5 Ways to Protect Yourself from MRSA

Protect yourself at all times

As we discussed last week, Canada’s Chief Public Health Officer recently reported a 1,000% rise in Healthcare-Associated MRSA in Canada. And earlier in the year, researchers at Toronto’s Sunnybrook Hospital told us that 1 in 12 adults in Canadian hospitals are either colonized or infected with MRSA, VRE (vancomycin-resistant enterococci) , or C. difficile (Clostridium difficile) . MRSA was the major offender because 67% of the patients who tested positive were positive for it.

Infectious disease experts agree that the single most important thing healthcare workers can do to prevent the transmission of MRSA and other pathogens is to wash their hands before and after seeing patients. The problem, however, as we reported last month, is that healthcare workers aren’t doing that, with doctors being the biggest offenders with compliance somewhere between 0 and 50%.

So if healthcare workers won’t do what they should, then it falls on the patient to do what they can to protect themselves. A number of experts recently offered the following suggestions:

1. Know What to Look For

In general, fevers, if they’re accompanied by shaking chills, if they’re getting worse instead of better, that would suggest there’s a bacterial process. With community-acquired MRSA, many people first notice a skin infection or boil that becomes larger and more painful. But if you do suspect such an infection, don’t rush to the emergency room, where you might be exposed to other bugs or infect others. Call your primary-care doctor first for advice.

2. Get a Flu Shot

When people get influenza, they actually become at higher risk as they recover for complicating bacterial infections. This is because people with weakened immune systems are more vulnerable to other bugs.

3. Ask Whether You Need that Antibiotic

Don’t assume you need one — antibiotics don’t work on viral infections like colds or the flu. If your doctor does recommend one, ask whether you really need it. Using antibiotics does kill off non-resistant bacteria in your body and makes you likely to acquire antibiotic-resistant bacteria – like MRSA – in their place.

4. Ask Your Doctors to Wash Their Hands

It is every patient’s right to have every health-care provider entering the room to have clean hands.   They’re supposed to do it, they are mandated for 100 percent hand- hygiene compliance, but the reality is it doesn’t happen. And that’s where the burden falls on the patient to make sure they do.

5. Advocate for Loved Ones in the Hospital

One of the ways drug-resistant bacteria spreads in hospital is through tubes inserted in the body, such as catheters. If someone you care about is on such a device, don’t be afraid to ask doctors whether they still need it, and when the tubes can come out. Every day that decision needs to be made: Do these things need to stay in or do they need to come out?  The key, is empowering patients or their advocates to stand up for their health-care needs.

HOTEL MRSA

About two weeks ago CBC’s current affairs program Marketplace aired The Dirt on Hotelswhere it investigated the prevalence of germs in six of Canada’s largest hotel chains. They went on a bacteria hunt and discovered not just bacteria, but the more troublesome antibiotic resistant bacteria, in every hotel chain they went to. MRSA, in particular, was found growing on a faucet in Toronto’s upscale Royal York Hotel, and on telephones, counter-tops, and bed comforters in the other hotels.

Erica Johnson, the CBC reporter who investigated this, says she has  resorted to self-help when she travels. She brings alcohol wipes with her and uses them on hotel room surfaces where her investigation revealed superbugs are most commonly found: on door handles, light switches, taps, the phone, clock radio, and the toilet seat. She puts a towel down for her toiletries, brings her own cup instead of using a hotel glass, and for the biggest offender – the tv remote, she puts it in a plastic bag and uses it that way!

What this investigation uncovered is but one example of what the US Centers for Disease Control and Prevention just published in their report Antibiotic Resistant Threats in the United States, 2013.  This first-ever assessment of the threat the country faces from antibiotic-resistant organisms contained the following warnings about MRSA’s impact on human health:

  1. Of the 23,000 people who die each year as a direct result of antibiotic resistant infections, MRSA is responsible for almost half of the deaths (11,285  = 49% ).
  2. The CDC rates the threat level posed to us by MRSA as “serious.” They conclude “This bacteria is a serious concern and requires prompt and sustained action to ensure the problem does not grow.”
  3. During the past decade, rates of MRSA infections have increased rapidly among the general population.
  4. While antibiotic-resistant infections can happen anywhere, most deaths related to antibiotic resistance happen in healthcare settings such as hospitals and nursing homes.
  5. Staph bacteria, including MRSA, are one of the most common causes of healthcare-associated infections.

The CDC emphasized that their numbers of infection and death are purposefully conservative. So for example, by way of contrast, the Journal of the American Medical Association reported in 2007 that 18,650 deaths each year in the US are associated with 94,360 invasive MRSA infections.

This is why, for example, the American Academy of Orthopedic Surgeons describe  MRSA as a “silent epidemic.”

How does Photodisinfection Work?

Photodisinfection is a topical, non-antibiotic antimicrobial therapy that destroys a broad spectrum of pathogens including fungi, bacteria and virus without damaging human tissue. Unlike antibiotics, Photodisinfection selectively kills virulence factors such as the endotoxins and exotoxins produced by pathogens, leading to a clinically observable anti-inflammatory effect. The treatment process takes only minutes, making it over 1,000 times more effective at biofilm killing than antibiotics.

Photodisinfection is a minimally invasive non-thermal therapy involving the light activation of a photosensitizer to eliminate topical infections in a highly targeted approach. Photodisinfection has been proven to be safe and effective in other applications such as for the dental, sinusitis and hospital acquired infection prevention markets. In dentistry, Photodisinfection has been proven to be highly effective for the treatment of caries, endodontics, restorative dentistry, periodontitis, peri-implantitis and halitosis. Many new applications of Photodisinfection are now under development.

The Photodisinfection Process: Instant Antimicrobial Therapy

Apply Photosensitizer to Infection Site & Illuminate with Appropriate Wavelength for Several Minutes

A photosensitizing solution is applied to the treatment site where the photosensitizer molecules preferentially bind to the targeted microbes.  The photosensitizer molecules are inactive at this stage.  A light of a specific wavelength and intensity illuminates the treatment site and a photocatalytic reaction occurs.  The wavelength is carefully chosen to maximize absorption of light energy by the photosensitizer.

This 2 step procedure results in the destruction of the targeted microbes and their virulence factors without damaging host cells.  This reaction involves the formation of short-lived, highly reactive free-radical oxygen species.  These radicals cause a physical disruption of the microbial cell membrane through oxidative reactions, resulting in immediate rupture and destruction of the cell.  This process occurs in seconds with total kills completed in minutes.

The Photodisinfection process has also been shown to eliminate a multitude of virulence factors, unlike antibiotics. When the light isremoved, the photocatalytic reaction ceases along with all antimicrobial action. Photodisinfection does not promote the development of resistance.

The Photodisinfection process is both pain-free and stress-free due to lack of side-effects or damage to human tissue.

Source: Eastman Dental Institute, UK

Soap vs. Hand sanitizer: Which is Better?

The Centre for Disease Control and Prevention’s (CDC) position is that hand sanitizer is a good alternative when soap and running water is not available. This implies a preference for good old fashioned hand washing. The CDC also states that hand sanitizers are not as effective when hands are visibly dirty and that do not they kill all germs.

If soap, followed by intense abrasion/scrubbing, is better than hand sanitizer use, the next question is what kind of soap is better, bars or liquid soap? It seems like it may be liquid soap but the jury is still out. Bar soap has been found to harbour some microorganisms but these organisms are not transferred from the bar to our skin’s surface. That is good to know, because don’t we all avoid someone else’s used bar of soap?

As a medical student, we had a whole class on the importance of hand washing and how to do a better job of it. I am not lying. At first, it seemed a waste of time, but before long, we all came to understand why this topic warranted an entire class. Hand washing is one of the easiest infection prevention procedures. It is simple to do but despite all of the well-known benefits to hand washing for the prevention of infection, the noncompliance rate is still too high in hospital settings and contributes, in turn, to the current levels of Hospital Acquired Infections. Common infections are transferred from person to person by hand-to-hand contact or via fomites which are inanimate objects on which bacteria or other microorganisms can survive. The trick to adequate hand washing is time and effort in scrubbing. I was taught to wash my hands for 20 seconds, the amount of time to sing “Happy Birthday” twice.

So from an infection control perspective, soap (either bar or liquid) and water is the way to go. Remember, you can help stop the spread of infection by simply doing a good job of washing your hands. So scrub away with either bar or gel soap and you can do your part in infection control!

1) http://www.cdc.gov/handwashing/
2) http://www.ncbi.nlm.nih.gov/pubmed/3402545

Nelson Mandela- In Critical Condition Suffering from Lung Infection

Our heart goes out to the family of Nelson Mandela and to the people of South Africa.  While prayers and well wishes flood in from around the world, we would like to add our own in the hopes that good intentions and earnest positive thoughts can make a difference to this special man in such critical condition.

http://bclc.uschamber.com/sites/default/files/Nelson_Mandela,_2000_(5).jpg

At a time like this, we are reminded that Nelson Mandela was an inspirational leader and remains a true international treasure.  His guiding principals were way ahead of his time.  I cannot of think of the Mandela legacy without immediately thinking of the backdrop of the severe human rights abuses currently raging in the Middle East and around the world. The world needs more Mandela’s, not one less. I will pray hard tonight.

Ondine CEO to Represent Photodisinfection at the World Congress of the IPA in Seoul, Korea

The World Congress of the International Photodynamic Association (IPA) is a biannual conference highlighting the advances in scientific and clinical research around the world. This year’s Congress is being held May 28th to May 31st, 2013 at the Ritz-Carlton Hotel, Seoul, Republic of Korea.  All of the leaders in the field of PDT and their work will be represented during this event. Clinicians, scientists, researchers, hospital administrators, and students are welcome to participate at this year’s conference. Registration details are available here.

About the International Photodynamic Association

The IPA was founded in 1986 and its membership consists of the most prominent international clinicians and scientists involved in performing and researching photodynamic therapy (PDT) and photodiagnosis (PD). The purpose of the IPA is to promote the study of diagnosis and treatment using light and photosensitisers, to disseminate such information to the members of the IPA, the medical community and to the general public.

The IPA organizes an International Congress every two years which is a unique opportunity to sum up research activities in the clinical and basic research aspects of PDT. The IPA Secretary General is Dr Alison Curnow, Peninsula Medical School. Inquiries, comments and contributions can be sent to ipa@pms.ac.uk. To become a member, visit our webpage here to register.

Ondine Biomedical CEO Carolyn Cross has been selected to be a Plenary Speaker at this conference. She has been noted for translating research from the labs into usable products for patients. There are twelve Plenary Speakers representing countries and research facilities from across the world, Carolyn being one of the two Canadian plenary speakers. We look forward to hearing what she and the other speakers have to say about the latest advances in photodynamics!

Ventilator Acquired Pneumonia: A Large Problem for Hospitals

Although hospitals are centers of refuge for those who need care, an unfortunate reality is that the number of people coming in and leaving these facilities inevitably results with the spread of disease and infections between patients, doctors, and other health care workers. These unintentionally transmitted diseases, born in hospital settings, are collectively known as Hospital Acquired Infections (nosocomial infections in medical literature). This class of disease results in over  99,000 deaths each year in the United States alone.

One significant form of nosocomial infection is Ventilator Acquired Pneumonia (VAP) which, as the name suggests, is pneumonia (an inflammatory condition of the lung) transmitted to patients while they are on mechanical ventilator breathing support. The incidence of this disease is between 8% and 20%, and mortality rates are between 20% and 50%. As a result, VAP has a critical impact on morbidity, length of stay, and cost of ICU care.

A significant contributor to such high rates of incidence and morbidity is the fact that patients on mechanical ventilation systems are often sedated and are rarely able to communicate or cough up the biofilm that grows in the tubes and drains down into the lungs. Typical symptoms of pneumonia may be absent or unobservable, leading to delays in detection and therefore treatment.  Under these conditions, the medical signs that a patient has acquired pneumonia are increased number of white blood cells on blood testing and new shadows (infiltrates) on chest x-rays. Other important signs are fever, low body temperature, purulent sputum, and hypoxemia (decreasing amount of oxygen in the blood).

If any of these symptoms are suspected by care takers, two conventional methods of diagnosis are deployed. The first is to collect cultures from the trachea while also scanning the chest with an x-ray to detect new or enlarging infiltrates. The other method is more invasive and involves a bronchoalveolar (where fluid is squired out small areas of the lung and recollected for examination), as well as a chest x ray.

Treatment regimens depend on the specific bacteria causing the inflammation, although a widely used first step is the prescription of empiric therapy (broad spectrum antibiotics) until the particular bacterium and its sensitivities are determined. Once the specific microorganisms implicated in generating pneumonia are known, more antibiotics are prescribed. The use of antibiotics raises the issue of resistance from the bacteria, and the related decrease of efficacy of the antibiotic in the years to come.

Photodisinfection is a non antibiotic approach under development by the research and development teams at Ondine Biomedical Inc., for the decolonization of the tubes of long term intubated patients. Pre-clinical studies have demonstrated proven effects of Photodisinfection directed toward the inner surface of the endotracheal tubes. The Exelume™ Photodisinfection system is currently being tested in NIH funded clinical trials in the US. Other Photodisinfection applications under development by Ondine include:  periodontitis, chronic sinusitis, burns & wounds, UTI, vertical transmission of HIV, nasal decolonization to reduce SSI, GI infection protection, etc.

Harming our Good Bacteria may be Harming Us in the Long Run

By the time we are 18, we have received 10-20 courses of antibiotics. This antibiotic usage has enabled us to live longer and healthier lives, by overcoming bouts of infections. But there are, of course, drawbacks to this antibiotic consumption. The most obvious and most worrying of these drawbacks, is the development of drug resistant bacteria (superbugs) such as MRSA. However, antibiotics also kill the normal microflora, the ‘good bacteria’ that we need to maintain good overall health. The long term implications of repetitive disruption of our microflora by antibiotics, unfortunately, are not understood and not being adequately investigated.

When in the right concentrations and when the body’s natural immune system is healthy, bacteria are an important part of us. In fact, there are 10 times more bacteria cells in us than there are human cells.5 Human cells and bacteria have developed a symbiotic relationship over time. In order to answer the question of whether harming the good bacteria is harmful to us in the long run, we need to understand more about bacteria.  So how are bacteria beneficial to us?

Firstly, in our stomach, intestines and colon, we have “good” bacteria that play a major role in breaking down our food into nutrients to be absorbed by our body and into waste material that is eventually eliminated.  Along the way, these good bacteria take up colonization sites thereby preventing harmful bacteria, and other pathogens, from taking residence where they do not belong.

Secondly, bacteria can also play a major role in the production of key elements in our body. For example, Bacteroides species of bacteria live in our colon and help us produce Vitamin K, needed for blood clotting. Helicobacter pylori (H. pylori) is another example of the body needing a bacteria to function properly. H. Pylori, while responsible for stomach ulcers in some people when in overabundance, seem to play a major role in the generation of key hormones that control our appetites. H. Pylori appears to affect the regulation of the two hormones, ghrelin and leptin, involved in human energy homeostasis and implicated in the control of food intake such as controlling hunger. Leptin signals to your body it is full while ghrelin stimulates appetite. In one study, it was determined that fewer than 6% of children’s stomachs in the United States, Sweden, and Germany now carry H. Pylori. The lack of Helicobacter pylori has been thought to be linked to the increase in gastroesophageal reflux, Barrett’s esophagus, and esophageal cancer. Interestingly, those lacking H. pylori are also more likely to develop asthma, hay fever or skin allergies.1 Dr. Martin Blaser, a professor of microbiology at New York University Langone Medical Center, suggests ‘that antibiotics may permanently alter your gut bacteria and interfere with important hunger hormones secreted by your stomach, leading to increased appetite and body mass index (BMI)’.3

Our bodies have been living in balance with our bacteria for thousands of years. It is a symbiotic relationship that is now being permanently altered by the use, overuse and misuse of antibiotics. No one knows at this point how seriously antibiotics are harming our long term health prospects. It will take decades worth of research and the resolve of governmental forces to undertake this large scale investigation. However, for today, it is worth asking the question; “By harming our good bacteria, are we not also harming ourselves in the long run?”

References: 1 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2435636/

2 http://articles.mercola.com/sites/articles/archive/2011/11/24/antibiotics-promote-obesity.aspx

3 http://www.jpp.krakow.pl/journal/archive/11_06_s5/articles/05_article.html

4 http://en.wikipedia.org/wiki/Bacteria

Food For Thought: Antibiotic Resistance Generated in Food Production

The expression “food for thought” is often used proverbially more than literally, although results from FDA reports make it necessary to consider how our food and livestock are processed and put serious thought into the food we eat. To make the case immediately apparent, consider that four fifths of all antibiotic consumption in the USA is not human consumption; it’s consumed by farm animals. To quantify this statement, in 2011, 7.7 million pounds of antibiotics were consumed by American people, while 29.9 million pounds went into meat and poultry production.

Ondine

Antibiotics Sold to Livestock Industry vs. Sold for Human Consumption.

The proportion of antibiotics fed to livestock is not a recent issue, it has been growing and the problems that arise from it have accumulated for over 50 years. An alarming development of bacteria that had grown drug resistant due to antibiotics in the livestock industry is MRSA (short for methicillin-resistant Staphylococcus aureus) which is a persistent threat to human health. Estimates indicate that MRSA kills 19,000 Americans each year, hospitalizes 370,000, and results in billions of dollars of additional health care spending. The intent of these statistics is not to frighten, but to raise awareness concerning administering millions of pounds of antibiotics annually to artificially boost animal growth. Maryn McKenna wrote a book chronicling the rise and danger of these superbugs (http://superbugthebook.com/).

What is important to note is that a vast majority of the provided antibiotics is not to target infections or better animal health. It is administered at a herd or flock wide basis through the animals water source or feed to promote growth and weight gain, as well as to preventatively help livestock survive harsh farm and living conditions. This is one reason why antibiotics are used, another is for therapy. Therapy is used when farm animals exhibit clinical diseases, and drugs can be an effective way to prevent catastrophic health risks that could be detrimental to the agricultural sector.

Administering antibiotics to animals is not an inherently bad thing to do, although it can become detrimental if done without caution and concern. The FDA’s report on the application of antimicrobial drugs in industry warns that “the development of resistance to this important class of drugs, and the resulting loss of their effectiveness as antimicrobial therapies, poses a serious public health threat”. In this article, the main point is not to suggest entirely eliminating antibiotic consumption in the livestock industry, but to manage it judiciously by targeting specific diseases. Another significant argument is that farmers and food corporations should “voluntarily” withdraw from using drugs which have a functional similarity to drugs used in humans, since this would reduce the concern for transmitting resistive bacteria on to humans through our food. Use of antibiotics for livestock growth promotion has been banned by many European countries, as they have determined that similar investment in more food resulted in the same growth yields without the additional antibiotic resistance generation.

It is evident that we can no longer take how our food is produced for granted. The expression food for thought is no longer some overused metaphor, it is a reality.

First Scientific Meeting of the Pan American Photodynamic Therapy Association – April 6th, 2013

This week, the 1st Scientific Meeting of the PanAmerican Photodynamic Therapy Association (PAPDT) will be held in Boston, Massachusetts on Saturday, April 6, 2013, from 8:30am-5:30pm. For the first time the Annual Scientific Meeting will be held in association with the American Society for Laser Medicine and Surgery (ASLMS) to enhance the basic science and clinical interdisciplinary aspects of photodynamic therapy, bringing together scientists, clinicians and engineers with an interest in both photonics and medicine to share their experiences from bench to bedside.

The main theme of this Scientific Meeting will be to discuss the basic science and clinical advances in cancer, antimicrobial and other photodynamic therapeutic applications with the declared focus of improving the scientist/clinician interface.  The PanAmerican Photodynamic  Therapy Association is soliciting abstracts for oral presentations and posters.  Please submit your abstract using the ASLMS online system for submission.  You will need to select “Photodynamic Therapy” as the presentation category.  Important to note, you must either email Michelle directly at michelle@aslms.org so that she knows the abstract is for the PanAmerican Photodynamic Therapy Association.  Students and young researchers are especially welcome.

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