PurThread | healthcare-acquired infections

Antibacterial Ions in Clay

May 28, 2013 By PurThread Leave a Comment

Dead dry land and drug Antibiotic-resistant pathogens such as E. coli and methicillin-resistant Staphylococcus aureus (MRSA) have created a need for new antibacterial approaches. Research featuring one such antibacterial innovation using clay, a material used for its medicinal properties since ancient times, was reported in PLOS ONE (the journal of the Public Library of Science).

In this case, the innovation involves the antibacterial mechanism: specific metal ions attached to the clay. Rather than taking advantage of clay’s absorption power, this study found that the effective antibacterial mechanism is the release of specific metal ions with microbiocidal properties from the clay’s surface.

Comparisons of the antibacterial effect on pathogens of similar clay samples with different levels of iron, copper, cobalt, nickel, and zinc ions demonstrate the dominant role of those ions. Variability of antibacterial strength in clay samples correlates with the clay’s chemical variability.

Now that the mechanism has been demonstrated, further research will look to standardize the composition and antibacterial efficacy of clay, and define appropriate safety precautions to avoid effects of toxic minerals that are often also present in clays. If this works out, it could lead to another point for ancient wisdom’s applicability to modern research innovations.

PurThread^TM Technologies Inc. is dedicated to developing proprietary antimicrobial textile technology. Our patent-pending, integration technology and fiber formulations incorporate an EPA-registered antimicrobial additive into every fiber and yarn to protect the fabric from degradation. Learn more about our antimicrobial textile technology.

PurThread also makes a range of freshness products for other markets such as the military, emergency first responders and performance athletic wear in which our next-generation technology and fiber formulations expand the high performance options available to protect fabrics from odor, mold and mildew causing bacteria.

Filed Under: News Tagged With: antibacterial, healthcare-acquired infections, pathogens

Gloves? Bands? Help for Hand Hygiene Compliance

April 30, 2013 By PurThread Leave a Comment

iStock_000014696689Small glove Hand hygiene (HH) compliance is widely recognized as an essential factor in preventing healthcare-acquired infections (HAIs). However, hand hygiene compliance is inconsistent at best. Estimates of overall HH compliance in the U.S. range from 26% to over 75%. In other words, no one knows for sure what is the real hand hygiene compliance rate .

Two recent announcements may hold hope for reducing HAIs:

A study of HAIs in a pediatric units, recently published in Pediatrics, indicates that mandatory gloving of clinicians may reduce the risk of HAIs. Between 2002 and 2010, the researchers from the University of Iowa compared HAIs during periods where mandatory gloving policies were in effect with other periods when gloving was not required. They found that the risk of HAIs was 25% lower during mandatory gloving periods, and thus, that the results suggest a potential clinical benefit for universal gloving in acute care pediatric units.

Addressing the hand hygiene compliance issue, as discussed in the December 13, 2012 installment of this blog, requires a combination of training, education, system change, workplace reminders, monitoring, and institutional culture changes.

A system introduced by a company called IntelligentM at the TEDMED conference last week claims to simplify the reminders and monitoring factors. The core of their system is a wristband (called a smartband) that interacts with RFID and Bluetooth tags on hand sanitizers, soap dispensers, and medical equipment and products.

The wristband will issue a vibrating reminder if the clinician approaches catheter packaging, for example, without having performed hand hygiene first, or when proper protocols have not been followed. The system can also report compliance data to the administrative department on an individual clinician or aggregated department or location basis.

Both of these measures—mandatory gloving and wristband monitoring systems—sound expensive and difficult to implement. However, the comparative cost in dollars or in patient consequences are likely to make these measures seem much more accessible.

Filed Under: News Tagged With: HAIs, hand hygiene compliance, healthcare-acquired infections

Infection control efforts undone by dirty needles?

April 17, 2013 By PurThread Leave a Comment

iStock_000012926478Small needle Infection control is a complex endeavor. As we’ve mentioned in this column many times before, successful healthcare-associated infection control requires a multifaceted approach: hand hygiene, environmental services, antimicrobial hard and soft surfaces, basic best surgical and instrument-handling practices and more. That’s why it’s so surprising to most Americans that reusing syringes or drawing multiple doses from single-use vials of medications in healthcare settings is still a problem.

Granted, it’s only a small percentage of injections that violate CDC injection safety protocols, but it’s somewhat shocking that it happens at all. Approximately 150,000 people¹ have been affected by inappropriate injection practices over the past decade. However, the impact on some of the affected patients and facilities can be dramatic, including outbreaks of MRSA, hepatitis B, and hepatitis C.

A survey reported in the American Journal of Infection Control, found that 6% of clinical personnel questioned said they “sometimes or always” use single-dose/single-use vials for more than one patient. Other less frequently cited practices that are inconsistent with current guidelines included overt syringe reuse and use of a bottle or bag of IV solution for more than one patient. All reported infractions, by the way, occurred about evenly in hospital and non-hospital settings—outpatient cancer clinics, hemodialysis clinics, dental offices, pain clinics, and so on.

The survey concluded that a multifaceted approach would be needed to reduce or eliminate unsafe injection practices. Use of educational resources from the Centers for Disease Control and Prevention (CDC) and others, redesign of devices to reduce the risks of unsafe practices, surveillance and monitoring, and enforcement of those protocols and laws. In addition, the study recommends developing a culture where patients, supervisors, and peers are vigilant to make sure safe practices are followed and vocal in questioning health care providers to make sure injections are safe.

¹ Dirty medical needles put tens of thousands at risk in USA USA Today, March 6, 2013

Filed Under: News Tagged With: healthcare-acquired infections, infection control, injection safety

Antibiotic Resistance: Hearing the alarm sound

April 5, 2013 By PurThread Leave a Comment

Big Red Bell Antibiotic-resistant bacteria have been the subject of recent news items designed to bring the issue to the world’s attention, and with the threat of widespread incurable infections, that attention may well be overdue. The story that triggered the media flurry aired on NPR’s All Things Considered, and reported on the increased incidence of carbapenem-resistant Enterobacteriaceae (CRE). CRE are resistant to nearly all antibiotics (including carbapenems, often the drugs of last resort), can transfer their resistance to other bacteria, and cause often fatal infections. The UK’s chief medical officer, Dame Sally Davies, reported to the Parliament’s Commons committee on Science and Technology that unless improvements are made, society may face an apocalyptic scenario in which routine infections are untreatable due to the lack of effective antibiotics. She also compared that risk to a catastrophic terrorist attack, a pandemic flu or massive flooding.

Here are some reasons none of us can be complacent about infection prevention:

According to the Centers for Disease Control (CDC) report that was the source for the NPR story, the proportion of bacteria that are antibiotic-resistant has quadrupled in the last 10 years.
Research by a team of doctors in Israel found that CRE infections were still present in patients a year after they were first identified, which gives rise to concern about community transmission of the bacteria once patients who had CRE are released from the hospital.
The development pipeline for new antibiotics is running dry. While a new infectious disease has been discovered in each of the past 30 years, very few new antibiotics have been developed in that time. A commonly cited reason for that situation is the high cost of development and the focus of pharmaceutical companies on more profitable drugs to treat chronic conditions.

Many efforts are underway to prevent or control the growth of antibiotic resistance. The CDC and Professor Davies’ Annual Report both provide guidelines and recommendations for approaching the problem. Those recommendations include:

Careful antibiotic management, sometimes referred to as “antibiotic stewardship,” to avoid overuse, misuse or abuse, and to prevent antibiotic resistance at the patient and community levels.
Government investment in and incentives for new antibiotic research and development.
Infection control and prevention directed at multiple bacteria and all—healthy and infected—patients.

PurThread also makes a range of freshness products for other markets such as the military, emergency first responders and performance athletic wear in which our next-generation technology and fiber formulations expand the high performance options available to protect fabrics from odor, mold and mildew causing bacteria.

Filed Under: News Tagged With: antibiotic resistance, antibiotic resistant bacteria, healthcare-acquired infections

Superbugs vulnerable to virus?

March 17, 2013 By PurThread Leave a Comment

Bacterial infections, including so-called superbugs, or antibiotic-resistant bacteria, may ultimately be addressed by viruses, or at least that’s the hope indicated by a study recently published in the journal Nature. It may sound like the plot of a cartoon or video game, but researchers at Tufts University School of Medicine found the first evidence that bacteriophages can “hijack” the host bacteria’s immune system and use it to destroy that host. Bacteriophages (or phages, for short) are viruses that prey on specific bacteria. The study followed a phage that is a viral predator of Vibrio cholera, the bacterium that causes human cholera epidemics, and verified the results by infecting the same strain of cholera bacteria with phage that lacked the adaptive immune system.

Most bacteria are vulnerable to phages, and have immune mechanisms to protect themselves. About half of known bacteria use an adaptive system, CRISPR/Cas (Clustered Regularly Interspaced Short Palindromic Repeats) that can rapidly respond to a wide variety of attacks. Phages were previously believed to be primitive DNA or RNA particles. This is the first evidence that something as complex as an adaptive immune system can be transferred from a bacteria to a virus. Once it’s transferred, that immune system adapts and turns on its former owner, and then the virus can replicate and destroy more bacteria.

With this knowledge, phage therapy, using phages to treat bacterial diseases, moves a little closer to becoming a reality. The research team is currently studying the mechanism by which the phage immune system disables the cholera bacteria’s defenses, a step towards the design of a phage therapy for cholera in humans. Hopefully, phage therapy for other superbugs will follow.

Holding out such hope is especially important in light of the recent report from the Centers for Disease Control and Prevention about the rise of carbapenem-resistant Enterobacteriaceae (CRE). Those CRE germs are resistant to nearly all current antibiotics, and what’s worse, are able to spread that resistance to other bacteria.

Until phages or other solutions are available, a multifaceted approach to getting superbugs under control is essential. We have to focus on reducing the risk of infection in addition to detecting and treating existing infections. Superior environmental hygiene practices are a critical part of that process, but are often dependent upon the vagaries of human behavior. While proper hand hygiene is the keystone of effective infection prevention systems, compliance is always lacking. So, healthcare leaders need to adopt technologies that continuously reduce bioburden on hospital surfaces around the clock – independent of human intervention.

iStock_000006470674Small bacteriophage

Bacteriophage (virus that infects bacteria)

Filed Under: News Tagged With: bacteria, healthcare-acquired infections, superbug, virus

Antimicrobial peptides and salivary proteins

February 26, 2013 By PurThread 1 Comment

Antimicrobial agents from living beings hold the promise of helping with efforts to reduce infections. Two separate research efforts indicate sufficient potential to warrant more research and, hopefully, application: One uses a genetically engineered variant of a protein found in human saliva to reduce Candida infections; the other applies the antimicrobial peptides found in fish gills to kill E. coli pathogens.

Boston University professor, Dr. Frank Oppenheim led a team that genetically engineered a variant of the human saliva protein, histatin 3, which is known to have antimicrobial—both antifungal and antibacterial—properties. The study, Anti-candidal activity of genetically engineered histatin variants with multiple functional domains, demonstrated that duplicating active functional domains in the amino acid sequence can enhance their antifungal properties. Histatin preparations have already demonstrated their effectiveness in reducing Candida infections in AIDS patients. Antibacterial and antifungal mouthwash is one possible application. Genetically enhanced histatins could also be used to address skin infections.

Meanwhile, researchers at Worchester Polytechnic Institute in Massachusetts hope to adapt the fish gill antimicrobial peptide to create bacteria-killing surfaces. Such surfaces may help reduce healthcare-acquired infections. Fish have evolved powerful defenses, including the antimicrobial peptide Chrysophsin-1 to trap and kill water-borne pathogens before they enter the bloodstream. The researchers’ study, Creating Antibacterial Surfaces with the Peptide Chrysophsin-1 is part of their effort to understand the biochemical mechanics of the pathogen-trapping process.

Using two different methods to attach the peptide to silicon and gold surfaces, the researchers then measured how well the bound peptides killed E. coli, a bacterial pathogen. When the peptides were absorbed directly into the gold and silicon crystals, and thus were lying flat on the surface, they killed 34 percent of the culture’s bacteria. However, when the peptides were glued so that the peptides seemed to be standing on their ends, they killed 82 per cent of the bacteria. Next on their research agenda is to adapt the process to titanium, stainless steel, and plastic, materials that are commonly used in food preparation and healthcare.

The peptide Chrysophsin-1, found in fish gills, is being studied for its antimicrobial properties and possible role in infection reduction in healthcare settings.

Filed Under: News Tagged With: antibacterial, antimicrobial, healthcare-acquired infections, infection reduction

NIH Outbreak Brings HAIs to National Attention

September 11, 2012 By PurThread

NIH Outbreak Brings HAIs to National Attention The National Institutes of Health’s (NIH) Clinical Center was open about the history of last year’s outbreak of Klebsiella pneumoniae, an antibiotic-resistant bacteria, despite their best efforts to prevent and contain it. That openness brought healthcare acquired infections (HAIs) and the issues of antibiotic use and development into the national media.

NPR’s Diane Rehm show on Tuesday, August 28^th did a good job of summarizing the issues:

Increasing use of antibiotics creates more antibiotic-resistant bacteria, like the one that caused the NIH outbreak.
Widespread use of antibiotics in animals, to promote growth, exacerbates the resistance to antibiotics in organisms.
Some doctors start treatment with a more broad-based antibiotic than the situation requires.
And the relatively short term in which people need to take antibiotics makes it less attractive or profitable for pharmaceutical companies to develop the new antibiotics we need to keep up with adaptive resistant bacteria.

One of the show’s guests made a comment that could be construed to mean that human error and the inevitability of people shortcutting the protocols are what prevent us from stopping the spread of a rampant infection. Dr. Michael Bell of the Centers for Disease Control said, “we can stamp out these infections very, very effectively. Once you detect, you protect. The problem is that people cheat. It’s very, very tempting, when you’re very busy and trying to do a lot of things for a lot of patients, to cuddle to a corner, to slip into a room without putting on a gown, slip back out. And when that happens, that opens a pathway for the organism to be carried to yet another patient.” Unfortunately, the NIH case disproves that idea.

That outbreak took place at one of the most advanced and specialized hospitals in the country. The hospital took all the right precautions of isolation, education, hygiene, and environmental service protocols, and even had personnel to monitor compliance to those procedures. And yet new cases of infection arose weekly. Clearly, handwashing and those other protocols are essential to controlling infection. However, by themselves, they’re not sufficient to the task.

Healthcare-acquired infections are a complex problem that will require ongoing and multi-faceted effort: careful antibiotic stewardship, hygiene and environmental service protocols, hard and soft surface management, ventilation and education—of medical personnel, patients, and the public—must work in concert to prevent and control infections.

Filed Under: News Tagged With: antibacterial, antibiotic resistant bacteria, antimicrobial, hand washing, healthcare-acquired infections, hospitals, superbugs

PurThread: Textile World’s Quality Fabric of the Month

August 28, 2012 By PurThread

We were honored by Textile World’s coverage this month. The article did a good job of summarizing the reason we are developing this fiber technology. Healthcare-acquired infections (HAIs) are a significant problem that kill almost 100,000 people each year in the US alone. Sadly as was seen in the recent stories about the 2011 superbug outbreak at NIH, hand hygiene and other current practices are insufficient to the challenge. We are developing continuously active fabrics based on proprietary integration technology and a complex element compound. Once these textiles complete a thorough government review, PurThread will introduce privacy curtains, scrubs, bed linens and other fabric products used in healthcare facilities with the goal of reducing bioburden on these soft surfaces, helping to break the chain of pathogen transmission from those surfaces to healthcare worker hands that all too frequently form the bus network delivering pathogens to patients.

The article refers to both the study showing that 92 percent of traditional hospital privacy curtains became contaminated within one week of being laundered, and an upcoming peer-reviewed study of the efficacy of PurThread privacy curtains in reducing bioburden on the curtains themselves. In developing these products we are focusing not only on delivering fabric surfaces that will make a measurable difference in tough clinical settings, but also on making fabrics that have a soft, comfortable feel and that require no special handling or laundry protocols.

We extend our thanks to Textile World for the recognition.

Filed Under: News Tagged With: antibacterial, antimicrobial, bioburden, contamination, fiber, healthcare-acquired infections, hospital privacy curtain, hospital-acquired infections, pathogen, textiles

Wiped Out: Disinfecting Hard Surfaces

July 17, 2012 By PurThread

As effective as hard surface disinfection protocols have become, there’s still a place for the extra jars of wipes because disinfecting happens at a single point in time and frequent recontamination is common. When one of our team went in for surgery a few years ago, his wife brought along a couple of jars of disinfecting wipes to his room, so that there would be no reason for personnel not to wipe down every area after every interaction. Not long before, that might have seemed excessive. But with what we now know about healthcare acquired infections (HAIs), it’s both common practice and common sense.

Since contact is with intact skin, environmental hard surfaces are considered to be noncritical items with little risk of directly causing infections in patients or staff. However, hard surfaces are touch points where bacteria can be spread and cross contamination can occur. Further, detergents or cleaning utensils can become contaminated and actually foster the spread of infections they are being used to prevent. For those reasons and to simplify environmental services training and practices, it generally makes sense for hospitals and healthcare facilities to disinfect environmental surfaces, rather than merely wash them with detergents. Individual facilities use protocols that match their needs and situations.

Ultimately, hard surface cleaning protocols boil down to a balance among contaminant elimination, product efficacy and resources (cost and available labor). The CDC provides guidelines for disinfection of equipment or environmental surface that can be summarized by the fact that more numerous or more resistant microorganisms require more potent disinfectants or more contact time (length of exposure of the item to germicide).

Disinfectants are available in spray, disposable wipe, or liquid detergent form, and alcohol, chlorine, quaternary ammonium, and phenolics each have their advantages in specific applications for hard surfaces. Surfaces that are likely to be touched more frequently may need more frequent disinfection, usually via disposable wipes. Other areas of the room may do well with spray or mop applications and reusable wipe cloths or mop heads.

As effective as hard surface disinfection protocols have become, though, there’s still a place for the extra jars of wipes brought in by a vigilant spouse because disinfecting happens at a single point in time and frequent recontamination is common. (See this article in the American Journal of Infection Control.)

Filed Under: News Tagged With: cleaning protocols, contamination, disinfectants, disinfection, disposable wipes, environmental services, hard surfaces, healthcare-acquired infections, recontamination

Happy Birthday to Hand Hygiene’s Dad?

June 26, 2012 By PurThread

Just before we celebrate the birthday of the U.S., we should stop and think about the 194^th anniversary of the birth of Dr. Ignaz Semmelweis.

Born in Hungary on July 1, 1818, Dr, Semmelweis was an assistant in the obstetrics unit of a Vienna hospital when he noticed that women whose babies were delivered by doctors and medical students had a much higher post-delivery mortality rate (13-18%) than women whose deliveries were performed by midwives or midwife trainees (2%).

He hypothesized that the differences were due to doctors and medical students handling corpses before performing deliveries, thus exposing the women to cadaveric material that led to puerperal (childbed) fever.

Dr. Semmelweis, father of hand hygiene

Despite the fact that his theory contradicted the miasmatic (bad or polluted air) theory of disease that was the prevailing wisdom of the day, Dr. Semmelweis conducted a controlled trial where physicians and students washed their hands with a chloride of lime solution before touching their maternity patients. The resulting 2% mortality rate (equivalent to that of the midwives) proved his point.

He later reduced the mortality rate even further (to 1%) by washing the medical instruments. Thus, he has been known as the “father of hand hygiene” and the “savior of mothers.”

What he offered in medical insight, he unfortunately lacked in change management skills. His understanding of germ theory 20 years before it was acknowledged was prescient, but he was never able to overcome the popular theories and resistance to change.

His handwashing protocols and improvements to healthcare were not implemented until long after his death, when Pasteur and Lister proved germ theory and the value of those protocols.

(Now that I’ve conveyed this story, I’m going to stop typing and go wash my hands. Thanks, Dr. Semmelweis!!)

Filed Under: News Tagged With: control infection, hand hygiene, hand hygiene compliance, hand washing, healthcare-acquired infections, hospital acquired infection, infection control, infection control measures in hospitals, infection rates