National Athletic Trainers’ Association (NATA) has released a new position statement guidelines on Preventing Skin Diseases released in July 2010 issue of the NATA Journal of Athletic Training.

The new position statement guidelines were presented at NATA’s 61st annual meeting and clinical symposium in Philadelphia and have been developed over the past five years by a committee of experts.

The position statement guidelines appear in the The position statement guidelines are part of an ongoing effort by NATA to reduce the incidence of skin diseases among athletes at all levels.

A recent review of infectious disease outbreaks conducted by the authors of the statement found that skin diseases accounted for more than 50 percent of all infectious diseases in competitive sports from 1922 through 2005.

“This statement underscores the need for prevention and education among athletes, athletic trainers, coaches and parents,” said Jack Doornbos, executive director, Molnlycke Health Care.  ”Education is the cornerstone of preventing skin diseases such as MRSA that can be debilitating for an athlete and a team.

Losing one key athlete can affect the performance of an entire team.  This is why we provide free educational materials including posters, DVDs, checklists and newsletters with proven best practices to help prevent skin infections in athletics,” he added.  ”All of these materials have been developed with the guidance of a panel of athletic trainers from all levels of athletics that are recognized experts in their field.”

Three of the seven key guidelines NATA issued address hygiene and care of the skin including ongoing hand hygiene, showering after sports and daily skin surveillance for lesions.  A new approach to helping prevent skin infections during sports is to shower or wash prior to activity with a cleanser that contains 4 percent chlorhexidine gluconate (CHG).(1)  CHG bonds to the skin and actively kills germs for up to six hours without leaving a residue.  This helps protect hands and body during contact.  A final shower after practice and competition cleans the skin again and removes any debris that may have been picked up.  If a shower is not possible before or after activity, washing hands and arms and other high-contact skin areas is another option that may be instituted.

Hibiclens, a 4 percent CHG wash, has been used in hospitals for decades.  Now professional athletes, college wrestlers and entire athletic teams use it before and after practices and games.  Molnlycke Health Care also manufactures an alcohol-based wipe, Hibistat®.  Individually-wrapped, containing 0.5 percent CHG and 70 percent isopropyl alcohol, Hibistat is intended to be used without water, which is perfect for recreational sports, camps and locations that do not have showers or sinks.

“We are encouraged that the authors stated that the guidelines will continue to be updated and evolve as new information becomes available,” said Doornbos.  ”We believe preventive measures before contact are an important component to a solid prevention program.”

Unlimited, free educational materials for parents, athletes and coaches about skin diseases including Methicillin-resistant Staphylococcus aureus (MRSA) are available at www.hibiclens.com or by calling 1-800-805-0585, ext. 7940.  Additionally, Hibiclens and Hibistat are available in the first aid section at drug stores including CVS, Rite Aid and Stop & Shop.  Hibiclens is also available in the first aid section at Walgreens, Walmart and Target.

Lee Ann Torrans
ltorrans@gmail.com

5 May 2010

An abstract of a study by Evans et al demonstrating whether daily bathing with cloths impregnated with 2% chlorhexidine gluconate will decrease colonization of resistant bacteria and reduce the rates of health care-associated infections in critically injured patients is presented. Daily bathing of trauma patients with cloths impregnated with 2% chlorhexidine gluconate is associated with a decreased rate of colonization by MRSA and Acinetobacter and lower rates of catheter-related bloodstream infection and MRSA ventilator-associated pneumonia.

Two emerging agents from Forest/AstraZeneca/Takeda and Trius are anticipated to drive the methicillin-resistant Staphylococcus aureus (MRSA) drug market to increase from $631 million in 2009 to $752 million in 2019 in the United States, France, Germany, Italy, Spain, the United Kingdom and Japan.

The Pharmacor 2010 findings from the topic entitled Methicillin-Resistant Staphylococcus Aureus find that Forest/AstraZeneca/Takeda’s ceftaroline and Trius’s torezolid will capture more than one-third of the MRSA drug market in 2019. A new drug application for ceftaroline for complicated skin and skin structure infections (cSSSIs) and community-acquired bacterial pneumonia was filed in the fourth quarter of 2009, and torezolid — a second generation oxazolidinone — is expected to begin Phase III clinical trials for cSSSI by end of 2010.

Torezolid, if approved, would join Zyvox as the second oxazolidinone with IV/oral formulations available in the MRSA drug market.

The Pharmacor 2010 findings also reveal that leading infectious disease experts in the U.S. and Europe consider the increased availability of oral formulations to be a key unmet need for MRSA treatment. Interviewed key opinion leaders indicate that the availability of additional oral MRSA therapies would offer a significant advantage over intravenous therapies, particularly in outpatient settings, community-acquired MRSA infections and infections such as osteomyelitis which require long-term treatment.

Lee Ann Torrans
ltorrans@gmail.com

7 June 2010

The trend of prescribing clindamycin for children with Staphylococcus aureus may build up resistance to treating the infection, a new study says.

Clindamycin use among children hospitalized with S. aureus increased threefold during the past decade, according to a study published online May 17 in Pediatrics. In 1999, the antibiotic was used to treat 21% of S. aureus cases. In 2008, 63% of such infections were treated with the drug.

The antibiotic became popular because it effectively treats methicillin-resistant S. aureus and it can be taken orally, unlike vancomycin, which is only available intravenously, said senior study author Jason Newland, MD. But he said the problem is that physicians are using clindamycin to treat cases of methicillin-susceptible S. aureus, which can be effectively treated with different antibiotics.

Clindamycin “is used a lot. And we’ve learned that has an incredible ability to become resistant over time. … We don’t want to overuse clindamycin,” said Dr. Newland, director of the Antibiotic Stewardship Program and director of the Office of Evidence Based Practice at Children’s Mercy Hospitals and Clinics in Kansas City, Mo. He also is an assistant professor of pediatrics at the University of Missouri-Kansas City School of Medicine.

Liz Power, spokeswoman for Pfizer Inc., manufacturer of Cleocin, said the company supports the responsible use of antibiotics to treat infections. “Resistance is an issue for anyone treating infectious diseases and physicians have to make the best decisions they can with their patients.”

Researchers recommend that physicians monitor antibiotic susceptibilities in their communities and practices to help them determine what drug they should use to treat S. aureus infections.

For this study, researchers examined data on 64,813 children younger than 18 who were hospitalized with an S. aureus infection between Jan. 1, 1999 and Dec. 31, 2008. The study involved 25 U.S. children’s hospitals.

The study said the incidence of S. aureus infection more than doubled among children. The increase was driven largely by MRSA, which increased tenfold during the study period.

In 1999, there were 2.0 cases of MRSA per 1,000 admissions, compared with 20.7 cases in 2008. During the same period, the MSSA infection rate remained relatively stable at about 12 cases per 1,000 admissions.

In the study period, 29,571 children were hospitalized with MRSA, and 374 died. Researchers are unsure whether the infection caused the children’s deaths. In 2005, the infection was associated with the deaths of more than 18,000 adults and children nationwide, according to the Centers for Disease Control and Prevention.

Lee Ann Torrans
ltorrans@gmail.com

Cepheid disclosed on 8 Jun 2010 that the US Food and Drug Administration has approved its Xpert SA Nasal Complete test. The molecular diagnostic product can identify and differentiate Staphylococcus aureas and Methicillin-resistant Staphylococccus aureus (MRSA) colonization and provide results in less than 1 hr. Cepheid will start offering the test in Jul 2010. Xpert SA Nasal Complete runs on Cepheid’s GeneXpert system.

Lee Ann Torrans

ltorrans@gmail.com

Researchers evaluating France’s national infection control program for healthcare facilities found significant decreases in the rates of healthcare-associated infections (HAIs) since 2004. The drop in HAIs, including MRSA and surgical site infections, could be attributed to important changes in the national infection control system. France’s national, regional and local coordinating centers have been reorganized to help facilities throughout the country comply and conform with mandatory public reporting requirements and key program objectives. The findings were presented at the Fifth Decennial International Conference on Healthcare-Associated Infections.

“The French National Program demonstrates the value of a national standard reporting system for healthcare-associated infections,” said Neil Fishman, MD, President of SHEA. “As seen in this study, public transparency can lead to a culture of accountability and continuous healthcare quality improvement. Having accurate data for action drives progress toward the elimination of HAIs, but we need the appropriate infrastructure to achieve these goals.”

Laetitia May-Michelangeli, MD Ministry of Health & Sports (MoH), and Christian Brun-Buisson, MD, chair of the national infection control program at Hospital Henri Mondor in Paris, worked with a team of infection control experts to evaluate the impact of the national program to reduce HAIs. Researchers evaluated aggregated data compiled from mandatory annual reports by national surveillance networks from 2005 through 2008. A random sampling of the facilities’ annual reports was verified through auditing by subsidiaries from the MoH.

“Many of the target objectives have been achieved,” said Dr. May-Michelangeli. “Most healthcare facilities (89 percent) have reached the best performance class for the global indicator of HAI control based on facility type, resources and activities.”

The findings are extracted from mandatory reporting records to the MoH. Every healthcare facility registered at the MoH has to provide an annual report on infection prevention programs. From these reports, researchers analyzed data from 2,800 facilities including large university hospitals, ambulatory care, long-term care or small community clinics.

“The national mandatory public reporting system has helped healthcare facilities to improve their infection control measures,” said Dr. Brun-Buisson. “Not only do these facilities have funding tied to their compliance with the program, but the media in France now publish a list of best and worst performing hospitals based on each facility’s annual report.”

The French National Program also looked to promote other priority initiatives to reduce HAIs, including advancing new research in the field, improving communication with patients on the risk of infectious diseases, standardizing monitoring methods for HAIs and adopting preventive practices for healthcare professionals.

Key achievements of the program include:

• MRSA cases have decreased by 40 percent;
• Local and regional infection control teams have been appointed in 94 percent healthcare facilities;
• The use of alcohol-based products for hand hygiene doubled in over 50 percent of the sites;
• Nearly all (90 percent) of the facilities have implemented an evaluation program and a system for quickly disseminating infection alerts (96 percent);
• Most facilities (89 percent) have an anti-infective drug committee and have produced guidelines for preventing surgical site infections (97 percent);
• Many facilities (88 percent) follow-up with patients’ antibiotic consumption; and
• Nearly all facilities (98 percent) provide patients an information leaflet on HAIs.

While France’s healthcare system is different from the U.S., researchers believe that reducing HAIs through public reporting can be successfully applied to any healthcare system. To further the goal of improving country-wide control of HAIs, MoH has initiated a second phase of the program that will continue through 2013. This phase includes revised national infection prevention and control objectives and goals for individual healthcare facilities.

BRITAIN FOCUSES ON REPORTING

HOSPITAL INFECTION RATES TO GO ONLINE WEEKLY

People will be able to check the weekly MRSA and Clostridium difficile (C diff) rates at their local hospital, the Government has announced.

From early next month, infection figures for all hospitals in England will be published every seven days on the data.gov.uk website.

Patients will be able to look at data for the previous three months and, over time, infection rates for bugs like E. coli will be added.

Weekly data from March to May for many hospitals is already up and running.

MRSA and C diff infections are now at their lowest level since records began.

Health Secretary Andrew Lansley said: “This is an important step towards our broader plans to provide more relevant information to patients.

“It will enable people to make meaningful choices because they will be able to make comparisons between different hospitals and healthcare organisations.

“We want to make the large amounts of data that are already collected and used internally in the NHS work for patients, not just managers.

“All information that is useful and relevant to patients should be published in an accessible and open way.”

The Government has said it will also look at whether figures should be provided at a department or ward level without breaching confidentiality of patients.

The Daily Telegraph

NHS patients will be able to check superbug infection rates at individual hospitals each week under plans to introduce greater transparency to the health service.

From next month, rates of MRSA and Clostridium difficile, which are linked to more than 8,000 deaths a year at hospitals, will be published online in an accessible format.

At present, rates are published only monthly, and are limited to statistics for NHS trusts, which can cover a number of different hospitals.

They are not easy to find using an ordinary internet search engine, meaning that patients struggle to find transmission rates in their local hospital, and so cannot avoid the poor performers.

Andrew Lansley, the Health Secretary, will announce that statistics which are usually available to NHS professionals will be shared with the public as part of a drive to improve transparency and give patients more choice. In time, it is hoped to be able to publish rates for individual hospital departments or even wards.

Other hospital-acquired infections, such as E-coli and MSSA, will also be included in time.

Mr Lansley said: “This is an important step towards our broader plans to provide more relevant information to patients. It will enable people to make meaningful choices because they will be able to make comparisons between different hospitals and health care organisations. We want to make the large amounts of data that are already collected and used internally in the NHS, work for patients, not just managers.

All information that is useful and relevant to patients should be published.

“So instead of publishing health care acquired infections on a monthly basis, we will publish them weekly. We will eliminate the long time lag between data collection and publication, reducing it to a week.

“And instead of data being published at a hospital trust level, which may include the figures for as many as three different hospital sites, we will disaggregate the data to individual hospitals and, confidentiality issues permitting, to ward or department level.

The NHS Choices website, says the worst trusts for infections during 2008/09 included Trafford Healthcare Trust, which covers Trafford General, Altrincham General and Stretford Memorial Hospitals, where there were 3.98 incidences of MRSA per 10,000 “hospital bed days”.

Sherwood Forest Hospitals NHS Trust, which includes King’s Mill, and Newark hospitals, had 3.22 cases.

Lee Ann Torrans
ltorrans@gmail.com

Some of the sleek new iPads users play with at city Apple stores are laced with potentially dangerous bacteria or are just plain dirty, a Daily News investigation revealed.

Of four iPads that were swabbed in two stores last month and then tested in a lab, two contained harmful pathogens.

“Eww,” said Brittany Smith, 20, of Canarsie, Brooklyn, after hearing the test results outside Apple’s flagship store on Fifth Ave. “Now I need some hand sanitizer.”

The News used medical swabs to covertly collect samples from two iPads in the midtown store and the Meatpacking District location on 14th St. They were then tested for culturable bacteria by the New Jersey-based EMSL Analytical Inc.

One sample, collected at the 14th St. store, contained Staphylococcus aureus, the most common cause of staph infections, which can lead to an array of ailments, from minor skin infection to meningitis.

“It can easily cause disease,” said research analyst Farbo Nekouei, who evaluated the data for ESML. “It’s not a good bacteria.”

The second swab from that store only contained benign, skin- borne microbes, but in unusually high quantities, pointing to an extremely grimy iPad.

A sample taken in the Fifth Ave. location registered Candida parapsilosis, a type of yeast, and Corynebacterium minutissimum, a bacteria commonly associated with skin rash. Both can cause infections, especially in people with weak immune systems or pre- existing conditions, Nekouei said.

Dr. Philip Tierno, director of Clinical Microbiology and Immunology at New York University Langone Medical Center, said that iPads handled by a multitude of strangers are bacteria breeding grounds.

“I’m surprised you found so little,” he said. “Two things increase the risk. The amount of time one spends on the apparatus, and the number of people who touch it.”

Apple said it sold more than 2 million iPads in the two months since they hit the market, and they’re currently not available without a pre-order.

The company defended the cleanliness of its stores, where visitors often wait in line to fiddle with the gadgets.

“We clean our products and our stores regularly throughout the day,” said Apple spokeswoman Amy Bessette. “And we are committed to creating a healthy environment for our customers.”

Some visitors at the stores were not bothered by unsanitary iPads, reasoning that they can’t be worse than the subway system. But others questioned the contraptions’ cleanliness.

“I did wonder about that because there were so many fingerprints on the one I touched,” Mary Jo Paine, a jewelry designer from Murray Hill, said outside the midtown store. “I went to the bathroom to wash my hands.”

That is the best defense strategy, said Tierno: “You have to wash your hands effectively after playing with these iPads.”

He said Apple should consider providing small disinfecting wipes to customers and installing small sinks or sanitizing gel dispensers inside its stores.

oyaniv@nydailynews.com

GRAPHIC: iGERMS

These harmful bacteria were found on iPads tested by the Daily News: Staphylococcus aureus: literally means “golden cluster seed,” it’s commonly found in the nasal vestibule or skin. Some strains can survive for months on dry surfaces and cause food poisoning or worse.

Candida parapsilosis: this fungus is one of the leading causes of yeast infection and hospital-acquired infections.

Corynebacterium minutissimum: can cause common superficial skin infections, such as Erythrasma.

POLL: Will you stop using store display devices? Vote at: www.NYDailyNews.com

Caption: Apple stores say they clean demo iPads throughout the day, but tests show that doesn’t stop the bacteria from building up. Photo by Jefferson Siegel

Document NYDN000020100607e66600020

Lee Ann Torrans
ltorrans@gmail.com

Australian researchers are calling for a major new research effort to develop entirely new antibiotics to counter the growing threat posed by Acinetobacter bacterial infections, epiNewswire reported Monday, June 14, 2010.

“Acinetobacter (species) have risen from relative obscurity to be among the most important sources of hospital-acquired infections,” the team wrote in the current issue of Microbiology and Molecular Biology Reviews. “The driving force for this has been the remarkable ability of these organisms to acquire antibiotic resistance determinants, with some strains now showing resistance to every antibiotic in clinical use.”

Acinetobacter is also markedly resistant to disinfectants and desiccation, and spread more readily in the hospital environment than other drug-resistant species, recent studies have shown.

Reviewing recent genetic research, the team concludes the bacteria not only rapidly acquires drug-resistance genes from other bacteria in the environment, but is innately more resistant to existing classes of antibiotics — and to stress in general — than other bacteria.

The full story is available at: http://bit.ly/9VXytG

Lee Ann Torrans
ltorrans@gmail.com

DALLAS, June 11 — Tiny red pharaoh ants have invaded operating rooms, intensive care units and nurseries in some Texas hospitals, posing a ‘’significant risk” to patients by feeding in open wounds, university researchers say.

”They have been found in all parts of the hospitals,” said Harry Howell, a research associate at Texas A&M University, which released a study on the ants Thursday. ”In some hospitals, we found them in surgery rooms. At Brooke Army Medical Center, we found the whole hospital was infested.”

The study said that about one-fourth of 57 hospitals surveyed were infested with the ants. Entomologists in the A&M Urban Integrated Pest Management Project said that the ants, a household pest in most of the world, were found to carry staphylococcus bacteria and other disease-causing organisms.

”For the debilitated patient, they pose a significant risk,” said Dr. David McMurray, a professor of microbiology and immunology. Findings Held Premature

The findings were disputed by Dr. Karl Shaner, vice president of research and development for the Texas Hospital Association, which cooperated with the study. He said that the limited survey, which covered less than 10 percent of the state’s 590 hospitals, had produced inconclusive evidence.

”My concern is that any inference that large numbers of hospitals have this problem and that it is highly contagious is premature,” Dr. Shaner said.

The survey, begun in April, turned up ants in intravenous tubes and glucose solutions. Mr. Howell said three ants were recovered from an opening in a patient’s neck.

”The most common thing like that was where you had a large open wound like a burn,” he said. ”The ants come to feed on the burn site and on the burn ointments.

”I would think that from some of the things we observe from the ants, that they have potentially more of a health hazard than cockroaches,” he added. ”We perceive them to be a problem in all health institutions.” Burn Center Problem Cited

He said the ”biggest problem” was at Brooke, which has a worldfamous unit that specializes in treating serious burns. Mr. Howell said that Brooke ”had burn patients whose wounds were infested and ants in cribs in the nursery.”

However, Brooke was able to get the ants out of its patient care area, and they remain only in a few administrative offices, Mr. Howell said.

A spokesman for the San Antonio facility, Ray Dery, said he was unaware of the study’s results, but knew that ”in the past we’ve had problems with ants – not problems that went unresolved.”

Mr. Howell said he could not identify other infested hospitals because the hospital association had requested anonymity for its members. But he said that all the hospitals had taken steps to get rid of the ants.

Officials at Brooke tried a residual insecticide spray, but it tends to act as a repellant so the ants do not cross it. Brooke then used a poison bait that has a low human toxicity so it could be placed around the hospital. The ants feed on it, then go back to the colony to feed the immature ants. Over a period of weeks the colony is killed off. Pest Control Efforts

Some pest control operators are doing this in other hospitals, but it is a tedious process, Mr. Howell said. Some just prefer to spray any ants they see.

Researchers are trying to determine if there is any link between the ants and hospital-acquired infections. Pharaoh ants in Europe were discovered to be carriers of bacteria and were also linked with the spread of swine pneumonia in a veterinary research facility.

”The fact that we find the bugs with the ants may be circumstantial evidence,” said Dr. David McMurray, a professor of microbiology and immunology. ”The real link has yet to be proven.”

Microbiologists in the A&M College of Medicine are trying to develop chemical baits to control the ants.

Lee Ann Torrans
ltorrans@gmail.com