Category Archives: Superbugs

Superbugs

The “Superbug” Civil War

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A few days ago I was thinking of the coincidence that the American Civil War had a widely reported military death toll of 620,000 and that is about the same as the death toll from Covid-19 in this country since the pandemic began.

Then magically an article appeared in Time magazine by Rachel Lance, PhD, that summarizes the situation better than I could. I draw pertinent information from her article. (Incidentally, Rachel has written a fascinating book on the Hunley story called, “In the Waves: My Quest to Solve the Mystery of a Civil War Submarine.” I would hope Clive Cussler, who discovered the final resting place of the Hunley, approves. I certainly do. It’s a fascinating story.)

In recent years our civilization has been confronted with a dizzying array of new, or at least newly discovered, diseases Many of these are viral hemorrhagic diseases such as Hanta, Marburg and Ebola. And then there are other viruses such as SARS and its offspring, SARS-CoV-2. And along came ZIKA to join the well known influenza and diarrhea and common cold viruses. Get rid of smallpox and polio and there are always other volunteers to fill their ranks.

And unless we think we are so smart, our old bacterial friends have become antibiotic resistant to keep us humble. That old scourge, Mycobacterium tuberculosis hangs around waiting to catch the unwary. Not wanting to be ignored, fungi are represented by Candida auris along with Cocidioides and Histoplasma. And parasites like the Plasmodium family have never gone away.

So lets compare the Civil War scourges with our current crop.

Here in no particular order are some prominent Civil War diseases (The list is not exhaustive.):

  • Typhoid fever
  • Typhus
  • Malaria
  • Yellow fever
  • Cholera
  • Gas gangrene
  • Gonorrhea
  • Syphilis
  • Diarrhea and Dysentery
  • Measles
  • Mumps
  • Whooping cough (Pertussis)
  • Chickenpox
  • Pneumonia
  • Erysipelas
  • Smallpox

Giant Microbes

It’s worth noting that malnutrition exacerbated the pathogenicity of these bugs. Accounts of the diets of many Civil War soldiers makes one wonder how they were able to function at all. Salt pork? Hardtack? Ugh! And “sanitary” facilities were worse than primitive. A bench across a latrine ditch excavating in one direction with the dirt filling in behind. And handwashing facilities? Are you kidding? It’s no wonder diarrhea and dysentery were rampant. And also why an army on the march was much healthier (think Sherman’s “March to the Sea”).

In spite of vaccines for many of these diseases, especially the childhood diseases, all of these delights are still of current interest.

Here are some current goodies to brighten your day:

  • C difficile (Clostridioides difficile)
  • Covid-19 (SARS-CoV-2)
  • MRSA (methicillin resistant Staph aureus)
  • C auris (Candida auris)
  • VRE (Vancomycin resistant enterococci)
  • CRE (Carbapenem resistant Enterobacteriaceae)
  • Zika virus
  • Malaria
  • Tuberculosis
  • Ebola virus
  • Influenza
  • Diarrhea
  • Pneumonia
  • Venereal diseases
  • Hanta virus

Standard Precaution Signs

This, of course, is just a sampling and many more could be listed. But you get the point. While it is still true that most microorganisms are harmless, or even beneficial, there are many that lurk around ready to pounce. If you’re not familiar with it already, you owe it to yourself to look up that old song, “Some little bug is going to find you someday.” (Google it.) The poem dates back to the late 1800s and a number of people have put it to music.

And with that cheery note. . . .

Gordon Short, MD
Brevis Corporation

Superbugs

Mercy, Mersa! Where did you come from?

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Methicillin resistant Staphylococcus aureus may always have been with us. It appears to be a genetic variant whose origins are unknown. But ever since those intrepid Brits, Fleming and Florey, discovered that some microorganisms may produce substances that inhibit the growth of other organisms, we have become dependent on these miraculous substances to treat all our infections. So far, so good. But Penicillium notatum probably never intended to be the savior of mankind. Furthermore, P. notatum is not the best critter to produce significant quantities of the magic substance.

Contact Precautions Signs & Labels

In the Sept 2021 Scientific American there is a little item about the related P. rubens. Fleming discovered penicillin in 1928 and its usefulness was appreciated by the beginning of World War II. How to ramp up production? Here is the story as told by Jim Daley in the article on page 22:

Andrew Moyer, a microbiologist there [Peoria, Ill], took on the problem. Moyer’s fellow researcher Mary Hunt found a moldy cantaloupe at a Peoria market and brought it to the lab for analysis. . . .As was the case with many women conducting research in that era, Hunt’s contribution to the discovery and study of that mold – which turned out to be Penicillium rubens – was diminished at the time. Moyer’s 1944 publication on P. rubens mentions Hunt only in the paper’s acknowledgments, and the press referred to her as “Moldy Mary.” P, rubens could better tolerate a new fermentation process that let it quickly produce hundreds of times more penicillin than previously studied strains, which let the Allies massively scale up antibiotic production. The same strain is still used to manufacture penicillin today.

Clean Up the Staph Button

But what does this have to do with MRSA? As the susceptible strains of Staph aureus have been killed off, the resistant strains that have maybe always been lurking around in small numbers have been allowed to flourish. Hence the search for modifications of penicillin that would still be effective. Methicillin has been the last candidate in the congregation to do the job. When bugs resistant to it showed up, we were in trouble. Which we still are. Especially since MRSA has an increased incidence in hospitals. What that means is that it is especially important to practice excellent hygiene procedures such as surface disinfection and frequent, good handwashing. Guess what. Brevis can help.

Gordon Short, MD

Superbugs

C. Diff. (Clostridioides Difficile)

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C. diff used to go by the moniker Clostridium difficile. Now it has been upgraded to Clostridioides difficile because the gurus in charge of nomenclature have to justify their existence. Of course the bug itself is unaware of the name change and so it just goes on producing colitis and diarrhea especially in guts that have been made susceptible by prior treatment with antibiotics that suppress the normal flora. C. diff is uncommon in the general population (about 3%) but likes to hang around hospitals where maybe 30% of patients are inhabited by this critter. Metronidazole and vancomycin have been used as treatments but the bug may become part of the normal flora and subject the person to repeat bouts of diarrhea.

Elimination of this bug from the environment is a challenge because it forms spores that are resistant to the usual alcohol antiseptics. Physical removal by good hand washing procedures is effective but who knows how to wash their hands? (Brevis can help!)

Contact Precautions Signs & Labels

Incidentally, the rest the Clostridium family consists of a bunch of bad actors that cause such delightful conditions as botulism, tetanus, and gas gangrene, a particular scourge of Civil War battlefield injuries that led to early amputations of injured limbs. Seems Clostridium perfrinens and related bugs were in the guts of horses and horse were ubiquitous on the battlefield. (I once had an autopsy on a man who was kicked by a horse in his leg. In a matter of hours, doctors noticed crepitation around the wound. Within a couple more hours they had performed a hindquarter amputation – disarticulation of the hip – but it was not soon enough and in several more hours he was in the morgue. Several years later my wife and I did a 5 day backpack trip from north to south across the Uinta mountains. On the final day we were hiking down a rough trail that thad been heavily traveled and damaged by horse packers. I warned my wife to be careful and not fall. Which she promptly did. Her knee hit a rock producing a superficial abrasion that drew a little blood. When we got down to the town of Roosevelt, I insisted Lee go to the local hospital where I knew the doctor. Terry thought I was being a little melodramatic but the autopsy had definitely focused my attention.)

Infection prevention, Superbugs

Flu Pandemic: On Its Way?

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Are you a germophobe quiz

 

When we think of the flu we tend to think of the seasonal flu, the one that arrives in the fall and hangs around through spring, the virus for which we get our annual flu shot.

 

When we think of a pandemic, we think of a crisis situation, a worldwide outbreak.

 

Is a pandemic flu even possible? Not only is it possible, it’s happened before. And according to an article by CNN’s Chief Medical Correspondent, Dr. Sanjay Gupta, it will happen again in the next 20 to 30 years.  

 

In 1918 the Spanish Flu caused 20% to 40% of the world’s population to fall ill, and more than 50 million people died. The Asian Flu killed 2 million in 1958-59. The Hong Kong Flu resulted in the death of a million people, 34,000 of which were in the United States, between September, 1968, and March, 1969.

 

The good news is, we’re better prepared than we have been in the past. The ability to quickly identify viruses, and develop and produce vaccines has seen vast improvement in recent years. The most ideal situation to be prepared for the worst would mean partnerships between governments, collaboration between the private and public sectors, adequate research and funding, as well as the general acceptance and recognition of the likelihood of a flu pandemic in our lifetime. With these in place, it would be fitting to quote epidemiologist Larry Brilliant, who lead the effort to eradicate Small Pox: pandemics can be optional.

Of course, whether you find yourself with flu (seasonal flu is still around in spring months!) or if you’re simply trying to avoid getting sick, remember to wash your hands properly with soap and water to prevent the spread of germs, or use an antibacterial hand rub (sanitizer). Avoiding touching your eyes, nose, and mouth is another way to avoid spreading germs, and when you’re sick, stay home as much as possible.

 

Sources:

http://www.cnn.com/2017/04/07/health/flu-pandemic-sanjay-gupta/index.html

https://www.cdc.gov/flu/protect/habits.htm

Superbugs

Bacteria that antibiotics can’t beat? We get to the gut of the matter.

Intestines Sketch

Hospital Acquired Infections (HAIs) are a serious problem throughout the world. There’s a growing recognition that surgical knives and operating rooms aren’t the only things that need a thorough cleaning. Spots like bed rails and even television remote controls in a hospital room can be highly contaminated. In fact, call buttons and bed trays are among the worst offenders. Bacteria can survive for extended periods of time on common healthcare “touch” surfaces. And it only takes a minute for a nurse or visitor with dirty hands to walk into a room, touch a vulnerable patient with germy hands, and undo the benefits of cleaning.

The emergence of a nasty strain of an intestinal bug called Clostridium difficile, or C-diff, triggered a renewed emphasis on hospital hygiene a decade ago. The diarrhea-causing C-diff superbug colonizes in the intestine and produces toxins that attack the gut, causing severe complications and sometimes death. Nearly 30,000 U.S. deaths annually are linked to C-diff. Complicating matters, a new strain of C-diff has emerged (NAP/0127). First identified in Canada, it produces a more severe colon infection that has now spread to all 50 U.S. states.

Why is C-diff worse than other hospital superbugs? They’re very difficult to clean away. Alcohol-based hand sanitizers don’t work and C-diff can persist on hospital room surfaces for days. The CDC recommends hospital staff clean their hands rigorously with soap and water. Or better yet, wear gloves. And rooms should be cleaned intensively with bleach.

Many patients also get C-diff infections as an unintended consequence of taking antibiotics for other illnesses. “Good” bacteria, normally found in a person’s intestines, help keep C-diff under control, allowing the bug to live in the gut without causing illness. But when a person takes antibiotics, both good and bad bacteria are suppressed—allowing C-diff to grow out of control because it’s resistant to most antibiotics that are used to treat common infections.

The rise of the C-diff superbug, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread. Germ-resistant copper bed rails, call buttons and IV poles. Antimicrobial linens, curtains and wall paint. Cleaning machines that resemble Star Wars robots and emit ultraviolet light or hydrogen peroxide vapors. Insurers are also pushing hospitals to do a better job and the government’s Medicare program has even moved to stop paying bills for certain infections caught in the hospital.

If you get a C-diff infection, what can be done? One fairly new treatment is a fecal transplant. Yes, you read that right, and it’s just what it sounds like. A stool sample of a healthy relative is liquefied and infused into the colon of a sick patient via a colonoscopy or enema. The goal is to repopulate the infected patient’s intestines with healthy bacteria and so far it’s been highly successful. There’s a great video story about it here.

We’re facing the demise of our most effective means to treat disease because we’re overusing antibiotics. We need to treat them not as a commodity, but a valuable medicine. Enforced cleaning and sanitary precautions will go a long way to preventing infection, too. If you’re ever a patient, you can play a role by washing their own hands. And if a nurse or visitor stops by, tell them to wash their hands!

You can also download a report from the The U.S. Department for Health & Human Resources about preventing and treating C-diff infections here.

Superbugs

What’s lurking on the surface can hurt you…

What you can't see can hurt you

Surfaces at facilities where we see our healthcare provider are just surfaces, right?

Healthcare facilities and hospitals are designed for function and efficiency, but the furniture and fittings are also designed to look good. Gurneys, beds, mobile x-ray machines…have you ever considered the impact of these devices on the materials like walls and floors? They’re a critical aspect of the healthcare environment.

It’s a well-known fact that bacteria can survive for extended periods of time on common healthcare “touch” surfaces. Bed rails, call buttons, and bed trays are among the worst offenders. In fact, an estimated 1 in 20 patients in U.S. hospitals pick up infections they didn’t have when they arrived, including some dangerous ‘superbugs’ that are difficult to treat. Which means the fight against Healthcare Acquired Infections (HAI) begins at the surface.

It’s also important to understand the unique nature of the healthcare environment when it comes to infection control. Unknowingly, microbial reservoirs are designed and built into healthcare environments via the surface materials that are selected.

How a surface looks—and especially what it costs—usually takes precedence over an evaluation of the surface function, cleaning recommendations, and how a surface might contribute to the spread of HAIs. Can the surface be cleaned and disinfected using standard products? And if we look at the surface after it has been cleaned and disinfected—at a microscopic level—is it truly clean?

Research has shown that pathogens live on surfaces for days, weeks, even months after they have been cleaned. Research has also shown that 20-40% of HAIs have been attributed to cross infection via hands or healthcare personnel who have become contaminated from direct contact with patients—or indirectly by touching contaminated surfaces. How can surfaces really be an issue?

Healthcare facilities employ rigorous cleaning and disinfection processes, and a wide variety of products and chemicals are used. Terminal disinfection often requires higher concentrations of chemicals like bleach-based products, which are effective in eliminating Clostridium difficile (“C-diff”). And they’re used frequently. Unfortunately though, the majority of surfaces used in our healthcare environments carry warnings against the use of harsh chemicals and disinfectants, many calling out bleach specifically. Damage can occur when these products are used, and the damage begins at a microscopic level—pits, cracks and fissures, the perfect environment for bacterial colonies to form and proliferate!

The Facilities Guidelines Institute for Design and Construction of Healthcare Facilities created a list of preferred surface characteristics (of the ideal product) published for the first time in 2006 and further refined and clarified in 2010 edition. Defining these surface characteristics was the beginning of a request that specifiers and healthcare professionals take a serious look at which surface materials are being placed where. You can find the guidelines here.

The rise of these superbugs, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread. We’ll talk more about that in our next article. You’ll find a great article about surfaces in healthcare on the Healthcare Surface Consultants blog, too.