Physician white lab coats worn in the hospital are frequently contaminated with harmful bacteria. The Society for Healthcare Epidemiology of America (SHEA) examined this problem and issued recommendations for hospitals in non-operating room areas. Although believed to enhance professional appearance and despite its historical role in American medicine, as physicians go from patient to patient, the white lab coat transmits bacteria from patient to patient unless careful and rigorous steps are taken to prevent this. Especially in the hospital, there is a real danger of cross-contamination with drug resistant strains of bacteria, such as methicillin resistant staphylococcus aureus (MRSA), vancomycin resistant enterococcus (VRE) and other multi-drug resistant organisms.
Infection Control is critical as there is a dangerous new strain of antibiotic resistant bacteria that has been found in about 5% of US hospitals last year. The Center for Disease Control warns that this new superbug is Carbapenem-Resistant Enterobacteriaceae (CRE). It is a difficult infection to treat and has a high mortality rate. Most of the CRE cases involved Klebsiella species of bacteria. CRE infections are important because once these bacteria invade the blood stream, mortality rates are greater than 40%. Most of these infections start in the urine. CRE strains frequently have other antibiotic resistant capabilities that make them immune from most antibiotics and several strains resistant to all antibiotics have been detected. New antibiotics that might be effective against CRE strains are years away from commercial availability. Because Enterobacteriaceae are the most common infective CRE organism in the health care setting, with pseudomonas and acinetobacter species being others, these bacteria have the potential for moving out of the hospital and into our communities.
Congress recently held a two-day hearing on the meningitis outbreak that caused 32 deaths and more than 430 illnesses across the country. In New Jersey, the state has identified at least 18 cases of the illness.
Babies can develop Early Onset Sepsis (EOS) immediately after birth, yet Complete Blood Cell Count test results (CBC) can remain normal. Although certain abnormalities in CBC were very specific for EOS, many babies had EOS with bacteremia and a normal CBC. A normal CBC cannot rule out EOS and clinical suspicion must be relied upon in order to start antibiotic treatment early and prevent serious injuries to the baby. Unfortunately, only 2,164 (1%) out of 166,092 babies with clinically suspected EOS actually had bacteria in the bloodstream, urine or cerebrospinal fluid. This study shows that doctors cannot rely on the CBC to diagnose babies with EOS, because a normal blood count does not rule it out. This means that a large number of babies still need to be treated empirically with antibiotics when there is suspicion of sepsis, even though most of them will not have bacteremia. A normal blood test is not a reason to withhold antibiotics if there are worrisome clinical signs.
Central line associated bloodstream infections (CLABSIs) can be significantly reduced by using basic infection prevention methods, as reported by Reuters Health Information service and in Critical Care Medicine. Central lines are used commonly to monitor and treat patients in Intensive Care Units (ICUs). Approximately 120,000 CLABSIs occur each year in ICUs resulting in 31,000 deaths. Five (5) preventive measures reduced these infections by over 80%:
Hunterdon Medical Center, a smaller 178 bed community hospital in central New Jersey, is beating the MRSA bacteria that cause some of the most deadly and costly infections in hospitalized patients, as recently reported in the Wall Street Journal. The hospital uses an Infection Prevention Program that has reduced the frequency of Clostridium Difficile (C. Diff.) infections by 79% and Methicillin Resistant Staphylococcus Aureus (MRSA) by 66%. These infections are largely responsible for much of the $33 billion cost associated with preventable infections in hospitalized patients. Currently, 1 in 20 patients admitted to hospitals gets a potentially deadly infection.