Tag Archives: Healthcare Acquired Infections (HAI)

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.

Science around the world

Forget germy handshakes. Do the fist-bump!

Humans are big on ritualistic touching. It’s an integral part of cultural exchanges throughout the world.

The traditional hongi greeting of the New Zealand Maori people involves pressing noses and foreheads together. In Botswana they lightly graze palms and fingers. In the U.S. we pat heads, offer high-fives, or connect with a pound hug (a one-armed “man” hug with a back slap). We’ve even been known to pat a bum or two. But the majority of the time, we shake hands.

Turns out, a handshake is FAR MORE LIKELY to spread bacteria. In fact, a handshake is about the grossest G-rated thing you can do with another person!

Scientists at Aberystwyth University in the United Kingdom recently conducted a study that compared how easily bugs migrate via a classic handshake, a high-five, and a knuckle-to-knuckle knock (or a “dap,” as the study calls it). It concluded that fist-bumps transfer 90% fewer germs than a handshake—followed by a “prolonged” fist-bump, then a high-five, and then a prolonged high-five. The handshake was the germiest. Why? It necessitates more flesh-to-flesh contact and lasts longer. Resesarch also showed that a firm grip spreads more than twice the number of bacteria than a “moderate handshake.” So the stronger your grip, the more germs you spread!

“People rarely think about the health implications of shaking hands,” says study lead Dave Whitworth, who was
inspired by increased measures to promote cleanliness in the workplace. “If the general public could be encouraged to fist-bump, there is genuine potential to reduce the spread of infectious disease.”

The study is of particular interest to healthcare providers, whose hands can spread potentially harmful germs to patients—and that can lead to healthcare-acquired infections (HAIs). HAIs are a leading cause of preventable harm and death in the U.S. In fact, the Centers for Disease Control and Prevention says that one in 25 hospitalized patients develops an HAI and 75,000 patients with HAIs die during their hospitalization each year. It’s unlikely we’ll see a lot of fist-bumping or high-fiving in hospitals anytime soon, but handshakes must be followed by effective handwashing!

Whether you call lit a dap, a fist-pound, or a fist-bump (our preference), this greeting is now being used by cool people everywhere—including President and Mrs. Obama, who popularized it during the 2008 Presidential campaign—because it’s the safest all of the ritualistic touching ways to exchange pleasantries. And if you think a fist-bump is strictly for the Obamas (or bromances, for that matter), think again: The Journal of the American Medical Association has called for a ban on handshakes in healthcare settings, recommending a fist-bump instead.

It’s germy world out there. So let up on that grip, champ. Grab our poster. Display it proudly. And spread the word (not the germs): Do the fist-bump!

Don’t miss this great video from CBS News, either.

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.