New study: Nursing home staff often fail to change glovesSep082017

From Infection Control Today:

Dirty glovesThe failure to change gloves is common among certified nursing assistants, and may be a significant cause of the spread of dangerous pathogens in nursing homes and long-term healthcare settings, according to a new study published in the September issue of the American Journal of Infection Control.
 
Certified nursing assistants (CNAs) are often the main providers of care in long-term care facilities (LTCFs), with significant patient contact. If a CNA uses gloves incorrectly, pathogens can easily be spread to patients and the environment, leading to healthcare-associated infections (HAIs). Researchers estimate that between 1.6 million and 3.8 million infections occur in LTCFs annually. Infections in LTCFs cause approximately 388,000 deaths per year and cost between $673 million and $2 billion annually.
 
“Gloves are an essential component of standard precautions, and proper use of gloves is a critical component of best practices to prevent HAIs,” said Linda Greene, RN, MPS, CIC, FAPIC, the 2017 APIC president. “This is especially important in long-term care, where residents are more vulnerable to infection and stay for extended periods. Facilities must continually educate healthcare providers about the importance of appropriate glove use to prevent infection and monitor adherence to this practice.”
 
In the first-of-its-kind prospective study by Deborah Patterson Burdsall, PhD, RN-BC, CIC, of the University of Iowa College of Nursing, researchers examined the degree of inappropriate glove use in a random sample of 74 CNAs performing toileting and perineal care at one LTCF. Inappropriate glove use — defined as a failure to change gloves, and when surfaces were touched with contaminated gloves — was frequently observed in this study.
 
The Centers for Disease Control and Prevention (CDC) recommends standard precautions requiring all CNAs to wear personal protective equipment, especially gloves, to avoid contact with blood, secretions, excretions, or other potentially infectious materials that may contain pathogens. CNAs must change gloves as a standard precaution at the following glove change points during patient care: when the gloves have touched blood or body fluids; after the CNA completes a patient task; after the gloves touch a potentially contaminated site; and in between patients.
 
“Glove use behavior is as important as hand washing when it comes to infection prevention,” said Burdsall. “These findings indicate that glove use behavior should be monitored alongside hand hygiene. The observations should be shared with staff to improve behaviors and reduce the risk of disease transmission.” 
 
While CNAs wore gloves for 80 percent of touch points, they failed to change gloves at 66 percent of glove change points. More than 44 percent of the gloved touch points were observed as contaminated, with all contaminated touches being with gloved hands. Of note, gloves were readily available on all units in public areas, shower rooms, patient rooms, and patient bathrooms to enhance availability and workflow.
 
To measure inappropriate glove use, the PI developed and validated the glove use surveillance tool (GUST), allowing them to record the type of surface, the sequence in which they touched surfaces during a patient care event, whether they wore gloves, and whether they changed gloves.
 
The frequency of contaminated gloved touches illustrates the significant potential for cross-contamination between patients and the healthcare environment from inappropriate glove use. This study supports the findings of earlier studies that describe inappropriate glove use by healthcare personnel. Based on information from such studies, infection prevention staff and educators should develop training programs using adult learning principles and evidence-based instructional methods to improve glove use.

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Antibiotic-resistant genes are being spread via animal feedAug302017

Excerpted from The Independent:

Antibiotic-resistant genes are being spread around the world in animal feed, according to new research that adds to fears humanity could lose one of our most important medicines.

A UK government-commissioned report last year estimated 10 million people a year could die worldwide by 2050 because of the rise of ‘superbugs’, prompting the then Prime Minister David Cameron to announce a crackdown on over-prescribing by GPs and lead efforts to tackle the problem at the United Nations.

Bacteria resistant to the ‘last resort’ antibiotic, colistin, was found in the UK in December 2015, following similar discoveries in parts of Europe, Africa and China.

There has been concern about antibiotics given to livestock for some time with the European Union banning farmers from using it as growth promoter.

And the new research, by scientists at Dalian University of Technology in China, found another source of the problem related to food production: antibiotic-resistant genes in fishmeal, meat-and-bone meal and chicken meal.

The scientists said fishmeal – “one of the most globally traded commodities” – was serving as “a vehicle to promote antibiotic-resistant gene dissemination internationally”.

This could help explain why resistant bacteria have been showing up in unexpected places around the world such as isolated caves and ancient permafrost.

 “Our study implies that long-term and repeated feeding with fishmeal may accelerate the emergence of antibiotic-resistant bacteria and even pathogens …,” the researchers wrote in the journal Environmental Science & Technology.

Read the full article at www.independent.co.uk/news/science/antibiotic-resistant-genes-spread-in-animal-feed-across-world-bacteria-germs-scientists-discover-a7920016.html

 

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Researchers use antibiotics combo to kill first strain of highly resistant E. coliAug302017

Excerpted from Infection Control Today:

The recent discovery of E. coli carrying mcr-1 and ndm-5 — genes that make the bacterium immune to last-resort antibiotics — has left clinicians without an effective means of treatment for this bacterium. But in a new study, University at Buffalo researchers have assembled a team of three antibiotics that, together, are capable of eradicating the deadly bacterium. The groundbreaking research was recently published in mBio, a journal for the American Society of Microbiology.

The researchers found that a novel combination of aztreonam, amikacin and polymyxin B — a last-resort antibiotic — was able to kill E. coli carrying mcr-1 and ndm-5 genes within 24 hours while also preventing regrowth. Traditional combinations of these antibiotics were unable to kill the E. coli and resulted in rapid resistance.

“The threat of Gram-negative bacteria, including E. coli carrying mcr-1, is worrisome,” says Zackery Bulman, PharmD, first author on the study, a graduate and former postdoctoral fellow at the UB School of Pharmacy and Pharmaceutical Sciences who is now an assistant professor at the University of Illinois at Chicago College of Pharmacy. “We believe that the appearance of mcr-1 and ndm-5 in patients may be a harbinger for what is to come. The golden era of antibiotics isn’t over yet, but we wanted to help clinicians prepare therapeutically for the occurrence of these strains.”

Brian Tsuji, PharmD, principal investigator and associate professor in the School of Pharmacy and Pharmaceutical Sciences, continued: “That is why the mcr-1 and ndm-5 strains represent an urgent threat, because of the high-degree of resistance combined with the potential for rapid spread in the community setting. We had to work quickly and think outside of the box, beyond traditional antibiotic combinations.”

“This is the first study to propose therapeutic solutions with three drugs against superbugs harboring mcr-1 and ndm-5. The results will help prepare clinicians for future occurrences of these pathogens.”

The rapid increase in antibiotic-resistant bacteria has resurrected the importance of polymyxins, a class of antibiotics that are effective but employed as a last resort because of the damage they can cause to the kidneys.

To avoid prescribing high dosages of polymyxins and to make up for the antibiotic’s weaknesses, the researchers decided to turn to new dosing strategies and multiple antibiotic combinations.

After conducting studies on dozens of combinations of more than 15 antibiotics paired with polymyxin B, the researchers discovered two effective treatments. Combinations of polymyxin B with either aztreonam or amikacin resulted in undetectable bacterial counts after 24 hours.

The E. coli, however, was able to regrow to initial levels after 96 hours and a subpopulation of amikacin-resistant strains arose after 10 days when exposed to the combination of polymyxin B and amikacin. Polymyxin B and aztreonam pushed the E. coli into a persistent but nonreplicating state. Only the triple combination eliminated the E. coli strain and prevented regrowth.

“We knew that polymyxins alone couldn’t work. Only the three drugs combined were able to work synergistically to suppress and kill the bacteria,” says Bulman. “We overcame the bacteria by pushing it as far as possible with an agent that it was resistant to while simultaneously administering two other antibiotics.”

The promising finding may provide a viable treatment against mcr-1 and ndm-5 strains.

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Read the entire article on http://www.infectioncontroltoday.com/news/2017/08/researchers-use-antibiotics-combo-to-kill-first-strain-of-highly-resistant-e-coli-in-us.aspx

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Mosquitoes capable of carrying Zika virus may have colony in OntarioAug232017

  • The insects tested negative for both the Zika and West Nile virus
  • Species can carry Dengue fever

From CBC.ca:

A mosquito species capable of transmitting the Zika virus and other tropical diseases may have established a colony in southwestern Ontario, a development that could mean changes for Canadian healthcare providers.

Two adult Aedes albopictus mosquitoes, also known as the Asian tiger mosquito, were recently trapped in Windsor-Essex, following the 17 found last year, according to the area’s health unit.

Staff are not sure how the insects arrived in Ontario, but the region’s acting medical officer of health said evidence suggests the mosquitoes may have hatched in the Windsor area.

“Seeing them this early, we’re more concerned about an established population here,” said Dr. Wajid Ahmed, explaining that last year the insects were found in mid-October. “This time around it’s mid-August, which is more suggestive that they just became adults here in this region.”

It’s also possible the insects were carried from the United States in a shipping container or by other cross-border traffic.

The two mosquitoes tested negative for both the Zika and West Nile virus, just like those captured in Windsor-Essex last year.

Ahmed said climate change bringing warmer temperatures to Windsor might help explain why mosquitoes are moving north.

“Once they establish themselves here it would be more difficult to control and maybe we’ll see some diseases we haven’t seen before,” he said, adding the species can also transmit dengue fever and chikungunya — both of which can cause fevers, and headaches along with muscle and joint pain.

“Our immune systems are not prepared for that,” Ahmed added. “Some of these tropical symptoms are way behind on our list of differential diagnosis so I think that would require some understanding and education from the healthcare provider perspective that these are also a possibility now.”

Read the full article on http://www.cbc.ca/news/canada/windsor/evidence-shows-mosquitoes-capable-of-carrying-zika-virus-may-have-colony-in-ontario-1.4249459

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