Q: What emerging infectious disease most warrants the attention ofinfection control practitioners?
A: "To me, the emerging infectious disease that warrants theattention of infection control practitioners is methicillin-resistant Staphaureus (MRSA). We have had the most exposure to it lately, but goodhandwashing and personal protection techniques would take care of this. Eventhough it is primarily a hospital-acquired pathogen, it worries me because I'mafraid there is a trend toward wearing surgical scrubs in to work and back homeagain. When I say back home, it does not necessarily mean they wear them, butcarry them home to launder. This pathogen can survive for a long time on fabricsused in the hospital, and carrying scrubs home to launder is dangerous.Nowadays, there is not much use of bleach during laundering. I work in theoperating room (OR) and I am having a difficult time trying to accept wearingscrubs in and out of the surgical environment as an accepted policy. We've gotto take care of our patients and eliminate some of our shortcuts. I have beenthe OR educator since December 2001. Trying to help young staff members learnhow to protect themselves and their patients has been a challenge. Every day Isee people too lazy or impatient to put on gloves to handle contaminatedobjects. To them, they only touch it for a second, then they run out and rinsetheir 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 useof proper personal protective equipment (PPE) will decrease the spread ofinfection a great deal. Infections tend to move in a chain of events. If thepatient arrives with an infection related to poor hygiene, and the nursing staffdoes not use proper protection techniques, the infection keeps moving throughcontacts during the hospital stay, and the patient returns home with the sameinfection. There has to be responsible, caring staff members who practice properinfection 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 theincreasing emergence of antimicrobial resistance in the microorganisms thatcause disease. There are numerous reports of HIV strains that are resistant tomany of the anti-retroviral agents in use today. This challenges infectiousdisease specialists who treat HIV patients and are often called upon to managethe post exposure prophylaxis of healthcare workers who have a high-riskexposure. We read about the increasing number of community-acquired MRSAinfections in people who have never been in a hospital. Knowing that bacteriareadily share DNA via plasmids, transposons, etc., I cringe when I review aurine culture report with both MRSA and vancomycin-resistant enterococcus (VRE).Will the enterococcus transfer its vancomycin resistance to the MRSA? In thisera of cost cutting I have seen the elimination of trained microbiologists fromthe medical lab and the unfortunate decrease in the ability of some labs toaccurately identify microorganisms and detect emerging resistancepatterns."
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 emergingpathogens linked to antibiotic usage, such as Clostridium difficile, areof concern to me. Many hospitals that do a yearly antibiogram (antibioticsusceptibility report) are seeing an increase in resistant organisms that mirrorthe increased use of vancomycin, levaquin and other antibiotics. It is notenough to restrict certain antibiotics on formulary, the educational componentto the prescriber must be there, also. Antibiotics must be specifically targetedto 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 publichealth education on this issue. As long as the public demands antibiotics andphysicians continue to cave in to those demands, the microbe is going towin."
Ginny Lipke, RN, CIC
Infection Control Manager, Piedmont Hospital, Atlanta
A:"The infectious disease most warranting the attention of infection controlpractitioners involves multi-drug resistant organisms. During 1989 - 1997, theNational Nosocomial Infections Surveillance (NNIS) reported a [more than]40-fold increase in VRE, while MRSA remains a predominate cause of nosocomialinfection. We now have vancomycin intermediate Staph aureus (VISA) as anoccasional pathogen and the resistance of VRE has been passed to Staph aureusin animal models, making this scenario likely in our patients. Gram-negativeorganisms have developed a frightening ability to acquire resistance and thepotential of these threats is disturbing to say the least. While technology hasallowed us to look at prevention in new ways, our healthcare institutions areunder increasing pressure to keep costs down. The Siouxland intervention hasshown we can virtually eliminate VRE given the appropriate resources (NEJM344(19) 1427-33). While other issues such as bioterrorism demand our attentionand preparation, many more patients die as a consequence of nosocomialinfections than acts of bioterrorism. By limiting the misuse of antibiotics, wecan slow the advancing resistance and decrease costs to our institutions. Manyinitiatives warrant our efforts as practitioners, but it is in the field oflimiting these organisms that we can have the most effective impact."
Infection Control Practitioner
University of Maryland Medical Center, Baltimore
We enjoy hearing from our readers and finding out what is on their minds. Ifyou would like to give us your feedback on this upcoming question, e-mail yourresponse to firstname.lastname@example.org. Be sureto include your name, title and facility name. The deadline for June's responsesis Friday, April 26.
How can medical device/instrument manufacturers design their products to help eliminate potential reservoirs for pathogens?
-- Compiled by Michelle Gardner
Onemore weapon eventually will be added to clinicians' arsenals against bacteria.Researchers at the University of Rochester's Center for Future Health areworking on the creation of a "smart" bandage designed to detect theformation of bacteria in a wound. Benjamin Miller, assistant professor ofchemistry, and Philippe Fauchet, professor and chair of electrical and computerengineering, have devised what is being described as a wafer-like silicon sensorthe size of a grain of sand that can identify and distinguish the differencebetween gram-negative and gram-positive bacteria. The university describes it asthe first substantial improvement in identifying bacteria since Hans ChristianJoachim Gram developed his staining technique in 1884.
"The Gram stain has been an important tool in analyzing bacteria formore than a century, but it's amazing to me that we're still using a procedurethat's out of the Stone Age," Miller says. "We can now get the sameinformation immediately, at home or in the doctor's office, and we're working onsimilar 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 lipidA on the surface of gram-negative bacteria. Researchers also plan to createbinding molecules that could signal the presence of antibiotic-resistant strainsof bacteria. The smart bandage won't be available anytime soon, as it is stillin the design and testing stages.
-- Kelly M. Pyrek
OurMicrobe of the Month column, penned by Roger P. Freeman, DDS, president ofInfectious Awareables Inc., has generated quite a loyal following since it firstappeared in the September 2001 issue of Infection Control Today magazine.Freeman tries his best each month to stump our readers with his cleverdescriptions of pesky pathogens, but you're a smart bunch of readers. Althoughwe wish we could award prizes to everyone who provides a correct answer, we canonly conduct a random drawing of the names of the first 25 winners who submit acorrect answer each month. Even if you don't see your name here, know thatyou're still a winner for reading Infection Control Today and for taking thetime 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; JoyceFrederick, 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; BethMonroe, 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; DeniseLeaptrot, CIC; Maryellen Laskowski, BSN, MPH, CIC; Shannon Hansen; LindaFerrara, RN; Nancy Kiernan-Campbell, MPH, SM(ASCP).