – a preventable infection!5,6

Progress is being made per CDC’s National and State Healthcare-associated Infection Progress Report such as these reported findings:

  • A 46 percent decrease in central line associated blood stream infection (CLABSI) between 2008 and 2013.7-9
  • A 19 percent decrease in surgical site infections (SSIs) related to the 10 select procedures tracked in the report between 2008 and 2013.7-9
  • A six percent increase in catheter associated urinary tract infections (CAUTI) between 2009 and 2013; although initial data from 2014 seem to indicate that these infections have started to decrease.7-9
  • An eight percent decrease in hospital-onset MRSA bacteremia between 2011 and 2013.7-9
  • A 10 percent decrease in hospital-onset difficile infections between 2011 and 2013.10

The ultimate goal, however, is zero preventable HAIs. It will take a multi-modal approach on multiple fronts of the battlefield.10-11 We are still experiencing thousands of needless deaths each year. It’s time for all of us – global healthcare professionals of all walks of life, private and public government agencies, professional organizations, and the general public – to join hands and confront this war head on! If we do not, the consequences will be tragic and potentially unwind all of the past public health advances that our parents, grandparents and great-grandparents enjoyed.

WE MUST ALL STRIVE TO DO BETTER

On this day – World MRSA Day – this editorial is aimed to inform laboratory professionals, business thought leaders, medical/health educators, healthcare professionals, healthcare facilities experts, EVS professionals, government agencies, professional organizations, philanthropists, and the clinical diagnostics field at large about MRSA awareness. We must all strive to do better regarding past, current and future paradigms for HAI detection, management and national and state strategies for reduction of these deadly infections.

Finally, medical laboratory professionals play an integral role in the healthcare system by providing diagnostic services that not only directly impact therapeutic management of patients, but also by offering their expertise in interpretation of the results in the mounting numbers and types of HAI identification. Further, medical laboratory professionals must inform physicians and others in the sometimes difficult and cloudy interpretation of antibiotic susceptibility assays and menus of tests available to physicians. In that light we should all have a basic grasp of the basis and rationale for interpreting HAI testing, and generally appreciate the downstream effects of reporting a result. Lastly, educators must become leaders in preparing clinically competent laboratory professionals, and other healthcare professionals, by providing them with opportunities to expand their training and understanding of antibiotic-resistant microorganisms in general, and HAI in particular.

We can and must be better. If not, we all fail. We fail ourselves. We fail each other. And, we especially fail those patients who need our voice and advocacy – even those who don’t know what questions to ask!

References:

  1. Felkner M, Rohde R, Valle-Rivera AM, Baldwin T, Newsome LP. Methicillin-Resistant Staphylococcus aureus Nasal Carriage Rate in Texas County Jail Inmates. J. Corr HealthCare. 2007. 13(4), 289-295.
  2. Rohde, RE. Two Laboratory Tests you Must Demand: Advice from MRSA Survivors and a Scientist, InfectionControl.tips 2016. 1(1-4)
  3. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of healthcare–associated infections. N Engl J Med 2014; 370:1198-1208.
  4. Rohde, R.E. Denham, R., & Brannon, A. Methicillin Resistant Staphylococcus aureus: Nasal Carriage Rate and Characterization in a Texas University Setting. Clinical Laboratory Science, 2009. 22(3): 176-184.
  5. Klevens RM, Morrian MA, Nadle J. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298:1, 763-771.
  6. Bancroft EA. Editorial: Antimicrobial resistance — It’s not just for hospitals. JAMA 2007; 298:1, 803-804
  7. Rohde RE. A Secret Weapon for Preventing HAI: A scientist’s message to hospitals trying to rid themselves of healthcare-associated infections. Elsevier Connect, July 15, 2014. Available from http://www.elsevier.com/connect/a-secret-weapon-for-preventing-HAI Accessed 9/2/2016.
  8. Rohde RE. Healthcare Facilities Today – published written interview, Scholar bringing EVS role in infection prevention to the forefront. Q2, April 2015: pp. 11-13. Available from http://www.healthcarefacilitiestoday.com/posts/Scholar-bringing-ES-role-in-infection-prevention-to-the-forefront–9115 Accessed 9/2/2016.
  9. Rohde, RE, Felkner M, Regan J, et al. Healthcare-Associated Infections (HAI): The Perfect Storm has Arrived! R.E. Rohde – Invited Focus Series. Clin Lab Sci Winter 2016;29(1):28-31.
  10. Dhagat PV, Gibbs KA, & Rohde RE. Prevalence of Staphylococcus, including Methicillin Resistant Staphylococcus aureus (MRSA), in a Physical Therapy Educational Facility. Journal of Allied Health 12/2015; 44(4):215-218.
  11. Centers for Disease Control and Prevention. (2012) Healthcare-associated Infections (HAI) Progress Report. Available from http://www.cdc.gov/hai/progress-report/index.html Accessed 9/2/2016.

Copyright © 2016 InfectionControl.Tips. All rights reserved. Used with permission. For more information, visit InfectionControl.tips

About Dr. Rohde Dr. Rodney E. Rohde is Professor, Research Dean and Chair of the Clinical Laboratory Science Program (CLS) in the College of Health Professions of Texas State University.

About E-Mist E-Mist helps healthcare organizations prevent and reduce HAIs. Founded on a legacy of electrostatic science and technology, the E-Mist Infection Control System and Process eliminates traditional disinfectant methods. The EM360 System is mobile, touchless, safer, cordless, and more cost-effective approach to environmental surface disinfection. E-Mist makes disinfection better, easier and more cost effective.

Superbug may be spreading to people through contaminated poultry

Story Source: George Washington University A new study offers compelling evidence that a novel form of the dangerous superbug Methicillin-Resistant Staphylococcus aureus (MRSA) can spread to humans through consumption or handling of contaminated poultry. The research, published online today in the journal Clinical Infectious Diseases, shows that poultry may be a source of human exposure to MRSA, a superbug which can cause serious infections and even death.

The study focuses on a special newly identified strain of MRSA associated with poultry. MRSA is often found in chickens, pigs and other food animals. Researchers know that farmers, farm workers, veterinarians and others working directly with livestock are at risk of MRSA infections. However, this new study, by an international team of researchers headed by Robert Skov, MD, at Statens Serum Institut and Lance Price, PhD at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University, shows that people with no exposure to livestock are becoming colonized and infected with this new strain of poultry-associated MRSA — most likely by eating or handling contaminated poultry meat.

“We’ve known for several years that people working directly with livestock are at increased risk for MRSA infections, but this is one of the first studies providing compelling evidence that everyday consumers are also potentially at risk,” says Lance Price, PhD, Director of the Antibiotic Resistance Action Center, which is based at Milken Institute SPH, and Director of Translational Genomics Research Institute Center for Food Microbiology and Environmental Health.

“This poultry-associated MRSA may be more capable of transmitting from food to people. As MRSA continues to evolve, it may spread from animals to people in new ways,” adds Jesper Larsen, PhD, a scientist and veterinarian at the Statens Serum Institut (Denmark’s equivalent to the U.S. Centers for Disease Control and Prevention), and lead author of the paper.

The researchers reviewed the national database at Statens Serum Institut and found 10 people living in urban areas of Denmark that had been colonized or hospitalized with MRSA. Skov, Price and their colleagues then used a type of sophisticated genetic analysis to study the MRSA from those cases and compare it to strains found in people, livestock and food products from other European countries.

The researchers found:

  • Ten Danes living in cities were colonized or infected with a novel strain of poultry-associated MRSA, a type of livestock-associated MRSA never identified before. None of the 10 people had worked on farms or had direct exposure to food animals.
  • The strain of poultry-associated MRSA identified in the study was not found in Danish livestock but could be traced to poultry meat imported from other European Union countries.
  • Isolates of the new strain found in the urban-dwelling Danes were virtually identical to each other, a finding that suggests they were all exposed from a common source — most likely contaminated poultry meat.

“Our findings implicate poultry meat as a source for these infections,” says Skov. “At present, meat products represent only a minor transmission route for MRSA to humans, but our findings nevertheless underscore the importance of reducing the use of antibiotics in food-producing animals as well as continuing surveillance of the animal-food-human interface.”

Other research suggests that modern farming practices, which often involve giving food animals low doses of antibiotics to spur their growth and compensate for overcrowding and unsanitary living conditions, has led to the rising tide of superbugs, like the new strain of MRSA identified in this study. In addition, food inspectors don’t typically test poultry and other food products for MRSA contamination and instead are focused on Salmonella and other more typical food-borne pathogens.

“We need to expand the number of pathogens that we test for in our food supply, and we need international leadership to reduce unnecessary use of antibiotics on industrial farms around the world,” Price says. “This isn't a problem unique to the EU or Denmark. Superbugs don’t respect political or geographical boundaries, so we have to work together to address this public health threat. I’m not sure that our international trade agreements are prepared to handle the specter of superbugs in meat.”

Skov adds: “I fear that if we don’t get antibiotic use in livestock under control, then new, more virulent strains of livestock-associated MRSA will emerge that pose a much greater threat to human health than what we are currently facing.”

The multi-center study, Evidence for human adaptation and Foodborne Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus, published today in the journal Clinical Infectious Diseases, was an international collaboration involving 25 institutions and led by researchers at the Milken Institute SPH, the Statens Serum Institute in Copenhagen, Denmark and the Translational Genomics Research Institute in Flagstaff, AZ.

Funding for this study was provided by the National Institute of Allergy and Infectious Diseases, National Institutes of Health.


Story Source: George Washington University. "Superbug MRSA may be spreading through contaminated poultry." ScienceDaily. ScienceDaily, 21 September 2016. <www.sciencedaily.com/releases/2016/09/160921085050.htm>

Infection Prevention: Touchscreens are contaminated

Touchscreens: The Mosquito of the Digital AgeBy Thomas Rolfe, Michael Nitti

Abstract The widespread and rapidly growing automation and digitization of our world has led to the installation of billions of touchscreens, both in our personal possession and in public use, such as at hospitals, airports, schools, restaurants, public transit, banks and government offices.

Warm touchscreens contacted by many people, or by individuals who themselves are in contact with potentially infected surfaces, are ideal hosts and transmitters of infectious disease. The touchscreen could be considered the mosquito of the digital age. In addition to being vectors of infectious disease, these tools are expensive devices and vulnerable to damage from cleaning protocols, vandalism and impact.

The use of an antimicrobial protective screen could be the simple, inexpensive solution to the problems faced by touchscreen users.

Main Article Touchscreens are everywhere: on your phone, tablet and car dashboard; and at the bank, the movie theatre, the airport and your hospital room. The pervasive use of smartphones, tablets and other touchscreen devices, both in healthcare settings and the general public, presents at least three issues:

1. Disease transmission Touchscreens are ideal media for pathogens of all kinds to flourish on, due to their regular contamination by unclean human hands and body fluids and their warm operating temperature. Bacteria thrive at 35˚C. Touchscreens in hospitals are well-known potential sources of infection (Shakir, 2015).

A significant infectious disease problem in healthcare today is nosocomial infection, an infection that originates in hospitals. An increasingly prevalent infectious disease problem is arising in schools, restaurants and elsewhere, due to the increasingly diverse sources of pathogens outside of healthcare settings and the increasing public use of touchscreens.

The infectious disease problem is better documented in the healthcare sector than in public areas.  Scientific reports have found that patients admitted to rooms that were previously occupied by patients infected with common multidrug resistant organisms (MDROs) have been found to be at a 1.5 to 2.5 times increased risk for developing the same infection (Stibich, 2016). Since there is no direct contact between the two patients, this risk of infection is almost exclusively associated with the environment. If not properly disinfected, these MDROs can linger on high touch surfaces for weeks to months, serving as a continued transmission risk for many future patients (Otter, 2013).

Studies conducted to determine contamination levels on smartphones have concluded that a smartphone is highly contaminated with the same microbes that are found on the hands of the user (Beckstrom, 2013).

CELL PHONES ARE EXCELLENT TRANSMITTERS OF INFECTIOUS DISEASE

Several studies have concluded that cell phones are excellent transmitters of infectious disease between individuals commuting between hospital wards, and the community at large (Tatem, 2011). Evidence from the healthcare environment suggests that all touchscreens in public use should be considered potential hotspots for the transmission of infectious diseases. A 2013 project at the University of Surrey tested a large sampling of smartphones and found fecal coliforms, Streptococcus, Staphylococcus aureus and much more (Ulgar, 2009).

2. Challenges of cleaning Healthcare environments have implemented aggressive cleaning protocols for high-touch surfaces (Weber, 2005), with the unfortunate side effect of damage to screens from the harsh chemicals. Alcohol, ammonia and bleach can ‘etch’ the surface of a screen and make it appear cloudy. Residue from cleaning products can crystallize and, when touched or rubbed, scratch the touchscreen surface. In non-healthcare settings, fear of damaging the screens means they are rarely cleaned with the vigor needed to remove pathogens.

3. Implications of impact Hospital environments are unusually rough on equipment and operating room monitors due to the frequent movement of equipment and the nature of an emergency environment. As a result, many touchscreen devices are physically damaged or destroyed unnecessarily because they have minimal impact resistance. Likewise, touchscreens in public spaces are subject to vandalism and abuse that could damage the screen.

Replacing or repairing touchscreens from damage is expensive, ranging from $100 for a smartphone to thousands of dollars for specialized equipment found in hospitals, airports, schools, restaurants, public transit, banks and government.

Although some newer smartphone screens incorporate an improved level of impact resistance, the bane of smartphone owners has been broken touchscreens. This has driven a massive business for aftermarket screen protectors, which to some degree protect the owner’s significant investment in their smartphone.

Protective Films Provide a Solution Today, hospitals are facing several threats that are driving their search for touchscreen protectors, which incorporate high quality, long lasting antimicrobial properties, impact resistance, privacy features and resistance to strong chemical sanitization protocols. (University of Surrey, 2013)

The ideal feature-set for such a multi-layered product would be:

  • broadly acceptable antimicrobial technology
  • maintenance of near 100% capacitance for continued functioning of touchscreens
  • proven impact resistance
  • availability of a privacy layer, and
  • resistance to chemical damage

Spyder Digital Research Inc. (SDR) offers a patented antimicrobial screen protector that meets all of these criteria and is FDA listed, EPA registered and REACH compliant. Available in any size, from smartphones to 60″ display screens, the protectors have a multi-year guarantee.

The active ingredient of the antimicrobial additives in the SDR solution is silver, a metal known to have antimicrobial properties (Fong, 2006).  Chemists are able to create glass with a low chemical inertness while still retaining antimicrobial metal ions, such as silver. With the presence of water or moisture, the glass will release these metal ions gradually to function as antimicrobial material.

Silver ions are able to bond strongly to the cellular enzymes of microbes and inhibit enzyme activity of the cell wall, membrane, and nucleic acids. Silver, with its positive charge attracts the negatively-charged microbes, thus disturbing their electric balance. The result is that the microbes burst their cell walls and are extinguished. Otherwise, silver ions are taken into the microbes, where they react and bond to the cellular enzyme microbes, thus inhibiting enzyme activity and multiplication of microbes. (Borrelli, 2015).

Conclusion Regulators, health care professionals and corporate leaders are just beginning to recognize the increased threat of infectious disease epidemics facilitated by touchscreens, both from a liability perspective and from a social responsibility perspective.  An opportunity exists now to prevent widespread illness and death from infectious disease contracted in public places.

Hospitals currently employ increasingly aggressive sanitizing protocols because of well-defined threats and substantial liabilities (Weber, 2005). In addition to touchscreens being an ideal environment for the spread of infectious diseases, they are also expensive devices that would benefit from protection from damage due to cleaning protocols or impact.

Promoting prophylactic measures for both healthcare and public use touchscreens is a simple, yet effective solution for a problem that promises to grow as touchscreens become used more and more extensively in our everyday lives.


Copyright © 2016 InfectionControl.Tips. All rights reserved. Used with permission. For more information, visit InfectionControl.tips

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