Let’s Connect the Silos in the War on HAI’s

The power of a common goal

 

I have seen a lot of conversations on social media and in print in the last year or so from experts in fields of cleaning supplies, architects, and researchers stating that their way is the best way to stop hospital infections. Even the centers for Medicare and Medicaid have stated they have the solution by stopping reimbursement to hospitals for any infections that they caused. Environmental disinfectant developers state they have the only answer; and clinical researchers state they hold the key. When I hear from the World Health Organization that we declared war on antimicrobial resistant pathogens years ago and not much has been accomplished it is disheartening, as I live with one of these pathogens.

Fighting hospital acquired infection is a collaborative endeavor and when it comes to the healthcare industry, all of the following are worthy of consideration:

Surface Materials

Materials to build hospital surfaces have come a long way. We know wood is porous and should not be accepted and we know sharp corners are impossible to disinfect. Along with being durable and easy to clean, surface materials should also be airtight and resistance to cracks and dents. Yet I have visited many health care facilities and notice many defects in surfaces used. Hospitals and clinics seem loath to take the initiative to replace old and worn surfaces. Plus the fact that there is no federal regulation on what surfaces a healthcare facility must use whether it be in hard surfaces, textiles, or medical devices.

Recent findings on contamination of healthcare surfaces include:

MRSA survives for 11 days on a plastic patient chart, more than 12 days on a laminated countertop, and nine days on a cloth curtain. Pseudomonas lives on hard dry surfaces for up to seven days.

In an investigation of contaminated room door handles in a university hospital setting, 27% of door handles were contaminated by MRSA or methicillin-sensitive Staphylococcus aureus (MSSA). In a hospital culture survey, 42% of hospital privacy curtains were contaminated with Vancomycin-Resistant Enterococcus (VRE) and 22% with MRSA

Environmental Services Staff

Unfortunately, cleaning and disinfection is often sub-par with many studies showing that EVS are cleaning and disinfecting only about 30 to 50 % of the surfaces that they should be. These include toilet handholds, light switches, doorknobs, bedside rails, nurse call buttons, TV remotes, and patient telephones.

Ongoing education, training and monitoring is important to ensure compliance and we need to ensure EVS staff is especially trained and knowledgeable about infections and that they help fight them. EVS should be certified after each training and training should involve uniform care, gloving, and the ability to communicate to healthcare personnel that they have a concern when warranted. EVS play a key front-line role in infection prevention and control.

Lab Personnel

Lab workers are a part of the puzzle also:

Proper Specimen Collection

Accurate Identification and Susceptibility Testing

Laboratory Information Systems for comprehensive information /ordering

Rapid Diagnostic Testing

Rapid reporting of Laboratory Data

Outbreak Recognition and Investigations – Molecular Typing

Maintaining Organism Storage

Maintaining Cultures of Specimens from Hospital Personnel and the Environment

The services that the infection control program can offer to the laboratory include functioning as a liaison to the clinical services to improve the quality of specimens sent to the laboratory and promoting appropriate use of cultures and other laboratory tests. It can also assist the laboratory with its system for monitoring antimicrobial agent susceptibilities by identifying the pathogens that are of nosocomial origin.

Researchers

Research for new methods of tacking ARM’s and new antibiotics is a large part of the puzzle. Some of the latest research has been done on the following and most show promise for conquering some of these pathogens.

CRISPR (pronounced “crisper”) stands for Clustered Regularly Interspaced Short Palindromic Repeats, which are the hallmark of a bacterial defense system that forms the basis for CRISPR-Cas9 genome editing technology. In the field of genome engineering, the term “CRISPR” or “CRISPR-Cas9” is often used loosely to refer to the various CRISPR-Cas9 and -CPF1, (and other) systems that can be programmed to target specific stretches of genetic code and to edit DNA at precise locations, as well as for other purposes, such as for new diagnostic tools. With these systems, researchers can permanently modify genes in living cells and organisms and, in the future, may make it possible to correct mutations at precise locations in the human genome in order to treat genetic causes of disease.

Quorum Sensing

The discovery that bacteria are able to communicate with each other changed our general perception of many single, simple organisms inhabiting our world. Instead of language, bacteria use signaling molecules which are released into the environment. As well as releasing the signaling molecules, bacteria are also able to measure the number (concentration) of the molecules within a population. Nowadays we use the term ‘Quorum Sensing’ (QS) to describe the phenomenon whereby the accumulation of signaling molecules enable a single cell to sense the number of bacteria (cell density). In the natural environment, there are many different bacteria living together which use various classes of molecules, as they employ different languages they cannot necessarily talk to all other bacteria.

Bacteriophage Therapy

A bacteriophage is a type of virus that infects bacteria. In fact, the word “bacteriophage” literally means “bacteria eater,” because bacteriophages destroy their host cells. All bacteriophages are composed of a nucleic acid molecule that is surrounded by a protein structure. A bacteriophage attaches itself to a susceptible bacterium and infects the host cell. Following infection, the bacteriophage hijacks the bacterium’s cellular machinery to prevent it from producing bacterial components and instead forces the cell to produce viral components. Eventually, new bacteriophages assemble and burst out of the bacterium in a process called lysis. Bacteriophages occasionally remove a portion of their host cells’ bacterial DNA during the infection process and then transfer this DNA into the genome of new host cells. This process is known as transduction.

 

Developers of Environmental Cleaning Agents

Cleaning is essential in the health care industry for environmental surface management and infection prevention and control. The Centers for Disease Control and Prevention (CDC) and Healthcare Infection Control Practices Advisory Committee recommend that all health care settings, regardless of the level of care provided, make infection prevention a priority and those standard precautions, including environmental cleaning, be used as a means to reduce infection transmission.

Every day there are new products created and we need this research and development to continue especially hand in hand with surface developers as they complement one another in efficiency and effectiveness. Products in hand washing, instrument disinfecting and surface disinfecting along and others are an integral key to the infection battle.

 

Hospital Designers

Hospital designers and architects play an important role by designing a space that has all the aspects of keeping dangerous pathogens out. Newer design models incorporate the patient’s perspective and are based on medical-outcome evidence, patient satisfaction, and patient safety. One of the most important shifts in hospital design in the past few years has been to design patient-care spaces for infection control.

  • How HVAC is implemented
  • Patient flow
  • Room design
  • OR and procedure room design
  • Floor design
  • Green space implementation

Patients

Patients, care givers, and family also play a role in the transmission of infections. You must be your own advocate and if you are unable to communicate it is important doe family to do so.

Some things patients can do consist of asking friends and family to not bring flowers or plants. They are great vectors for pathogens. Ask your doctor or anyone that uses a stethoscope on you to wipe them down as well as asking all to wash hands. Do not lay your eating utensils on your bed. Linens and bed covers hold and can transmit C-Diff and other bacteria.

Have your family bring wipes to cover surfaces that they see EVS miss and ask if the antibiotic you are getting is necessary. Overuse and needless use of antibiotics contributes to the strength and resistance superbugs maintain.

We all need to collaborate and communicate to make sure we win this war. No one solution is the answer and this requires teamwork to defeat a killer that will take out 10 million people by 2050 per CDC estimates.

 

 

Mary Millard M. Ed is a public speaker on HAI’s and is an advocate for patients as well as research and funding on ARM’s. She is also a Board Member for the Healthcare Surfaces Summit.

 

References

American Journal of Infection Control

Volume 43, Issue 5, 1 May 2015, Pages 424-434

 

Centers for Disease Control and Prevention

 

Centers for Medicare & Medicaid Services

 

Calfee DP, et al. Supplement Article: SHEA/IDSA Practice Recommendation Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals. Infection Control and Hospital Epidemiology 2008; 29:S62-S80.

Facilities Guidelines Institute and the AIA Academy of Architecture for Health, with assistance from the U.S. Department of Health and Human Services. Guidelines for Design and Construction of Hospitals and Health Care Facilities, 2001 edition

Hosokawa S, Ole I, Kamiya A. Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus. Journal of Hospital Infection, Volume 51, Issue 2, June 2002. Pages 140-143.

Ju Hun Lee, Christopher M Warne, Heung-Wuk Lee

Nature Protocols 12, 1999–2013

2018 Healthcare Surfaces Summit !

The 2018 Summit was a resounding success, and our keynote speaker Steve Tomasino of the EPA stayed for the entire event!

Companies joining this year were PDI, Eastman Chemical, Microban, and Contec. They all joined in our round-table discussions as well as offered their expertise in the breakout groups for education, research, and more.

It was an honor to officially be voted in as a Board Member.

I look forward to next year as we solve the issue of surface transmission of infections!

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Steve Tomasino of the EPA

 

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Breakout sessions                       gathering                                     

 

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Linda Lybert talks surface testing

 

New Research is Sounding Promising!

There is a trickle of new “out of the box” thinking when it comes to tacking the superbug crisis. Many drug companies have given up on antibiotic research as they state it is too time consuming and not cost effective. This has led some research institutes and universities to try alternative treatments to eradicate antibiotic resistant pathogens.

Bacteriophage Therapy

bacteriophage
A virus cell

A bacteriophage is a particular type of virus cell that infects bacteria. There are many types of phage cells

This receptor structure is so specific that a  phage can only attack bacteria having a cell surface that exactly “matches”. After adsorption to the bacterial surface, the phage injects its nucleic acid into the bacterium that will now be forced to produce a new phage generation by using the bacterial enzyme equipment. This therapy has been used overseas with moderate success and has recently been adopted for clinical trials in the United States. To date two companies are producing these “phage cocktails”.

New Immune System Enhancer

Microscopic view of bacterial pneumonia.

Researchers at Lehigh University in Pennsylvania fused part of an existing antibiotic with a molecule that attracts antibodies unleashed by the immune system to fight invaders such as bacteria. This uses a patients healthy immune system to attack pathogens in the bloodstream and makes the immunity enzymes stronger. Think of it as Gatorade for your immune system.

This is accomplished by fusing an antibiotic with a molecule that attracts the immune cells and they go to work immediately.

Quorum Sensing

Image result for quorum sensing

Quorum sensing is the regulation of gene expression in response to fluctuations in cell-population density. The more bacteria that are gathered, the more they “talk” to each other. Quorum sensing bacteria produce and release chemical signal molecules called autoinducers that increase in concentration as a function of cell density. The detection of a minimal threshold stimulatory concentration of an autoinducer leads to an alteration in gene expression. This can alter the DNA of a bacterium and kill it. Hpow great to tell bacteria to commit suicide. Quorum sensing has been around since the 1960’s but lately rediscovered as antibiotics are losing.

These are just a few of the innovations that are coming about. But this does not mean that hospitals and health care centers should relax on infection control. We need a multi pronged solution to a growing crisis!

 

References

https://www.ncbi.nlm.nih.gov/pubmed/11544353

018/jul/05/new-drug-uses-immune-system-to-wipe-out-deadly-bacteria

 

 

 

 

 

Facts About Hospital Acquired Infections

advocateAll hospitalized patients are susceptible to contracting an infection. Some patients are at greater risk than others, young children, the elderly, and persons with compromised immune systems are more likely to get an infection. Other risk factors are long hospital stays, the use of indwelling catheters, failure of healthcare workers to wash their hands, failure to properly sterilize instruments, and overuse of antibiotics.

In American hospitals alone, the Centers for Disease Control (CDC) estimates that HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:

  • 32 % of all healthcare acquired infection are urinary tract infections
  • 22 % are surgical site infections
  • 15 % are pneumonia (lung infections)
  • 14 % are bloodstream infections

The overall direct cost of HAIs to hospitals ranges from $28 billion to 45 billion annually. While the range is wide, HAIs are clearly expensive. Not only to hospitals with re admissions and extra care ; but also to the patient with compounded physician visits, fuel costs, medications costs as well  as a devastating change in lifestyle.

gp-chart-0302-infectionsjpg-95a6a0bf6161c447

As patients we must speak up! You can lobby congress for funding the fight on antibiotic resistance, write letters to local agencies, get on social media about it as well as lobby local TV outlets to talk about this growing threat.

Inspiring Bio Sales Team!

I was recently invited by T2 Biosystems in Lexington Massachusetts to tell my story at a global sales meeting. T2 has just created a new whole blood pathogen detection system that will give a physician faster results than a culture when they have a septic patient. This system was recently FDA approved! Many said my story both moved them as well as inspired them to show potential hospitals how this can save lives. Thank you T2!!

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Amy Crosby and Karla Gonye of T2 marketing with myself

New Board Appointee!

“Silent Threats…..silent patients”

The Healthcare Surfaces Summit

What an honor to be appointed as an Advisory Board member for the Healthcare Surfaces Summit. The Summit meets every August along with registered attendees that consist of researchers, prevention innovators, infection control professionals, as well as members of the CDC to brainstorm solutions to hospital infections. New innovations are showcased so that they can be launched as solutions.

Mary Millard (guest speaker), Linda Lybert, Glenda Schuh

 

Linda Lybert, president of Healthcare Surfaces Consulting and the founder of the HSS, along my myself and Glenda Schuh, RN, BSN, CIC.

 

 

 

You are welcome to visit the website and sign up if you have an innovation or insights on stopping this insidious problem.

Healthcare Sufaces Summit