Antimicrobial properties protect cystic fibrosis patients from infection

Antimicrobial properties protect cystic fibrosis patients from infection

Published Date: 14 April 2010 I

TS antimicrobial properties have been known for centuries - the Egyptians, Greeks, and Romans all used copper to clean wounds and promote good hygiene.But now the substance is enjoying a rebirth - and a new Sheffield healthcare development is leading the way.

The Cystic Fibrosis Unit at the Northern General Hospital will be the first NHS facility to embrace copper's unique properties by using it on door handles, locks and push and and kick door plates. it is just one of the pioneering elements of the unit which is being brought to the city as part of a £1 million Star-backed campaign to make it 'world class'.

The Copper Development Agency has also got on board, commissioning metal worker Adaesi Ukairo to produce a piece of copper artwork for the unit.

Bryony Samuel, from the agency, said: "The science behind the use of copper in infection control is not new, but what is more recent is the laboratory work which proves that it does kill germs and viruses. A study found that there was 90 to 100 per cent less contamination on copper surfaces, compared to non-copper surfaces."

The news is particularly relevant to cystic fibrosis patients who are very vulnerable to infection.
Rebecca Haverty, lead designer from the unit's architects Race Cottam, said: "Common materials such as plastics may look clean but they have no inherent antimicrobial efficacy.
Copper alloys can help to fight infection so we were very keen to use them."

Consultant Dr Frank Edenborough added: "Once CF patients get infections they can be difficult to get rid of and they tend to suffer recurrent bouts. The more they have an infection, the more their lungs are damaged." Visit www.shctonline.org.uk or call 0114 271 1351

http://www.thestar.co.uk/news/Antimicrobial-properties-protect-cystic-fibrosis.6224420.jp

Patient segregation and aggressive antibiotic eradication therapy can control methicillin-resistant Staphylococcus aureus at large cystic fibrosis cen

J Cyst Fibros. 2010 Mar;9(2):104-9. Epub 2010 Jan 3.

Patient segregation and aggressive antibiotic eradication therapy can control methicillin-resistant Staphylococcus aureus at large cystic fibrosis centres.

Doe SJ, McSorley A, Isalska B, Kearns AM, Bright-Thomas R, Brennan AL, Webb AK, Jones AM.
Manchester Adult CF Centre, University Hospitals of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK. simondoe@doctors.org.uk

BACKGROUND: The prevalence of MRSA in patients with CF has risen in recent years. We adhere to a policy of segregation and barrier nursing to manage patients with MRSA, and we actively pursue eradication of MRSA. We have evaluated our experiences of MRSA infection in our large adult CF centre.

METHOD: A retrospective review of all MRSA-positive patients from 1998 to 2008 was undertaken. Isolates were subjected to molecular identification to elucidate possible patient-to-patient transmission events. Eradication attempts were scrutinised.

RESULTS: We have maintained a low incidence and prevalence (below 3%) of MRSA within this large cohort. A total of 15 pulsotypes of MRSA were identified among the 24 isolates examined, epidemiological data suggested no patient-patient transmission. Based on 6 month follow-up data, successful eradication was achieved in 81% patients. This includes those who had harboured infection for some time. Twenty-one (80.8%) required only one course of treatment, 3 (11.6%) patients required two different regimes and 2 (7.5%) required three courses to fully eradicate the organism.

CONCLUSION: Strict infection control procedures can control MRSA infection and keep the prevalence low in CF clinics. Eradication is achievable in the majority of patients even when significant time has lapsed from initial isolation. In some instances, up to 3 courses of antibiotics were required to achieve eradication.

Ten Steps to Preventing Infection in Hospitals

As CFer's, this is a no-brainer. We know that there is often poor infection control in the hospital setting.

But we're particularly vulnerable to picking up C Dif, MRSA and even Cepacia in hospitals if proper infection control isn't followed. I thought this article served as a great reminder for us all....

OCTOBER 27, 2009

Ten Steps to Preventing Infection in Hospitals
Too many patients get sick in the very places that are supposed to heal them



By STEPHANIE SIMON

The facts are frightening: As many as one in 10 patients hospitalized in the U.S. will come down with an infection—often due to the very care that is supposed to be restoring health.
These infections afflict nearly two million patients a year, cause close to 100,000 deaths and cost up to $6.5 billion.

But they are not inevitable.

Here are 10 ways to prevent infection in health-care settings—a list gleaned from conversations with doctors, nurses, administrators, the nonprofit Committee to Reduce Infection Deaths, and the Association for Professionals in Infection Control and Epidemiology.
We've divided the list into two parts: first, promising new technologies, and second, a look at back-to-basics techniques that many hospitals have reinvigorated, with great success.

NEW TECHNOLOGIES
1. UNDERCOVER AGENTS
Some of the most vicious vectors of infection can survive for weeks on medical equipment and in patient rooms. The culprits include the drug-resistant MRSA bacteria, which can cause staph infections, and the nasty Clostridium difficile, or C. diff, which causes severe diarrhea.
Hospitals, of course, have rigorous protocols for cleaning. But how well are they doing?
To find out, Philip Carling, an epidemiologist at Caritas Carney Hospital in Dorchester, Mass., went undercover. He developed an invisible solution with fluorescent markers and sprayed it all over patient rooms in dozens of hospitals. Then he let cleaning crews do their thing. Afterward, he went over each room with a black light. Any spot the crews missed would glow fluorescent.
Turned out they missed a lot.

Toilets sparkled. But bathroom light switches and door knobs did not. Telephones, nurse-call buttons and grab rails were all routinely contaminated.

Showing the results to cleaning crews—and training them to do better—helped a great deal, boosting compliance with proper cleaning techniques to 77% from 44%. Dr. Carling has licensed the fluorescent solution and a training program to

2. ROBOTIC HELPERS When surgeon Bolanle Asiyanbola tested emergency-room equipment that had been disinfected by hand, she found one in four pieces was still contaminated with bacteria.
Enter SUDS, a shower-sized cubicle with a fogging mechanism inside.
Dr. Asiyanbola led the team at Johns Hopkins that developed SUDS to disinfect even the most hard-to-clean equipment, such as electrocardiogram wires. She recently published a study showing that devices cleaned in SUDS stayed clean for two days, even after they'd been reused.
SUDS is not yet on the market. But other systems are, among them the Bioquell Z, a little machine that sprays a disinfecting hydrogen-peroxide vapor—and looks an awful lot like the Star Wars robot R2D2.

Crews wheel the Bioquell Z, which is made by Bioquell Inc., of Horsham, Pa., into a patient's room and seal the door. About 90 minutes later, the room and any equipment inside are disinfected, with no residual smell.

3. COMPUTER SURVEILLANCE One of the hottest new fields in infection prevention is data mining. Software such as CareFusion Corp.'s MedMined Data Surveillance tracks a hospital's admission, discharge and transfer data and laboratory results.
The system might pick up on, say, a spike in urinary-tract infections on one floor. Doctors can then take immediate precautions—reviewing procedures, disinfecting equipment and checking for defective catheters.

Such software can cost tens of thousands of dollars to install and more to run, but devotees say it saves money and lives.

And don't underestimate the motivational power of data. Stephen Streed, director of epidemiology at Lee Memorial Health System in Florida, tracks infection rate by surgeon—and then posts a list annually in his four hospitals. The list is coded to protect anonymity, but each surgeon knows his or her ranking.

"They growl a bit, but then they find their way to my office and ask, 'Why am I in the bottom third of this list?' " Dr. Streed says. Those at the bottom soon improve. "It's a very, very powerful tool," he says.

4. BUG-BLASTING BATHS Recent research suggests that washing ill patients daily with a mild antibacterial soap can cut bloodstream infections dramatically.

The soap of choice, chlorhexidine glutonate, comes in several formulations, including a bar of soap and a baby-wipe cloth. It's available over the counter.

Many doctors are wary about prescribing antibacterial agents because overuse can spur the rapid evolution of drug-resistant bugs. But some experts suggest it may be helpful for patients facing surgery to shower with chlorhexidine for two to four days before the operation.

5. REPORTING LAWS At least 25 states have passed laws requiring hospitals to report rates of common infections. In most cases, the reports are—or soon will be—publicly available. That, of course, is a big incentive for hospitals to improve. Another incentive: Medicare now limits reimbursement for treatment of hospital-associated infections.

All this is helping change hospital culture. "We used to think of this as the job of the infection-control nurse," says Nancy Foster, a vice president at the American Hospital Association. "Now we know everyone needs to be involved."

BACK TO BASICS

1. HAND HYGIENE David Hooper, the chief of infection control at Massachusetts General Hospital, says the key to preventing infection is simple: Listen to your mother. "Wash your hands and clean your room," he says.

Hospitals that have placed dispensers of alcohol-based hand sanitizer at every turn—in patient rooms, in hallways, by elevators, at nursing stations—see a dramatic increase in compliance with basic hand hygiene, from less than 50% to 80% or more. That's a huge step toward preventing infection. [edited to add by Amy: these hand sanitizers do NOT kill C Diff and often don't work effectively against MRSA.... so WASH YOUR HANDS instead of using these hand sanitizers and demand that health care workers do the same]

2. CHECK-IT-TWICE LISTS Several years ago, Peter Pronovost, a critical-care specialist at Johns Hopkins Medical Center, began touting the humble checklist as a powerful tool to ensure procedures are done accurately and safely. (See the accompanying interview with Dr. Pronovost.)

Checklists are now common in intensive-care units and operating rooms—but they're also starting to pop up in bedside medical charts.

Some hospitals require each shift nurse to review a checklist for each patient, answering questions such as: Does this patient have a catheter? If so, is it still necessary?
"Patients get all these tubes stuck in them and they stay there forever because people forget about them," says Barbara DeBaun, a nurse who advises the Bay Area Patient Safety Collaborative in San Francisco. "That can be a major source of infection."

3. CAN'T-MISS KITS Hospitals have begun to create portable kits filled with all the equipment needed for common procedures, such as inserting an intraveneous line or changing a dressing. That way, the nurse doesn't have to run back to the supply closet mid-procedure because he's forgotten a sterile drape or a skin-prep solution. And he's less likely to forget those steps in the first place.

4. ORAL FIXATION Nurses can go a long way to preventing ventilator-associated pneumonia—one of the most common infections in intensive-care units—by regularly cleaning a patient's mouth, gums and teeth. This keeps bacteria to a minimum.

Elevating the head of the patient's bed at 30 to 35 degrees is also crucial. And patients should be weaned from sedation at regular intervals.

5. SWAB AND STUDY Quick diagnostic tests now allow hospitals to identify infected patients within hours, rather than days.

There's still debate about whether all incoming patients should be tested for particularly nasty pathogens such as MRSA.

But at the very least, when patients who do show symptoms are tested, the quick results can shape an effective response. The pathogen C. diff, for instance, is not killed by alcohol-based scrubs, so health-care providers and visitors must wash with soap and water upon entering and exiting rooms of infected patients.

Infection control in cystic fibrosis: barriers to implementation and ideas for improvement

Curr Opin Pulm Med. 2009 Jul 30. [Epub ahead of print]

Infection control in cystic fibrosis: barriers to implementation and ideas for improvement.

Saiman L, Garber E.

aDivision of Infectious Diseases, Department of Pediatrics, Columbia University and Department of Epidemiology, NewYork-Presbyterian Hospital, USA bDivision of Infectious Diseases, Department of Pediatrics, Columbia University, New York, New York, USA.

PURPOSE OF REVIEW: This review will focus on recent research documenting baseline adherence to infection control recommendations and barriers to their implementation as experienced by multidisciplinary cystic fibrosis (CF) care providers. In addition, controversies regarding optimal infection control will be discussed. Finally, suggestions to improve infection control in CF will be proposed.

RECENT FINDINGS: Compliance with recent guidelines was assessed for clinical microbiology laboratories and for infection control policies at CF care centers in the United States. Unlike earlier reports, the vast majority of laboratories used selective media for Burkholderia cepacia complex and identified all species of nonlactose fermenting Gram-negative bacilli. Fewer used selective media for Staphylococcus aureus or used agar-based susceptibility testing assays for Pseudomonas aeruginosa. Only 103 (65%) of 158 CF care centers provided written infection control policies for review and these were more likely to address inpatient than outpatient settings. Surveys of healthcare professionals showed that access to a copy of the CF infection control guidelines reduced barriers to adherence to selected infection control practices.

SUMMARY: These data suggest that access to national infection control guidelines and written local policies are critically important to improving infection control for CF.

PMID: 19644375 [PubMed - as supplied by publisher]

Infection control in cystic fibrosis: cohorting, cross-contamination, and the respiratory therapist.

Respir Care. 2009 May;54(5):641-57.

Infection control in cystic fibrosis: cohorting, cross-contamination, and the respiratory therapist.

O'Malley CA.

Department of Respiratory Care, Children's Memorial Hospital, 2300 Children's Plaza, Box 58, Chicago IL 60614. comalley@childrensmemorial.org.

Cystic fibrosis (CF) is a complex genetic disease characterized by lung infections that lead to early morbidity and death. Pathogens that commonly infect the lungs of patients with CF include Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, and Burkholderia cepacia. Aggressively treating pulmonary infection with antibiotics has contributed to improved survival in patients with CF but has also promoted multiple-drug-resistant bacteria. Other complexities include the ability of bacteria to form biofilms, which makes them more resistant to antibiotics, and emerging pathogens in CF, of which the clinical importance is not yet clear. Increasing evidence of patient-to-patient transmission of CF pathogens led the Cystic Fibrosis Foundation to produce evidence-based infection-control recommendations, which stress 4 principles: standard precautions, transmission-based precautions, hand hygiene, and care of respiratory equipment. Respiratory therapists need to know and follow these infection-control recommendations. Cohorting patients infected with B. cepacia complex is one of several interventions successful at keeping the spread of this pathogen low, but cohorting patients who are infected/colonized with other microbes is controversial, the main argument of which is not being certain of a patient's present respiratory culture status at any given patient visit.

PMID: 19393108 [PubMed - in process]

***Full text of the article should be available shorty.....