Nursing homes can expect some new guildlines coming this fall with regards to MRSA and infection control.

While many studies have looked at MRSA in hospitals, “we found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people,” the reviewers said.

That’s despite nursing home conditions that are ripe for breeding the bacteria, including residents with compromised immune systems living in close proximity and taking multiple medications that can foster bacterial resistance.

Open wounds such as bed sores – a common problem in nursing homes – and the use of catheters, also common, enhance older people’s vulnerability.

Recognizing the importance of the issue, the Association for Professionals in Infection Control and Epidemiology (APIC) is updating its MRSA recommendations to “apply more specifically to long-term care settings,” according to Liz Garman, a spokeswoman.

Those new recommendations are due to be released late this summer, she says.

One of the typical things is strict isolation of patients who test positive for this infection. There are not enough single beds in most nursing homes to accommodate this. It will be interesting to see how nursing homes follow up on the recommendations.

This sounds promising. Would this be helpful to CNA’s?

Canadian-made technology may provide health-care workers with a convenient reminder to disinfect before they touch their patients, helping eradicate so-called superbugs from hospital settings.

Even though diligent hand hygiene is known to significantly cut hospital-acquired infections, studies show that health-care workers wash their hands before seeing a new patient only about 30 to 40 per cent of the time. Physicians on rounds are among the worst offenders.

Superbugs are posing an increasing threat. These include MRSA (methicillin-resistant Staphylococcus aureus) and Clostridium difficile as well as E. coli and strains of viral influenza.

Now, researchers at the Toronto Rehabilitation Institute have developed a hand hygiene device. It consists of a sensor worn around the neck, infrared lights above the patient’s bed, and an alcohol gel dispenser attached to the waistband.

A health-care worker wears the sensor and a beep is triggered when the person approaches a patient’s bed, reminding them to use the sanitizing gel. If the health-care worker has already done so, the beep will not sound.

The system also records the time of entry and exit from each patient area and the number of times hands are disinfected. This data can be downloaded into a computer so individual staff members can check their overall hand hygiene and compare it anonymously against their peers.

Toronto Rehab nurse Veronique Boscart said a couple of pumps means she has just prevented the transfer of bacteria from patient A to patient B.

“Often because there is such a high demand, I wouldn’t disinfect my hands in between two patients,” she told CBC News. “This system reminds me to do so.”

When we consider how often we should wash our hand, these reminder devices could come in handy. The technology that goes into this stuff amazes me.

Nursing homes are not prepared to deal with MRSA…says this article:

“Much of the research effort around MRSA to date has focused primarily on hospitals,” said Carmel Hughes, lead review author.

MRSA spreads easily — most commonly via the hands of health care workers — and first-line antibiotics, like penicillin, are ineffective against the organism. Nursing home residents are particularly vulnerable because infection with the bug tends to increase with advancing age.

Close living proximity, multiple medications, pressure sores and catheters all make nursing homes ideal for breeding and spreading MRSA. However, nursing homes appear to have been short-changed in the medical literature on prevention, despite studies repeatedly reporting that residents are at higher risk.

“Many different ways of preventing the spread of MRSA have been studied, particularly in hospitals; however, we found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people,” the reviewers say.

A reminder as to why it’s SO important to wash your hands:

LONDON (AP) - Nurses who didn’t wash their hands and left patients lying in soiled beds were cited in an official report blaming mismanagement for the deaths of 90 people who contracted a bacterial infection in hospitals in southern England.

“Significant failings” at all levels contributed to infections of more than 1,000 patients at three hospitals, the Healthcare Commission said Thursday.

The patients were infected with Clostridium difficile, or C. diff, which can cause diarrhea, colitis and other intestinal problems, officials said.

“The Healthcare Commission has passed the copy of the report to us and that is being reviewed,” said a spokesman for Kent Police, speaking on condition of anonymity in line with force policy.

The report into the spread of the highly contagious bacterium said nurses at three hospitals run by the Maidstone and Tunbridge Wells NHS trust were often too busy to wash their hands and left patients in their own excrement.

Across the pond they’re having HUGE problems battling these germs and bugs. It sounds like hand washing isn’t on top of the things nursing staff do over there.

A very interesting article.

TORONTO (CP) — People who have C. difficile spores in their gastrointestinal tracts but who aren’t sick may be serving as a source of infection for others in hospitals and long-term care facilities battling outbreaks of the difficult-to-contain diarrhea, a new study suggests.

U.S. researchers found these seemingly unaffected patients were nearly as likely as people sick with Clostridium difficile diarrhea to have the bacteria on their skin or on objects in their bedside area.

They even found spores on and around patients who weren’t shedding C. difficile - a discovery that suggests health-care workers were unwittingly spreading bacteria from asymptomatic carriers to non-carriers in the facility.

“It’s kind of been passed down over the years that the patients we should worry the most about are the patients who are having diarrhea,” said senior author Dr. Curtis Donskey, a researcher at Case Western Reserve University and director of infection control at the Louis Stokes Veterans Affairs Medical Center in Cleveland, Ohio.

“But there are a lot of patients in hospitals and nursing homes who are carrying the organism. And even though they’re not having diarrhea, they’re often incontinent or very sick and often have kind of reduced standards of hygiene.”

And this:

But Muto thinks the findings point to a more general problem with the way bed-bound hospital patients and nursing home residents are bathed.

Muto’s facility was the first to battle the new epidemic strain of C. difficile. In their efforts, her infection control team has looked into the composition of patient cleansing products sold to hospitals and health-care facilities. They were surprised by what they found.

“It turns out that a lot of the products that are used in health care have no soap in them at all. They just are emollients,” she said.

“Who would ever think you’d have to ask if there was soap in the product if you were looking for something to bathe your patients?”

Donskey agreed more effective bathing approaches should be investigated.

Better check those ingredients of cleaning products like SOAP. Sounds like they may not contain…soap.

More info about MRSA.

A type of infection that used to be seen only in hospitals has become increasingly common among the general public.

But health officials say there’s no reason to panic. Just be vigilant and wash your hands.

For decades, hospitals have been fighting methicillin-resistant Staphylococcus aureus (MRSA), a bacterial infection that cannot be cured with widely used antibiotics such as penicillin. The illness usually affects the skin, but can also spread to the bloodstream and internal organs.

According to the Centers for Disease Control and Prevention, in 1974 only 2 percent of staph infections in hospitals were MRSA. By 1995, MRSA accounted for 22 percent, and by 2004, 63 percent.

Infections of any kind are always a risk when someone is hospitalized, especially when they are critically ill and are hooked up to devices such as feeding tubes and IVs, on which bacteria can grow.

What’s disturbing is that MRSA is now showing up in people who have never received treatment in a hospital.

“We originally thought that what we were seeing was MRSA in hospitals ‘leaking’ out into the community,” said Nicole Coffin, a spokeswoman for the CDC. “But with further research, we found that it was essentially a different strain of bug.”

No one knows for sure why this “community-acquired” MRSA is becoming more prevalent. But Coffin said the dominant theory is that overuse of antibiotics has led to the development of drug-resistant germs.

“It’s misleading to call MRSA a ’superbug,’” Coffin said. “It’s not resistant to every antibiotic.”

Not yet, anyway. But studies suggest that even some of the broad-spectrum antibiotics are losing their effectiveness.

I wonder how many of these people in the community, who have MRSA, are actually health care workers?

Coffin said about 30 percent of people carry staph bacteria in their nasal passages, even if they’re not sick, and about 1 percent have the drug-resistant type.

When a person’s immune system is compromised, such as when they get the flu or they’re in a traumatic accident, the dormant MRSA germs can start proliferating.

“Even if they have no symptoms when they come into the hospital, the infection can be activated at any time,” said Meisch. “That’s why we have to isolate them.”

If the patient comes into the hospital and already has a wound that is draining pus, a culture is performed to check for MSRA.

Coffin said the infection can occur in anyone who has “compromised” skin. “That includes cuts, abrasions, turf burns,” she said.

Athletes need to be especially careful, because they’re more likely to have such injuries and they also come into close physical contact with each other. But Coffin said it’s a myth that community-acquired MRSA is an athlete’s disease.

“You can’t assume that because you’re not involved in sports, you can’t get it,” she said. “Everyone in the community is potentially at risk. And what’s unusual about it is that it seems to affect people who are normally healthy.”

Coffin said some MRSA infections are mild, resulting in nothing more than pimple-like nodules or boils.

“But if you have a skin infection of any kind, you need to go to the doctor,” she said. “MRSA can become invasive and can even result in death, though that’s rare.”

Health care workers needs to be especially careful I think. We wash our hands and wear gloves and gowns and all that. But, we are still exposed to these germs every day. Heed the advice here: Any kind of skin issue- infection or cluster of “pimples’ that don’t go away can be a MRSA infection.

Interesting. Of all the states, I would have thought New York or California. Not Hawaii!

Hawaii had the highest prevalence of drug-resistant Staphylococcus aureus in the nation last fall when 1,200 hospitals, long-term care and rehabilitation facilities were surveyed across the country.

The study covered 187,058 patients in the facilities, of whom 8,654 either were infected or “colonized” with methicillin- resistant staph A, said Susan Slavish, infection prevention and control coordinator at the Queen’s Medical Center.

In participating Hawaii facilities, 91 patients were identified with the superbug out of every 1,000, compared with 46 per 1,000 patients in the study overall, she said.

Although she has seen drug-resistant staph increasing here over the years, Slavish said, “I think I was surprised we were No. 1.”

Other high superbug states were Maine, New York and South Carolina, which had more than 60 patients with the drug-resistant bug per every 1,000 patients.

The comprehensive study was reported at the annual meeting of the Association for Professionals in Infection Control and Epidemiology June 25-28 in San Jose, Calif. Participating facilities were not identified, but more information will be available when the study is published, said Slavish, who attended the meeting.

Another related article about these infections:

By the Numbers

2% In 1972, the percentage of hospital-acquired infections that were drug-resistant.

50%-70% In 2006, the percentage of hospital-acquired infections that are drug-resistant.

30% The percentage of Americans who “carry” staphylococcus aureus harmlessly in their nasal passages.

2 million The number of hospital-acquired infections in the United States each year.

23% The mortality rate among patients whose blood becomes infected with a strain of staphylococcus aureus that’s resistant to common antibiotics.

10 days The average time a hospital stay is extended when a patient contracts an antibiotic-resistant infection.

$21,394 The average additional cost for treating a drug-resistant infection (as opposed to a hospital-acquired infection easily treated with antibiotics).

$45 billion The estimated national total costs associated with treating hospital-acquired infections.

WASH YOUR HANDS!!!

C Diff. The infection that can run rampart in nursing homes and hospitals. Nursing Homes Magazine has an article about this nasty illness we deal with, often:

Clostridium difficile—also known as C. diff—is a bacterium commonly found in hospitals and long-term care (LTC) settings. Infection can lead to diarrhea, colitis, and other symptoms that can be debilitating and even deadly, particularly in the elderly. In recent years, there have been several reports of infection affecting both individuals and whole groups of patients treated in hospitals and healthcare facilities around the world. Based on available reports, hundreds of thousands of people experience symptoms related to C. diff infection each year, and that number is growing as more virulent and resistant strains emerge.

Some interesting facts:

Although clinicians report that C. diff spores are present in most hospital and LTC settings, many questions remain as to why some infected patients go on to develop symptoms while others do not. In fact, most of those infected—70–90%—experience no symptoms at all. Others go on to develop symptomatic disease and potentially recurrent life-threatening symptoms.

I always assumed those who tested positive for C Diff had the symptoms as well.

While discontinuation of antibiotic therapy is generally the first-stage treatment, it can also introduce serious risks for some patients. A sudden cessation of treatment might reexpose patients to the infection that therapy was originally intended to treat or prevent. Also, after cessation of antibiotic therapy, treatment typically—and paradoxically—involves the use of antibiotic therapy. This makes C. diff infection one of the few health problems that is both caused by and treated with antibiotics.

This makes sense of course.

There have also been some difficulties recorded with the use of antibiotic therapy to treat this infection. Patients treated with metronidazole, an antibiotic commonly used to treat moderate infection, show a failure rate of at least 10% and a recurrence rate reaching 30% or more. Many experts also express concern that treatment with vancomycin, prescribed for more severe cases of infection, could be contributing to greater drug resistance among other infection-causing organisms. In recent years, there have been many reported cases of selection of vancomycin-resistant Enterococcus species following treatment with the antibiotic.

NOT what we need: C Diff to become a superbug.

Many infectious disease specialists believe that new and more virulent strains of C. diff could someday represent a potentially serious threat to public health. As researchers explore possible correlations between strain virulence and higher incidences of community-acquired CDAD, clinicians have become particularly concerned about strains of community-acquired CDAD occurring in people who have not previously been treated with antibiotics. A recently discovered epidemic C. diff bacterium produces up to 20 times more toxin than other strains and, even more ominously, appears to be resistant to fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin. This strain has thus far been found only in hospitalized patients and some LTC facilities and not in the community.

And this news doesn’t surprise me at all: Community acquired C Diff. The challenges this will present will be very difficult to deal with.

Heightened awareness of C. diff could help facilities develop more effective preventive strategies to reduce incidences of infection. Most basic strategies call for increased attention to personal hygiene. Because the primary means of transmission seems to be via the hands of healthcare workers and other patients and residents, proper sanitation (handwashing) and barriers (gloves, gowns) are considered by infectious disease experts to be the most effective measures of disease control in healthcare settings. Regular and thorough cleaning of patient rooms with antibacterial cleaning agents—including bleach at a 1:10 dilution in water—can be effective in reducing the presence of C. diff spores in the environment.

We can’t say it LOUD enough: WASH YOUR HANDS. WITH SOAP AND WATER. DO not use gel sanitizers- they don’t kill all the spores. I know of a few nursing homes in my area that insist the staff DO USE the gels, and also, use the gels to wipe down surfaces and door knobs! These places have entire units of residents infected and re-infected with C Diff…it’s because they’re not following the proper hand cleaning procedures.

CDC Web Site on C Diff

About noroviruses:

A breakthrough announced this week by scientists at the University of Southampton’s School of Medicine will lead to greater understanding of noroviruses, the most common cause of non-bacterial gastroenteritis around the world.

Traditionally very little has been known about the biology of noroviruses because of the difficulty in culturing and manipulating these pathogens in the laboratory. Now the Southampton team, assisted by colleagues at the University of Otago and Washington University Medical School, has devised a system for manipulating the genome of the murine norovirus (MNV) which affects rodents. This breakthrough will lead to a greater understanding of how these pathogens work and, it is hoped, lead to ways of controlling them.

Human noroviruses, which are closely related to the murine norovirus, are responsible for extensive outbreaks of diarrhoea and vomiting in cruise ships, hotels, schools and hospitals. Up to a million cases of norovirus infection are estimated to occur annually in the UK.

‘The human noroviruses have been exceedingly difficult to work with as there is no cell culture system to propagate these viruses, and as a result very little is known about their biology,’ comments Professor Ian Clarke, who heads the Virus Group at Southampton.

‘In the absence of a cell culture system, MNV is a surrogate for study of the human noroviruses. This study represents the culmination of a ten-year research quest in Southampton to obtain recovery of a live norovirus from its nucleic acid.’

The team in Southampton included Drs Vernon Ward, Christopher McCormick, Omar Salim and Paul Lambden and Professor Clarke. Together with Drs Larissa Thackray, Christiane Wobus and Skip Virgin at Washington University School of Medicine they devised a novel way of introducing a complete DNA copy of the MNV RNA genome into human cells grown in the laboratory. This allowed recovery for the first time of intact, functional viral particles from human tissue culture. They also used their system to mutate the virus so that they could identify a sequence that is essential for viral replication.

Their reverse infectious genetics system will be an essential tool for understanding the replication and molecular biology of this and human noroviruses and will help in the development of antivirals aimed at controlling infections.

The work, which was funded through a Wellcome Trust project grant, is published in the Proceedings of the National Academy of Sciences (USA) this week.

Good work. Now if we get these antivirals to work…

FYI: