Category: Healthcare-Associated Infections (HAIs)

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

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.

From a Chronic Urinary Tract Infection to Disability: The Dangers of Bacterial Biofilms

When most of us think of diabetes, urinary tract infection isn’t something that immediately comes to mind.  Of course, there are the usual complications, such as heart disease, kidney damage, foot ulcers, and blindness—but increased susceptibility to infections is something that many people miss.  For an acquaintance of mine, however, a chronic, treatment resistant, urinary tract infection has come to define her diabetic experience of the last 10 months.

Despite having her blood sugar levels under strict control, my acquaintance went a little overboard last Christmas, enjoying a few too many cookies and chocolates—something all of us have been guilty of at one time or another.  Sugar, unfortunately for diabetics, and my acquaintance, thickens the blood and makes it more difficult to supply organs such as the heart, kidneys, and nerves with oxygen.   As a result of this little misadventure, she developed very specific type of nerve damage, called neurogenic bladder.   Neurogenic bladder, in a nutshell, damages the involuntary nerves that make urination possible and allow the bladder to be emptied.

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The Underreporting of Pneumonia Infections In Hospitals

Ventilator-Associated Pneumonia (VAP) is a type of lung infection that occurs in individuals receiving mechanical intubation. In intensive-care units, VAP is one of the leading causes of healthcare-associated infections, however there is currently no reliable definition of a VAP patient. Preventing VAP continues to be a priority, as it is associated with increased healthcare costs, longer hospital stays, and increased mortality and morbidity.

Defining a VAP infection is based on subjective elements and will need further standardization. A new system that is currently scheduled for implementation in 2013 will categorize VAP into 4 levels:

  1. Ventilator-associated condition (VAC)
  2. Infection-related complications (IVAC)
  3. Possible VAP
  4. Probable VAP

Like other healthcare-associated infections, the underreporting of infection rates continues to be a general trend. With healthcare-associated infections being the most common type of hospital-related complication, this fact is even more alarming. In a recent review of over 100 hospitals in California concluded that approximately 1/3 of all healthcare-associated infections go unreported. Read More

Study Shows That 1 In 3 Healthcare-Associated Infections Go Unreported

In a recent study conducted by the California Public Health Authorities, it was concluded that approximately one-third of the infections that should have been reported under California law were in fact not reported. This study, which was conducted in 2011, reviewed one-hundred hospitals in the state.

Several states have passed laws requiring the mandatory reporting of infection statistics from hospitals and other healthcare facilities. I personally had the honor of testifying at the Rhode Island State House in 2009 on behalf of such a bill, which was eventually made law. Public reporting of healthcare-associated infection statistics from hospitals and other applicable healthcare facilities is important for several reasons, including the fact that such statistics provide the public with tangible evidence that can help public health officials and other professionals better gauge the problem at hand. Yet as this study proves, more progress in this area is still needed in order to curb the unnecessary deaths due to healthcare-associated infections.

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Healthcare-associated Infections Kill 5 Times More People Than AIDS Every Year

It has been over 30 years since the Centers for Disease Control and Prevention reported the first cases of HIV/AIDS. Since then, so much has been done to learn more about the virus and disease, as well as significant attempts to raise awareness and prevent the transmission of the virus to uninfected individuals. It is estimated that nearly 30 million people have died as a result of HIV/AIDS since the early 1980s. While these needless deaths are truly a tragedy, what is almost more shocking is the fact that in the United States, more people die annually as a result of something many of you may have not heard of: Healthcare-associated Infections.

Healthcare-associated infections include a wide range of bacteria, fungi, and viruses that a patient acquires while in any healthcare setting. Common HAIs include central-line associated bloodstream infections, urinary tract infections, ventilator-associated pneumonia, and surgical site infections. Collectively, more than 1.7 million HAIs occur every year, killing more than 99,000 people. AIDS kills 18,000. Read More

Two-Time Cancer Survivor Fights Off Deadly MRSA Infection

In April 2003, while the budding and blossoming of new life surrounded the springtime air, Sally would soon be left fighting for her life. Sally, a two-time cancer survivor, was sent to the hospital to undergo reconstructive surgery on her breasts. After a few hard years of treatment for breast cancer, Sally was fortunate to have won the battle against cancer and hoped to put her struggles behind her.

The surgery was a success, but as with any surgical procedure, nothing could have prepared Sally for the pain she was about to endure. Numerous stitches held Sally’s incisions together. She was told not to move without assistance from medical personnel. One nurse entered Sally’s room to turn her and make her more comfortable, but this required further medical staff. While Sally was waiting for the medical staff to arrive, she took the initiative to attempt to turn over on her own. This caused several stitches to detach from the incision, which slowed down the healing process.

Sally subsequently developed severe, swollen blotches on her body. Such manifestations caused her more pain than the actual incisions from the procedure. Her incisions soon became infected as well, although Sally’s doctor neglected to disclose the type of infection she had acquired. According to Sally, the doctor assumed the infection was MRSA. Methicillin-resistant Staphylococcus aureus, or MRSA, is a superbug that does not get better with first-line antibiotic treatments, thus considered “resistant.”

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Latest Hospital Safety Ratings Report Reveal Shocking Results

The recent release of individual safety ratings for several hospitals across the United States raise further evidence of both the possible risks that can occur while receiving healthcare, as well as the achievements of several institutions. Included in such reports were over 1,150 hospitals in 44 different states. While the majority of such institutions scored below 50% on measures of safety, the most common area of failure related to communication. Nearly half of the involved facilities reported the lowest possible score for communication related to medication safety and plans for patient transition post-hospitalization. This finding really resonated with me, as one of the biggest things I try to stress while promoting patient safety is communication.

It is important to remember that many healthcare professionals are often very busy, given the overall climate of the field. This shouldn’t, however, be an excuse for patients to overlook the importance of talking to their doctors about any questions they may have regarding their health, medication, diagnosis, or anything related to gaining a better understanding of their current state. Even when your healthcare providers may appear to be in a rush, don’t hesitate to ask questions; doing so will not only make their job easier in the long run, but also promote your health and safety. Improving patient safety is an undertaking that can only be successful when all involved parties make an effort towards the common goal.

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It Took Half A Century To Develop A C. Difficile Treatment

It has taken 50 years, but a new drug has been released as a treatment for infections caused by Clostridium difficle. The new drug, called Dificlir, is an antibiotic treatment that has been shown to cut the chances of relapse from this type of infection in half.

C. diff, a gram-positive bacteria that can cause a serious and potentially fatal infection of the colon, can be found naturally in the gut flora of approximately 3% of adults and two-thirds of children. As a part of the body’s natural flora, the bacteria can live without causing any problems. For those who have experienced the painful and explosive symptoms of such infections, which include extreme diarrhea and abdominal pain, the release of this new drug is great news. It is also significant considering that C. diff has become more virulent over the past few decades, evolving into a key player in the emerging threat of antibiotic resistance.

The new drug works by preventing C. diff bacteria from producing the toxins that cause the disease and its immobilizing symptoms. By preventing such symptoms, the drug inadvertently prevents others from contracting the disease, as microbes are less likely to spread in the absence of the explosive diarrhea. It has taken over ten years to develop this new type of antibiotic, which is also called fidaxomicin.

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A Silent Epidemic: A Documentary That Could Save Your Life

In August of 2008, I lost my father to a number of healthcare-associated infections including C. diff, MRSA, and pseudomonas. As I began my freshman year at Providence College the following week, I started doing research to learn more about what happened to my dad, and what I learned astonished me. HAIs infect approximately 1.7 million individuals annually in the United States alone, killing nearly 99,000 of those who become infected. I also learned that these infections are largely preventable.

As I learned more about healthcare-associated infections, I knew I had to do something to help bring that information to others. The perfect opportunity arose when I became a film minor, with the hope of eventually making a film to raise awareness. In January of 2012, I contacted Pat Mastors, who I had met the winter after my dad passed away. Pat lost her father in 2007 as a result of C. diff, and has since become a huge advocate for patient safety and awareness, creating the Patient Pod, which is a tool to help keep patients safe in hospitals, nursing homes, and other related environments. She has also been an immense help in the production of this film, as she put me in contact with a number of individuals across the country, and also set up my interview with Dr. David Lowe, an infectious disease specialist who saved the life of one of her close friends. Dr. Lowe’s interview was also immensely helpful, as he explained complicated scientific information in a way that the average person can easily understand.

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