Posts Tagged ‘hospital-acquired infection’

Can Copper Surfaces and Duct Tape Reduce Hospital Infections and Deaths?

Thursday, July 7th, 2011

Image from medgadget.com

How many times have you heard about someone entering the hospital healthy, or relatively so, and developing a dangerous infection while hospitalized? What about the number of times that you may have visited your own doctor’s office or your child’s pediatrician’s office and wondered whether the cold you got a few days later was coincidence or the result of having been in the waiting and exam rooms following other sick patients? Have you ever considered what cleaning procedures are done in hospital rooms when one patient is discharged before another takes their place?

In the past, Brian Nash and the other legal bloggers here at Eye Opener have written posts and made mention of the importance of hospital cleanliness and sterility, see the related posts below. We have been involved in cases involving the devastating results of infections. However, everyone knows that there are going to be germs in hospitals. Even the best hospitals have to work to keep the patients, rooms and visitors clean and safe.

Well, there is news that may make keeping hospitals and other health care environments less germy in the future. Two recent articles have focused on seemingly simple solutions, copper and duct tape, that may have major impacts on infection control.

Copper Surfaces Dramatically Reduce Infections by Killing Bacteria

A Reuters’ article reports that a recent study “presented at the World Health Organization’s 1st International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland” shows that “replacing the most heavily contaminated touch surfaces in ICUs with antimicrobial copper will control bacteria growth and cut down on infection rates.” According to the Reuters’ article:

[a]ntimicrobial copper surfaces in intensive care units (ICU) kill 97 percent of bacteria that can cause hospital-acquired infections, according to preliminary results of a multisite clinical trial in the United States. The results also showed a 40 percent reduction in the risk of acquiring an infection.

This news could have a profound impact on health-care costs, disease spread, and most importantly lives lost. If hospitals are able to replace some of their current surfaces with copper surfaces, at least in the parts of the hospital that are most frequently the source of infections, there could be a dramatic improvement in hospital-acquired infections.

Hospital-acquired infections (HAIs) are the fourth leading cause of death in the United States behind heart disease, strokes and cancer.

According to estimates provided by the Centers of Disease Control and Prevention, nearly one in every 20 hospitalized U.S. patients acquires an HAI, resulting in 100,000 lives lost each year.

From Reuters

Perhaps even more infections could be prevented if these changes could be made outside of just ICUs. For instance, perhaps copper surfaces could replace highly touched surfaces on sink handles, the doors to hospital rooms, hospital bed rails, or in out-patient surgery centers and long-term care facilities that are not housed within hospitals.

Duct Tape Warnings Keep Others Far Enough Away from Infected Patients

Image from ducttapesales.com

An article from Medicalnewstoday reports that some hospitals are using plain duct tape – just colored red – to achieve a reduction in infection rates from highly infectious patients without having to deal with the hassle and expense of all visitors or hospital personnel who enter the room having to rescrub and use new gowns every time they enter the room of an infected patient. The study looked at highly infectious diseases like C. diff that require isolation of patients and very careful hand washing to avoid spreading the infection. So how does duct tape help?

The Association for Professionals in Infection Control and Epidemiology (APIC) commissioned a study to corner off a three foot perimeter around the bed of patients in isolation. Medical personnel could enter the room unprotected if they stayed outside the perimeter. Direct patient contact or presence inside the perimeter meant a redo of the cleansing process. The concept, called “Red Box” employs red duct tape, a color used as it provides a strong visual reminder to those who enter the room to be aware.

The study found that 33% of all who entered the rooms could do so without the addition of gowns and gloves, saving the environment, hospital and patient costs, and time without compromising the patient or the medical personnel.

From Medicalnewstoday

How Else Can We Reduce Infections?

What ideas do you have for the use of copper surfaces? Do you think that copper surfaces or duct tape could make a dramatic difference in the safety of hospital admission? What about the cost? Do you think that hospitals would pay the upfront costs of replacing surfaces with copper to be able to dramatically cut infection rates? What about other low cost solutions like duct-tape around the perimeter of the bed? Can you think of other low-cost solutions that could minimize infections and maximize safety?

Related Posts:

New federal study finds ‘lax infection control’ at same-day surgery centers

FDA warning to healthcare professionals: use sterile prep pads!

Sepsis – Simple steps in ER saves lives

Thursday, October 7th, 2010

Following summer headlines citing extensive hospital deficiencies in screening a fatal illness known as sepsis, there is some good news out of Kaiser Permanente this week.

Sepsis as defined by Wikipedia as a serious medical condition affecting the whole body. As we know, it can even be fatal. Sepsis is caused when a harmful infectious organism invades the body. Invasion can occur through the blood, urine, lungs, skin, or body tissue. The body reacts with an inflammatory response that is characterized by fever or low body temperature, low blood pressure, and an increasing high white blood cell count.  In earlier times the condition was commonly called “blood poisoning”.

As the patient becomes sicker, the body becomes overwhelmed by an acid called lactate acid. It is formed as a result of lowered oxygen to organs and tissue resulting in a condition known as lactic acidosis. As the condition progresses, the body eventually can not overcome the acidosis and low tissue oxygen perfusion. Death ensues often despite aggressive medical treatment.

Kaiser reported 17 participating hospitals in Northern California began using a 6-step diagnostic and treatment tool known as a “sepsis bundle” in 2008 to rapidly diagnose and treat sepsis. Using this new tool and computerized medical records, Kaiser found the patient death rate improved significantly from 25% to 11%, the patients’ hospital stays were 3 days shorter, and $36 million was saved.

However, just the day before Kaiser released their data, another article in FierceHealthcare – daily news for healthcare executives - listed infections add an average 19 days to a hospital stay with a cost per patient of $43,000. This study was published by the Agency for Healthcare Research and Quality who concluded that 12% of all infections were classified as sepsis. Two months ago, Fierce Healthcare reported excerpts from new research published in the Archives of Surgery by a surgeon named Laura Moore practicing at Houston’s Methodist Hospital. Dr. Moore performed a retrospective review of 364,000 general surgery patients registered in the American College Of  Surgeons National Surgical Quality Improvement Database. Sepsis occurred in 2.3% totaling 8,372 patients.  She also wrote mortality from sepsis has doubled in the last 20 years. Sepsis is the leading cause of death in general surgery ICU’s.

In December 2008, the European Society of Critical Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine launched the Surviving Sepsis Campaign. Sepsis is estimated to kill 1,400 people worldwide each day. Mortality rates from severe sepsis are rated as high as lung, breast, and colon cancer. The campaign wrote severe sepsis is expected to grow at 1.5 % annually with an additional 1 million cases per year in the USA by 2020. The campaign sited the cause for this is due to the aging population and increasing invasive medical procedures. HIV and cancer rates are increasing, which will also impact severe sepsis rates.

Sepsis varies greatly in its progression and symptoms seen in each patient. This makes early diagnosis and treatment challenging for even the best ICU physicians. Symptoms such as fever, rapid pulse rate, and respiratory difficulty are commonly seen in a host of other medical conditions. Obtaining an accurate diagnosis can take precious time. In an effort to improve the diagnosis and survival rates, the campaign challenged to USA hospitals to adopt and implement a “sepsis bundle” program and begin reducing mortality by 25% over the next 5 years.

So what is a sepsis bundle? The Surviving Sepsis Campaign chose medical therapies called “elements” designed to give physicians worldwide a framework to standardize sepsis practices. Their specific intent was to reduce the chaotic approaches seen in many clinical settings. The campaign founders consolidated world medical care data and practices that had shown clear positive impact on outcomes. They challenged critical care physicians to choose a grouping of these elements based on their patient population. Next,  physicians were to apply their individualized “sepsis treatment bundle” and  study the outcomes by using the campaign’s measurement database. By choosing to delete an element(s), the hospital would be classified as non-compliant and their performance data would likely show poorer outcomes.

In the sepsis resuscitation bundle, there were 5 critical elements. In the sepsis management bundle there were 4 elements.  So neither bundle is too complicated or intricate to put into medical practice. Now two years later, those early hospitals that accepted the challenge and implemented a sepsis bundle program are publishing their success data. Another fine example was published by Barry Evans, RN, MSN, Adult Critical Care Data Coordinator at the University of Rochester/Strong Health.

Kudos to Kaiser Permanente California, Strong Health, and all the other critical care services who accepted the 2008 challenge for US patients and are making it happen. Can’t wait to see the campaign’s worldwide end data in 2013!

We've Heard of MRSA – Now We Learn that Doctors Struggle to Treat Gram-Negative Bacterial Infections – NYTimes.com

Saturday, February 27th, 2010

An article in yesterday’s New York Times by Andrew Pollack - Doctors Struggle to Treat Gram-Negative Bacterial Infections – NYTimes.com – brings to the public’s awareness that  Gram-negative organisms such as Klebsiella pneumoniae and Acinetobacter are becoming almost as common but have very few treatment options in the form of effective antibiotic coverage.        

The bacteria, classified as Gram-negative because of their reaction to the so-called Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Their cell structure makes them more difficult to attack with antibiotics than Gram-positive organisms like MRSA.

Mr. Pollack reports that “[a]ccording to researchers at SUNY Downstate Medical Center, more than 20 percent of the Klebsiella infections in Brooklyn hospitals are now resistant to virtually all modern antibiotics. And those supergerms are now spreading worldwide.”

The number of infections occurring annually in hospitals is simply staggering – roughly 1.7 million hospital-associated infections, according to the Centers for Disease Control and Prevention. More horrifying is the CDCP’s estimate that when taking into account all types of bacteria combined, these organisms cause or contribute to 99,000 deaths each year.

“For Gram-positives we need better drugs; for Gram-negatives we need any drugs,” said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-U.C.L.A. Medical Center in Torrance, Calif., and the author of “Rising Plague,” a book about drug-resistant pathogens.

Mr. Pollack’s article also sheds light on yet another little-known but equally tragic fact – a physician’s choices in treating some of these deadly Gram-negative bacteria are not without significant risks to the patient – neuro and nephrotoxicity.

Doctors treating resistant strains of Gram-negative bacteria are often forced to rely on two similar antibiotics developed in the 1940s — colistin and polymyxin B. These drugs were largely abandoned decades ago because they can cause kidney and nerve damage, but because they have not been used much, bacteria have not had much chance to evolve resistance to them yet.

“You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.”

As many are aware or becoming increasingly aware, the drug-resistant bacteria are believed to be the by-product of overuse of antibiotics by healthcare providers over the past many decades.  Specialists in infectious disease have been vocal advocates for the judicious use of antibiotic therapy and avoidance of the ‘take a pill’ first approach by many front line providers such as internists.

In his article, Mr. Pollack provides a link to a campaign started by the parents of a 27 year old young man, who survived his post-operative, hospital-acquired MRSA infection twice only to die a victim of a Gram-negative organism, Enterobacter aerogenes. These advocates for prevention of hospital-acquired infections, Armando and Victoria Nahum, started the Safe Care Campaign.  A visit to this site is most instructive and we invite you to do so.


The Unexpected Killers: Hospital-Acquired Infections

Wednesday, February 24th, 2010

According to an article published by NPR, a recent study found that as many as 48,000 people die each year in the U.S. from hospital-acquired infections. Researchers say that this is the first truly national study of its kind, involving 69 million cases of hospital-acquired infections in 40 states.

This study, unlike its predecessors, specifically isolated cases of hospital-acquired infections from cases involving patients  with possible existing infections at the time of admission. In part, this was accomplished by focusing on patients admitted to undergo elective surgery.

The researchers found the death toll from avoidable pneumonia and sepsis is bigger than from traffic fatalities. It’s more than three times higher than that for AIDS, and roughly twice as much as annual deaths from firearms.

Examples of hospital-acquired infections include: pneumonia, sepsis (infection of the blood), urinary tract infections, gastroenteritis, clostridium difficile (c-diff), tuberculosis, and staphylococcus-related infections.

Most hospital-acquired infections can be effectively treated with the proper choice of antibiotics.  There is simply no justification for such an incredibly high mortality rate  to be associated with a series of preventable and treatable medical conditions. For this reason, the results of the study are truly disturbing.

Contributing author: Jon Stefanuca