Hot Topics in Infection Control
Community Acquired MRSA on the Rise in Children
Lindsey Tanner, AP, Surgical Products, May 17, 2010
A recent study published in Pediatrics indicates that community acquired cases of methicillin resistant Staphylococcus aureus (MRSA) have surged in the child population over the past several years. Hospitalizations of children with these antibiotic resistant staph infections have increased 10 fold, from 2 cases per 1000 hospital admissions in 1999 to 21 cases per 1000 hospital admissions in 2008. According to Dr. Buddy Creech, an infectious disease specialist at Vanderbilt University, the results are “a good example of how something that is not unexpected remains alarming,” Findings such as these highlight the need for effective infection prevention practices within schools, child care centers and daycare facilities. Hand hygiene remains the critical component to prevent the transmission of pathogenic microorganisms, however the environment can also have a significant impact. Protocols should be in place to ensure high touch, hand contact surface are adequately cleaned and disinfected on a frequent basis. An ideal disinfectant will achieve broad spectrum germicidal activity in rapid, realistic contact times balanced with a preferable safety profile.
To Test or Not to Test
As disinfectants are more widely used throughout healthcare facilities, so too are automated dilution control systems for quick and efficient dispensing of the chemicals. Although these systems are typically highly accurate, their use does not replace the need to implement quality control measures to monitor proper dilution as indicated by the Provincial Infectious Disease Advisory Committee (PIDAC) in their recently published Best Practices for Environmental Cleaning for Prevention and Control of Infections. This includes the use of Chemical Indicator Strips or Test Strips. These strips are intended to indicate whether there may be a glaring issue with dispensing such as water quality, water pressure, proportioning tip malfunction, etc. It is important to clarify that these strips are not pass/fail and are therefore not absolute. The colour coding also means the results may be subjective. Therefore, test strips for surface disinfectants are meant for periodic testing of dilution systems to ensure quality control and periodic checks on staff practices for facilities that are free pouring.
Norovirus, It Only Takes A Little To Spread A Lot
Hospital Infection Control & Prevention, April 2010 Newsletter
A health care-specific CDC guideline on managing a norovirus outbreak is expected later this year to underscore the important infection control measures, says MacCannell. Even when an outbreak is resolved, it can recur if the virus is still circulating in the community, she says. "Studies show that even if you have exposure to norovirus and recover, re-infection even within a year can occur quite quickly," she says. "It is a community-based disease. It can have a seed in the community and make its way into the health care setting." It can take as few as 100 viral particles to start an infection, she says.
Antimicrobial Surfaces
In healthcare there has been a gaining interest in the utilization of surfaces made of materials which carry some inherent antimicrobial qualities or have been treated with antimicrobial coatings. Intended as a proactive means to reduce bacterial load on surfaces, copper,
silver and stainless steel surfaces treated with titanium dioxide and
other coatings are being strongly marketed as infection prevention
and control gains notoriety.
Recently the US Environmental Protection Agency (EPA) registered
275 copper alloys as antimicrobial materials. When uncoated, these
alloys apparently kill more than 99.9% of bacteria. The solid
materials can be used to make surfaces that are frequently touched,
offering a second line of defence against bacteria. However, it’s
important to remember that the use of antimicrobial copper is
intended as a supplement to routine infection control practices and
doesn’t act as a substitute for them. Therefore, regular cleaning and
disinfection practices must be maintained, which brings into question
the ability of soft metals such as copper to withstand the rigours of
regular cleaning and disinfection.
As addressed by Ontario’s Provincial Infectious Disease Advisory
Committee (PIDAC) in their Best Practices for Environmental
Cleaning for Infection Prevention and Control in All Health Care
Settings, “Treated surfaces and equipment have not been well
studied in clinical settings and little data exists to show how these
antimicrobial chemicals (coatings) will endure after exposure to
hospital-grade cleaners and disinfectants or whether they will prevent
disease.” Further into the document PIDAC takes the formal stance
“Antimicrobial treated surfaces are not recommended.”