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Swine Flu and Hospital Acquired Infections

Frank Bailey — Sun, 26 Apr 2009 12:42:45 GMT

Swine flu confirmed in a Queens school…what next? Although these cases are mild, is it possible this virus could mutate much like the viruses have in antibiotic resistant strains? Remember MRSA, C. diff, and VRE.

President Obama has been getting regular updates on this virus and apparently the World Health Organization has warned countries around the world to be on the alert for any unusual flu outbreaks. According to Yahoo News, a deadly swine flu strain in Mexico has killed up to 81 people and likely sickened 1,324 since April 13. The CDC has confirmed 11 cases of swine flu in California, Texas and Kansas in addition to the cases in New York.

What concerns me, is that this outbreak is minor compared to the incidences of MRSA infections contracted every day in our hospitals and nursing homes for failure to follow guidelines as simple as washing hands between patients. What has to be done to get the attention of health care workers and stop the spread of these hospital acquired infections?

Are lawsuits the answer? Surely there has to be some other way to get the attention of the administration in our hospitals and nursing homes…

Originally posted at InjuryBoard by Frank Bailey

MRSA Invades The House Of Representatives Gym

Frank Bailey — Wed, 15 Apr 2009 17:04:29 GMT

MRSA has invaded the House of Representatives gym. The gym is used by some of the most powerful people in government. White House Chief of Staff Rahm Emanuel, is a regular. I have been blogging about MRSA in hospitals, but never imagined it would reach the House of Representatives gym.

A statement from the House Chief Administrative Officer released yesterday stated:

“A House employee has reportedly contracted Methicillin-resistant Staphylococcus Aureus (MRSA). That House employee is also a member of the House Staff Fitness Center (HSFC).”

“As a precautionary measure and in accordance with the recommendations of the Office of the Attending Physician, the HSFC has thoroughly disinfected the House gym .The HSFC is in the process of notifying its members of the possible exposure and providing educational resources for gym members.”

An e-mail sent to House employees Tuesday by Kathy Zumbar, the House gym’s wellness and fitness coordinator, stated, “The infected employee will stay away from the gym until the condition has healed completely. The gym has been scoured the place clean with “Simple Green D Pro 3 disinfectant, virucidal, fungicidal.”

Staph infections often begin with a small cut, which gets infected with bacteria. Infections can range from the “simple boil” to “flesh-eating” conditions. The staph infection is contagious if the wound is draining, and can be especially dangerous “if people share towels or other items that are contaminated.”

Some lawmakers who sleep in their offices shower in the House gym. Will they become infected?

Can this be a blessing in disguise that this terrible infection is now at the heart of our government? Will this be enough to force lawmakers to take action and require hospitals to follow the SHEA and CDC Guidelines to prevent the spread of these infections? For those of you who read this and are familiar with disinfectants, is the Simple Green D Pro 3 a good choice?

Originally posted at InjuryBoard by Frank Bailey

Hospital Acquired Infections and C. diff.

Frank Bailey — Sat, 11 Apr 2009 16:29:00 GMT

Hospital acquired infections are on the rise in the United States. I have recently been blogging about MRSA, but today I want to address another killer, Clostridium difficile or “C. diff.”

C. diff. killed more patients in England in 2006 than MRSA, and the same virulent strain,ribotype 027 has begun to show up in some of our hospitals. So what are we to do?

Outside hospitals, C. diff. is found in about 5% of the population. It normally does not cause any problems because the other good bacteria in our gut keep it in check. The problem starts when a patient is given antibiotics. The antibiotics kill the good bacteria and C. diff. takes over causing severe diarrhea and inflammation.

The bacteria are spread in the hospital through oral-fecal contamination. A 2006 study in the Journal of Hospital Infection found that as many as one-third of blood pressure cuffs rolled from patient to patient carried C. diff. spores on the inside of the cuff. It is easy for a patient to touch their arm and then their food spreading the spores to their mouth and eventually their gut. This is especially true with patients who are fed in bed…those patients really don’t have an opportunity to wash their hands before they eat and are at risk to contract C. diff.

Cleaning is the key to stopping the spread of these deadly bacteria, but it has to be more than just routine cleaning to be effective against the C. diff. spores. Rigorous cleaning with bleach is required to disinfect rooms. Everything, bed rails, telephones, call buttons, toilet seats, and tables must be cleaned. Washing hands with soap and water is required to prevent the spread by healthcare workers. (Alcohol-based sanitizers are not as effective against C. diff. as soap and water)

Many physicians are not well versed about C. diff. A study in one hospital showed that 39% did not know the spores could be transferred from one patient to another on equipment such as stethoscopes and blood pressure cuffs.

Education of personnel about the dangers of spreading C. diff. and controlling antibiotic use are the best weapons to fight this hospital acquired infection. Treating C. diff. has been estimated to add $3.2 billion to the cost of medical care a year. What will it take to wake up hospital administrators to ensure rudimentary preventive measures are put in place and enforced?

Originally posted at InjuryBoard by Frank Bailey

MRSA And Your Life Update

Frank Bailey — Sun, 05 Apr 2009 09:16:01 GMT

MRSA. How would you like to die from a preventable infection you contracted while hospitalized for minor surgery? That is what is happening to thousands of people every year. Is it possible the CDC, a government agency that is supposed to protect people, is underreporting these infections?

According to the latest figures published by the CDC, 1,700,000 patients contract hospital acquired infections each year. But when you look at the numbers, the fastest growing, and one of the most difficult to cure, MRSA (methicillinn resistant Staphylococcus aureus), is growing by leaps and bounds. In 1993, there were only an estmated 2000 MRSA infections reported in American hospitals. Then in 2005 there were 368,000 reported cases. In 2007, according to the American Journal of Infection Control, 2.4 percent of all patients had MRSA infections. That would result in an amazing 880,000 victims a year.

But, let's look futher. MRSA only accounts for eight percent of hospital acquired infections according to Julie Gerberding, M.D., the director of the CDC. What about other superbugs such as VRE, (vancomycin resistant Enterococcus) and C. diff , (Clostridium difficile)?

These new facts discredit the CDC's official 1,700,000 estimate.

There are many applications of life saving changes that need to be implemented in our hospitals. MRSA screening is one. The test is a noninvasive simple skin test. At Evanston Northwestern Healthcare System, a group of three hospitals near Chicago, the screening reduced MRSA infections seventy percent! Dr. Lance Peterson, the study's lead author, stated, "If it works in these three hospitals, it will work anywhere."

NEW...More about the work at Evanston Northwestern Healthcare. Evanston received the John M. Eisenberg Patient Safety and Quality Award for its work.

MRSA infection rates were cut by 60% within the first year of the program. Universal MRSA surveillance has also decreased the risk of other patients and staff becoming infected. Peterson indicated that "The biggest risk for getting a MRSA infection is becoming colonized in the nose with it. Our program has successfully prevented nasal colonization of patients coming to ENH for their care. We want people to come here for their healthcare and not go home with something unexpected that will later cause an infection – and the program is successful in doing just that."

If your hospital doesn't do MRSA screening, ask why they aren't utilizing this safe proceedure to protect their patients. I would be interested in their answer.

What about screening healthcare workers? Can they be the main carriers?

Originally posted at InjuryBoard by Frank Bailey

Will Influenza Epidemic Repeat History?

Frank Bailey — Sun, 26 Apr 2009 16:06:06 GMT

The more a person thinks about the recent outbreak of swine flu the more convincing is the argument that these deadly microbes such as MRSA and VRE must be stopped. In 1918 there was a influenza epidemic at a military camp near Boston. Hundreds of people died. Here is a letter written by one of the camp physicians. It is the first idea of a mixed infection.

“Camp Devens is near Boston, and has about 50,000 men, or did have before this epidemic broke loose…. This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed….. These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the colored men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up. There is no doubt in my mind that there is a new mixed infection here, but what I don’t know.”

W. John Martin M.D. Ph.D. first talked about this type of occurrence. Dr. Martin wrote, “Among the bacteria commonly cultured were Pneumococcus, Streptococcus and Staphylococcus. While H1N1 influenza virus has been retrieved from victims of the 1918 epidemic, no formal study has been reported of possible toxin producing bacteria from this period.”

Dr. Martin went on in his interesting article to say, “The vast majority of bacteria are essentially harmless to mankind. Bacteria can, however, become infected with their own sets of viruses, some of which can transfer toxin producing capacities to otherwise relatively harmless bacteria. Bacteria viruses can also transfer the capacity of bacteria to resist certain types of antibiotics. The combination of toxin producing capacity with antibiotic resistance is now occurring, especially among Staphylococcus aureus. Of great concern is a toxin complex known as Panton-Valintine-Leucocidin or PVL. This toxin can easily incapacitate the host inflammatory response by directly killing white blood cells (leucocytes). The toxin can also destroy otherwise healthy tissues if the bacteria producing the toxin can gain entry into the tissues. The PVL toxin was originally detected in antibiotic susceptible bacteria.”

There are so many simple things that can be done to stop the spread of these hospital acquired infections, and some hospitals are making wonderful progress. But, why aren’t all hospitals putting the guidelines into practice?

Originally posted at InjuryBoard by Frank Bailey

MRSA: Can It Come From Food Animals?

Frank Bailey — Wed, 22 Apr 2009 16:17:00 GMT

Ever dream of being eaten alive by trillions of microbes? Since I started blogging about MRSA, C. diff. and VRE, I have. Take a look at my previous blogs; MRSA in the House of Representatives Gym , Guidelines For Preventing MRSA And VRE ,and Hospital Acquired Infections and C. diff and you will see what is bugging me...it is these antibiotic resistant microbes.

Now I am worried that the antibiotics fed to food animals, such as cattle, chickens, and pigs, may be partly the blame for these antibiotic resistant microbes. According to the lobbyist, farmers couldn't survive unless they feed their animals these antibiotics and these are not fed to sick animals, but to healthy animals.

Their logic is that the antibiotics kill the microbes in the animals and the animals don't have to expend energy fighting these bugs, and so get fatter faster. Without these antibiotics, meat would be so expensive, people couldn't afford to buy it and the farmers would go bankrupt. I know my wife and I always buy "Smart Chicken" and it is more expensive than "Natural Chicken," but we can still afford some now and then.

An article published in the Journal of Antimicrobial Chemotherapy indicates that, even if resistant pathogens do reach man; the clinical consequences of resistance may be small. The article goes on to state, "The application of the 'precautionary principle' is a non-scientific approach that assumes that risk assessments will be carried out."

I am interested in what you think about this article. Who funded it? Are there more recent articles that debunk this line of thinking?

Anyone else out there dreaming about being eaten alive...

Originally posted at InjuryBoard by Frank Bailey

Guidelines For Preventing MRSA And VRE

Frank Bailey — Mon, 13 Apr 2009 15:53:29 GMT

Thanks to Michael Bennett for his comment and link to the 2003 SHEA Guidelines for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus. The Guidelines present a scholarly look at Antibiotic-resistant pathogens and their important and growing threat to the public health.

The Guidelines recognize that infectious diseases are in aggregate the leading cause of human death worldwide and the third leading cause of human death in the United States. More than 70% of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat these infections.

The Guidelines make recommendations in nine critical areas:

I. Surveillance Cultures to Identify the Reservoir for Spread
II. Proper Hand Hygiene
III. Barrier Precautions for Patients Known or Suspected to Be Colonized or Infected With Epidemiologically Important Antibiotic-Resistant Pathogens Such as MRSA or VRE
IV. Antibiotic Stewardship
V. Decolonization or Suppression of Colonized Patients
VI. Education Programs
VII. Adequate Methods of Disinfecting
VIII. Computer Alerts for Colonized Patients
IX. Dedicated Noncritical Patient-Care Equipment

Where these recommendations have been implemented, the incidence of MRSA infections has shown a drastic fall. In Denmark, the prevalence of MRSA blood isolated reached a peak of 33% in the 1960’s, but declined steadily after introduction of a policy to control transmission, and has been maintained at less than 1% for 25 years. In Finland and the Netherlands, the prevalence of MRSA has been maintained at lower that 0.5%.

Why is it that hospitals in the United Stated have been unable to achieve these results? After all, we are the richest country in the world. It is well past time for our hospitals to implement these measures and take their heads out of the sand.

Originally posted at InjuryBoard by Frank Bailey

Why Do We Continue To Have MRSA In Our Hospitals?

Frank Bailey — Wed, 08 Apr 2009 15:54:45 GMT

What’s new about hospital acquired infections that will change the landscape? Can it be that lawsuits which would have failed a few years ago now have a chance of winning? Can it be that the United States has fallen behind the hospitals in Denmark, Finland, and Holland that have nearly wiped out drug-resistant infections such as MRSA by implementing a few basic precautions like washing your hands immediately before touching a patient? The landscape is certainly changing here in the United States. But, is it soon enough to save the thousands of people that become needlessly infected in our hospitals?

We have to ask ourselves, why is it that 52% of the time on average, doctors failed to wash their hands before touching a patient? Can it be that hard?

Why is it that hospitals continue to place new patients in a room previously occupied by a patient with MRSA which increases the risk of infection because the bacteria are still on the floors and furniture? The new study in Infection Control and Hospital Epidemiology documents that you are at increased risk of infection if you are placed in a semi-private room with a MRSA patient, yet this is done every day.

There is a growing body of evidence that hospital acquired infections are preventable (a never event) if the staff uses correct procedures. Many hospitals continue to shave the surgical site which leaves tiny nicks in our protective skin…just the place for bacteria to enter the body. Sometimes busy nurses forget to give a prophylactic antibiotic within an hour of the incision…how hard can that be? Or how hard can it be to advise patients to reduce their risk of infection by showering with Chlorhexidine soap daily before elective surgery?

What is the best approach for us as citizens to put a stop to this needless suffering…I welcome your responses.

Originally posted at InjuryBoard by Frank Bailey

Swine Flu...Is It Worth $1.5 Billion Dollars?

Frank Bailey — Thu, 30 Apr 2009 10:59:25 GMT

Last night President Obama went out of his way to change the name of this virus to the more scientific H1N1 and pledged $1.5 billion dollars to fight a possible pandemic.

I am thinking, how about $1.5 billion dollars dedicated to the prevention of hospital acquired infections, especially MRSA, a known killer that takes over 18,000 American lives a year. And that is according to the latest figures from the CDC. This MRSA bacteria infects an estimated 94,000 patients according to 2005 figures from the CDC, and what are we doing about it?

Where are our priorities? We spend $300,000 for a photo op of Air Force One over the Statute of Liberty, $1.5 billion to fight Swine Flu, but how much to wipe out MRSA, a terrible tragic killer that has been proved over and over again???

I think it is time we all contact our representatives and demand laws to force hospitals to clean up their act and implement the 2003 SHEA Guidelines for Preventing Nosocomial Transmission of MRSA.

Please comment with updated evidence based information and ideas to stop MRSA infections.

Originally posted at InjuryBoard by Frank Bailey

New Roof Crush Tests: Volvo XC90 vs. Ford Explorer

Frank Bailey — Tue, 16 Dec 2008 16:06:29 GMT

Beginning in 1970, the auto industry fought efforts by the National Highway Traffic Safety Administration (NHTSA) to issue a dynamic roof crush standard that protects occupants in rollover crashes. Why would the auto industry take such a position?

During that time, the number of deaths to occupants in rollover crashes climbed from 1,400 to over 10,000 each year while total occupant fatalities declined from 43,200 to 33,300. What accounts for that amazing increase in deaths from rollover crashes?

Although numerous federal courts have upheld the dolly rollover test as a reliable dynamic test, NHTSA has stuck with the ineffective, quasi-static roof crush standard issued in 1971 even though it initially was to be phased out by 1977.

In other major crash modes, front and side impacts, NHTSA has issued effective dynamic crash test standards that have reduced death and serious injury, but why not roof crush tests?

Public Citizen now has the results of dynamic roof crush tests on the Jordan Rollover System (JRS). The tests were sponsored by the Santo Family Foundation on a Volvo XC90s. State Farm donated the vehicle. This is one time that I applaud State Farm for doing something right.

Ford Motor Company (Stock at $3.11 today) has obtained Protective Orders in 24 courts prohibiting the public from seeing the test. Wonder why? Roof crush tests show Volvo XC90 occupants escape serious injury in multiple rollover crashes while Ford Explorer occupants suffer serious injury.

In a multiple two roll test, the maximum roof intrusion in the XC90 was only 2.6 inches and the peak roof intrusion velocity was less than 4 miles per hour. In contrast, the Explorer had maximum roof intrusion of 11.5 inches and peak roof intrusion velocity of nearly 12 miles per hours. This exceeds known thresh holds for death or serious injury.

Examination of actual accidents from NHTSA shows only one Volvo XC90 in a rollover crash. Like the XC90 in the JRS test, this Volvo had minimal roof intrusion and the two occupants suffered no serious injury. In sharp contrast, the NHTSA files revealed multiple cases of severe roof crush in other vehicles that tested poorly in the JRS.

After 35 years of increasing rollover fatalities due to weak roofs and weak standards, it is time to issue a dynamic roof crush standard using the JRS to match the lifesaving dynamic standards NHTSA has for front and side impacts.

Call or email your representative today and ask that they put aside their love for the auto industry and start putting the safety of their constituents first.

Originally posted at InjuryBoard by Frank Bailey