Friday, November 14, 2008

Superbugs in the news

The Ministry of Health and Long Term Care keeps track of many health issues.

Read about C. difficile -- a bacteria that causes infectious diarrhea and can spread in a health care settings.
Find out about C. difficile rates in Ontario hospitals. Canadian hospitals and Ministry of Health & LTC are so concerned about these diseases that they are instituting Hospital Standardized Mortality Ratios (HSMR) in an attempt to warn the public about these risks.
  • Clostridium Difficile Associated Disease (CDAD) => superbug that produces toxins
  • Methicillin Resistant Staphylococcus Aureus (MRSA) => bacteria
  • Vancomycin Resistant Enterococcis (VRE) => intestines & female genital tract
  • Central-Line Primary Bloodstream Infection (CLI) => catheters and tubes that carry chemotherapy, intravenous fluids, antibiotics, blood products.
  • Ventilator-Associated Pneumonia (VAP) => a mechanical ventilator helps a patient breathe. Can affect 8 to 28% of those on ventilation. Mortality ranges from 1 to 50%, depending upon health issues.
  • Surgical Site Infection Prevention => any surgery has risks in this regard. If surgeons are not wearing cleans gowns (scrubs), if nurses come in wearing uniforms that have not been properly laundered, or if instruments have not been properly sterilized.

What are we talking about?

Firstly, C. Difficile (short for Clostridium difficile), and secondly, MRSA (Methicillin-resistant Staphylococcus aureus) are the big superbugs that threaten those in institutional care. Home caregivers are also vulnerable. Many caregivers are seniors and have health issues of their own.

C. Diff grows in the bowels, and produces toxins, and kills both good and bad bacteria. The good bacteria is important for the digestive system. The bad bacteria, in normal amounts, exists around us. The nose carries some, the bowels pass it all! We live with these bacteria every day on our hands, secreted in bodily fluids and waste, where is can live benignly in low-risk, healthy adults ad on unclean surfaces.

Another issue: E. coli (Escherichia coli ), while not a superbug, as we have seen is present in fecal matter in humans and animals. it can be present in beef, unpasteurized apple cider, milk, fruits and vegetables, water, and in both raw and cooked foods, well water, and lakes and streams. It is spread hand to mouth in humans and causes the same symptoms as C. Diff: bowel irritation, diarrhea, fever, nausea and vomiting. Unlike the superbugs, it cannot live on surfaces, is not spread by kissing or normal social interactions. But in those who are already weak, it can kill as we have seen in contaminated spinach, romaine lettuce, and has been found in restaurants, day care centres, and other places where children and adults gather. Food handlers must be the most vigilant.

What happens?

A patient on antibiotics, who ingests C. diff, is in danger of developing this disease. Risk factors include :
  • A history of antibiotic usage
  • Bowel surgery
  • Chemotherapy
  • Prolonged hospitalization
  • Elderly
  • Serious underlying illnesses or debilitation
Symptoms can include anything from mild to severe abdominal cramps, high fever, severe diarrhea, leading to dehydration, inflammation of the colon and even death. This can happen through contact with a surface, and then using the contaminated hand to eat, rub an eye, or any other activity that allows the bacteria to enter the body. Bleach is the only thing that kills it. Alcohol sanitizers don't kill this superbug. The bacteria can enter your body through catheters, or an open wound, such as a bedsore, which affects those unable to get out of bed.

Why are these people vulnerable?

Those who are ill, and frail, and on antibiotics are at risk. Antibiotics kill all good and bad bacteria. The symptoms show us why that is: those who are ill may not be eating well, they may already be dehydrated, and unable to replace fluids and electrolytes in their bodies. The Canadian Centre for Occupational Health and Safety says that those already on antibiotics, the elderly or very ill are most at risk. If you have diseases that affect your autoimmune system, you cannot fight off these superbugs.

The most frail depend upon many caregivers for their ADLs. Those in hospital and Long-Term Care see many PSWs, therapists, or volunteers in a day, as well as nursing staff. Each time a new person enters their room to bring them medications, water, snacks, change their bed, get them up out of bed, to transfer them to a wheelchair, they risk bringing bacteria with them.

What can you do about it?

At there are many suggestions that might help. The Ministry of Health & LTC, has good suggestions. Unfortunately, for vulnerable seniors, they may be unable to advocate for themselves. If doctors and nurses are unable to remember to wash their hands, how can we expect frail and ailing seniors to remember to do so, as well.

The suggestion if that you ask your Primary Care staff if they have washed their hands.
Others include various preventative measures. One problem is that Primary Care deliverers do not change their scrubs or their protective gloves. Another issues involves items, such as door handles, surfaces, i.e., food trays, stethoscopes, blood pressure cuffs and bed rails, and even privacy curtains that are washed infrequently.

If you are at home and caregiving, you must be careful to thoroughly wash everything after any contact. Bedding needs to be washed in hot water, and dried on high heat, if possible. This includes clothing, and cloths. You can buy protective padding that will help cover mattresses.

Why is hand washing important?

Hand washing, when done correctly, is the single most effective way to prevent the spread of communicable diseases. Good hand washing technique is easy to learn and can significantly reduce the spread of infectious diseases among both children and adults. Wash after you change rooms, before and after eating and preparing meals, and after going to the bathroom, or serving any of the needs of care recipients.

There are five steps to keeping hands bacteria-free :

1. Wet your hands with warm running water.
2. Add soap, and then rub your hands together, making a soapy lather. Do this away from the running water for at least 15 seconds, being careful not to wash the lather away. Wash the front and back of your hands, as well as between your fingers and under your nails.
3. Rinse your hands well under warm running water.
4. Pat hands dry with a paper towel.
5. Turn off water using same paper towel and dispose in a proper receptacle.

What does the future hold?
Eventually, I predict, these superbugs will spread throughout Primary Care, as it spreads to those being cared for in their own homes, by home care personnel who are not vigilant in washing their hands. With the increasing number of frail seniors, many with polypharmacy issues, being cared for in their homes I believe that protocols must be set up to ensure that we prevent the communication of diseases.

Some care staff work in both institutions, schools, and home care. Visitors are likely to be visiting both a school and a senior's home. We all need to be vigilant. The alcohol-based products available in gel at most front doors of such are not as safe as we might think. Hand washing is far better as a deterrent. Profit and non-profits, senior's support networks and every place where we live, eat, work and play are at risk. Every agency that welcomes groups must develop a protocol to prevent these bacteria from getting hold of our frail citizens.

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