United in the fight against germs
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It could be the plot of a science fiction movie. Invaders attack in stealth mode, mutating to stay one step ahead of whatever agent tries to destroy them. Bolstered by the fight, the strongest multiply, sharing their defense systems with an army of millions. Those that have peacefully coexisted in our midst for decades join the attack, striking the most vulnerable among us. Oh, and they are invisible to the naked eye.
Long under the microscope of concerned scientists, the proliferation of these drug-resistant superbugs has now caught the attention of policy makers. Last fall, President Obama signed an executive order establishing a task force charged with developing and implementing a National Strategy for Combating Antibiotic Resistance.
Nurses, of course, didn’t have to wait for the president to sound the alarm to recognize the dangers of antibiotic resistance. Theresa Brown, RN, a Scrubs contributing editor and New York Times columnist, hopes the president’s action provides a wake-up call to the public. “There’s a real lack of understanding about what we could be up against,” says Brown. The rise of untreatable infections gives us a Back to the Future–like glimpse of what medicine was like before the introduction of antibiotics. To preserve the effectiveness of the antibiotics we have, “we need a multidisciplinary effort that includes MDs, pharmacists, nurses, hospital epidemiologists, and infection prevention and control departments,” says Patricia Stone, PhD, RN, FAAN, director, Center for Health Policy at Columbia University School of Nursing in New York City. In short, she says, “there needs to be a culture change.”
The president’s plan is a move in the right direction. It calls for research into new anti-infective therapies as well as improved diagnostics. It also includes major investment in national surveillance and reporting systems to track drug-resistant bacteria and to monitor antibiotic usage, which have been shown to decrease inappropriate prescribing in hospitals, says Stone.
Change is already happening. Some hospitals have invested in pricey technology and products to curb the spread of antibiotic-resistant infections. On the research front, the fight against infectious disease is making for some pretty strange bedfellows (and that’s a good thing), helping to fast-track sophisticated diagnostic equipment, new vaccines and innovative anti-infection therapies. Scientists are also exploring the vast microbial communities that live within us and around us, in order to provide a better picture of our invisible world. Some breakthroughs are years away from practical application, while others are available today. Here, a roundup of innovative products and potentially game-changing research.
When it comes to prevention, think VRE: vaccinate, regulate, educate.
1. Vaccinate for immunity: Scientists are testing new vaccines for some of the most virulent diseases. If successful, these have the potential to save millions of lives, including healthcare workers who are at ground zero of every epidemic. Under the auspices of the World Health Organization (WHO), two Ebola vaccines are being tested in 10 sites across three continents. WHO is working to compress a standard two- to four-year process into a few months. And several companies are in a race to bring vaccines to prevent clostridium difficile to market. Sanofi Pasteur completed Phase II testing—two placebo-controlled, double-blind, multisite trials—with favorable results; Phase III testing is underway. Pfizer’s animal testing found its vaccine to be 100 percent effective in warding off C. diff. They are now conducting Phase II clinical trials. Both vaccines are part of the FDA’s fast-track drug program.
2. Regulate to protect antibiotics: Given that 70 to 80 percent of our antibiotic supply is used for animals—to promote growth and as a prophylaxis to prevent the spread of infection in crowded industrial plants—that would be a good starting point for curbing antibiotic resistance, says Brown. “Frankly, I can’t understand how that’s been allowed to continue,” she says, echoing a sentiment held throughout the healthcare community. Unlike the European Union, the U.S. currently has no regulation against the use of medically important drugs in animals. In fact, the agricultural industry isn’t even required to report its pharmaceutical usage.
3. Educate to increase awareness: “Without proper knowledge, even the most technologically advanced [protective] equipment is useless,” says Stacy Nigliazzo, an RN who works in a Houston emergency department. At her hospital, there’s been a renewed focus on staff education. Thankfully, that seems to be the trend, with infection preventionists educating nurses on best practices and using technology to provide data back to nursing units. Hospitals are also becoming “very proactive now about being sure their staff is well trained to use PPEs [personal protective equipment],” says Elaine Larson, PhD, RN, FAAN, CIC, associate dean for research at Columbia University School of Nursing. Even nurses with lots of experience treating Ebola patients say you have to practice putting on and taking off protective gear so you won’t be making mistakes if the time comes to use it. So drill, baby, drill.
Scrubs, high-touch surfaces, your hands— all may be factors in the spread of pathogens. These four innovative products aim to break the chain of transmission.
1. High-Tech Hand Washing: Hand hygiene is number one on the infection protection to-do (again and again and again) list. Now, some hospitals are employing high-tech hand-washing systems with motion sensors that connect to badges worn by staff members and serve as reminders to wash thoroughly (flashing red: stop and wash; flashing green: proceed to your patient). “In hospitals where the safety culture is such that the staff want to know when they are doing the right thing or not, they can be very helpful,” says Larson. What about the Big Brother aspect? (The systems also track who’s washing and who’s not.) “Nurses have expressed concerns about what will be done with the information,” says Larson. “So the important thing is to be transparent about how the information is used.”
2. Copper Alloy in the ICU: Some ICUs have gotten a makeover—among them, Memorial Sloan Kettering Cancer Center in New York City, and the Medical University of South Carolina and the Ralph H. Johnson Veterans Administration Medical Center, both in Charleston. In an effort to curb HAIs, these hospitals have replaced the standard plastic, aluminum or stainless steel of some of the most frequently touched surfaces in patient ICU rooms with copper alloy—a natural antimicrobial material (why do you think it’s the preferred substance in plumbing for pipes?). All three centers were sites in a randomized controlled trial comparing the rooms fitted out in copper alloy with conventional ICU rooms. Earlier research had demonstrated that the continuous antimicrobial properties of copper greatly reduce the bio-burden in a patient’s room, but last year’s study, published in Infection Control and Hospital Epidemiology, found evidence that it can reduce the risk of HAIs by more than 50 percent. Does that mean there will be a run on copper furniture by hospital execs? Maybe. According to a health economics study from the University of York in England, the reduced rate in HAIs may mean a quick recoup on the capital investment. The bottom line? It’s good for the bottom line.
3. Robotic Cleaners: If they can perform surgery, why not have robots clean patient rooms, too? Well, in some hospitals they do. The R2-D2s rolling down hospital corridors operate in unoccupied rooms, sanitizing by pulsating waves of ultraviolet C for about 15 minutes. Do they kill pathogens? Absolutely. Are they effective at curbing HAIs? We’ll have to wait for the science for that answer. Until then, at upwards of $100,000 per automated cleaner, most hospitals will stick with manual labor.
4. Canine Sniffers: Dogs have an incredible olfactory capacity, as we all know. So researchers at the University Medical Centre in Amsterdam decided to train a beagle named Cliff to recognize the odor of clostridium difficile from stool samples. The beagle’s well-honed sense of smell led him to correctly identify 300 out of 300 samples (30 were positive). Next, he roamed a hospital unit giving the sniff test to 30 subjects. Without the benefit of feces, Cliff’s rapid diagnostic nose had an accuracy rate of 83 percent. Still better (and certainly faster) than conventional C. diff labs.
We can outsmart pathogens by sending mixed messages and looking for clues. Here’s a microbial field guide.
Did you know that bacteria are social? Yep, they communicate in one language with those within their species and another language with the general population. Even the nastiest pathogen needs a gang of comrades before it can go on the attack. So it sends out a chemical message, “Hey, anyone out there?” It’s called quorum sensing, and it’s through that ability that many bacteria become virulent. Scientists are researching ways to send pathogens mixed messages, either by inhibiting or disrupting the signal. The thinking is, this approach will cause the cells to self-destruct rather than attack. While the research is promising, application is still years away.
Our bodies are hosts to trillions of microorganisms, a complex ecosystem affecting and affected by the ecosystems of the buildings we work and live in. Marine microbiologist Jack Gilbert, PhD, director of the Hospital Microbiome Project, is studying the shifting microbial landscape of the University of Chicago’s Center for Care and Discovery. For two months before the hospital opened, and 10 months after it became operational, researchers took daily samples of microorganisms from bed rails, bathrooms, floor tiles, and the bodies of willing patients and staff. “Before we can understand how to control the spread of pathogens,” says Gilbert, “we have to understand them in the context of their communities.” His study will provide some context, but much more research is needed to get a real picture. Because as it stands, says Gilbert, “we know more about the ecology of Lake Michigan than we do the ecology of a hospital.”
Of course, in a perfect, medically sound world, “control” and treatment” would be non-issues. Until then, know that a united effort is underway, and we here at Scrubs will continue to bring you the latest news in infection prevention. You can learn more about this at our #ProtectNurses initiative here: scrubsmag.com/protect-nurses.
So are you satisfied with the effort being made to protect healthcare workers in particular against the threat of infection? Tell us what you think in the comments section below!