International Study of the Prevalence and Outcomes of Infection in Intensive Care Units

The Journal of the American Medical Association (JAMA) has taken a one-day snapshot of the number of infected patients in ICUs worldwide — and the results are not good.

Of the tens of thousands of patients surveyed, at over a thousand hospitals, in over 75 countries, more than 50% were considered infected.

The patients who had been in the ICU the longest (prior to the study day) had higher rates of infection “especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species”.

“The ICU mortality rate of infected patients was more than twice that of noninfected patients… as was the hospital mortality rate”.

JAMA’s conclusions? “Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.”

Abstract here.

CBC coverage here.

Toronto doctor says he regrets urging flu shot for hospital board

Board members at Mount Sinai Hospital were offered the vaccine last Monday, the first day it became available, despite public health officials advising only those who were most vulnerable to line up for the shots.

Donald Low, chief microbiologist at the hospital, said a clinic was set up on the first floor for staff and others. There was no word of a vaccine shortage at the time.

“It happened to be the same day that there was a board meeting at the hospital. And I encouraged board members to get the shot,” Dr. Low said today. “There was no indication that there would be any shortage.”

“What seemed like a good idea at the time was a bad idea. And you got to pay the price for it.”

Full Article: here

More Toronto hospital execs given H1N1 shot

The lineup of people in Toronto who have jumped the queue for their H1N1 vaccination is longer than first thought.

Already it has been revealed that members of the board of directors at Toronto’s Mount Sinai Hospital were offered the shot last week, before it was available to people in the province’s high-risk groups.

Now CBC News has learned the board members of the University Health Network — which represents Princess Margaret, Toronto Western and Toronto General — and St. Michael’s Hospital have also had their shots.

Full Article: here

Vaccinating NHL Hockey Teams – Let’s Find a Scapegoat

As the slow, cumbersome and often incompetent roll out of the hiney (H1N1) vaccine continues, Canadians are looking for someone to get mad at.

Right on cue, the Calgary Flames have stepped into the breach. Earlier this week, the public learned that the Calgary Flames and their families had a special vaccine clinic of their own – ahead of pregnant women, young kids and people with underlying medical problems. An Alberta health official identified as “the most senior staff member involved” in the decision to allow the vaccination of members of the Flames and their families was fired.

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But please don’t blame the Flames, the Leafs or the Raptors. They didn’t jump the queue. To conclude they did so is to assume there was an orderly queue to begin with. We now know that the roll out of the vaccine—contrary to assertions by David Butler Jones, head of the Public Health Agency of Canada – has been anything but praiseworthy. It has been marked by confusion and lack of co-ordination.

Full Article: here

October 18-24 is 2009’s International Infection Prevention Week (US) and National Infection Control Week (Canada).

About National Infection Control Week (Canada)

In Canada, Infection Control Week originated in 1988 to highlight infection control efforts in Canadian hospitals, long-term care facilities and in the community. It was an opportunity for infection control professionals to educate staff and the community about the importance of infection prevention and to promote the important work that was being done by infection control professionals in a visible and fun way. In 1989 the federal government proclaimed Infection Control Week as an annual event. (from CHICA-CANADA)

About International Infection Prevention Week (US)

In 1986, President Ronald Reagan proclaimed the third week in October as National Infection Control Week and called all ‘federal, state, and local government agencies, health organizations, communications, media, and people’ to take part in educational activities and programs during this designated week. (from APIC)

To mark Infection Prevention Week, APIC is hosting live webinars on Tuesday, Wednesday and Thursday of this week, each dedicated to a particular “theme” in infection prevention. Tuesday’s webinar will be on “Collaboration“; Wednesday is “Hand Hygiene“, with a special focus on guidelines; and Thursday is “Surgical Site Infection/ OR Safety“.

If you don’t attend the webinars, you can still check out APIC’s educational brochures and guides, such as Tips to Prevent and Fight the Flu, Clean Hands Save Lives and Infection Control in an Emergency/Disaster Situation.

Comic carries hygiene message

Peterborough Regional Health Centre (PRHC) officials are hoping a new comic book will help raise awareness about hand hygiene and hospital-acquired infections, such as Clostridium difficile.

The Bug Stops Here! will be released Sept. 23 at a free public event at the hospital. The comic book is for staff and visitors and is produced by PRHC.

The nine-page book is about a young girl named Sammy who goes to the hospital to visit her sick grandmother.

Along the way she learns about C. difficile, hand washing and other ways to prevent catching infections.

Full Article: here.

Back in January, our newsletter’s MediaWatch section included a story on the dangers of scrubs as fashion statement.

This past weekend, the CBC’s Sunday Edition ran their coverage of this story:

We all know hospitals are dangerous places, literally crawling with dangerous bugs. In fact, around 8,000 Canadians a year die of infections caused by microbes such as C.Difficile which pollute hospital emergency wards, treatment rooms and patients’ rooms. But what can happen when all those hospital bugs begin turning up in coffee shops, on public transit, or even grocery stores carried by hospital personnel wearing their green scrubs, their uniforms, outside the hospital?

Listen to their coverage (in hour 2) here.

New strains of MRSA (Methicillin-resistant staphylococcus aureus), of VRE (Vancomycin-resistant enterococci), C. difficile, even TB are becoming drug-resistant.  Some are now classified as XDR:  extensively drug-resistant.  Many of these “superbugs” spread fastest in what should be the most hygienic and safe of environments — hospitals.

Hospital-acquired infections (HAI) are a growing fear in the public’s mind, litigation is on the rise, and millions are spent on new cleaning protocols alone.  The average cost of hospital care for patients who acquired infections is over $180,000 (US) compared with $31,000 (US) for regular acute patients.  A single class action suit in Canada (against Ontario’s St. Joseph Brant hospital) totaled $50M, and since 2005 the UK’s National Health Service (NHS) has paid £12 million to people claiming compensation involving superbugs.  Financial news sources in the US are predicting this as just the beginning of a wave of superbug-related litigation.

Yet one of the most effective strategies in combatting hospital-acquired infections (HAI) is simple contact management — tracing and understanding interactions:  between patients and staff, patients and equipment, staff and equipment.  Hospitals currently lack the means to track the spread of these outbreaks within their walls, and unable to isolate where contamination occurred and how it is spreading, time and resources are spent starting from scratch every time.

Keeping track of who touched what and what went where, done manually, can quickly add to, not alleviate the burden on overworked professionals.  However, data gathered through RFID happens automatically (no extra steps for hospital personnel); is accurate; and is available in real-time.

That’s why Infonaut Inc has created a precise RFID and GIS-based infectious disease risk-management tool, called Hospital Watch Live (HWL).

“We are very excited to be working on this project and about the potential it brings to the healthcare industry,” said Niall Wallace, CEO, Infonaut. “This innovative health IT product will help health stakeholders control the spread of infectious diseases such as C. difficile. In the future, we hope that hospitals, long-term care facilities and other health facilities will be able to use this system to help manage and reduce the impact of future number of disease outbreaks.”

When a “Patient Zero” is identified in Hospital Watch Live, GIS mapping technology combines with RFID locators to support immediate risk assessment, containment and outbreak mitigation.  RFID tag technology enables hospitals to literally see who and what infected patients have interacted with, where they have been, and which equipment has been in close proximity to them – all turned into actionable information.  An analytical extension determines potential commonalities and high-risk contacts. Profiles are dynamically generated: as people and assets interact with each other, associated risk levels change to reflect new inputs.

“We recognize the importance of supporting the development of this unique system that could help staff manage the spread of infectious diseases at SAH [Sault Area Hospital] while creating a value-added product for use throughout the healthcare sector,” said David Orazietti, MPP for Sault Ste Marie.

A Beta implementation of Hospital Watch Live will launch within the next month at the Sault Area Hospital (SAH), a provincial leader in C. difficile management.

“The Sault Area Hospital is pleased to collaborate on this innovative solution with Infonaut,” said Marc Bouchard, Chief Information and Privacy Officer, Sault Area Hospital. “The project will see the development of what should be an interesting tool that could assist our ongoing efforts in infection control and prevention.”

The next phase of development on the HWL solution includes installation and simulated use in George Brown College (GBC)’s Controlled Applied Learning Environment (CALE), Simulated Practice Centre (SPC).  George Brown’s $1.2 million advanced facility incorporates an electronic health records system, video camera broadcast system, and complex simulation mannequins.  Nursing students will use the system as part of the infection control curriculum, and other faculty and students will be involved in the testing and development of system components.

This relationship gives Infonaut a strategic advantage, as testing on hyper-real simulations that give hospitals and healthcare organizations added confidence in the robustness of Infonaut’s technology.  Robert Luke, Director of Research and Innovation at GBC said of Infonaut’s technology: “This is the kind of applied research the country needs — innovation meeting real needs.”

To learn more about this product, or the rest of the Infonaut Live suite, please contact Sandra Linklater, Director of Business Development at slinklater[at]infonaut[dot]ca or 705-987-3816.

>>Spread of Swine Flu Puts Japan in Crisis Mode

On Thursday, confirmed cases of the H1N1 flu virus in Japan reached 279, centering on Kobe and the neighboring city of Osaka, in western Japan. Like many other countries, Japan has reported mild flu cases and no deaths. Still, it is in crisis mode: more than 4,800 schools have been closed in the region, medical services are swamped, and testing laboratories are working around the clock.

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The outbreak has come as a particular shock for hygiene-obsessed Japan, where hand-washing is religiously taught in schools, children play in sanitized sandboxes, and everything from underwear to ballpoint pens comes with supposed antibacterial properties.

Full Article: here.

>>Mexico City ends swine flu alert, no cases in week

Mexico City lowered its swine flu alert level from yellow to green on Thursday, and the mayor said “we can relax” now that there have been no new infections for a week.

City Health Secretary Armando Ahued said nobody has been hospitalized with respiratory infections in the last three days, and no swine flu cases have been confirmed since May 14. “We are seeing a 96.1 percent drop in cases, and that’s why we are dropping the alert level to green today,” Ahued said.

Full Article: here.

Only 7 percent of hospitals meet Leapfrog medication error prevention (CPOE) standards and few hospitals are  meeting mortality standards, according to the 2008 Leapfrog Hospital Survey, released Wednesday.

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Other highlights of the 2008 hospital survey include:

• Low percentages of reporting hospitals are meeting volume and risk-adjusted mortality standards or adhering to nationally endorsed process measures for eight high-risk procedures, where following nationally endorsed and evidence-based guidelines is known to save lives:
  • 43 percent for heart bypass surgery;
  • 35 percent for heart angioplasty;
  • 32 percent for high-risk deliveries;
  • 23 percent for pancreatic resections;
  • 16 percent for bariatric surgery;
  • 15 percent for esophagectomy;
  • 7 percent for aortic valve replacement; and
  • 5 percent for aortic abdominal aneurysm repair.
• Sixty-five percent of participating hospitals do not have all recommended policies in place to prevent common hospital-acquired infections (HAIs).

Full article:  Most hospitals fall short on safety measures, Leapfrog survey shows

Thousands of patients undergoing treatment or surgery at Scottish hospitals are to be screened for MRSA, Nicola Sturgeon, the Health Secretary, said yesterday.

The national screening programme, which follows pilot programmes by three Scottish health boards, will take place over the next 12 months and will focus on the elderly and people admitted for kidney disease, skin problems and vascular surgery, a group deemed to be most at risk. The only patients not to be screened will be psychiatric, obstetric and paediatric patients.

Ms Sturgeon made the announcement as official figures showed a drop in the number of cases of Clostridium difficile and MRSA in Scottish hospitals.

Full Article: Scottish hospitals to screen patients for superbugs

The definition of an “outbreak” was recently called into question, when a number of patients at St. Joseph’s Healthcare acquired c.difficile — but in a pattern which didn’t exactly match reporting guidelines.

This caused confusion within the hospital over whether to declare an outbreak situation, as well as highlighting the delay between an identified rise in infections, and when the public finds out about it.

Eventually, all outbreaks get reported in each hospital’s monthly filing on a public website set up by the Health Ministry. But it could be a month before the public hears about it, Baker acknowledges. Hundreds of patients and visitors could pass through a hospital in that time.

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One definition says an outbreak occurs when three or more new cases appear within seven days in one ward. It is also an outbreak when six or more cases occur within 30 days in a single ward or unit.

But at St. Joe’s, the current C. diff outbreak was not confined to one ward. Cases were spread through the hospital.  Chief of staff Dr. David Higgins says that made it difficult to establish whether St. Joe’s was in outbreak or simply faced a seasonal rise in C. diff.

“That’s why we agonized over this for several days,” says Higgins.

Full article: What makes it an oubreak?