Inc. risk to newly circ'ed baby boys from hospital infections, hepatitis etc.

[Minuteman]

Just a couple of HHS.gov links I want to put somewhere so I can find them again.

Healthcare-Associated Infections:
http://www.hhs.gov/ash/initiatives/hai/index.html

Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care and Treatment of Viral Hepatitis:
http://www.hhs.gov/ash/initiatives/hepatitis/

[Minuteman]

From the HHS.gov Newsroom (12 May 2011):

http://www.hhs.gov/news/press/2011pres/05/20110512a.html

News Release

FOR IMMEDIATE RELEASE
May 12, 2011


Contact: OASH Press Office
(202) 205-0143
HHS Announces Action Plan to Prevent and Treat Viral Hepatitis

The U.S. Department of Health and Human Services today launched its action plan to prevent and treat viral hepatitis, a silent epidemic affecting 3.5 – 5.3 million Americans.

Though viral hepatitis is a leading infectious cause of death in the U.S., many people who have it don’t know they are infected, so they are at greater risk for severe – or even fatal – complications of the disease. Exacerbating the problem is the fact that health care providers often lack the appropriate training to conduct risk assessments, offer prevention counseling, provide diagnoses and treat viral hepatitis.

“These infections have fueled a tragic cascade of human suffering,” said Howard K. Koh, MD, MPH. “The new HHS action plan on viral hepatitis represents an unprecedented call to action for better education, treatment and prevention.”

In January 2010, the Institute of Medicine (IOM) released a report on hepatitis, highlighting barriers that impede efforts for hepatitis prevention and control. The new HHS plan -- Combating the Silent Epidemic: US Department of Health and Human Services Action Plan for the Prevention, Care and Treatment of Viral Hepatitis -- is a response to the IOM report. It outlines a comprehensive action plan to raise awareness about viral hepatitis; creates more opportunities to train health professionals to diagnose, treat, vaccinate, and ultimately save lives; and builds upon the new health insurance reform law to improve patient access to comprehensive viral hepatitis-related prevention and treatment services through expanded coverage.

The plan’s success is contingent on leadership of government at all levels and the active and informed participation of communities, non-governmental organizations, health care providers, and the private sector.

“No one government agency can fight viral hepatitis alone, and here at CDC, we believe this action plan will not only strengthen the work we’ve been doing, but help all of us across the government collaborate to take our nation’s prevention efforts to the next level,” said CDC Director Thomas R. Frieden, MD, MPH. “Far too many Americans are unaware of the serious impact of viral hepatitis and the devastating consequences that can result from leaving it untreated. The time for action is now.”

“We have seen the increasing prevalence of viral hepatitis in our network of health centers and among people living with HIV/AIDS in underserved areas and we know that minorities and medically vulnerable populations are disproportionately affected,” said Health Resources and Services Administrator Mary K. Wakefield, RN, PhD. “This action plan is our best chance at stopping the disease with increased access to information and quality care for those at risk and those who are already infected.

HHS is committed to ensuring that new cases of viral hepatitis are prevented and that persons who are already infected are tested, informed about their infection, and provided with optimal counseling, care and treatment. This increasing commitment is evidenced in the new Healthy People 2020 plan, the first Healthy People publication to document increasing viral hepatitis awareness among infected persons as a formal HHS objective.

To read the plan, see http://www.hhs.gov/ash/initiatives/hepatitis. For more information on viral hepatitis, see http://www.cdc.gov/hepatitis/


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[Minuteman]

"The Impact of HIV-Hepatitis Co-Infection" (blog.AIDS.gov 19 May 2011):

http://blog.aids.gov/2011/05/the-impact-of-hiv-hepatitis-co-infection.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+aids%2Fgov+%28Blog.AIDS.gov%2 9

The Impact of HIV-Hepatitis Co-Infection

By John W. Ward, M.D., Director, Division of Viral Hepatitis, CDC

May is Hepatitis Awareness Month, an observance intended to remind us of the high, under-recognized hepatitis-associated disease burden in this country and of the often neglected opportunities for prevention and care. An estimated 3.5-5.3 million Americans have chronic viral hepatitis, which is a leading cause of primary liver cancer. People living with HIV are disproportionately affected by viral hepatitis and the related adverse health outcomes. Of those infected with HIV, more than 25% are coinfected with Hepatitis C and an estimated 10% with Hepatitis B. While highly active antiretroviral therapy has extended the life expectancy of HIV-infected persons, liver disease–much of which is related to Hepatitis C–has become the most common non-AIDS-related cause of death of among this population.

HIV, Hepatitis B, and Hepatitis C share common modes of transmission. People living with HIV who are also living with viral hepatitis are at increased risk for serious, life threatening complications. As a result, all persons living with HIV should be tested for Hepatitis B and Hepatitis C by their doctors. Co-infection with hepatitis may also complicate the management of HIV infection.

In order to prevent co-infection with Hepatitis B, the Advisory Committee on Immunization Practices recommends universal Hepatitis B vaccination of susceptible patients with HIV/AIDS. Hepatitis A and Hepatitis B vaccines are also recommended for all men who have sex with men, users of illicit drugs, and others at increased risk of infection. There is no vaccine for Hepatitis C.

In 2010, an interagency work group of U.S. Department of Health and Human Services (HHS) experts was created to develop a comprehensive strategic action plan to respond to the viral-hepatitis-associated disease burden. The HHS Action Plan for the Prevention, Care and Treatment of Viral Hepatitis describes opportunities to improve coordination of viral hepatitis prevention activities across HHS, and the framework needed to engage other agencies and nongovernmental organizations in prevention and care. Various strategies throughout the plan outline methods of integration of HIV and viral hepatitis in education, prevention and services. The HHS Action Plan was released last week on May 12.

To learn more about the Viral Hepatitis Action Plan or Hepatitis Awareness Month, visit the Viral Hepatitis Web site and follow CDC’s viral hepatitis Twitter account @CDChep Exit Disclaimer.

Posted in: HIV Policy & Programs, Viral Hepatitis

[Minuteman]

"View HHS Release of the Viral Hepatitis Action Plan" (blog.AIDS.gov 19 May 2011):

http://blog.aids.gov/2011/05/view-hhs-release-of-the-viral-hepatitis-action-plan.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+aids%2Fgov+%28Blog.AIDS.gov%2 9

By Miguel Gomez, AIDS.gov Director

Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care & Treatment of Viral HepatitisIn a blog post on May 12, we reported on the HHS’s release of the Action Plan for the Prevention, Care & Treatment of Viral Hepatitis (Action Plan) (PDF 672KB) at the National Press Club in Washington, D.C. If you missed the event, we encourage you to watch a live webcast Exit Disclaimer of the release of the Action Plan.

Signaling the commitment of HHS to combating and treating viral hepatitis, the Action Plan will help HHS improve its current efforts to prevent new cases of viral hepatitis and related disease by 1) identifying steps that can be taken to reach specific goals; 2) leveraging opportunities to improve coordination of viral hepatitis activities across HHS operating divisions; 3) setting priorities for HHS to develop public-health and primary-care infrastructure needed for viral hepatitis prevention and care at the federal, state, and local levels; and 4) providing a framework for HHS to engage other governmental agencies and nongovernmental organizations in viral hepatitis prevention and care.

To download a copy of the plan, click here (PDF 672 KB).

Posted in: HIV Policy & Programs, LGBTQ Health, Viral Hepatitis

[Minuteman]

"FDA Approves Second New Treatment for Hepatitis C" (blog.AIDS.gov)

http://blog.aids.gov/2011/05/fda-approves-second-new-treatment-for-hepatitis-c.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+aids%2Fgov+%28Blog.AIDS.gov%2 9

By Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

On May 23, the U.S. Food and Drug Administration (FDA) announced the approval of telaprevir for the treatment of chronic viral hepatitis C. According to the U.S. Centers for Disease Control and Prevention, chronic viral hepatitis C affects 3.2 million Americans. Left untreated, chronic viral hepatitis C can lead to cirrhosis, liver cancer, and unwitting transmission to others.

The approval of telaprevir marks the second new treatment approved for chronic hepatitis C. On May 13, the FDA announced the approval of boceprevir. Edward Cox, M.D., M.P.H., director, Office of Antimicrobial Products in FDA’s Center for Drug Evaluation and Research, calls the new treatments “a major step forward in the battle against chronic hepatitis C”, offering patients with this condition a greater chance at a cure.

In a major initiative to bring attention to combating viral hepatitis, the U.S. Department of Health and Human Services recently released the Action Plan for the Prevention, Care & Treatment of Viral Hepatitis (PDF 672KB). Among its goals, the Action Plan calls for a 25% reduction in the number of new cases of hepatitis C and an increase in the proportion of persons who are aware of their hepatitis C virus infection.

Read the FDA’s full announcement on the approval of telaprevir.

Posted in: FDA, Hepatitis, HIV Policy & Programs, LGBTQ Health, People Living With HIV, Research

[Minuteman]

"Transfusion-transmitted hepatitis B virus infection"

http://www.jhep-elsevier.com/article/S0168-8278%2809%2900391-2/abstract

ABSTRACT:

Volume 51, Issue 4, Pages 798-809 (October 2009)

Transfusion-transmitted hepatitis B virus infection☆

Daniel Candotti [1] Corresponding Author Informationemail address, Jean-Pierre Allain [2]

published online 10 June 2009.

Hepatitis B virus (HBV) remains a major risk of transfusion-transmitted infection due to the pre-seroconversion window period (WP), infection with immunovariant viruses, and with occult carriage of HBV infection (OBI). Reduction of HBV residual risk depends upon developing more sensitive HBV surface antigen (HBsAg) tests, adopting anti-HBc screening when appropriate, and implementing HBV nucleic acid testing (NAT), either in minipools or more efficiently in individual samples. HBV NAT combines the ability to significantly reduce the window period and to detect occult HBV carriage substantiating decades of clinical observation that HBsAg-negative/anti-HBc-positive blood could transmit HBV. Clinical observations suggest limited transmission rate of occult HBV compared to WP. Low transmission rate might be related to low viral load observed in OBIs or to the presence of mutants associated with occult carriage. OBIs carrying detectable anti-HBs (∼50%) are essentially not infectious by transfusion. However, recent data suggest that the neutralizing capacity of low anti-HBs may be inefficient when overcome by exposure to high viral load. Anti-HBc blood units without detectable anti-HBs appear moderately infectious except in immunocompromised recipients. Immunodeficient elderly and patients receiving immunosuppressive treatments may be susceptible to infection with lower infectious dose even in the presence of anti-HBs. The immune status of blood recipients should be taken into consideration when investigating “post-transfusion” HBV infection. Pre-transfusion testing and post-transfusion long-term follow-up of recipients, and molecular analysis of the virus infecting both donor and recipient are critical to definitively incriminate transfusion in the transmission of HBV.

Associate Editor: M. Colombo
Keywords: Hepatitis B virus, Transfusion, Transmission, Occult HBV infection, Immunosuppression
Abbreviations: HBV, hepatitis B virus, WP, window period, OBI, occult HBV infection, HBsAg, HBV surface antigen, NAT, nucleic acid testing, EIA, enzyme immunoassay, ELISA, enzyme-linked immunosorbent assay, CLIA, chemiluminescence immunoassay, CLEIA, chemiluminescent enzyme immunoassay, FFP, fresh-frozen plasmas, RBC, red blood cells, PC, platelet concentrates

1 National Health Service Blood & Transplant, Cambridge Blood Centre, Long Road, Cambridge CB2 2PT, UK

2 Department of Haematology, University of Cambridge, Cambridge, UK

PubMed citation / Link:

J Hepatol. 2009 Oct;51(4):798-809. Epub 2009 Jun 10 http://www.ncbi.nlm.nih.gov/pubmed/19615780

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From the FDA NCTR Research Highlights 17 June 2011.

http://www.fda.gov/AboutFDA/CentersOffices/NCTR/WhatWeDo/NCTRPublications/ucm076767.htm

Drug-Induced Hepatotoxicity in Pediatric Patients—June 8

William Salminen, Ph.D., presented an invited talk at the 10th Annual World Pharma Congress, Drug Safety Summit: New Assays and Tools for Predicting Hepatotoxicity in Philadelphia, Pennsylvania. The presentation reviewed the major developmental phases of the maturing liver with an emphasis on phases that may pose unique sensitivities to drug-induced liver injury in children, which is an underserved area of research.

For additional information or a copy of the PowerPoint presentation, “Pediatric Drug-Induced Liver Injury – Children Are Not Just Small Adults,” please contact Dr. William Salminen, Division of Systems Biology, FDA/NCTR.

[Minuteman]

"Healthcare-Associated Infections (HAIs) and AHRQ's Role in their Prevention"

http://www.ahrq.gov/about/nac2011/nac0411/munier/munierslides.htm

On April 8, 2011, William B. Munier, MD, made this presentation at the meeting of the National Advisory Council.

1. Healthcare-Associated Infections and AHRQ's Role in their Prevention
2. Magnitude of the Problem
3. New CLABSI Estimates
4. AHRQ's Central Role
5. AHRQ's Role in the National Effort
6. AHRQ's Role in the National Effort
7. Five Phases of Translational Research1
8. Michigan Keystone ICU Project
9. AHRQ HAI Investments
10. Infection Types—Major Focus Areas
11. Healthcare Settings
12. AHRQ HAI Projects—FY 2010
13. Illustrative HAI Projects
14. Nationwide Implementation of CUSP for CLABSI—Interim Report
15. Expanding the Impact of CUSP Beyond CLABSI
16. Facing Forward
17. AHRQ HAI Investments

Current as of April 2011

Internet Citation:

Healthcare-Associated Infections and AHRQ's Role in their Prevention. Slide Presentation from the April 8, 2011, Meeting of the National Advisory Council (Text Version). Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/nac2011/nac0411/munier/munierslides.htm

You can download the PPT slideshow here (366 KB):

http://www.ahrq.gov/about/nac2011/nac0411/munier/munierslides.ppt

[Minuteman]

Surgical Site Infections links on the Institute for Healthcare Improvement website:

http://www.healthcare.gov/center/programs/partnership/resources/infections.html

Surgical Site Infections
# SHEA and IDSA Compendium on Surgical Site Infections: http://www.jstor.org/stable/10.1086/591064
# The Surgical Care Improvement Project (SCIP) is a national quality partnership of organizations interested in improving surgical care by significantly reducing surgical complications. http://www.qualitynet.org/dcs/ContentServer?c=MQParents&pagename=Medqic/Content/ParentShellTemplate&cid=1122904930422&parentName=Topic
# American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP): http://www.acsnsqip.org/
# Institute for Healthcare Improvement on Surgical Site Infections: http://www.ihi.org/IHI/Topics/PatientSafety/SurgicalSiteInfections/

Posted on: April 12, 2011

[Minuteman]

"How to not get invasive group A strep" HHS HealthBeat 24 August 2011.

http://www.hhs.gov/news/healthbeat/2011/08/20110824a.html

From the U.S. Department of Health and Human Services, I’m Ira Dreyfuss with HHS HealthBeat.

Invasive group A streptococcal disease can be anywhere from minor to fatal. At the Centers for Disease Control and Prevention, Chris Van Beneden says the bacteria are spread through mucus, or contact with infected wounds or sores. She says otherwise healthy people can carry the bacteria without symptoms. But she also says the germs can lead to conditions such as pneumonia and bloodstream infection.

``The spread of all types of group A strep infection can be reduced by good hand washing, especially after coughing and sneezing, and before preparing foods or eating.’’ (9 seconds)

Van Beneden says antibiotics can treat the disease. People also can control their risk of infection.

An article on invasive group A strep is in the CDC’s journal Emerging Infectious Diseases.

Learn more at hhs.gov.

HHS HealthBeat is a production of the U.S. Department of Health and Human Services. I’m Ira Dreyfuss.

Last revised: August 24, 2011

[Minuteman]

"HHS awards $137 million to states to boost prevention and public health" HHS.gov Newsroom 25 August 2011.

http://www.hhs.gov/news/press/2011pres/08/20110825a.html

News Release

FOR IMMEDIATE RELEASE
August 25, 2011


Contact: HHS Press Office
(202) 690-6343
HHS awards $137 million to states to boost prevention and public health

Affordable Care Act funds will create jobs and target health improvement, local capacity building

HHS Secretary Kathleen Sebelius today awarded up to $137 million, partly supported by the Affordable Care Act, to states to strengthen the public health infrastructure and provide jobs in core areas of public health. Awarded in nearly every state, the grants enhance state, tribal, local and territorial efforts to provide tobacco cessation services, strengthen public health laboratory and immunization services, prevent healthcare-associated infections, and provide comprehensive substance abuse prevention and treatment.

“More than ever, it is important to help states fight disease and protect public health,” said Secretary Sebelius. “These awards are an important investment and will enable states and communities to help Americans quit smoking, get immunized and prevent disease and illness before they start.”

The grants will fund key state and local public health programs supported through the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Most of these grant dollars come from the Prevention and Public Health Fund created by the Affordable Care Act. Additional SAMHSA dollars supplement this investment.

“CDC supports state and local public health departments which are key to keeping America safe from threats to health, safety, and security from this country or anywhere in the world,” said Centers for Disease Control and Prevention Director Dr. Thomas Frieden. “With these funds, CDC is strengthening our ability to prevent and combat diseases and keep Americans safe against expensive and dangerous health threats.”

“These funds will allow us to bolster public health services to communities and build on successful programs that have helped people lead healthier lives. Today’s investments will help us prevent future health care costs from problems such as tobacco-related illness and substance abuse,” said Pamela Hyde, administrator of SAMHSA.

The awards include:

* $1 million to further enhance the nations’ public health laboratories by hiring and preparing scientists for careers in public health laboratories, providing training for scientists, and supporting public health initiatives related to infectious disease research.
* Nearly $5 million to help states and territories enhance and expand the national network of tobacco cessation quitlines to increase the number of tobacco users who quit. Quitlines are the toll-free numbers people can call to obtain smoking cessation treatments and services.
* More than $42 million to support: improvements to the Immunization Information Systems (registries) and other immunization information technologies; development of systems to improve billing for immunization services; planning and implementation of adult immunization programs; enhancement of vaccination capacity located in schools; and evaluations of the impact on disease of recent vaccine recommendations for children and adolescents.
* $2.6 million to the Emerging Infections Programs around the country to continue improvement in disease monitoring, professional development and training, information technology development, and laboratory capacity.
* $9.2 million to eight national non-profit professional public health organizations to assist state, tribal, local, and territorial health departments in adopting effective practices that strengthen their core public health systems and service delivery. They will also enhance the workforce by providing jobs in critical disciplines of epidemiology and informatics, thus attracting new talent to public health.
* $1.5 million to evaluate and prevent ventilator-associated pneumonia to reduce cases of Methicillin-resistant Staphylococcus aureus (MRSA) infections and protect Americans from healthcare-associated infectious diseases.
* Up to $75 million to fund nine Screening, Brief Intervention, Referral and Treatment programs over the next five years. These programs will allow communities throughout the nation to provide more comprehensive substance abuse screening, secondary prevention, early intervention and referrals to treatment for people at higher risk for substance abuse. The actual award amounts may vary, depending on the availability of funds and the performance of the grantees.

Today’s announcement is another part of the Obama Administration’s broader effort to improve the health and well-being of our communities through initiatives such as the President’s Childhood Obesity Task Force, the First Lady’s Let’s Move! campaign, the National Quality Strategy, and the National Prevention Strategy. Similar to the Obama Administration’s Partnership for Patients which aims to make hospitals safer, more reliable and less costly, today’s announcement is also an important step in improving the quality of health care for all Americans.

A full list of grantees is available at: http://www.hhs.gov/news/press/2011pres/08/state_prevention_grants.html.


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[Minuteman]

"Dangerous Bacteria Hide Out in Nurses', Doctors' Uniforms" HealthDay News 31 August 2011.

http://liveweb.archive.org/http://www.nlm.nih.gov/medlineplus/news/fullstory_115991.html

Israeli study found worrisome pathogens on 60% of items sampled
URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_115991.html (*this news item will not be available after 11/29/2011)

By Robert Preidt
Wednesday, August 31, 2011

WEDNESDAY, Aug. 31 (HealthDay News) -- The white coats and medical scrubs worn by hospital staff may harbor hazardous bacteria, a new study finds.

Researchers in Israel swabbed nurses' and physicians' uniforms and found potentially dangerous bacteria on more than 60 percent of the clothing items.

The team, from the Shaare Zedek Medical Center in Jerusalem, analyzed swab samples collected from three parts -- sleeve ends, pockets and abdominal area -- of the uniforms of 75 registered nurses and 60 doctors.

Potentially dangerous bacteria were found on 60 percent of the doctors' uniforms and 65 percent of the nurses' uniforms. Especially dangerous drug-resistant bacteria were found in 21 of the samples from nurses' uniforms and six samples from doctors' uniforms. Eight of the samples had methicillin-resistant Staphylococcus aureus (MRSA), which is becoming tough to fight using conventional antibiotics.

The bacteria on the uniforms may not pose a direct risk of disease transmission, but the findings suggest that many hospital patients are in close proximity to antibiotic-resistant strains of bacteria, the researchers said.

"It is important to put these study results into perspective," Russell Olmsted, president of the Association for Professionals in Infection Control and Epidemiology (APIC), said in an association news release. "Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of hand hygiene to prevent the movement of microbes from these surfaces to patients."

The study appears in the September issue of the American Journal of Infection Control, the official publication of APIC.

SOURCE: Association for Professionals in Infection Control and Epidemiology, news release, Aug. 31, 2011

HealthDay
Copyright (c) 2011 HealthDay. All rights reserved.

Link to Abstract on the American Journal of Infection Control website:

http://www.ajicjournal.org/article/S0196-6553%2811%2900117-9/abstract

Abstract:

Nursing and physician attire as possible source of nosocomial infections

Background

Uniforms worn by medical and nursing staff are not usually considered important in the transmission of microorganisms. We investigated the rate of potentially pathogenic bacteria present on uniforms worn by hospital staff, as well as the bacterial load of these microorganisms.

Methods

Cultures were obtained from uniforms of nurses and physicians by pressing standard blood agar plates at the abdominal zone, sleeve ends, and pockets. Each participant completed a questionnaire.

Results

A total of 238 samples were collected from 135 personnel, including 75 nurses (55%) and 60 physicians (45%). Of these, 79 (58%) claimed to change their uniform every day, and 104 (77%) defined the level of hygiene of their attire as fair to excellent. Potentially pathogenic bacteria were isolated from at least one site of the uniforms of 85 participants (63%) and were isolated from 119 samples (50%); 21 (14%) of the samples from nurses’ gowns and 6 (6%) of the samples from physicians’ gowns (P = NS) included of antibiotic-resistant bacteria.

Conclusion

Up to 60% of hospital staff’s uniforms are colonized with potentially pathogenic bacteria, including drug-resistant organisms. It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.

Key Words: Uniform, attire, pathogenic bacteria, nosocomial infection

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"Kids Carrying MRSA Germ Prone to Serious Infection: Study" HealthDay News 31 August 2011.

http://liveweb.archive.org/http://www.nlm.nih.gov/medlineplus/news/fullstory_115989.html

Separate hospital rooms, topical antibiotics and antiseptics can help with prevention, experts say
URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_115989.html (*this news item will not be available after 11/29/2011)

By Robert Preidt
Wednesday, August 31, 2011

WEDNESDAY, Aug. 31 (HealthDay News) -- Hospitalized children who carry a dangerous type of antibiotic-resistant bacteria but show no signs of illness are still at high risk for developing full-blown infections, a new study finds.

The germ -- methicillin-resistant staphylococcus aureus (MRSA) -- is linked to more than 18,600 deaths a year in the United States.

Johns Hopkins Children's Center researchers examined the medical records of 3,140 children admitted to the pediatric intensive care unit between 2007 and 2010. Of those children, 153 arrived at the hospital already colonized with MRSA -- that is, the germ was living in the nose or on the skin but not causing infection.

Compared to non-carriers, the children who carried MRSA before they arrived at the hospital were nearly six times more likely to develop invasive MRSA infections after discharge and eight times more likely to develop them while still in the hospital.

Invasive MRSA infections are serious infections that affect the whole body, and they can be life-threatening.

Among the children who were MSRA-free when they came to the hospital, 15 acquired MRSA while in intensive care. Seven of those 15 developed serious infections, six of them while still in the hospital.

"Hospitalized children colonized with MRSA have a very real risk for invasive infections, both while in the hospital and once they leave, so mitigating this risk is a serious priority," lead investigator Dr. Aaron Milstone, a pediatric infectious disease specialist, said in a Hopkins news release.

"We need standardized protocols on ways to protect MRSA carriers from developing invasive infections while also minimizing its spread to others. In the meantime, there are certain things healthcare providers can do to protect all patients," he added.

Measures that help prevent the spread of MRSA include rigorous hand washing by health care providers and isolation of MRSA carriers in private rooms.

Putting a topical antibiotic in the nostrils of MRSA carriers and bathing them with antiseptic solution may also reduce these children's risk of full-blown infection and transmission to other patients.

The study was published online in the Aug. 30 issue of the journal Clinical Infectious Diseases.

SOURCE: Johns Hopkins Medicine, news release, Aug. 30, 2011
HealthDay
Copyright (c) 2011 HealthDay. All rights reserved.

[Minuteman]

"Eliminating CLABSI: A National Patient Safety Imperative
Second Progress Report on the National On the CUSP: Stop BSI Project"

http://www.ahrq.gov/qual/clabsiupdate/

Executive Summary:

Background

Healthcare-associated infections (HAIs) are infections that people acquire while they are receiving treatment for another condition in a health care setting. They are costly, deadly, and largely preventable. The U.S. Department of Health and Human Services' Action Plan to Prevent Healthcare-Associated Infections is focusing attention on the need to dramatically reduce these infections; a recent Centers for Disease Control and Prevention (CDC) report suggests that considerable progress is being made towards this goal. As part of this initiative, the Agency for Healthcare Research and Quality (AHRQ) is funding a national effort to prevent central line-associated bloodstream infections (CLABSIs) in U.S. hospitals. The On the CUSP: Stop BSI project is led by a unique partnership. This partnership consists of the Health Research & Educational Trust, the nonprofit research and educational affiliate of the American Hospital Association; the Johns Hopkins University Quality and Safety Research Group, which developed an innovative approach for improving patient safety; and the Michigan Health & Hospital Association's Keystone Center for Patient Safety & Quality, which used this approach to dramatically reduce CLABSIs in Michigan. This report summarizes progress made in the first 2 years of the On the CUSP: Stop BSI project.
Participation

On the CUSP: Stop BSI requires that participating States have a lead organization that works with hospitals across their State to implement the clinical and cultural changes needed to reduce CLABSIs. Thus far, 46 hospital associations and one umbrella group have committed to leading the project in their States. Collectively, these groups have recruited more than 1,055 hospitals and 1,775 hospital teams to participate in the project. Twenty-two States began the project in 2009, 14 States and the District of Columbia began during 2010, and 9 States and Puerto Rico began the effort in 2011.
Project Impact

* We examined the impact of the project on patients from units/teams in cohorts 1-4 that began participating in the project in 2009 and 2010. Compared to a baseline CLABSI rate of 1.87 infections per 1,000 central line days in these units, after 10-12 months of participation in the project, CLABSI rates in these cohorts have decreased to 1.25 infections per 1,000 central line days, a relative reduction of 33 percent.
* The percentage of units with zero quarterly CLABSIs increased from 27.3 percent at baseline to 69.5 percent for cohorts 1 through 4 at the end of period 4.
* For improvement in safety culture, there was little change in team members' responses to questions about the safety culture on their units between the baseline and followup surveys.

Conclusions

Progress toward achieving the project's stated goals is encouraging, but substantial work remains. Key conclusions thus far include:

* Hospital adult ICUs included in this report are drawn from 32 states and territories, and more than 750 hospitals. This is an increase of 10 states and 400 hospitals since November 2010. These units have reduced their CLABSI rates by an average of 33 percent. As of November 2010, CLABSI rates had decreased by an average of 35 percent indicating rates are continuing to decrease but at a marginally slower rate.
* At baseline, many of these units had CLABSI rates below the national mean and were still able to reduce their rates.
* The project demonstrates that even among hospitals that have already achieved low CLABSI rates, further improvement is possible and achievable.

[Minuteman]

Cross-reference:

"Device-associated infections rates in adult, pediatric, and neonatal intensive care units of hospitals in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings"

http://www.foreskin-restoration.net/forum/showthread.php?t=8975

Higher risk to pediatric & neonatal patients from hospital infections (inc. central line) in the Philippines than for adults, and significantly higher than in the United States.

[Minuteman]

"Tick-borne Illness May Lurk in Blood Supply" HealthDay News 5 September 2011.

http://liveweb.archive.org/http://www.nlm.nih.gov/medlineplus/news/fullstory_116138.html

Researchers say screening test for babesiosis in donated blood needed
URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_116138.html (*this news item will not be available after 12/04/2011)

Monday, September 5, 2011

MONDAY, Sept. 5 (HealthDay News) -- An uncommon, but potentially fatal, tick-borne illness may be creeping into the U.S. blood supply and doctors need to develop a way to spot it, researchers report.

Babesiosis is a parasitic infection that is transmitted through a tick bite or during a blood transfusion. Symptoms range from mild flu-like symptoms to severe difficulty with breathing, organ damage and death. People with compromised immune systems are most at risk for fatal babesiosis infection.
...
Babesiosis in the U.S. blood supply "is something to be reckoned with, and by the time that anyone develops a test that is simple enough to be used by blood banks, it will be too late," he said. Excluding people with a history of babesiosis infection from the blood donor pool won't work because most people don't know they have it.
...
SOURCES: Philip Tierno, Ph.D., director, clinical microbiology and immunology, New York University Langone Medical Center, New York City; Barbara Herwaldt, M.D., M.P.H., medical epidemiologist, U.S. Centers for Disease Control and Prevention, Atlanta; Sept. 6, Annals of Internal Medicine

[Minuteman]

"Hospitalized Kids May Receive Up to 35 Meds a Week" HealthDay News 6 September 2011.

Another reason not to predispose baby boys to unnecessary hospitalisation.

Cross-reference: See also reply #7 on this thread.

http://liveweb.archive.org/http://www.healthfinder.gov/news/newsstory.aspx?Docid=656533&source=govdelivery

Excerpt:

And info on many of those drugs' safety, effectiveness in children is lacking, researchers say.
...
On the first day in children's hospitals, patients younger than 1 year at the 90th percentile of daily medication use received 11 drugs and those 1 year or older received 13 drugs. In general hospitals, patients younger than 1 year received 8 drugs and those 1 year or older received 12 drugs.

By the seventh day of hospitalization in children's hospitals, patients younger than 1 year at the 90th percentile of total use of different medications had received 29 drugs and patients 1 year and older had received 35 drugs. In general hospitals, patients younger than 1 year had received 22 drugs and patients 1 year and older had received 28 drugs.
...
The study is published online Sept. 5 in the journal Archives of Pediatrics & Adolescent Medicine.
...
SOURCE: JAMA/Archives journals, news release, Sept. 5, 2011

[Minuteman]

"Hepatitis information for the public page" on the CDC website.

http://www.cdc.gov/hepatitis/PublicInfo.htm

Could be advantageous to cite their own information in submissions to the CDC/HHS.

Hepatitis B (HBV) seems to be the major concern for spread via blood transfusions (difficult to detect in donor blood).

[Minuteman]

List of FDA approved Viral Hepatitis Therapies available at:

http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/ucm151494.htm

[Minuteman]

"CDC Moves to Make Organ Transplantation Safer"

http://liveweb.archive.org/http://www.healthfinder.gov/news/newsstory.aspx?Docid=657121&source=govdelivery

Proposed guideline would screen more aggressively for hepatitis B and C.

WEDNESDAY, Sept. 21 (HealthDay News) -- More thorough donor screening and more advanced organ testing to help protect transplant patients from infectious diseases are recommended in a draft of an updated organ transplant guideline released Wednesday by the U.S. Centers for Disease Control and Prevention.

The goal of the new guideline is to reduce infections such as HIV (the virus that causes AIDS), hepatitis B virus (HBV), and hepatitis C virus (HCV). Screening is already done for HIV, but HBV and HCV should be added to the screening process, the CDC said.

From 2007 to 2010, the CDC was involved in more than 200 investigations of suspected, unexpected transmission of HIV, hepatitis B and hepatitis C through transplants. In some of the confirmed cases, the transplant recipient died due to the infection.

The existing guideline was created in 1994. Other major proposed changes to the guideline include updated and more sensitive tests for donor organs, and a revised set of donor risk factors that can help doctors get a better idea of possible problems with donors' organs.

The new draft guideline focuses on organ safety because the U.S. Food and Drug Administration has already implemented tighter regulations for tissue and semen donors.

"Our first priority must be patient safety. These recommendations will save lives and reduce unintended disease in organ recipients," Dr. Matthew J. Kuehnert, director of the CDC's Office of Blood, Organ and Other Tissue Safety Office, said in a CDC news release. "The guideline will help patients and their doctors have information they need to fully weigh risks and benefits of transplanting a particular organ."

The Draft 2011 Public Health Service Guideline for Reducing Transmission of HIV, HBV, and HCV through Solid Organ Transplantation can be found at www.regulations.gov. The review-and-comment period will last 60 days.

More information

The United Network for Organ Sharing has more about organ transplantation. External Links Disclaimer Logo

(SOURCE: U.S. Centers for Disease Control and Prevention, news release, Sept. 21, 2011)

[Minuteman]

"Clostridium difficile infection in hospitalized children in the United States"

Clostridium difficile (according to Wikipedia) is a bacteria 'that causes severe diarrhea and other intestinal disease when competing bacteria in the gut flora have been wiped out by antibiotics'.

Boys hospitalised and administered antibiotics as a result of circumcision-related infections are thus conceivably at higher risk from the increasing incidence of Clostridium difficile infection among hospitalised children.

Abstract:

Clostridium difficile infection in hospitalized children in the United States.

Nylund CM, Goudie A, Garza JM, Fairbrother G, Cohen MB.

Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. cade.nylund@usuhs.mil

OBJECTIVES:

To evaluate the trend in Clostridium difficile infection (CDI) among hospitalized children in the United States and to evaluate the severity of and risk factors associated with these cases of CDI.

DESIGN:

A retrospective cohort study using the triennial Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 1997, 2000, 2003, and 2006.

SETTING:

Hospitalized children in the United States.

PARTICIPANTS:

A nationally weighted number of patients (10 474 454) discharged from the hospital, 21 274 of whom had CDI.

MAIN EXPOSURE:

Discharge diagnosis of CDI.

MAIN OUTCOME MEASURES:

Trend in cases of CDI; effect and severity were measured by length of hospital stay, hospitalization charges, colectomy rate, and death rate.

RESULTS:

There was an increasing trend in cases of CDI, from 3565 cases in 1997 to 7779 cases in 2006 (P < .001). Patients with CDI had an increased risk of death (adjusted odds ratio [OR], 1.20; 95% confidence interval [95% CI], 1.01-1.43), colectomy (adjusted OR, 1.36; 95% CI, 1.04-1.79), a longer length of hospital stay (adjusted OR, 4.34; 95% CI, 3.97-4.83), and higher hospitalization charges (adjusted OR, 2.12; 95% CI, 1.98-2.26). There was no trend in death, colectomy, length of hospital stay, or hospitalization charges during the 4 time periods (ie, 1997, 2000, 2003, and 2006). The risk of comorbid diagnoses associated with CDI included inflammatory bowel disease, with an OR of 11.42 (95% CI, 10.16-12.83), and other comorbid diagnoses associated with immunosuppression or antibiotic administration.

CONCLUSIONS:

There is an increasing trend in CDI among hospitalized children, and this disease is having a significant effect on these children. In contrast to adults, there is no increasing trend in the severity of CDI in children. Children with medical conditions (including inflammatory bowel disease and immunosuppression) or conditions requiring antibiotic administration are at high risk of CDI.

Pubmed Link (archived) / Citation:

http://liveweb.archive.org/http://www.ncbi.nlm.nih.gov/pubmed/21199971 / Arch Pediatr Adolesc Med. 2011 May;165(5):451-7. Epub 2011 Jan 3.

[Minuteman]

"Hospital privacy curtains laden with germs" Reuters Health, 22 September 2011.

http://liveweb.archive.org/http://www.nlm.nih.gov/medlineplus/news/fullstory_116763.html

(Reuters Health) - The privacy curtains that separate care spaces in hospitals and clinics are frequently contaminated with potentially dangerous bacteria, researchers said in Chicago this week.

To avoid spreading those bugs, health care providers should make sure to wash their hands after routine contact with the curtains and before interacting with patients, Dr. Michael Ohl, from the University of Iowa, Iowa City, said at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy.

"There is growing recognition that the hospital environment plays an important role in the transmission of infections in the health care setting and it's clear that these (privacy curtains) are potentially important sites of contamination because they are frequently touched by patients and providers," Dr. Ohl told Reuters Health.

Health care providers often touch these curtains after they have washed their hands and then proceed to touch the patient. Further, these curtains often hang for a long time and are difficult to disinfect.

[Minuteman]

"Mycobacterium abscessus in Healthcare Settings" CDC Healthcare Associated Infections (HIA) page (viewed 28 September 2011).

http://liveweb.archive.org/http://www.cdc.gov/HAI/organisms/mycobacterium.html

Excerpt:

General information about Mycobacterium abscessus

Mycobacterium abscessus [mī–kō–bak–tair–ee–yum ab–ses–sus] (also called M. abscessus) is a bacterium distantly related to the ones that cause tuberculosis and leprosy. It is part of a group of environmental mycobacteria and is found in water, soil, and dust. It has been known to contaminate medications and products, including medical devices.

M. abscessus can cause a variety of infections. Healthcare-associated infections due to this bacterium are usually of the skin and the soft tissues under the skin. It is also a cause of serious lung infections in persons with various chronic lung diseases, such as cystic fibrosis.

People with open wounds or who receive injections without appropriate skin disinfection may be at risk for infection by M. abscessus. Rarely, individuals with underlying respiratory conditions or impaired immune systems are at risk of lung infection.

[Minuteman]

"Viral Hepatitis Surveillance – United States, 2009" CDC Viral Hepatitis Statistics & Surveillance page.

http://www.cdc.gov/hepatitis/Statistics/2009Surveillance/

Viral Hepatitis Surveillance – United States, 2009

Entire report in a printable format Adobe PDF file [PDF - 9,527 KB] - updated 9/22/2011

Table 1 - Health-care-associated hepatitis B virus (HBV) and hepatitis C virus (HCV) outbreaks reported to CDC for investigation, 2009

Hepatitis A virus

PAGE

DESCRIPTION
Table 2.1 Reported cases of acute, hepatitis A, by state ― United States, 2005–2009
Table 2.2 Clinical characteristics of reported cases of acute, hepatitis A ― United States, 2009
Table 2.3 Number and rate of deaths with hepatitis A listed as a cause of death, by demographic characteristic and year — United States, 2004–2007
Slide 2.1 Number of reported and estimated acute hepatitis A cases — United States, 1990–2009
Slide 2.2 Incidence of acute, hepatitis A, by age group — United States, 1990–2009
Slide 2.3 Incidence of acute, hepatitis A, by sex — United States, 1990–2009
Slide 2.4 Incidence of acute, hepatitis A, by race/ethnicity — United States, 1990–2009
Slide 2.5 Distribution of risk behaviors/exposures associated with acute, hepatitis A — United States, 2009
Slide 2.6a Acute, hepatitis A reports, by risk exposure — United States, 2009
Slide 2.6b Acute, hepatitis A reports, by risk behavior — United States, 2009
All seven slides in PowerPoint 2007 format Microsoft PowerPoint file [PPTX - 784 KB]



Hepatitis B virus

PAGE

DESCRIPTION
Table 3.1 Reported cases of acute, hepatitis B, by state ― United States, 2005–2009
Table 3.2 Clinical characteristics of reported cases of acute, hepatitis B ― United States, 2009
Table 3.3 Number of laboratory-confirmed, chronic hepatitis B case reports — National Notifiable Diseases Surveillance System (NNDSS), 2009
Table 3.4 Reported cases of laboratory-confirmed, chronic hepatitis B virus (HBV) infection, by sex, race/ethnicity, age group, and case criteria — Emerging Infections Program (EIP) Enhanced Viral Hepatitis Surveillance, 2009
Table 3.5 Number and rate of deaths with hepatitis B listed as a cause of death, by demographic characteristic and year — United States, 2004–2007
Slide 3.1 Number of reported and estimated acute hepatitis B cases — United States, 1990–2009
Slide 3.2 Incidence of acute, hepatitis B, by age group — United States, 1990–2009
Slide 3.3 Incidence of acute, hepatitis B, by sex — United States, 1990–2009
Slide 3.4 Incidence of acute, hepatitis B, by race/ethnicity — United States, 1990–2009
Slide 3.5 Distribution of risk behaviors/exposures associated with acute, hepatitis B — United States, 2009
Slide 3.6a Acute, hepatitis B reports, by risk exposure — United States, 2009
Slide 3.6b Acute, hepatitis B reports, by risk behavior — United States, 2009
All seven slides in PowerPoint 2007 format Microsoft PowerPoint file [PPTX - 830 KB]



Hepatitis C virus

PAGE

DESCRIPTION
Table 4.1 Reported cases of acute, hepatitis C, by state ― United States, 2005–2009
Table 4.2 Clinical characteristics of reported cases of acute, hepatitis C ― United States, 2009
Table 4.3 Number of laboratory confirmed, chronic (past or present) hepatitis C case reports — National Notifiable Diseases Surveillance System (NNDSS), 2009
Table 4.4 Reported cases of laboratory-confirmed, chronic hepatitis C virus (HCV) infection, by sex, race/ethnicity, age group, and case criteria — Emerging Infections Program (EIP) Enhanced Viral Hepatitis Surveillance, 2009
Table 4.5 Number and rate of deaths with hepatitis C listed as a cause of death, by demographic characteristic and year — United States, 2004–2007
Slide 4.1 Number of reported and estimated acute hepatitis C cases — United States, 1992–2009
Slide 4.2 Incidence of acute, hepatitis C, by age group — United States, 1992–2009
Slide 4.3 Incidence of acute, hepatitis C, by sex — United States, 1992–2009
Slide 4.4 Incidence of acute, hepatitis C, by race/ethnicity — United States, 1992–2009
Slide 4.5 Distribution of risk exposures/behaviors associated with acute, hepatitis C — United States, 2009
Slide 4.6a Acute, hepatitis C reports, by risk exposure — United States, 2009
Slide 4.6b Acute, hepatitis C reports, by risk behavior — United States, 2009

All seven slides in PowerPoint 2007 format Microsoft PowerPoint file [PPTX - 1,851 KB]

[Minuteman]

Van Howe RS, Robson WL (2007) The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus Clin Pediatr (Phila). 2007 May;46(4):356-8 Abstract archived at http://liveweb.archive.org/http://www.ncbi.nlm.nih.gov/pubmed?term=17475996 Retrieved 06 October 2011

Abstract

Outbreaks of community-associated methicillin-resistant Staphylococcus aureus were recently reported in newborns at 3 major urban centers. Boys were disproportionately infected. A literature review and a statistical analysis confirmed that male newborns are significantly more likely to be infected with Staphylococcus aureus. Circumcision is a possible explanation for the recent outbreaks.

[Minuteman]

"First National Publication of Infection Rates on MyHospitals" Australian Department of Health & Ageing media release 27 October 2011.

Joint release
The Hon Nicola Roxon MP
Minister for Health and Ageing

The Hon Jason Clare MP
Member for Blaxland
27 October 2011

For the first time all Australians are able to see how well their local public hospital is controlling serious staph blood infections (staphylococcus aureus bacteraemia), with the release today of hospital infection rates on the MyHospitals web site.

Minister for Health and Ageing Nicola Roxon and Federal Member for Blaxland Jason Clare made the announcement today at Bankstown Hospital.

“The Gillard Government believes that patients have a basic right to know about the performance of their public hospitals. The publication of infection rates caused by these potentially deadly bacteria will drive improved hospital performance,” Minister Roxon said.

“Hospital beds are important, but we want people to know what’s been hidden under the mattress. Now for the first time patients will be able to see how their hospital performs in controlling infections.

“Staphylococcus aureus bacteraemia (SAB) is a serious bloodstream infection which is often associated with surgical and other invasive medical procedures.

“They are approximately 7,000 SAB infections each year. Often they can also be resistant to antibiotics.

“It can be difficult to treat, but infection can often be prevented by taking simple precautions. Improved hand washing especially for doctors, nurses, carers and hospital staff is one of the most effective ways of doing this.

“The numbers and rates of infections are available to all Australians for over 450 public hospitals, representing over 87% of patient bed days.

“The Gillard Government’s reform is delivering greater transparency and accountability in the health system. Through National Health Reform a new authority will report on all Australian hospitals, public and private alike, with more detailed information on patient care, safety and quality and health outcomes,” said Minister Roxon.

Ms Roxon said SAB had been accepted as a national indicator of patient safety and health care quality since 2008. Though incidence of infection was collected by all states and territories, it had not always been publicly reported at hospital level.

The national benchmark for SAB is no more than two infections per 10,000 occupied bed days for acute care public hospitals.

The MyHospitals web site can be accessed at www.myhospitals.gov.au

Federal Member for Blaxland Jason Clare said the announcement was good news for Bankstown Hospital which had performed well.

“This is a really good result for Bankstown Hospital and I would like to thank the staff for their continued work to minimise the threat of hospital acquired infections,” Mr Clare said.

Bankstown Hospital is already benefiting where patients are already benefiting from the Commonwealth’s investments in health reform, including:

o $2 million for surgical equipment
o $6.5 million for a four year investment in Geriatric Evaluation and Management day hospital services from 2009-10.

[Minuteman]

"Hospital Rooms Crawling With Drug-Resistant Germs: Study" HealthDay News 02 November 2011.

http://liveweb.archive.org/http://www.nlm.nih.gov/medlineplus/news/fullstory_118243.html

Excerpt:

Nearly half of patient rooms sampled tested positive for Acinetobacter baumannii

WEDNESDAY, Nov. 2 (HealthDay News) -- Nearly half of 50 hospital rooms tested by researchers were colonized or infected with a multidrug-resistant bacteria, a new study says.

University of Maryland School of Medicine researchers found Acinetobacter baumannii (MDR-AB) bacteria on multiple surfaces, including bedrails, supply carts and floors. This species of bacteria, which has caused infection outbreaks in health care facilities over the last decade, can survive on surfaces for long periods of time. MDR-AB infections mainly occur in patients who are very ill, wounded or have weakened immune systems.

For the study, the researchers analyzed samples collected from 10 surfaces in each of 50 hospital rooms occupied by patients with a recent (less than two months prior to sampling) or remote (more than two months) history of MDR-AB.

The surfaces selected for sampling included bedrails, bedside table, door knob, vital sign monitor touchpad, nurse call button, sink, supply cart drawer handles, infusion pump, ventilator surface touch pad, and the floor on both sides of the bed.

The researchers found that 9.8 percent of the surface samples from 48 percent of the rooms showed evidence of MDR-AB. The surfaces most commonly contaminated were supply cart handles (20 percent), floors (16 percent), infusion pumps (14 percent), ventilator touchpads (11.4 percent), and bedrails (just over 10 percent).

These findings are a cause for concern because these surfaces are routinely touched by health care workers, the researchers said.
...
SOURCE: American Journal of Infection Control, news release, Nov. 1, 2011

[Minuteman]

"Med Students Need Hand Holding on Hand Washing" HealthDay News 14 December 2011.

http://liveweb.archive.org/http://www.healthfinder.gov/news/newsstory.aspx?Docid=659442&source=govdelivery

Too many don't know when they're supposed to wash up, study finds.

A new study finds that two out of three medical students don't know when to clean their hands.

Researchers gave seven scenarios to 85 third-year medical students at Hannover Medical School, in Germany, and asked them to identify which of the situations required hand hygiene.

Only 33 percent of the students correctly identified the five scenarios that required hand hygiene: before contact with a patient; before preparation of intravenous fluids; after removal of gloves; after contact with the patient's bed and after contact with vomit.

Only 21 percent of the students correctly identified the five correct and two incorrect situations.

The researchers also found that the medical students expected their own hand hygiene would be better than nurses', even though studies show that nursing students have a higher rate of hand-hygiene compliance than medical students.

"There is no doubt that we need to improve the overall attitude toward the use of alcohol-based hand rub in hospitals," researchers concluded in a journal news release. "To achieve this goal, the adequate behavior of so-called 'role models' is of particular importance."

The study appears in the December issue of the American Journal of Infection Control.

More information

The U.S. Centers for Disease Control and Prevention has more about hand hygiene.

(SOURCE: American Journal of Infection Control, news release, December 2011)

[Minuteman]

"CMS gives consumers access to more details about infection rates at America’s hospitals" CMS mailing-list email dated 7 February 2012.

New data will save lives, cut costs.

Central line-associated bloodstream infections (CLABSIs) are among the most serious of all healthcare-associated infections, resulting in thousands of deaths each year and nearly $700 million in added costs to the U.S. healthcare system. Today, the Centers for Medicare & Medicaid Services (CMS) announced that Hospital Compare will now include data about how often these preventable infections occur in hospital intensive care units across the country. This step will hold hospitals accountable for bringing down these rates, saving thousands of lives and millions of dollars each year.

“Including central line-associated bloodstream infections information on Hospital Compare will save lives and cut costs,” said acting CMS Administrator Marilyn Tavenner. “Adding this information to Hospital Compare extends the Administration’s commitment to make American healthcare safer.”
...
Hospital Compare is one of Medicare’s most popular web tools. The site receives about 1 million page views each month and is available in English and in Spanish. More information about Hospital Compare is online at http://www.hospitalcompare.hhs.gov
...
Click here to view the CMS video with Nancy Foster, Vice President of Quality and Patient Safety Policy at the American Hospital Association discusses CMS' Hospital Compare: http://www.youtube.com/user/CMSHHSgov?feature=mhee#p/u/0/cf99WBNhYEc

[Minuteman]

Buffet-Bataillon S, Rabier V, Bétrémieux P, Beuchée A, Bauer M, Pladys P, Le Gall E, Cormier M, Jolivet-Gougeon A (2009) Outbreak of Serratia marcescens in a neonatal intensive care unit: contaminated unmedicated liquid soap and risk factors J Hosp Infect. 2009 May;72(1):17-22. Epub 2009 Feb 25 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19246120

Abstract:

This study describes an outbreak of Serratia marcescens and its investigation and control in a neonatal intensive care unit (NICU). During a three-month period, five infants were colonised or infected by a single strain of S. marcescens. A case-control study, culture surveys and pulse-field gel electrophoresis analysis implicated a bottle soap dispenser as a reservoir of S. marcescens (P=0.032). Infants with S. marcescens colonisation or infection were also more likely to have been exposed to a central or percutaneous venous catheter (P=0.05) and had had longer exposure to endotracheal intubation (P=0.05). Soap dispensers are used in many hospitals and may be an unrecognised source of nosocomial infections. This potential source of infection could be reduced by using 'airless' dispensers which have no air intake for the distribution of soap. Prompt intervention and strict adherence to alcoholic hand disinfection were the key factors that led to the successful control of this outbreak.

[Minuteman]

"NIH-Supported Scientists Investigate a Newly Emerging Staph Strain" NIH News 28 February 2012.

http://www.niaid.nih.gov/news/newsreleases/2012/Pages/MRSAstaphGenome.aspx

Genome Sequence Analysis Helps Characterize Transmissible Bacterium

WHAT:
Using genome sequencing and household surveillance, National Institutes of Health (NIH) scientists and their colleagues from Columbia University Medical Center and St. George’s University of London have pieced together how a newly emerging type of Staphylococcus aureus bacteria has adapted to transmit more easily among humans. Their new study underscores the need for vigilance in surveillance of S. aureus.

A methicillin-resistant S. aureus (MRSA) strain known as livestock-associated (LA)-ST398 is a cause of severe infections in people in Europe who have close contact with swine, but the bacterium does not transmit well from person to person. More recently, a variant of LA-ST398 that presently is susceptible to methicillin has emerged as a significant cause of community-associated infections in several countries, including the United States, Canada and China. The new strain primarily infects the skin and soft tissue, but it can cause more severe disease.

Based on samples from 332 households in northern Manhattan, New York, scientists have determined that this new strain, named ST398-NM, efficiently transmits from person to person—in contrast to the transmission characteristics of the livestock-associated strain.

By analyzing and comparing the genomes of LA-ST398 and ST398-NM, the study, led by Anne-Catrin Uhlemann, M.D., Ph.D., at Columbia, charted several ways in which the bacterium has adapted to its hosts. For example, they learned that the human-adapted strain (ST398-NM) contains human-specific immune evasion genes, whereas the livestock-adapted strain does not. They also found that ST398-NM adheres well to human skin, thus increasing its ability to colonize and infect people.

The study authors say it is possible that the ST398-NM strain emerging in northern Manhattan could acquire genes making it resistant to methicillin. Scientists at the NIH National Institute of Allergy and Infectious Diseases and their colleagues plan to continue global surveillance of ST398, paying close attention to its molecular adaptations. Their work promises to inform the development of new diagnostic and surveillance strategies against this emerging pathogen.

This study on the human-adapted variant of ST398 strain complements a study that a different group of scientists published in mBio on Feb. 21. That study, also supported by NIH, focused on the evolution of the ST398 strain in livestock, including the effect of antibiotic use. Lance Price, Ph.D., and Paul Keim, Ph.D., at the Translational Genomics Research Institute in Flagstaff, Ariz., led that study with colleagues from around the world.

ARTICLE:
A-C Uhlemann et al. Identification of a highly transmissible animal-independent Staphylococcus aureus ST398 with distinct genomic and cell adhesion properties. mBio DOI:10.1128/mBio.00027-12 (2012).

L Price et al. Staphylococcus aureus CC398: Host adaptation and emergence of methicillin resistance in livestock. mBio DOI: 10.1128/mBio.00305-11 (2012).

WHO:
Frank DeLeo, Ph.D., Acting Chief, Laboratory of Human Bacterial Pathogenesis, NIAID. Dr. DeLeo is an expert in host innate immune interactions with bacteria and is one of the study authors.

[Minuteman]

"Medical Waste" EPA website.

http://www.epa.gov/osw/nonhaz/industrial/medical/index.htm Accessed: 2012-03-20. Archived by WebCite at http://www.webcitation.org/66JrbZbyc

More circumcisions mean more scalpels, needles etc. in use, exposing healthcare workers, patients, and the public to a higher risk.

Excerpt:

Medical waste is all waste materials generated at health care facilities, such as hospitals, clinics, physician's offices, dental practices, blood banks, and veterinary hospitals/clinics, as well as medical research facilities and laboratories.

The Medical Waste tracking Act of 1988 defines medical waste as "any solid waste that is generated in the diagnosis, treatment, or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals." This definition includes, but is not limited to:

* blood-soaked bandages
* culture dishes and other glassware
* discarded surgical gloves
* discarded surgical instruments
* discarded needles used to give shots or draw blood (e.g., medical sharps)
* cultures, stocks, swabs used to inoculate cultures
* removed body organs (e.g., tonsils, appendices, limbs)
* discarded lancets

[Minuteman]

"Hepatitis B program helps cut infant infections" Reuters Health 27 March 2012.

http://www.nlm.nih.gov/medlineplus/news/fullstory_123452.html Accessed: 2012-03-28. Archived by WebCite at http://www.webcitation.org/66Vsms66o

Excerpt:

A program to prevent chronic hepatitis B infection in newborns seems to be working, according to a new study from researchers at the Centers for Disease Control and Prevention.

They found that more babies exposed to hepatitis B through their moms have gotten vaccinated right away, and fewer have ended up with chronic infections, since the program started in 1990.

That's important because the virus can be passed between mother and child during birth, and over the long run chronic infection increases the risk of liver failure and cancer.
...
And even if those women do get screened, she said, they may not have the resources to bring their babies back for the multiple hepatitis B shots necessary for protection.

"It's a completely preventable disease, that's the thing that's frustrating," said Tran, a hepatitis researcher who wasn't part of the study team.

[Minuteman]

"Hepatitis B Fact Sheet No. 204" WHO Media centre July 2012.

http://www.who.int/mediacentre/factsheets/fs204/en/

Excerpts:

Key facts

* Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
* The virus is transmitted through contact with the blood or other body fluids of an infected person.
* Two billion people worldwide have been infected with the virus and about 600 000 people die every year due to the consequences of hepatitis B.
* The hepatitis B virus is 50 to 100 times more infectious than HIV.
* Hepatitis B is an important occupational hazard for health workers.
* Hepatitis B is preventable with the currently available safe and effective vaccine.
...
Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem and the most serious type of viral hepatitis. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer.
...
The likelihood that infection with the hepatitis B virus becomes chronic depends upon the age at which a person becomes infected. Young children who become infected with the hepatitis B virus are the most likely to develop chronic infections:

* 90% of infants infected during the first year of life develop chronic infections;
* 30–50% of children infected between one to four years of age develop chronic infections.

In adults:

* 25% of adults who become chronically infected during childhood die from hepatitis B-related liver cancer or cirrhosis;
* 90% of healthy adults who are infected with the hepatitis B virus will recover and be completely rid of the virus within six months.

[Minuteman]

"Follow-Up Lacking for Babies After Hepatitis B Vaccination: CDC" HealthDay News 27 September 2012.

www.healthfinder.gov/news/newsstory.aspx?Docid=669065

Testing needs to ensure vaccine blocked mother-to-child transmission of virus.

THURSDAY, Sept. 27 (HealthDay News) -- Many U.S. babies born to mothers infected with hepatitis B do not receive recommended follow-up testing after vaccination, a new study finds.

About 25,000 infants are born to hepatitis B-infected mothers each year in the United States, according to background information in the study. Without vaccination, 40 to 90 percent of those infants would become infected. Up to 90 percent of those who contracted the virus would develop chronic infection and possibly die from cirrhosis or liver cancer.

Infants born to mothers infected with hepatitis B should receive the hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth, the federal Advisory Committee on Immunization Practices recommends. Infants should complete the three-dose hepatitis B series, which is up to 95 percent effective in preventing infections.

Between ages 9 months and 18 months, these infants should also receive post-vaccination blood testing to ensure they did not become infected and are protected, the committee advises. The virus is usually not detected until complications develop.

The study, by Ruthie Benson of the Texas Department of State Health Services and colleagues, is published in the Sept. 28 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

For the study, the researchers analyzed data from the Enhanced Perinatal Hepatitis B Case Management Projects. They found that more than 80 percent of infants received recommended vaccinations but only 64 percent also received recommended follow-up testing.

Of those infants, 93 percent were protected from hepatitis B infection, 1 percent became infected and 3 percent were still susceptible to infection. Susceptible infants can be revaccinated and retested.

Timely post-vaccination blood testing is critical to protect infants against hepatitis B infection and to monitor progress toward eliminating the transmission of hepatitis B from mothers to infants, the researchers concluded.

More information

The Hepatitis B Foundation has more about hepatitis B and pregnancy.

(SOURCE: U.S. Centers for Disease Control and Prevention, news release, Sept. 27, 2012)

[Minuteman]

"Certain antibiotics increase the risk of treatment failure in children with MRSA-related skin and soft-tissue infections" AHRQ 7 September 2012.

http://www.ahrq.gov/research/oct12/1012RA19.htm

Children continue to be at risk for developing methicillin-resistant Staphylococcus aureus (MRSA) infections of the skin and soft-tissue (SSTIs). These antibiotic-resistant infections have forced clinicians to look for optimal antibiotics to treat them. A recent study of three different antibiotics found that, compared with clindamycin, use of trimethoprim-sulfamethoxazole (TMP-SMX) or β-lactams was linked to increased risks of treatment failure and infection recurrence in MRSA-prevalent communities in which clindamycin resistance remains low. This link was stronger for children who underwent a drainage procedure.

The study included 47,501 children up to 17 years of age being treated for SSTIs from 2004 to 2007. Treatments were as follows: 61.9 percent received a β-lactam, 22.3 percent received TMP-SMX, and 15.7 percent received clindamycin. Duration of treatment was slightly longer (9.7 days) for TMP-SMX compared to 9.4 days for the other two antibiotics. The use of β-lactams declined significantly from 85.1 percent of all prescriptions in 2004 to 43.8 percent by 2007. On the other hand, there was a dramatic increase in the use of TMP-SMX from just 3.9 percent in 2004 to 38.5 percent in 2007. Children undergoing a drainage procedure were more likely to receive either clindamycin or TMP-SMX.

Among the 6,407 who did receive drainage, 8.9 percent experienced a treatment failure and 22.8 percent had a recurrence. β-lactams and TMP-SMX were associated with increased risks for treatment failure and recurrence compared to clindamycin. In the non-drainage group, the recurrence rate was 18.2 percent and the treatment failure rate was 5.9 percent. The authors note, however, that, although β-lactams are no longer recommended when MRSA is a consideration, these agents may still be effective for nonpurulent SSTIs such as uncomplicated cellulitis or impetigo. The study was supported in part by the Agency for Healthcare Research and Quality (HS13833).

See "Comparative effectiveness of antibiotic treatment strategies for pediatric skin and soft-tissue infections," by Derek J. Williams, M.D., M.P.H., William O. Cooper, M.D., M.P.H., Lisa A. Kaitenbach, M.S., and others in Pediatrics 128(3), pp. e479-e487, 2011.