MRSA review Methicillinresistant Staphylococcus aureus MRSA are isolates

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MRSA… review • Methicillin-resistant Staphylococcus aureus (MRSA) are isolates of the bacterium Staphylococcus aureus

MRSA… review • Methicillin-resistant Staphylococcus aureus (MRSA) are isolates of the bacterium Staphylococcus aureus that have acquired genes encoding antibiotic resistance to all penicillins, including methicillin and other narrow-spectrum β-lactamase-resistant penicillin antibiotics. [1] The first MRSA was discovered in the UK in 1961, but MRSA are now widespread in the hospital setting. MRSA is commonly termed a superbug. • MRSA may also be known as oxacillin-resistant Staphylococcus aureus (ORSA) and multiple-resistant Staphylococcus aureus, while non-methicillin resistant strains of S. aureus are sometimes called methicillin-susceptible Staphylococcus aureus (MSSA) if an explicit distinction must be made. • Although MRSA has traditionally been seen as a hospital-associated infection, community-acquired MRSA strains have appeared in recent years, notably in the U. S. and Australia. [2] The abbreviations CA-MRSA (community-associated MRSA) and HA-MRSA (hospitalassociated MRSA) are now commonly seen in medical literature.

 • Staph superbug may be infecting patients • June 25, 2007 07: 23

• Staph superbug may be infecting patients • June 25, 2007 07: 23 PM PST • A dangerous, drug-resistant staph germ may be infecting as many as 5 percent of hospital and nursing home patients, according to a comprehensive study. At least 30, 000 U. S. hospital patients may have the superbug at any given time, according to a survey released Monday by the Association for Professionals in Infection Control and Epidemiology. The estimate is about 10 times the rate that some health officials had previously estimated. Some federal health officials said they had not seen the study and could not comment on its methodology or its prevalence. But they welcomed added attention to the problem. "This is a welcome piece of information that emphasizes that this is a huge problem in health care facilities, and more needs to done to prevent it, " said Dr. John Jernigan, an epidemiologist with the U. S. Centers for Disease Control and Prevention. At issue is a superbug known as Methicillin-resistant Staphylococcus aureus, which cannot be tamed by certain common antibiotics. It is associated with sometimes-horrific skin infections, but it also causes blood infections, pneumonia and other illnesses. The potentially fatal germ, which is spread by touch, typically thrives in health care settings where people have open wounds. But in recent years, "community-associated" outbreaks have occurred among prisoners, children and athletes, with the germ spreading through skin contact or shared items such as towels. Past studies have looked at how common the superbug is in specific patient groups, such as emergency-room patients with skin infections in 11 U. S. cities, dialysis patients or those admitted to intensive care units in a sample of a few hundred teaching hospitals. It's difficult to compare prevalence estimates from the different studies, experts said, but the new study suggests the superbug is eight to 11 times more common than some other studies have concluded. The new study was different in that it sampled a larger and more diverse set of health care facilities. It also was more recent than other studies, and it counted cases in which the bacterium was merely present in a patient and not necessarily causing disease. The infection control professionals' association sent surveys to its more than 11, 000 members and asked them to pick one day from Oct. 1 to Nov. 10, 2006, to count cases of the infection. They were to turn in the number of all the patients in their health care facilities who were identified through test results as infected or colonized with the superbug. The final results represented 1, 237 hospitals and nursing homes — or roughly 21 percent of U. S. inpatient health care facilities, association officials said. The researchers concluded that at least 46 out of every 1, 000 patients had the bug. There was a breakdown: About 34 per 1, 000 were infected with the superbug, meaning they had skin or blood infections or some other clinical symptom. And 12 per 1, 000 were "colonized, " meaning they had the bug but no illness. Most of the patients were identified within 48 hours of hospital admission, which means, the researchers believe, that they didn't have time to become infected to the degree that a test would show it. For that reason, the researchers concluded that about 75 percent of patients walked into the hospitals and nursing homes already carrying the bug. "They acquired it in a previous stay in health care facility, or out in the community, " said Dr. William Jarvis, a consulting epidemiologist and former CDC officials who led the study. The infection can be treated with other antibiotics. Health care workers can prevent spread of the bug through hand-washing and equipment decontamination, and by wearing gloves and gowns and by separating infected people from other patients. The study is being presented this week at the association's annual meeting in San Jose, Calif. , but has not been submitted for publication in a peer-reviewed medical journal. • • • • •

HANDWASHING!!!!

HANDWASHING!!!!

THE 2006 CAMPAIGN; In Clean Politics, Flesh Is Pressed, Then Sanitized By MARK LEIBOVICH

THE 2006 CAMPAIGN; In Clean Politics, Flesh Is Pressed, Then Sanitized By MARK LEIBOVICH The New York Times October 28, 2006 Campaigns are filthy. Not only in terms of last-minute smears and dirty tricks. But also as in germs, parasites and all the bacterial unpleasantness that is spread around through so much glad-handing and flesh-pressing. ''You can't always get to a sink to wash your hands, '' said Anne Ryun, wife of Representative Jim Ryun, Republican of Kansas. Hands would be the untidy appendages that transmit infectious disease. Like so many other people involved in politics these days, Mrs. Ryun has become obsessive about using hand sanitizer and ensuring that others do, too. She squirted Purell, the antiseptic goop of choice on the stump and selfproclaimed killer of ''99. 99 percent of most common germs that may cause illness, '' on people lined up to meet Vice President Dick Cheney this month at a fund-raiser in Topeka. When Mr. Cheney was done meeting and greeting, he, too, rubbed his hands vigorously with the stuff, dispensed in dollops by an aide when the vice president was out of public view. That has become routine in this peak season of handshaking, practiced by everyone from the most powerful leaders to the lowliest hopefuls. Politics is personal at all levels, and germs do not discriminate. Like chicken dinners and lobbyists, they afflict Democrats and Republicans alike. It would be difficult to find an entourage that does not have at least one aide packing Purell.

Mysophobia An abnormal fear of dirt or contamination • Compulsive hand-washing • Anxiety over

Mysophobia An abnormal fear of dirt or contamination • Compulsive hand-washing • Anxiety over disorganization, sloppiness or lack of control

Use of Alcohol… • 70% ethanol • Alcohol doesn't cut through grime well, so

Use of Alcohol… • 70% ethanol • Alcohol doesn't cut through grime well, so dirt, blood, feces or other body fluids or soil must be wiped or washed away first, if the alcohol in the sanitizer is to be effective. In such cases, hand washing with soap and water is advised.

Dr. Levy Says…. • • • Dr. Levy wrote: ''Bacteria are a natural, and

Dr. Levy Says…. • • • Dr. Levy wrote: ''Bacteria are a natural, and needed, part of life. Most live blamelessly. In fact, they often protect us from disease because they compete with, and thus limit the proliferation of, pathogenic bacteria. The benign competitors can be important allies in the fight against antibiotic-resistant pathogens. '' In making a case against products spiked with antibacterials, he explained: ''Like antibiotics, antibacterials can alter the mix of bacteria; they simultaneously kill susceptible bacteria and promote the growth of resistant strains. These resistant microbes may include bacteria that were present from the start. But they can also include ones that were unable to gain a foothold previously and are now able to thrive thanks to the destruction of competing microbes. '' Given the chance to proliferate, some of these emergent organisms ''may become new agents of disease, '' Dr. Levy said. The most frequently used antibacterial agent in consumer products is triclosan. Laura Mc. Murry and colleagues in Dr. Levy's laboratory have shown that while triclosan wipes out the most sensitive bacteria, it also gives rise to bacteria that resist its action by pumping the chemical out of their cells. ''Residues are the potential problem, '' Dr. Levy said. ''We're talking about chemicals that can stick around in the home and continue to select for resistance when the levels of these chemicals drop. Then even high levels of the chemicals won't work. '' Another potential problem of creating a superhygienic environment is misdevelopment of the immune system in children that persists throughout life. The developing immune system may need to be primed to function properly.

Handwashing… • • • *Always wash your hands with soap and water after using

Handwashing… • • • *Always wash your hands with soap and water after using the toilet, before preparing or eating food, after working in the garden or changing a dirty diaper. *Thoroughly rinse under running water all fruits and vegetables before eating or preparing them, including foods like melons and grapefruit. Skins can harbor diseasecausing microorganisms that contaminate the edible part of the food, especially if it sits around unrefrigerated for a while. *Always thaw foods in the refrigerator. Do not leave cooked foods unrefrigerated for more than two hours, or for more than one hour when the temperature reaches 90. *Use separate cutting boards for uncooked meat, poultry or fish, and for vegetables, fruits and bread. Always wash surfaces, including the sink, and utensils that have been in contact with raw meat, poultry, fish or eggs with hot soapy water as soon as you are through using them. *Plastic cutting boards, sponges and dishcloths can be sanitized in the dishwasher. *To sanitize a surface or object, use bleach, denatured alcohol or hydrogen peroxide. These do their work and disappear, leaving no residue to foster microbial resistance. Laundry detergent with bleach is fine. *Infant clothing, bedding, etc. might be washed separately from adult laundry, but no special detergent is needed. If you use cloth diapers, they should always be washed separately in hot water with bleach. *Close the lid on the toilet before you flush it to keep tiny droplets containing microorganisms from spewing into the air. The rules change if someone in the household is seriously ill or has a compromised immune system. ''Products containing antibacterial agents are best reserved for use when someone is very sick, '' Dr. Levy said. ''When caring for a sick person, hand washing should take more than one minute. ''

How effective are antibacterial soaps and hand sanitizers against the viruses that cause “stomach

How effective are antibacterial soaps and hand sanitizers against the viruses that cause “stomach flu”?

 • • • Handwashing is known to be one of the most effective

• • • Handwashing is known to be one of the most effective ways to prevent the spread of germs and disease, but how effective are popular antibacterial soaps and alcohol-based hand sanitizers against the germs that are the most common cause of “stomach flu” ie. gastrointestinal illness characterized by nausea, vomiting, diarrhea and abdominal pain? A team of researchers from Emory University and North Carolina State University conducted a study to address this important public health question. Stomach flu is usually caused by a group of viruses called “noroviruses”. The CDC estimates that these viruses are responsible for about 23 million cases of stomach flu in the United States each year, and these viruses have been associated with hundreds of outbreaks in nursing homes, schools and universities, childcare centers, hospitals, cruise ships, hotels, summer camps and other settings where people are in close contact and share living quarters or eat institutional or restaurant food. These viruses are spread by ingestion of fecal-contaminated food or water, by person-to-person contact or contact with fecalcontaminated objects. Foodborne outbreaks usually involve food prepared by infected foodhandlers with virus on their hands. Because these viruses are highly infectious, only a very small amount (about 2 -10 virus particles) is enough to cause infection and illness. Careful and frequent handwashing is considered to be a key public health barrier to prevent the spread of these infections. In this study, a known amount of norovirus was placed on the fingers of volunteers and allowed to dry. The investigators tested one common liquid antibacterial soap and one popular brand of an alcohol-based hand sanitizer to see how effective they were at removing the virus from the fingers compared to rinsing with water only. They found that washing the fingers with plain water gave the greatest level of norovirus reduction, with an average of about 96% removal. Washing the fingers with an antibacterial liquid soap gave an average of about 88% removal. The alcohol-based sanitizer was not effective at removing the virus from the volunteers’ fingers and only resulted in an average removal of 46%. This study was a collaboration between Emory University and North Carolina State University and was funded by a grant from the International Life Sciences Institute of North America (ILSI-NA). The experiments were conducted by Dr. Pengbo Liu in the Hubert Department of Global Health at the Rollins School of Public Health of Emory University. Dr. Liu presented his findings at the annual meeting of the American Society for Microbiology in Orlando, FL on May 22, 2006. These findings have important implications for healthcare settings, food service establishments, childcare centers, schools and other venues that rely on alcohol-based hand sanitizers because of convenience. These settings are at greatest risk of norovirus outbreaks because of frequent person-to-person contact and/or food preparation, and employees as well as residents in these settings need to practice effective handwashing techniques. Although washing with plain water proved to be a successful way to remove the norovirus from fingers, additional research is needed to develop hand sanitizers that are effective against this group of viruses.