The “Superbug” was super preventable

The “Superbug” was super preventable
2/26/2015

RECENT “SUPERBUG” OUTBREAK MAKES GOOD CASE FOR DISPOSABLE PRODUCTS

As seen in recent headlines, the Ronald Reagan UCLA Medical Center notified 179 patients they may have been exposed to carbapenem-resistant Enterobacteriaceae (CRE) from contaminated duodenoscopes. CRE is highly resistant to antibiotics and can kill up to 50 percent of infected patients (1). A total of seven UCLA patients were infected and two have died since February 24 (2).

The duodenoscopes at the center of the recent “superbug” poses a great question: Are reusable products always best practice?

Reusable medical tools clearly have irreplaceable benefits. They, first and foremost, are cost effective by avoiding the need to reorder and restock inventory. Secondly, the quality of reusable products is typically higher than their one-time use counterparts.

So where should the line be drawn between using a product that is reusable versus a product that is intended for one-time use? The answer is simple: the cleaning process. If the risk of using a reusable product outweighs the reward, then the switch should be a no-brainer.

The biggest debate surrounding the UCLA controversy is the lack of effective cleaning methods. Duodenoscopes, compared to other endoscopes, improve the efficiency and effectiveness of ERCP, according to the FDA. However, they are challenging to clean. Some parts of the scopes are difficult to access and effective cleaning of all areas may not actually be possible (3). In fact, an 18-year-old infected UCLA patient is now allegedly suing the duodenoscope manufacturer for negligence and failing to provide an effective and validated reprocessing protocol (1).

If a medical tool—regardless of its purpose—is going to be used on more than one patient, then extensive cleaning procedures need to be outlined to prevent infection and cross-contamination. If effective cleaning cannot be guaranteed between uses, clinicians should consider alternatives such as disposable products.

For example, clinicians could utilize disposable instruments that are pre-sterilized and individually packaged. This eliminates any chance of human error in the cleaning process. A disposable speculum is another example of a common product that may be more effective than a reusable speculum. If discarded after use, there is a much lower risk of cross-contamination between patients.

Reusable products and disposable products both have their benefits; however, the key to maintaining patient safety is assessing the context of its use and selecting the most effective option.

1. http://www.latimes.com/business/la-fi-ucla-outbreak-patients-20150225-story.html
2. http://www.apic.org/Resource_/TinyMceFileManager/mediaImages/ERCP_Press_Release_APIC_SHEA_02242015.pdf
3. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm434871.htm

How Clean Are Your Hands, Really?

How Clean Are Your Hands, Really?
7/2/2015


Infection control is an obvious concern in a healthcare environment. There is no doubt reducing the risk of infection is of high important in a context where unwanted bacteria is synonymous with procedure complications, additional antibiotics, longer recoveries, and higher readmission rates.

But what about those of us that don’t spend a majority of our time in a healthcare facility? We spend our days in an office. In cubicles. Break rooms. Our dining room tables and living room couches. Should we be concerned about unwanted bacteria as well?

Of course.

Countless bacteria lingers in common, every day places. Let’s walk through an average day.

6:00 a.m. arrives and you wake up in your bed which, essentially, is a collection of dead skin cells, body oils, sweat, fungal mold, spores, bacteria, and dust mites and their feces (1).

You walk to the bathroom to start getting ready for your day. The bathtub, specifically near the drain, houses an average of 119,468 bacteria per square inch (2). And on your toothbrush dwells about 100 million bacteria including E. coli, staphylococci, and—sorry—fecal germs (3).

It’s time for a quick breakfast so you head to the kitchen. Be careful; you’re fridge poses a risk. 83 percent of fridges test positive for common molds within their seals and 26 percent of fridge handles are considered high risk for illness transmission. Even the sponge sitting in your sink is a breeding ground, possibly holding 10 million bacteria in just it’s dirty water alone (4).

Time to leave and you flip the light switch—217 bacteria per square inch (5).

You get in your car to drive to work. Did you know that the steering wheel of your car harbors nine times more germs than a public toilet seat? Approximately 80 bacteria lurk on each square inch of toilet, but approximately 700 inhabit the interior of a car (6).

You realize you are low on gas and pull into the local gas station. You pay with cash, where a live flu virus can live for up to 17 days (7). But the cash isn’t the only concern. Did you know that 71 percent of gas pump handles are contaminated with germs that can make you ill (8)?

You finally get to work and sit at your desk. Your keyboard has 70% more bacteria that a toilet seat. Your office phone is about 400 times dirtier than a toilet seat. And the area where your hands rest can house about 10,000,000 bacteria (5).

You give a few handshakes to your coworkers as the day progress. But did you know 80 percent of infections are spread through hand contact (5)?

Your day will continue in this mass submersion of bacteria. More door handles. More light switches. TV remotes. Handrails. Restaurant menus. It’s endless. But don’t panic. Of course, all statistics are dependent on cleaning habits. And not all bacteria are bad. In fact, you need bacteria to maintain your health and immune system. Most people with a healthy immune system and good hygiene habits don’t have to be too concerned. Likewise, simple precautions can be taken to ensure an everyday bacteria does not become a threat, such as proper hand washing.

So don’t let the facts scare you—just use them as a friendly reminder that infection control is not just a concern limited to hospitals or healthcare workers. It should be on all of our radars.

Sources:
1. Beantown Bedding Statistics
2. CBS News
3. MedicineNet.com
4. CBS News
5. YGraph.com
6. Dailymail.co.uk
7. Time
8. Forbes