On a popular reality show that resurrects failing restaurants, the celebrity chef used a fluorescent marker system to show the owner how to practice good handwashing technique and sanitation in the kitchen.  I bet some of you have used the same method for hand hygiene demonstrations on your units.

Hawaii 5-O and NCIS - Los Angeles teamed up to find and destroy a smallpox cache being used to threaten North America and not one month later, Blue Bloods had a similar challenge in their plot.

A funny rerun of the Big Bang Theory took place in a hospital. Sheldon pontificated about how patients will survive their cardiac arrest but should be really worried about contracting a "super bug" in the hospital.  And the episode ended when he entered an isolation room without protective equipment and the staff quarantined him in the room since he was possibly exposed.

I tried not to critique the accuracy of these episodes because, of course, these shows are meant to be entertaining and may be unrealistic representations.  Yet it does remind us how much you do in your daily routines to help protect yourself and others.

A study in the journal Infection Control & Hospital Epidemiology describes that at Wake Forest Baptist Medical Center, during routine quality assurance testing, a robot that prepares IV medications in the pharmacy was found to have Bacillus cereus bacteria in drug samples. The study was conducted although only one instance of contamination was noted.

The contamination was traced to the machine's washing station and its associated tubing. Although the robot alerts operators when routine cleaning is needed, according to a report on the study by HealthDay, "the washing station is not considered a sterile part of the robot and the manufacturer does not specify a formal cleaning and maintenance procedure."

The study authors say their findings highlight the importance of routine screening of medication prepared by robotic dispensers.

When we think of infection control, we usually think of the techniques and practices that human beings employ to stop the spread of pathogens. We sometimes forget that Mother Nature has some pretty effective infection control measures of her own, including the weather. So while most of us enjoyed this year's unprecedented mild winter, it turns out that there were some drawbacks, too: It seems that ticks, skunks and other critters have also been taking advantage of the balmy weather.

Insects and wild animals have been out and about much earlier than usual this year, increasing their chances of picking up bacteria and viruses and transmitting them to us. This year, tick bites have been reported as far north as Chicago in February, and states from New Mexico to Maine have seen spikes in their numbers of rabid animals, particularly skunks. This could translate into an increase in Lyme disease and rabies cases in 2012.

So, if you are heading out for a hike on a beautiful spring day, it might be a good idea to apply some DEET or other tick repellant before you go, and check yourself for ticks when you get back home. If Fido is going along with you, make sure his flea and tick protection and rabies vaccine are up to date.

And here's hoping you don't encounter any skunks, rabid or otherwise.

The attention being given to CAUTIs is evident across the continuum of care.  Several states including Pennsylvania and New Jersey require acute care hospitals to report CAUTI rates. Two of the CMS quality measures for nursing homes are the percent of resident that develop UTIs and the percent of residents who have a urinary catheter inserted and left in. 

With all this attention, the government is also offering help so healthcare facilities can implement the best practices.  The Partnership for Patients includes CAUTI prevention as one of several patient safety goals and has established networks to help achieve these goals.

You may already be involved in these activities and know there are plenty of resources with templates, protocols and education programs about UTI prevention. The catheter manufacturers and some state health department websites offer material. For example, the Pennsylvania Patient Safety Authority has several tools available.

So, is CAUTI reduction a realistic goal?  I think so and more importantly, it's one measure that can be truly nurse driven. 

Except for two trips to the ER and a doctor's office appointment, my son hasn't left the house in 10 days. His tonsils are the size of golf balls. Formerly a 220-pound high school offensive lineman, he's lost 30 pounds in the last month. Basically, his body has been transformed into a snoring, drooling production facility for the Epstein-Barr virus (EBV).

"The kissing disease" might be a cute euphemism for mono, but the illness can be really vicious in teens and young adults. Fortunately, EBV is not such a big deal for the rest of us. According to the CDC, 95% of adults between the ages of 35 and 40 have already been infected. Most of them got the virus as young children and never experienced significant symptoms. And healthy adults who were previously infected can transmit EBV just as readily as sick teenagers can. As a result, no special precautions are recommended when a member of the household has infectious mononucleosis.

This means that on those rare occasions when my son gets off the couch, I probably don't have to follow him around with bleach wipes and hand sanitizer. I probably don't have to wear latex gloves to pick up after him. I probably don't have to throw popsicles at him from the next room because the hand-off is too risky. And the paper plates and plastic utensils that I bought can probably stay in the cupboard until picnic season.

In other words, all of the obsessive-compulsive things that I've been tempted to do are a bit over the top. Good handwashing is good enough. Intellectually, I know that. Just like I know that the vaporizer on his nightstand is worthless. But at least the smell of Vicks makes me FEEL like I'm helping him. Vacant gestures give me something to do when there's really so little I can do.

In reality, only time and rest and fluids can fix this. Thankfully, I think he may have turned the corner. He's stopped asking me if he's going to die, and started asking if he'll be better in time to take his girlfriend to the prom.

"Maybe," I say. "But you'll still be contagious for a while after your symptoms go away. We'll have to see what the doctor says."

"Please?" he asks, before collapsing back onto the couch in a stupor.

Great. Now I have to figure out how to germ-proof my car, too. I wonder if they make hazmat tuxedoes.

A study from the University of Michigan Health System released April 3 ahead of print in Circulation notes that older adults who get infections of any kind, such as urinary, skin or respiratory tract infections, are three times more likely to be hospitalized for a blood clot in their deep veins or lungs.

"Over half of older Americans who were hospitalized for such blood clots had an infection in the 90 days prior to the hospitalization," says lead author Mary Rogers, PhD, research assistant professor in Internal Medicine at the University of Michigan Medical School and research director of the Patient Safety Enhancement Program at the U-M Health System and the VA Ann Arbor Healthcare System.

If the infection occurred during a previous hospital or nursing home stay, patients were nearly seven times more likely to be admitted for a blood clot. Those who got the infection at home were nearly three times more likely to be sent to the hospital for a blood clot within 90 days.

Last year, there were 10,521 new cases of TB in the United States. California, Florida, Texas and New York accounted for 50% of these cases so depending on where you live, you may be thinking, "TB? Is that still a problem - I haven't seen a case since nursing school." 

The MMWR reports that there were 3.4 new cases per 100,000 population in the U.S. last year.  The good news is this is a 6% decrease from 2010 but it still far from the goal of less than one case per 1 million population.  And TB remains a problem in developing countries, especially in China, India and Africa.  In fact, the CDC estimates that one-third of the world is infected with tuberculosis. Though many of these people may never develop active, contagious disease, there remains the potential for them to reactivate this infection and pose a risk to others.

In the United States, foreign-borne individuals continue to be more affected by TB. For example, the case rate among Asians was 25 times greater than non-Hispanic whites. Importantly, most foreign-borne people developed TB more than 2 years after they had been in the U.S. This most often reflects reactivation of latent TB disease that was acquired abroad.  This is important because control efforts can be implemented to address these scenarios.  Plans that promptly recognize active disease are vital. But just as important are plans that screen and provide treatment for latent TB in high prevalence groups.

While you may not personally feel impacted by TB, many of our grandparents or great-grandparents lived through times of high prevalence and death from TB. Public health efforts have been successful in this effort.  Toward that spirit, let's join the CDC in their campaign to "Stop TB in My Lifetime."

Last year, an elderly woman in Rome, Italy, died from pneumonia caused by Legionella that was traced to her dentist's water line. The source of the infection was relatively easy to confirm: The patient had left home only twice during the incubation period, each time for a dentist appointment.  After her illness was reported, health officials identified Legionella in the dental unit's water pump that genetically matched the strain found in the patient.

 Legionnaires' disease, or the less serious variant known as Pontiac fever, can occur when mist or vapor containing the bacteria is inhaled.  Legionella thrives in standing water, especially when it's kept at or near body temperature.  The bacterium is frequently found in facilities with complex plumbing systems, and over the years, there have been highly publicized outbreaks in hotels, hospitals, and nursing homes. In 2011, a hot tub at the Playboy Mansion was also investigated as the cause of a suspected outbreak. 

While this is the first time that a dental water line has been confirmed as a source of Legionnaires' disease, links have been suspected in the past.  As a group, dental professionals have been shown to have higher than usual Legionella antibody titres.  And after a California dentist died from a Legionella infection, the bacteria was found at both his home and his office---with significantly higher bacterial counts being detected at the office.  This raises exposure concerns for both patients and dental professionals.  

It is a risk that has long been recognized.  In 2003, the CDC issued guidelines for infection control related to dental water lines.  But since individual dental offices might have different infection control procedures, patients might want to have a conversation with their dental care providers about the implementation of these guidelines.  Dental professionals can find helpful information on this topic on the Organization for Safety, Asepsis and Prevention's website at http://community.advanceweb.com/controlpanel/blogs/www.osap.org.

I last spoke about C. difficile in April of 2010 when a NY Times article pointed out the alarming increase in cases in our country.

Well, the bad news is C. difficile is still a problem in U.S. health care settings. Although a small percentage of people can be colonized with this organism, the trouble starts when this leads to infection. Infection with C diff causes pseudomembranous colitis that leads to diarrhea. Care of these patients can add more than $5,000 to the hospital expenses and more importantly, some cases are fatal -14,000 deaths annually have been estimated.

The MMWR published Vital Signs: Preventing Clostridium difficile Infections on March 9.

The article notes a three-fold increase in cases from 2000 to 2009. The emerging infectious disease program classified cases based on their onset:

1. Occurring more than 3 days after acute care hospitalization

 

2. Residing in a nursing home

 

3. Community onset - these cases were further examined for prior hospitalization or other healthcare exposure within the past 12 weeks.

 

And not surprisingly, 94% of the C. diff cases were associated with some type of healthcare exposure.

Prevention of C. difficile focuses on four areas: early detection, prompt isolation, environmental decontamination and antibiotic stewardship. The MMWR refers to efforts in three states that did demonstrate a 20% reduction in hospital-acquired cases through a combination of these four factors

A significant point is "Because antibiotics disrupt the normally protective bacterial populations of the lower intestine in a manner that increases risk for CDI for 3 or more months, antibiotics received in one setting often predispose a patient to develop CDI in another setting." This really stresses that C. difficile has impact across the continuum of care.

Six states currently have mandatory reporting of hospital onset cases. But soon, all hospitals participating in the Centers for Medicare and Medicaid Services' Inpatient Prospective Payment System Quality Reporting Program will be required to report C. difficile cases. Public reporting by itself will not change how one hospital compares to another but mandatory reporting in England did demonstrate a 50% reduction in cases.

How is C. difficile affecting care at your facility?

Yet we often assume the surgical instruments used during a procedure are perfectly safe. Many people -- doctors, nurses and patients -- really have no idea what happens to the surgical instruments after use, just that they go down to the central processing and come back up ready for use.

Recently, NBC's Today Show presented a story on the impact of cleaning and sterilization of surgical instruments.

Dr. Nancy Snyderman, NBC's medical editor reported on a man who developed an infection after shoulder surgery. He subsequently needed 7 surgeries because of the infection. The story describes how instruments are cleaned and sterilized. It also stresses the importance of the team members who perform these tasks. The story really makes you appreciate the value of a competent central sterile technician and encourages certification for those performing these vital functions.

Watching the video might encourage you to visit the staff in the central processing area of your facility to learn more and to thank them for their unseen diligence for patient safety.

Another interesting finding of the study is that chronic hepatitis infection is most prevalent among people born 1945-1965, and most of them do not know they are infected.

"One of every 33 baby boomers is living with hepatitis C infection," the Associated Press quoted Dr. John Ward, the CDC's hepatitis chief, as saying. While sharing a needle while injecting illegal drugs has become the biggest risk factor for hepatitis C, before 1992 it was commonly spread through blood transfusions, the AP wrote. Casual injection-drug use back in the 1960s, ‘70s and ‘80s, was a suspected factor in the instances of baby boomers with the virus, according to the AP story.

Federal health officials are considering whether anyone born between 1945 and 1965 should get a one-time blood test to check their HCV status.

Three researchers from the Institute for Medical Microbiology and Hospital Epidemiology at Hannover Medical School in Hannover, Germany, collected surveys from 85 medical students in their third year of study during a lecture class that all students must pass before bedside training and contact with patients commences.  Students were given seven scenarios, of which five ("before contact to a patient," "before preparation of intravenous fluids,"  "after removal of gloves,"  "after contact to the patient's bed," and "after contact to vomit") were correct hand hygiene (HH) indications. Two-thirds (67 percent) of the students correctly identified all five true indications, and only 21 percent correctly identified all true and false indications.

Additionally, the students expected that their own HH compliance would be "good" while that of nurses would be lower, despite other published data that show a significantly higher rate of HH compliance among nursing students than among medical students. 

The surveyed students further believed that HH compliance rates would be inversely proportional to the level of training and career attainment of the physician, which confirms a previously discovered bias among medical students that is of particular concern, as these higher-level physicians are often the ones training the medical students at the bedside.

"There is no doubt that we need to improve the overall attitude toward the use of alcohol based hand rub in hospitals," conclude the authors. "To achieve this goal, the adequate behavior of so-called ‘role models' is of particular importance."

How do you think the docs in your hospital would rate?

The Partnership for Patients (PFP) is a federal initiative whose aim is to improve care by reducing preventable adverse events.  The PFP has 12 indicators right now - 4 of which are infection related for acute care hospitals: prevention of UTI, central line infections, surgical site and ventilator associated pneumonias.

Ambulatory care centers are required to follow CMS regulations for environmental issues and safe injection practices among others.  Long-term care facilities must provide documentation of how many residents received vaccinations.

All of this means that someone in your facility will be tracking compliance with these measures. With more use of electronic medical records, tracking these events will be easier but we still need the personal interaction to provide feedback - both positive and negative.  We probably all agree these measures reduce infections and we like it that someone ensures that other people - like the housekeeper - is doing their job correctly. 

 So what causes lack of compliance with these infection prevention measures? Lack of equipment, poor training, limited time?  How do we ensure compliance among nurses? And how do you feel about someone checking on the care you provide?

Dehydration is usually the most common complication and varies among populations, with the very young and very old being at greatest risk.. Therefore, hydration is very important during this time. Try to keep drinking water, any electrolyte replacement or juice.    

Good handwashing is key to prevention.  Once a person does have the virus, it is important for those around them to practice good handwashing; do not share anything with the contaminated person, and solid surfaces should be cleaned with a bleach solution. 

In nursing homes and hospitals, even daycares, this virus is easily spread. There are guidelines for institutions to follow published by the CDC. 

Have you or anyone in your household ever had this virus? What did you find to be the best remedy for your symptoms?

ADVANCE welcomes the newest Insight blogger, Pam Strohmeyer, RN. She is a clinical research associate at Welch Allyn in Beaverton, OR. She has nearly 15 years of experience as a staff nurse and charge nurse in various ICU settings. In addition to her nursing background, she has a BS in biology and is currently pursuing an MS in clinical research administration at The George Washington University in Washington, DC. Prior to joining Welch Allyn, she conducted clinical research in medical imaging, co-authoring several papers and abstracts on the topics of nuclear medicine and positron emission tomography (PET). 

Would you drink a beaker full of potentially infectious bacteria to prove a point? Dr. Barry Marshall did, and in the process, he changed the way modern medicine looks at peptic ulcer disease. He also won a Nobel Prize for his efforts---not bad for a day's work (however icky).

In the 1980s, Marshall and his partner, Robin Warren, proposed that stomach ulcers were caused by Helicobacter pylori (H. pylori). This went against the conventional wisdom of the day, which held that diets and lifestyles were to blame. To test his hypothesis, Marshall drank some of his bacterial culture, and he promptly developed gastritis. Marshall and Warren's discovery meant that the previous suspects --- spicy foods and emotional stress --- were officially off the hook. This opened the door to new diagnostic tests and antibiotic treatment regimens for peptic ulcer disease. It also introduced the possibility of a future vaccine against gastric ulcers and stomach cancer.

Over half of the world's population may already be colonized with H. pylori. Scientists aren't sure why only some of the people who harbor the bacterium go on to develop ulcers. But for those who do, the effects can be painful and even life-threatening. Therefore, the ability to treat the cause, and not just the symptoms, has been a huge step forward.

But while antibiotic therapy has a better track record against ulcers than those old-fashioned antacids and bland diets had, many ulcers still recur after treatment. That's because H. pylori is a tough bug. The very fact that it's able to survive in the harsh, acidic environment of the stomach makes it difficult to eradicate. It burrows into the gastric lining where it's hard to reach, and it uses urease to break down the proteins we eat to make an ammonia shield for itself against the stomach's hydrochloric acid. Sometimes several courses of antibiotics are needed to resolve the infection.

As a result, an ounce of prevention may be worth a pound of cure. Unfortunately, H. pylori's mode of transmission is still poorly understood. It may spread through direct contact, or it may be a food-borne pathogen. Either way, good hand hygiene is essential for prevention, as is thoroughly washing and cooking your food.

And whatever you do, don't drink on the job...especially from a beaker.