medicine and health

By Charlene Laino
WebMD Health News

Reviewed by Laura J. Martin, MD

Oct. 19, 2012 -- A new report suggests that hospital food is frequently contaminated with the dangerous diarrhea bug Clostridium difficile (C. diff).

Houston researchers found that about one-fourth of nearly 100 hospital food samples they tested were positive for C. diff. Among the worst culprits: turkey, chicken, and egg products, vegetables and fruits, and desserts. Almost all were cooked.

It's only one hospital. And no cases of human infection were linked to the food.

But together with past research, the findings suggest that contaminated food may be an important route of spread of C. diff in hospitals, says researcher Hoonmo Koo, MD, an infectious diseases specialist at Baylor College of Medicine in Houston, Texas.

Moreover, the temperatures at which hospital foods are cooked may be too low to kill the bug, he says.

An infectious diseases expert not involved with the research says the major C. diff strains that contaminate food are different from the ones responsible for human disease.

"You should be more concerned about whether your doctor or nurse is washing their hands before touching you than about anything coming up from the cafeteria," says Stuart Cohen, MD, professor of medicine at the University of California School of Medicine, Davis. Contaminated hands are a proven risk factor for infection.

Each year, C. diff strikes about 500,000 Americans, mostly in hospitals and nursing homes. C. diff disease can range from mild diarrhea to life-threatening intestinal inflammation known as colitis. The bug produces toxins that damage the gut.

Most cases of hospital-acquired C. diff happen in people taking so-called broad-spectrum antibiotics. These kill many different types of bacteria (including good bacteria), which allows C. diff to overgrow. During this time, patients can get sick from C. diff picked up from contaminated surfaces or spread from a health care provider's hands.

C. diff is linked to about 14,000 deaths every year, according to the CDC.

The new study was presented at the annual meeting of the Infectious Diseases Society of America in San Diego.

C. diff has been recovered from pigs, cows, and chickens, and the bug has been found in retail meat and salad greens. A few studies have found that the C. diff strains found in animals are the same ones causing human disease, but others have found the opposite.

A 2008 CDC study concluded that "although they share similar clinical features, evidence suggests that the predominant strains causing C. diff [disease] in humans and different animal species are distinct."

Overall, though, surprisingly few studies have examined the possible link between C. diff disease in food, animals, and humans, according to both the CDC and Koo.

So the researchers tested about 2 tablespoons of each food item served over 80 days at a university hospital in Houston. The number that tested positive for C. diff:

Four of eight (50%) turkey samplesFour of 12 seafoods (33%)Two of 17 beef servings (12%)One of eight pork servings (13%)Six of 14 chicken and egg products (43%)Six of 27 vegetables and fruits (22%)None of two grainsThree of five desserts (60%)

The researchers did not actually trace any case of illness to contaminated food, Cohen notes.

"I'm not surprised that many of the foods tested positive," he says, pointing to the studies finding C. diff in retail meats.

But whether it is causing infection is another story, Cohen says.

"It may be contributing but it is not a driving force," he says.

To be on the safe side, though, make sure your food is cooked thoroughly, as high temperatures should kill the spores, Cohen says.

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

SOURCES: Infectious Diseases Society of America Meeting 2012, San Diego, Oct. 17-21, 2012. Hoonmo Koo, MD, assistant professor of medicine, infectious diseases division, Baylor College of Medicine, Houston. Stuart Cohen, MD, professor of medicine, infectious diseases division, University of California School of Medicine, Davis.

Sunday, October 21, 2012

Ultraviolet light effective in hospital infection control, study suggests

3:19 AM

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ScienceDaily (Oct. 18, 2012) — Research being presented at IDWeek 2012™ shows that a specific spectrum of ultraviolet light killed certain drug-resistant bacteria on the door handles, bedside tables and other surfaces of hospital rooms, suggesting a possible future weapon in the battle to reduce hospital-associated infections.

Researchers at Duke University Medical Center and the University of North Carolina Hospital System used short-wave ultraviolet radiation (UV-C) to nearly eliminate Acinetobacter, Clostridium difficile or vancomycin-resistant enterococci (VRE) in more than 50 patient rooms at the two medical facilities.

"We're learning more and more about how much the hospital environment contributes to the spread of these organisms," said lead researcher Deverick J. Anderson, MD, an assistant professor of medicine at Duke and co-director of the Duke Infection Control Outreach Network. Given previous findings by the University of North Carolina team that UV-C is effective at decreasing methicillin-resistant Staphylococcus aureus (MRSA) in hospital rooms, he believes that the new study lays critical groundwork.

"We have a solid foundation to show that this approach succeeds in both experimental and real-world conditions," Anderson said. "Now it's time to see if we can demonstrate that it indeed decreases the rate of infections among patients."

His group's work is among the significant research being discussed at the inaugural IDWeek meeting, taking place through October 21 in San Diego. With the theme Advancing Science, Improving Care, IDWeek features the latest science and bench-to-bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases, including HIV, across the lifespan. More than 1,500 abstracts from scientists in this country and internationally will be highlighted over the conference's five days.

"Healthcare-associated infections are linked with significant morbidity and mortality," said Liise-anne Pirofski, MD, an IDWeek chair for the Infectious Diseases Society of America. "Although there are multiple sources for these infections, the hospital environment itself can play an important role. The findings of this study suggest that UV light could hold promise for eliminating bacteria from hospital rooms and reducing the risk of infection with these difficult bacterial pathogens in the healthcare environment. That would be a result to benefit us all."

UV-C, which is harmful to microorganisms, has been used for decades in food, air and water purification and to sterilize equipment in laboratory settings. This study demonstrates that its medical application may offer new strategies for reducing the estimated 1.7 million hospital-associated infections that occur annually in the United States. The cost of treating these infections, often involving increasingly antibiotic-resistant bacteria, ranges from an estimated $4.5 billion to as much as $11 billion.

In their study, the Duke and University of North Carolina researchers questioned whether UV-C could be utilized to eliminate three of the most problematic germs and improve the cleanliness of patient rooms. Given the tough economics of healthcare today, hospitals' environmental services are under pressure to turn rooms over quickly, and many surfaces can get missed by even the most diligent crews.

The study focused on general-medical and intensive-care units of the two medical centers and identified patients with infections from the targeted bacteria. Clostridium difficile, or C. diff as it is commonly known, can trigger serious intestinal conditions. Acinetobacter can cause pneumonia and serious blood, wound and urinary tract infections. VRE most frequently infects the urinary tract, bloodstream, wounds or catheter sites. Each bacterium can survive for prolonged periods on surfaces.

After the patients were discharged, the researchers obtained multiple cultures from each of five specific locations in the hospital rooms and bathrooms -- "high-touch" areas that included bed rails, remote controls and toilets. A special machine with eight UV bulbs mounted on a central column was then positioned strategically in each room and turned on for as long as 45 minutes to eradicate both vegetative bacteria and bacterial spores. Fifteen more cultures were taken from the same locations in every room, and the pre- and post-treatment bacteria counts were compared.

The numbers of bacterial CFUs, or colony-forming units, fell precipitously. Fifty-two CFUs of Acinetobacter were seen before irradiation, but only 1 CFU afterward -- down 98.1 percent. As for VRE, the proportion decrease was nearly the same -- 719 CFUs before and 15 after, a 97.9 percent drop.

The culturing initially was not sensitive enough to isolate C. diff, but improved techniques allowed the researchers to do further testing and the results in the UV-C treated rooms were just as dramatic.

"We would never propose that UV light be the only form of room cleaning, but in an era of increasing antibiotic resistance, it could become an important addition to hospitals' arsenal," Anderson said.

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The above story is reprinted from materials provided by Society for Healthcare Epidemiology of America, via EurekAlert!, a service of AAAS.
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Child's home address helps predict risk of readmission to hospital

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ScienceDaily (Oct. 18, 2012) — Simply knowing a child's home address and some socioeconomic data can serve as a vital sign -- helping hospitals predict which children admitted for asthma treatment are at greater risk for re-hospitalization or additional emergency room visits, according to new research in the American Journal of Public Health.

The use of a so-called "geographic social risk index," based on census measures of poverty, home values and number of adults with high school degrees, also can help hospitals identify families likely to report financial or psychological hardship -- both of which are linked to adverse asthma outcomes, says Andrew Beck, MD, a pediatrician at Cincinnati Children's Hospital Medical Center and lead author of the study.

"The use of this data to help identify children admitted to the hospital with asthma who may need more aggressive, targeted assessments and/or interventions may prevent asthma attacks and reduce disparities," says Dr. Beck.

"These interventions could include enhanced care coordination, community health workers or help with better housing," adds Robert Kahn, MD, senior investigator of the Cincinnati Children's study. "The index could work like an extra vital sign at admission, increasing our ability to know a child's likelihood of returning to the hospital. This would allow you to trigger an enhanced clinical care pathway right at the start of an admission. Reducing such readmissions is increasingly critical in the era of healthcare reform."

The researchers geocoded home addresses (grouping households by geographic area) and constructed the social risk index from assigned census tract regions. This data included extreme poverty rates, median home values and high school graduation rates. Based on this information, 601 children hospitalized for asthma were evaluated and placed in one of three categories, or risk strata: low, medium or high risk.

The researchers found that 39 percent of all patients were rehospitalized or returned to the emergency room within 12 months.

Compared to children at low geographic risk, children in the high risk category were 80 percent more likely to be rehospitalized or revisit the emergency room. In addition, high-risk children had caregivers who were five times more likely to report two or more financial hardships in their households and three times more likely to report psychological distress. Children in the medium-risk category were 30 percent more likely to be readmitted or return to the emergency room.

The links between socioeconomic disparities and childhood asthma are well-established. Poor, urban and minority children are at the highest risk for emergency room treatment and hospital admission. Despite this, say the Cincinnati Children's researchers, clinical care guidelines designed to standardize care for child asthma sufferers do little to account for how socioeconomic disparities affect asthma.

"Most children receive the same inpatient care despite differences in socioeconomic risk for poorer outcomes," says Dr. Beck. "Early identification of children at increased risk could allow additional assessments and services to be put in place prior to discharge to improve patient outcomes. It also could help to target and use scarce and overburdened hospital and community resources more efficiently."

The researchers now hope to use the geographic social risk index to study other asthma outcomes and other conditions, such as diabetes mellitus. Ultimately, they want to assess whether the introduction of geographic data into clinical care leads to more in-depth and reliable triage of patients. They also want to evaluate whether this data helps link hospital- or community-based care to those patients most likely to benefit from it.

This project was supported by the Bureau of Health Professions (BHPR), Health Resources and Services Administration (HRSA), and Department of Health and Human Services (DHHS), under the Cincinnati Children's Hospital Medical Center Ruth L. Kirschstein National Research Service Award Primary Care Research Fellowship in Child and Adolescent Health (T32HP10027). Cohort recruitment and database assembly were supported by a Thrasher Research Fund New Investigator Award and a Cincinnati Children's Outcomes Research Award. Further support came from a Robert Wood Johnson Faculty Scholars Award and the National Institutes of Health (grant 1R01AI88116. Use of Research Electronic Data Capture was supported by the Center for Clinical and Translational Science and Training (grant NCRR/NIH UL1-RR026314-01).

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The above story is reprinted from materials provided by Cincinnati Children's Hospital Medical Center.
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Journal Reference:

Andrew F. Beck, Jeffrey M. Simmons, Bin Huang, and Robert S. Kahn. Geomedicine: Area-Based Socioeconomic Measures for Assessing Risk of Hospital Reutilization Among Children Admitted for Asthma. American Journal of Public Health, 2012; DOI: 10.2105/AJPH.2012.300806

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Sharp rise in children admitted to hospital with throat infections since 1999

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ScienceDaily (Oct. 19, 2012) — The number of children admitted to hospital in England for acute throat infections increased by 76 per cent between 1999 and 2010, according to new research published October 19 in Archives of Disease in Childhood.

Acute throat infection (ATI), which includes acute tonsillitis and acute pharyngitis, is one of the most common reasons for consulting a GP. The majority of ATIs are self-limiting and can be managed at home or by the GP, but a small proportion may require hospital admission.

This study investigated admission rates for children up to age 17 with ATI alongside trends in tonsillectomy rates, between 1999 and 2010. The study was motivated by concerns that the decline in tonsillectomy rates in recent years has led to an increase in hospital admissions for tonsillitis of increased severity. It also investigated whether performing fewer tonsillectomies is associated with higher rates of complications such as quinsy, an abscess that can occur when an infection spreads from a tonsil to the surrounding area.

The research, which was funded by a fellowship from the National Institute for Health Research, showed that the number of children admitted to hospital with ATI increased from 12,283 in 1999 to 22,071 in 2010 -- a rise in admission rate of 76 per cent. Short hospital stays, lasting less than two days, increased by 115 per cent over the decade, and accounted for the majority of admissions. Stays of two or more days in hospital for ATI decreased slightly, while quinsy rates remained stable. The authors found no evidence of an association between tonsillectomy trends and admission rates or the severity of ATI or quinsy.

The authors suggest that the dramatic increase in ATI admissions is probably explained by a large number of children being admitted for ATIs who would have formerly been managed in the community. The reasons for this may include changes in the provision of out-of-hours care in general practice and an increase in workload in Accident in Emergency departments. The four hour maximum waiting time in A&E, introduced in 2002, might have meant that doctors, who are under greater pressures, are more inclined to admit children to hospital with an ATI, the authors suggest.

Dr Elizabeth Koshy, from the School of Public Health at Imperial College London, who led the study said: "It is very concerning that there has been a major increase in hospital admissions for children with acute throat infections, particularly among those aged under five. We think this is likely to be due to problems at the primary care and secondary care interface. Our findings relating to short hospital stays suggest that many of the children admitted with acute throat infections could have been effectively managed in the community. Our study highlights the need to urgently address the issue of healthcare access, with improved models of integrated care within primary and secondary care, to avoid potentially unnecessary hospital admissions for relatively minor infections in the future."

Although these findings suggest that declining tonsillectomy rates do not appear to be associated with an increase in more severe ATI or quinsy rates, further research is needed to confirm this. Dr Koshy adds: "Tonsillectomy is a major and costly operation with potentially serious complications. So it seems sensible for clinicians to maintain a high threshold for referring children with recurrent throat infections for tonsillectomy and restrict it to those children who are most severely affected by these infections."

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The above story is reprinted from materials provided by Imperial College London.
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Journal Reference:

E. Koshy, J. Murray, A. Bottle, P. Aylin, M. Sharland, A. Majeed, S. Saxena. Significantly increasing hospital admissions for acute throat infections among children in England: is this related to tonsillectomy rates? Archives of Disease in Childhood, 2012; DOI: 10.1136/archdischild-2012-301755

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