ICPs Identify MRSA, VRE as Threats
Q: What emerging infectious disease most warrants the attention of infection control practitioners?
A: "To me, the emerging infectious disease that warrants the attention of infection control practitioners is methicillin-resistant Staph aureus (MRSA). We have had the most exposure to it lately, but good handwashing and personal protection techniques would take care of this. Even though it is primarily a hospital-acquired pathogen, it worries me because I'm afraid there is a trend toward wearing surgical scrubs in to work and back home again. When I say back home, it does not necessarily mean they wear them, but carry them home to launder. This pathogen can survive for a long time on fabrics used in the hospital, and carrying scrubs home to launder is dangerous. Nowadays, there is not much use of bleach during laundering. I work in the operating room (OR) and I am having a difficult time trying to accept wearing scrubs in and out of the surgical environment as an accepted policy. We've got to take care of our patients and eliminate some of our shortcuts. I have been the OR educator since December 2001. Trying to help young staff members learn how to protect themselves and their patients has been a challenge. Every day I see people too lazy or impatient to put on gloves to handle contaminated objects. To them, they only touch it for a second, then they run out and rinse their hands. It only takes a second to be exposed to death. It's not instant, but it's death nevertheless. Regular, proper handwashing techniques and the use of proper personal protective equipment (PPE) will decrease the spread of infection a great deal. Infections tend to move in a chain of events. If the patient arrives with an infection related to poor hygiene, and the nursing staff does not use proper protection techniques, the infection keeps moving through contacts during the hospital stay, and the patient returns home with the same infection. There has to be responsible, caring staff members who practice proper infection control to prevent the spread of infectious diseases."
Rosie S. Goolsby, RN, CNOR, BSN
Baptist Memorial Hospital, North Mississippi, Oxford, Miss.
A: "My personal concern is not a specific infectious disease. It is the increasing emergence of antimicrobial resistance in the microorganisms that cause disease. There are numerous reports of HIV strains that are resistant to many of the anti-retroviral agents in use today. This challenges infectious disease specialists who treat HIV patients and are often called upon to manage the post exposure prophylaxis of healthcare workers who have a high-risk exposure. We read about the increasing number of community-acquired MRSA infections in people who have never been in a hospital. Knowing that bacteria readily share DNA via plasmids, transposons, etc., I cringe when I review a urine culture report with both MRSA and vancomycin-resistant enterococcus (VRE). Will the enterococcus transfer its vancomycin resistance to the MRSA? In this era of cost cutting I have seen the elimination of trained microbiologists from the medical lab and the unfortunate decrease in the ability of some labs to accurately identify microorganisms and detect emerging resistance patterns."
Susanne Ferrigno, MS, MT(ASCP), CIC
Infection Control Practitioner
Asheville VA Medical Center, Asheville, N.C.
A: "MRSA and VRE immediately come to mind, but all emerging pathogens linked to antibiotic usage, such as Clostridium difficile, are of concern to me. Many hospitals that do a yearly antibiogram (antibiotic susceptibility report) are seeing an increase in resistant organisms that mirror the increased use of vancomycin, levaquin and other antibiotics. It is not enough to restrict certain antibiotics on formulary, the educational component to the prescriber must be there, also. Antibiotics must be specifically targeted to the organism. Although we are affected in the hospital, this is a local, state and national problem. Americans want a quick fix, a pill for everything. But what we really need is education and the judicious use of antibiotics. Unfortunately, there are not enough state funds or national funds for public health education on this issue. As long as the public demands antibiotics and physicians continue to cave in to those demands, the microbe is going to win."
Ginny Lipke, RN, CIC
Infection Control Manager, Piedmont Hospital, Atlanta
A: "The infectious disease most warranting the attention of infection control practitioners involves multi-drug resistant organisms. During 1989 - 1997, the National Nosocomial Infections Surveillance (NNIS) reported a [more than] 40-fold increase in VRE, while MRSA remains a predominate cause of nosocomial infection. We now have vancomycin intermediate Staph aureus (VISA) as an occasional pathogen and the resistance of VRE has been passed to Staph aureus in animal models, making this scenario likely in our patients. Gram-negative organisms have developed a frightening ability to acquire resistance and the potential of these threats is disturbing to say the least. While technology has allowed us to look at prevention in new ways, our healthcare institutions are under increasing pressure to keep costs down. The Siouxland intervention has shown we can virtually eliminate VRE given the appropriate resources (NEJM 344(19) 1427-33). While other issues such as bioterrorism demand our attention and preparation, many more patients die as a consequence of nosocomial infections than acts of bioterrorism. By limiting the misuse of antibiotics, we can slow the advancing resistance and decrease costs to our institutions. Many initiatives warrant our efforts as practitioners, but it is in the field of limiting these organisms that we can have the most effective impact."
Infection Control Practitioner
University of Maryland Medical Center, Baltimore
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to help eliminate potential reservoirs for pathogens?
"Smart" Bandage Designed to Diagnose Infection
One more weapon eventually will be added to clinicians' arsenals against bacteria. Researchers at the University of Rochester's Center for Future Health are working on the creation of a "smart" bandage designed to detect the formation of bacteria in a wound. Benjamin Miller, assistant professor of chemistry, and Philippe Fauchet, professor and chair of electrical and computer engineering, have devised what is being described as a wafer-like silicon sensor the size of a grain of sand that can identify and distinguish the difference between gram-negative and gram-positive bacteria. The university describes it as the first substantial improvement in identifying bacteria since Hans Christian Joachim Gram developed his staining technique in 1884.
"The Gram stain has been an important tool in analyzing bacteria for more than a century, but it's amazing to me that we're still using a procedure that's out of the Stone Age," Miller says. "We can now get the same information immediately, at home or in the doctor's office, and we're working on similar ways to detect dozens of other potentially harmful bacteria."
The bandage is designed to change color if bacteria or infection are present; this is achieved by the bandage sensing the presence of a molecule called lipid A on the surface of gram-negative bacteria. Researchers also plan to create binding molecules that could signal the presence of antibiotic-resistant strains of bacteria. The smart bandage won't be available anytime soon, as it is still in the design and testing stages.
-- Kelly M. Pyrek
Mystery Microbe Sleuths Win Prizes
Our Microbe of the Month column, penned by Roger P. Freeman, DDS, president of Infectious Awareables Inc., has generated quite a loyal following since it first appeared in the September 2001 issue of Infection Control Today magazine. Freeman tries his best each month to stump our readers with his clever descriptions of pesky pathogens, but you're a smart bunch of readers. Although we wish we could award prizes to everyone who provides a correct answer, we can only conduct a random drawing of the names of the first 25 winners who submit a correct answer each month. Even if you don't see your name here, know that you're still a winner for reading Infection Control Today and for taking the time to e-mail us. We thank you for making us a part of your busy day.
The December 2001 winners (herpes) are: Helen J. Molchan, RN, CIC; Joyce Frederick, RN, MSN, CIC; Martha Bliss; Mary M. McNally, RN, CIC; Beverly Mann, RN; Pamela K. Weiss, RN, BSN, CIC; Ellen Cockrell, BSN, RN; Patty Carson.
The January 2002 winners (Giardia lamblia) are: Cindy Woolard, MT; Beth Monroe, RN; Karen Anderson, MT, CIC; Sarah Buckelew; Sharon Wells, RN, MS, CIC; Sally Bola, BSN, MSA, CIC; John Noll, RN, BA, CNOR; Susanne Ferrigno, MS, MT (ASCP), CIC.
The February 2002 winners (Streptococcus pneumoniae) are: Paula Masterson, RN, CIC; Linda Hester, BS, MT (ASCP), CIC; Joanne Dixon, RN, BSN, CIC; Denise Leaptrot, CIC; Maryellen Laskowski, BSN, MPH, CIC; Shannon Hansen; Linda Ferrara, RN; Nancy Kiernan-Campbell, MPH, SM(ASCP).