Reader FeedbackICPs Identify MRSA, VRE as Threats

April 1, 2002

Reader Feedback
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."

Marc-Oliver Wright
Infection Control Practitioner
University of Maryland Medical Center, Baltimore

We enjoy hearing from our readers and finding out what is on their minds. If
you would like to give us your feedback on this upcoming question, e-mail your
response to mgardner@vpico.com. Be sure
to include your name, title and facility name. The deadline for June's responses
is Friday, April 26.

June's question is:

How can medical device/instrument manufacturers design their products
to help eliminate potential reservoirs for pathogens?
-- Compiled by Michelle Gardner

"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.

Once again, Infectious Awareables Inc. (www.iawareables.com)
and the Glo Germ Company (www.glogerm.com)
have generously provided prizes to our winners.

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).