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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.

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: 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

Infectious Norovirus: What Can We Learn from Vomiting Larry?

February 12, 2013 By PurThread Leave a Comment

The robot’s name may be fanciful, but the task it’s tackling is quite serious. Researchers at the Health and Safety Laboratory in Derbyshire in Great Britain are using “Vomiting Larry” to learn more about how the infectious norovirus spreads. Vomiting Larry is a humanoid simulated vomiting system that expels a water and fluorescent liquid mixture enabling ultraviolet light to track the pattern and distance of expulsion, if you will.

That pattern is particularly important in understanding the spread of norovirus, a highly contagious virus that causes vomiting and diarrhea. In most cases, it is extremely unpleasant for a few days, but under some conditions it can be very dangerous or even fatal.

Named for an early outbreak at a high school in Norwalk, Ohio, norovirus is the leading cause of foodborne disease and the cause of half of all worldwide gastroenteritis outbreaks, according to the report Noroviruses: The Perfect Human Pathogens? from the Centers for Disease Control (CDC). The CDC estimates that norovirus caused 21 million cases of acute gastroenteritis annually in the U.S. alone.

When norovirus invades human cells in the intestinal tract, it rapidly multiplies, and causes the violent emptying symptoms, referred to above. The expelled fluids contain billions of infectious doses of the norovirus, and many paths exist for transmitting those doses to a new host.

Noroviruses are notoriously robust, able to survive freezing and heating as well as many common chemical disinfectants, and can live on surfaces for up to two weeks. Among the ways infectious noroviruses can spread is through ingestion of airborne or aerosolized particles. With such potent doses of the virus carried in such small amounts of fluid, it’s critical that all surfaces and objects in range of those aerosolized particles be effectively disinfected, or discarded.

That’s why Larry is vomiting fluorescent fluid: to determine how far and wide expelled fluid can travel. Some of that fluorescent fluid has been traced more than three meters from Larry. So an object or surface about ten feet away from an incident that was contaminated two weeks ago could still cause transmission of the norovirus. The researchers intend to publish their more detailed findings in relevant journals and hope that the results can contribute to healthcare and procedure guidance in hospitals other medical facilities.

The robustness of the norovirus makes prevention and control of outbreaks particularly difficult. The CDC recommends rigorous hand hygiene (especially mechanical washing with soap and water), exclusion and isolation when possible, environmental disinfection (particularly with a high concentration of chlorine bleach), and thorough cooking of food whenever possible.

Meanwhile, let’s hope Larry is doing what he does, so we won’t have to.

“Vomiting Larry” helps researchers understand the spread of infectious norovirus
Warning: This video shows the robot doing what he was built to do. If you’re a little squeamish, please don’t press ‘Play.”

PurThread hopes to help hospitals reduce bioburden on fabric surfaces in the patient environment. Our linens, privacy curtains, and scrubs are easy substitutes for current healthcare textiles. We are researching the impact of these products in the clinical environment. A recent article in the journal Infection Control and Hospital Epidemiology (ICHE) cited encouraging preliminary results from a randomized, controlled clinical study that incorporated privacy curtains using PurThread technology. The EPA has not yet reviewed any potential public health claims for PurThread products.

Filed Under: News Tagged With: hand hygiene, infectious, norovirus

Is that C. diff you sniff? Good dog!

February 5, 2013 By PurThread Leave a Comment

It’s no secret that the canine sense of smell is much more sensitive than our own. Now researchers in the Netherlands have shown how that sensitivity can be applied to identification and diagnosis of Clostridium difficile with remarkable accuracy. More importantly, implementing a canine-based monitoring system for early detection could help control the spread of the infection.

The research paper in the British Medical Journal, Using a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: proof of principle study, describes how a 2-year-old beagle was trained to differentiate known C. diff-infected stool samples from controls. Further, the researchers trained the dog to sit or lie down when C. diff was detected.

The dog’s accuracy was very impressive: sensitivity and specificity were both 100% using samples in the lab. On detection rounds, he correctly identified 25 of the 30 known cases, and 265 of the 270 controls. The paper estimates that most cases of C. diff take 2-7 days to diagnose and start treatment, and suggest that a regular program of canine detection rounds could lead to earlier detection and treatment.

Looking forward to seeing how else you can help, Dr. Dawg.

Filed Under: News Tagged With: Clostridium difficile, early detection, hospital associated infections, infection control, prevention, treatment

Hand Hygiene in Everyday Life

January 29, 2013 By PurThread Leave a Comment

Hand Hygiene in Everyday Life We wouldn’t normally look to a study about business sustainability for data about handwashing and hygiene, but the 2012 Tork Report: The Sustainability Gap contains an informative, and sometimes troubling, section on the effects of health and hygiene on sustainability.

For example, although 70 percent of Americans say they practice good hand hygiene,

33 percent of men don’t wash their hands after using the restroom. (Time to rethink that hearty handshake?)
98 percent of those interviewed underestimated the average number of surfaces we touch every 30 minutes (answer: 300)
Only 10% of Americans knew that germs stay alive for 48 hours on inanimate surfaces.
Fewer than half of Americans wash their hands after using exercise equipment, handling money, or taking public transportation, each of which is likely to be more contaminated with germs than the restroom.
47 percent of employed adults in the U.S. eat meals at their workstation, where desks can carry 400 times more dangerous bacteria than the average public toilet seat.

So while we’re all in the mode of resolving to change some behavior or other, we can try to wash our hands more frequently, and eat at our desks less often. And, it’s probably a good time (any time is probably a good time) to use a disinfectant wipe on your workstation.

Filed Under: News Tagged With: antimicrobial, bacteria, disinfectant, germs, hand hygiene, surface contamination

Nurse Wise, Pound Foolish?

December 19, 2012 By PurThread Leave a Comment

Hospital staffing is a delicate balance between patient comfort and hospital profitability. However, that ratio doesn’t always follow intuitive guidelines: In some instances, an increase in staffing can actually save money.

A recently published study indicates that when a nurse’s patient load is high enough to increase burnout, the incidence of two types of healthcare-associated infections—urinary tract infections and surgical site infections—also increases. The results in Nurse staffing, burnout, and health care-associated infection¹ show the correlation between adding 1 patient to a nurse’s workload and an additional 5-7 infections per 1000 patients.

Beyond workload, the study also used a survey to measure nurse burnout. Reducing infection rates saves hospitals money – adding to the bottom line, and the authors examine the financial impact of reducing infection rates by reducing burnout. While burnout reduction measures such as optimized staffing levels, educational intervention, performance feedback, and social support all require investment, the return on that investment from reduced infection rates may be significant.

Of course, increasing nurse staffing levels and instituting or increasing other measures to reduce burnout could have additional benefits. Besides reducing infection rates and improving other patient outcomes, those actions can enhance nurses’ well-being and morale.

¹ AJIC: American Journal of Infection Control
Volume 40, Issue 6, Pages 486-490, August 2012

Filed Under: News Tagged With: burnout, HAIs, healthcare associated infections, nurse staffing level, nursing, patient care, surgical site infections, urinary tract infections

Hand Hygiene Compliance as Part of a Multifaceted Approach to Infection Control

December 13, 2012 By PurThread 1 Comment

What are the top 10 ways to spread germs? Why do we so frequently use the term “multifaceted approach” when we talk about what’s required to address the problem of healthcare associated infections (HAIs)? Here’s one reason: hand hygiene is widely acknowledged as an essential element of any HAI control program, and hand hygiene compliance rates vary widely among medical personnel, let alone hospital visitors.

The Resources section of this site includes some basic information about hand hygiene. In addition, we provide links to two other comprehensive programs to help healthcare facilities improve their hand hygiene compliance rates. The advice in those programs fall into five categories:

Training and education – making sure all personnel, including new hires, understand the proper protocols
System change/infrastructure – supplies and systems to make compliance easy
Workplace reminders – basically strategically placed signage
Monitoring and feedback – praise for compliance, accountability for non-compliance
Institutional culture – patient safety, and especially hand hygiene, should be a priority, and everyone should know it.

World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy

Society of Healthcare Epidemiology of America (SHEA) How-to Guide: Improving Hand Hygiene – A Guide for Improving Practices among Health Care Workers

Filed Under: News Tagged With: HAIs, hand hygiene, hand hygiene compliance, healthcare associated infections, infection control, patient safety