The new ICHE is here, the new ICHE is here!!!

Congrats to all of the authors who had articles published in this August's ICHE. Now that ICHE has a massive new impact score, I suspect most of them now feel like Navin when he says, "Page 73 - Johnson, Navin R.!  - I'm somebody now! Millions of people look at this book everyday! This is the kind of spontaneous publicity - your name in print - that makes people. I'm in print! Things are going to start happening to me now."  Well, I hope all the things that happen to these fine authors are a little more positive.

Highlights:

Page 737, Boyce, John M et al. looked at the impact of an automated mobile UV-C light unit on environmental contamination in 25 rooms after patient discharge. They report the unit significantly reduced aerobic colony counts and C. difficile spores.

Page 743, Rutala, William A et al. wrote an accompanying editorial that concluded that "there is now ample evidence that no-touch systems such as UV-C light or hydrogen peroxide can reduce environmental contamination...(however) only a single study using a before-after design has been published that demonstrated that such a system can reduce healthcare-associated infections." There we go again, hospital infection prevention: the queen (or king) of intermediate outcomes. Would be pretty cool if there were more independent (federal or foundation) resources to study HAI prevention interventions, such as these.

Page 791, Gupta, Kalpana et al. report the results of a cohort of all patients at the VA Boston Health Care System that had clean or clean-contaminated in 2008-2009 and a nasal MRSA PCR test less than 31 days prior to surgery. 6.6% of the patients were MRSA+ and were at significantly higher risk for postoperative MRSA infections (RR, 8.46; 95% CI, 1.70–42.04). Interestingly, vancomycin prophylaxis was associated with higher SSI risk in those negative for nasal MRSA (RR, 4.34; 95% CI, 2.19–8.57) but not in MRSA+ patients.

Page 818, Tohme, Rania A et al. reviewed hepatitis B vaccination rates and immunity among healthcare students during a 10-year period at Emory University. They report that among 4,075 students, only 60% had documented vaccination and 84% had anti-HBs concentration greater than or equal to 10 mIU/mL. It is interesting that despite CDC and ACIP (1995) recommendations of routine vaccination of children aged 11-12 years, and for all less than 18yo in 1999, the majority of students were only recently vaccinated.

If I left you off this list, sorry! You are still awesome!

Copper kills MRSA

VDB's design now only 2.5% Copper

Dr. Bill Keevil of the University of Southampton was just interviewed by the New Scientist. In the article and accompanying video, he demonstrated the MRSA-killing ability of copper. In the study, his group coated copper or stainless steel plates with 10⁷ MRSA. The copper-coated plates began to kill off the MRSA in minutes.  One caveat is that the study seems to have been supported by the Copper Development Agency. Oh, wouldn't it be great if copper killed MSSA and other bacteria too?

New Scientist, April 5, 2011
Weaver et al. Journal of Applied Microbiology, Dec 2010

No MRSA on Gym Equipment!?!

Modern Torture Devices

Some days when I'm tired, I don't feel like going to the gym. As someone who follows the IC literature, I always had a ready excuse for myself and others if I didn't want to go.  Too risky!  I don't want to catch MRSA, haven't you read the papers?

So I was depressed when I saw the headline this morning about a new study in AJIC from the University of Florida that found no MSSA and no MRSA on gym equipment surfaces before or after routine cleaning. They sampled 3 gyms (private, high school and university) on 3 separate occasions and obtained 240 samples. They swabbed gyms mats, benches, dumbells, cardio machines and weight machines. Oh well, back to the drawing board...and back to the gym.

Kathleen Ryan et al. AJIC March 2011

The Suncoast News - March 9, 2011

Kill this spore!

This month’s issue of Infection Control and Hospital Epidemiology has an interesting article from the University of Michigan group, demonstrating that having a prior room occupant with C. difficile associated disease (CDAD) is a risk factor for CDAD. Spores are hard to kill, and survive for months in the hospital environment. Meanwhile, environmental cleaning practices are highly variable….but clearly not good enough in most hospitals to eradicate C. difficile spores from the environment during terminal room cleaning. I have nothing to add to the excellent commentary on the article by David Weber and Bill Rutala. The future of environmental cleaning likely resides in touchless technologies like hydrogen peroxide vapor/mist and UV light.

Image: Transmission EM of C. difficile spore, from the Journal of Bacteriology.

VRE Forever!

Without despair we will share
And the joys of caring will not be replaced
What has been must never end
And with the strength we have won't be erased
When the truths of love are planted firm, they won't be hard to find
And the words of love I speak to you will echo in my mind

I believe when I fall in love with you
It will be forever
I believe when I fall in love this time
It will be forever

Stevie Wonder  -  I Believe (When I Fall in Love It Will Be Forever), 1972

One of the most consistent obstacles to halting the spread of MDROs in hospitals is the ability for the organisms to persist in the environment.  Nosocomial outbreak pathogens such as MDR-Acinetobacter baumannii have been shown to persist for up to a year in vitro. Vancomycin-resistant Enterococcus faecium (VREFm) has been shown to persist for up to 4 months.  Now a new letter to the editor in the March issue of Journal of Hospital Infection suggests that we may have underestimated VREFm.

Researchers at the University Medical Centre Utrecht took an outbreak CC17 VREFm strain and a non-outbreak but concurrently isolated non-CC17 VREFm strain recovered during a year 2000 outbreak and placed 1ml at 10^9 cfu/ml of each strain in 104 bottles to dry. They then tested for recovery weekly and then quarterly.  I have pasted the survival curve below.  Survival for both strains was gradual to 10^4 at 9 months and 10^2 during the next 30 months.  Out to week 170-194 between 1-7 colonies were detected. Thus, these strains survived almost 4 years!!!

Certainly gives you something to think about.  Just another reason to love the enterococcus and Stevie Wonder - the pride of Saginaw, Michigan.

Reference: Wagenvoort et al, JHI March 2011