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.

…

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?

Five seniors with C. difficile have died at St. Joseph’s Hospital in the last month.

That is nearly one in three of those who got the bacterial infection that causes severe diarrhea.
…
C. diff is one of three outbreaks St. Joseph’s Healthcare is currently battling.

Another senior died during the first week of March from invasive Group A streptococcus, which was spreading on the geriatric psychiatry unit at the Centre for Mountain Health Services.

Three wards remain closed to visitors at the downtown hospital as St. Joseph’s tries to contain the Norwalk virus.

Full Article:  Three St. Joe’s patients die of C. diff since April 1

>>March 21st

Simple techniques slash hospital infections: meeting

Jasper Palmer didn’t think he was doing anything special when he balled up his paper hospital gown and stuffed it into one of his gloves. He just knew it was tidy and would stop the gown from spreading germs.

But the technique is one of the simple innovations that has reduced rates of infection with so-called superbugs at his and other hospitals by 26 percent to 62 percent, infection control experts told a meeting of the Society for Healthcare Epidemiology of America in San Diego on Saturday.

>>March 23rd

Simple ideas from hospital staff cut superbug rates

Borrowing ideas from hospital workers who have devised their own clever strategies for reducing superbug spread can lead to huge drops in infection rates throughout a hospital, say infection control experts.

The experts told a meeting of the Society for Healthcare Epidemiology of America in San Diego on Saturday that using an approach called positive deviance (PD) at three U.S. hospitals helped to reduce the incidence of MRSA (multifaceted methicillin-resistant Staphylococcus aureus) at their facilities by 26 to 62 per cent.

>>March 25th

Northern Ireland scientists find a new weapon in MRSA war

A new weapon that could help wipe out the deadly MRSA virus has been developed by researchers from Northern Ireland.
Experts from Queen’s University have discovered new agents that can kill colonies of MRSA and other antiboitic resistant hospital-acquired infections.

The antimicrobial agents also prevent any growth of the potentially lethal bacteria.

C difficile outbreak leaves three hospital patients dead

Three patients have died as a direct result of a C difficile outbreak at hospital in the South East.

East Sussex Hospitals trust has recorded 62 cases of the infection at Eastbourne District General Hospital since 1 January and has reviewed the histories of the affected patients.

The trust said on Tuesday that three patients had died as a direct result of being infected and it had contributed to a further 10 deaths.

>>March 27th

‘Search and destroy’ kills MRSA

A private hospital in Dublin has instituted a strict ’search-and-destroy’ policy to combat MRSA infections.

See a video of Dr. Fidelma Fitzpatrick from the Irish Health Protection Surveillance Centre discuss the facts of healthcare-associated infections here.

Today marks World TB Day, the anniversary of the day in 1882 when the cause of tuberculosis (the TB bacillus) was first discovered.

This year the awareness-raising around TB Day is tied to awareness of new strains of the disease — strains which are highly drug resistant, classified as either multi-drug resistant (MDR-TB), or extensively drug-resistant (XDR-TB).  2008-09 marked the highest ever number of M/XDR-TB cases reported to WHO.

WHO is calling the rise in cases of M/XDR-TB alarming, and an urgent global health priority. From April 1st to 3rd, they are is sponsoring a three day meeting in Beijing, which will bring together health ministers from 27 countries with high rates of M/XDR-TB.

“To allow this form of TB to become widespread would be a setback of epic proportions”
–WHO Director-General, Dr Margaret Chan, in her address to the 61st World Health Assembly. [link]

Environmental cleaning intervention reduces transmission of multidrug-resistant organisms in ICUs

A rigorous environmental cleaning intervention can reduce the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and other multidrug-resistant organisms in hospital intensive care units (ICUs), according to a new study released today at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA). Researchers found that following an enhanced cleaning protocol reduced the spread of MRSA to patients exposed to rooms in which the prior occupant had been colonized or infected.

Canadian Medical Association Journal (CMAJ) has published “Hospital infection control strategies for antibiotic-resistant organisms”:

Identified risk factors include:

…increasing age of patient and severity of disease, increasing length of hospital stay, admission to an intensive care unit and proximity to patients carrying an antimicrobial-resistant organism. Use of broad-spectrum antibiotics and/or prolonged use of antibiotics are also risk factors.

Full Article:  “Hospital infection control strategies for antibiotic-resistant organisms”

>>Mar 10/09

Support Services Crucial to Infection Control, Study Says
CUPE says control of HAI is “much more complex than people just washing their hands”:

The research paper draws from reports in countries including Canada, Scotland and the United Kingdom, which note that clinical studies and audits have linked HAI outbreaks with understaffing, increased workload, high turnover and inadequate training.

Charlottetown medical unit reopens after superbug causes lockdown
A Charlottetown hospital, which recently stated an outbreak of MRSA and VRE was over, just re-opened after lockdown to control another superbug problem.

Part of Charlottetown’s Queen Elizabeth Hospital was locked down Monday afternoon and night, and has since reopened after a patient tested positive for a superbug.

Hospital officials are still trying to determine the source of the bacteria.

>>Mar 11/09

How contractors are battling infection during hospital construction
Building Design & Construction looks at how hospital infection control can be considered at the earliest stage of construction or renovation.

Every year, about 90,000 patients in U.S. hospitals contract nosocomial infections — they get sick (or sicker) from something they caught in the hospital. Two or three thousand of them die as a result.

Building Teams are helping to attack this problem by taking steps to control the spread of infection sources during construction of new facilities or additions, or during renovation of existing hospitals.

>>Mar 12/09

Kenta Secures $10M to Advance Antibodies against Nosocomial Infections
Kenta Biotech has raised $10m in private financing to cover the “ongoing development of two antibodies targeting aggressive bacteria that cause nosocomial infections.”

>>Feb 28/09

Antibiotic resistance: The ongoing challenge for effective drug therapy
The Journal for the American Academy of Physician Assistants (JAAPA) posts the first in a series of three articles on antibiotic resistance that “reviews this serious health threat, explains why the challenge is never-ending, and offers possible solutions.”

>>Mar 4/09

A 76-Year-Old Man With Recurrent Clostridium difficile Associated Diarrhea
JAMA article takes an in-depth look at the management of c.difficile by following the case of Mr S — examining the difficulties in managing c.difficile treatment can complicate the management of other conditions.

>>Feb 16/09

States consider requiring hospitals to screen for MRSA
Four states (California, Illinois, New Jersey and Pennsylvania) require hospitals to screen high-risk patients for MRSA.  Eight states considered such legislation last year, and Washington and Kentucky filed new bills in late January.

The rate of patients entering the hospital with methicillin-resistant Staphylococcus aureus increased eightfold between 1999 and 2006. Politicians in statehouses around the country say hospitals need to take a more active approach to stopping MRSA’s spread.

A show of hands reveals the value of good hygiene
A study at the Cleveland Veterans Affairs Medical Center gives a visceral lesson in the need for cleaning protocols and hand hygiene:

To show how infected – and contagious – an asymptomatic carrier could be, a physician examined the patient with an ungloved hand and then pressed his hand into a petri dish. After incubation, researchers were surprised to see MRSA bacteria growing in the dish so thickly that images of the physician’s fingers are easily discernable.

Jury awards $17.5 million to man who lost limbs from MRSA infection
A Texan man has been awarded a multi-million dollar settlement after he lost his limbs to gangrene that set in after septic shock from undiagnosed MRSA.

>>Feb 17/09

Bacterial Infections in Hospitals Decline
Time Magazine writes on the misleading nature of headline-grabbing superbug scares – that despite stories about sports teams and schools, superbugs are still largely found only in hospital settings.

The goal now is to further reduce the risk of MRSA in vulnerable populations by identifying them early on: according to the Association for Professionals in Infection Control and Epidemiology, 10 states currently require screening of high-risk patients, including those in the ICU and with weaker immune systems, for MRSA, and other states may soon adopt similar screening laws.

>>Feb 7/09

MRSA’s on the Move
Nurses dealing with the risks when MRSA moves from hospitals to community-based clinics — particularly for patients with diabetes.

“MRSA is not a word we take lightly around here,” said Candy Gauthier, LPN, staff nurse in The William W. Backus Hospital department of endocrinology and metabolism, an offsite clinic based in Norwich, CT. “It’s scary to think that this is not just occurring in the hospital anymore.”

>>Feb 9/09

Next Biotech Opportunity Could be in Hospital-Acquired Infections
Kalorama Information, a medical market business intelligence firm, speculates in their new report that it will be biotech companies who lead the way in combatting HAI.

Hospital acquired infections (HAI) are exacting a significant toll on human life, ranking among the top ten leading causes of death in the United States. With an estimated 5%-10% hospital patients acquiring an infection, about two million cases each year and about 90,000 deaths, there is a huge associated financial burden which a new report from Kalorama Information, “Nosocomial Infections: Market Assessment for Diagnostics and Therapeutics,” estimates at between $4.5 billion and $5.78 billion annually.

…

“HAIs, especially the foreign bugs, are a considerable problem and the healthcare community needs help,” said Bruce Carlson, publisher of Kalorama Information. “Unfortunately, the pharmaceutical industry has practically abandoned developing treatments. It will fall to the biotechnology community, and biotech companies have a market opportunity here that could provide them a major revenue stream.”

>>Feb 12/09

“The war against superbugs”
CBC digs into the “War on Superbugs”:

“A study published in the American Journal of Infection Control in December 2008, found that rates of hospital-acquired infections soared in Canada between 1999 and 2005.

Rates of methicillin-resistant Staphylococcus aureus – known as MRSA — more than doubled in the period from 1999 to 2005, said the study, which was based on a survey of hospitals with 80 or more beds.

There were 5.2 cases of MRSA per 1,000 hospital admissions in 2005, up from two per 1,000 in 1999. There was also an upward trend in C. difficile infections, and the number of hospitals reporting new cases of infection with VRE soared.”

>>Feb 13/09

BioScience Laboratories Approved to Test MRSA on Human Volunteers
In the States, BioScience Laboratories have received approval to begin testing their product’s efficacy against MRSA on human skin.