Idea #314 for December 29th, 2009: The Link Between Disinfectants And Resistant Pathogens

Misuse of antibiotics has been associated with the rise of resistant strains of pathogens that have plagued hospitals in the US. New research suggests that misuse of disinfectants may also play a role in the spread of superbugs. Researchers examined whether benzalkonium chloride, a common disinfectant, might lead to resistant strains of a certain bacterium known to cause disease in people with weakened immune systems.

Their results showed that the bacteria eventually became resistant to the disinfectant, as well as the antibiotic Cipro. Since the research took place in a lab, we shouldn’t necessarily jump to conclusions about its relevance to real-life situations. However, the scientists behind the research have a few recommendations about household use of disinfectants. For one, they should not be diluted, as that may allow some bacteria to survive and breed other resistant bacteria. Also, ample time should be afforded to let the disinfectants work so that the vast majority of bacteria are killed. Disinfectants shouldn’t be avoided altogether, they should just be used more wisely to avoid contributing to the superbug epidemic.

Read more about this issue here.

Idea #296 for December 11th, 2009: Food Fight or Improving Food Safety In School Lunches

Considering that many American children rely on school lunches on a daily basis, we should expect that this government-subsidized program delivers a quality product. That’s why it’s disheartening and surprising to hear that meat used by school lunch programs is not even up to the standards of fast-food restaurants, in some cases. Jack in the Box, for instance, sets the acceptable level of bacteria in their beef ten times lower than the USDA does for school lunch meat. And the type of chicken used in school lunches is deemed sub-standard by KFC and Campbell’s Soup. In fact, this type of chicken is normally reserved for pet food.

If not properly cooked, the meat in school lunches could contain enough bacteria to cause food poisoning. Tougher standards don’t have to come at a high cost. The safety changes that Jack in the Box implemented only added a fraction of a penny to the cost of a pound of beef. That’s trivial compared to the cost of treating children sickened by E. coli or salmonella from tainted meat. At the very least, school lunch programs should strive for the level of quality demanded by the fast food industry.

http://www.usatoday.com/news/education/2009-12-08-school-lunch-standards_N.htm

Idea #280 for November 25th, 2009: Looking Over Your Shoulder or A Simple Way to Boost Hand-Washing Compliance in Hospitals

Proper hand-washing compliance remains a problem across many medical facilities. Not thoroughly washing hands can lead to the spread of pathogens including MRSA. A program recently instituted at UCLA Medical Center, however, has led to dramatic changes in the compliance rate of hand-washing there. It could serve as model for other hospitals in the future.

UCLA has achieved their success with using a simple method: enlisting undergrads to observe hand-washing in the hospital and report on the results. They have seen their compliance with hand-washing guidelines rise from 50% to 93% since the program began. Apparently, simply having people watch over medical staff during washing can make them more careful. It’s something for other medical facilities to keep in mind, especially if they are looking for a low-cost way raising compliance.

Read more about this program in the Wall St Journal.

Idea #199 for September 5th, 2009: Cleaning Up or Fighting the Spread of MRSA on Medical Equipment

A lot has been made over the spread of MRSA within hospitals and other medical facilities. MRSA is a strain of staph bacteria that is resistant to even the strongest antibiotics, and is responsible for infections that are not easily clear-up. Eradicating MRSA has proven difficult and it continues to be a problem in many places. Researchers in Israel have found an often ignored area that is a potential vector for the spread of drug-resistant pathogens: chest X-ray equipment.

The researchers observed technicians perform nearly 200 chest X-rays and found that proper sanitation protocol was followed only 1% of the time. Drug-resistant bacteria was found on 39% of the X-ray machines. Then, after educating the technicians on correct protocol, the rate of compliance went up to 42%, which is far from perfect, but more importantly none of the machines tested positive for resistant bacteria. The lesson here is that with timely intervention and proper education, a facility can decrease or eliminate the presence of antibiotic resistant bacteria like MRSA on their equipment.

Read more about this research here.

Idea #180 for August 17th, 2009: Washing Up or Encouraging Proper Hand-Washing in Hospitals

The act of hand-washing is more important than many realize, and that is especially true in medicine. A study in 2000 by the Institute of Medicine claimed that, of all the hospital-related errors that lead to death, the spread of bacterial infections was one of the top causes. Insufficient hand-washing may be partly to blame for that stat.

Cedar-Sinai came up with an interesting way to make sure more doctors were washing their hands. At the time, only about 65% of the doctors were washing their hands to the degree that it was compliant with JCAHO standards. So a team of staff there began handing out Purell bottles to doctors in the parking lot, as well as giving Starbucks giftcards to doctors who they found washing up properly. Soon the rate of compliance jumped to 80%, which was an improvement, but still not acceptable.

Then came the idea that changed the culture of hand-washing at Cedar-Sinai forever. Hospital leadership decided to take handprints on petri dishes of some of the doctors and culture those prints to show the bacterial colonies. The results were visually striking, displaying forests of bacteria in the outline of a hand. One such image was then used as the standard screen-saver for all computers at the hospital, and staff were confronted with it frequently. Hand-washing compliance rose to nearly 100%, where it still is today. It’s a fascinating way of getting a message across, and that type of non-standard methodology could be used in other locations that suffer from the same problem.

Read about this story in the NY Times.

Idea #23 for March 13th, 2009: Squashing Superbugs or Staph Infections in Hospitals

When you hear about “staph infections” in the media, what they are referring to is an infection by the Staphylococcus aureus bacterium. In hospital settings, staph infections can be deadly and in fact kill an estimated 13,000 people a year, in addition to the 300,000 left sickened. Hospitals are prime vectors for the spread of staph because of their high volume of sick people in close proximity, some of whom already have compromised immune systems. Particularly concerning are the antibiotic-resistant strains of staph, most prominently methicillin-resistant S. aureus (MRSA), which accounts for over 60% of hospital staph infections. These superbugs are very difficult to treat, as they are immune to the strongest antibiotics available.

This isn’t a battle we are doomed to lose, though. Hospitals in the Netherlands have devised an effective means of containing the spread of MRSA in recent years. They call the technique “Search and Destroy” and because of it, MRSA infections now account for less than 1% of Dutch hospitals’ total staph infections. The main components of their strategy are: isolating high-risk patients and carriers, screening other patients, and treatment of those patients that acquire MRSA. Screening and quarantining patients does not come cheap, so hospitals will have to weigh the costs vs. benefits if they were to implement a similar plan. But Search and Destroy has shown some success in American hospitals that have tried it. A hospital in Rhode Island, for instance, has seen their MRSA infection rate cut almost in half since adopting the technique in 2002. If the US decided on an effective way of eradicating MRSA in its hospitals, we could save thousands of lives and billions of dollars each year.

For more about the Dutch plan, see this news story or this one.

Also see this article about the future of cleansers and santiation technology here or perhaps this article on defeating bacteria with… bacteria.