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Safe Cannula.com Website To Help Stop The Spreading Of CA-MRSA

Check this 2 Page Full-Colour PDF File About MRSA: http://www.medifix.org/safec/images/MRSA%20Flyer.pdf

This may sounds like a B-movie on the Sci-Fi Channel, but the CA-MRSA scare is all too real - one of several health alerts this year that proved just how vulnerable we are despite all our scientific know-how and advances in medicine.

Invasive procedures, operations, plastic surgery, transplant surgery, hip or knee replacement, open heart surgery, bypass and minor surgical procedures will come to a grinding halt. The very technology we’ve created to help us live more comfortable and, yes, often healthier lives will turn around and bite us-hard..........

Say No To Antibiotics

Antibiotics are often given by doctors for coughs, colds and flu. Very high temperature does not mean to say you are very ill. Most bacterial infections produce mild temperature (hot & cold). Prescribing an antibiotic for all these symptoms will make MRSA get stronger.......

Introduction

Relatively a harmless bacteria that people carry on their nose and hands called as Staphylococcus has now suddenly becomes a dangerous predator "CA-MRSA", immune to antibiotics, chemical wash and antiseptic. This bacteria is threatening our very existence in this universe.

The CDC noted, the proportion of potentially-deadly Methicillin-resistant staphylococcus aureus, or MRSA, has been growing among the percentage of all staph infections. In 1974, MRSA represented 2 percent of all staph infections; that number rose to 22 percent in 1995 and 63 percent in 2004 and is growing at an alarming rate now threatening our existance..........

Hospital infections will cause the next wave of class-action lawsuits, bigger than the litigation over asbestos. Hospitals being sued are saying that their infection rates are within national norms. But for most infections, the only acceptable rate is zero.

Our Videos & Articles listed: http://loveforlife.com.au/node/5360

CA-MRSA

Health authorities & politicians are continuing to treat MRSA as purely a hospital problem and trying to assuage public opinion. They are spending billions on a fighting a battle they will never win. CA-MRSA is a killer bug infecting healthy adults and children in one to two days.

A major concern is that MRSA can be carried by asymptomatic patients. Worldwide, it is estimated that up to 53 million people are asymptomatic carriers of MRSA. Of these it is estimated that 2.5 million reside in the United States. Approximately 1% of the U.S. population is colonized with MRSA. Both infected and colonized patients contaminate their environment with the same relative frequency.

Despite advice from doctors, Government in UK continue with their NHS reforms and establishing polyclinics. We think this will be the future "Bug Chambers" doomed to wipe off a generation. We must stop them spreading. These bacteria are present every where and is transfered by contact. Soon we may not have doctors and nurses nor the NHS to help us when the epidemic hits us really hard in few years time..............

Antibiotics

Antibiotics paved the way for doctors to develop new technologies (IVF, plastic surgery, hip replacement, minimally invasive surgery, stents, total parentral nutrition's, transplant surgery and cardiac surgery).

Number pharmaceutical companies, there were active decisions taken that "Antibiotic research was not going to be profitable enough to meet their obligation to shareholders". Investing in R&D was stopped in 1970 and so now its too late and they may never find a new treatment, so please be prepared..........

Learn more about Antibiotics (cut and pasted below - see Antibiotic):

Prevention

Practical procedures performed using plastic disposable products in hospitals like inserting catheters, cannula, endotracheal tubes, urinary catheters, dialysis, naso-gastric tubes, colostomy & long lines create a safe entry point for these bacteria to enter your blood circulation.

These plastic devices are contaminated with bacteria are placed in yellow containers for weeks before incinerating. Hospitals in developing nations dispose these contaminated waste in waste disposable site often near health centres and hospitals. Global warming makes ideal situation for these bacteria to multiply and spread in the community...........

Pandemic

During influenza pandemic of 1918 more people died due to secondary Staphylococcus aureus than the World War I & II. The estimated potential worldwide death toll ranges from 7.4 million to 180 million to 360 million, extrapolating 1918’s deaths to today’s population.

Given global air travel, the virus & bacteria could spread swiftly, possibly reaching all continents in three months, the WHO asserts. The federal government fears that 9 million Americans may become sick.

" We are heading towards a "pre-antibiotic era" with no effective treatment for some infections". The Royal Society of Medicine..................

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Antibiotic - http://www.medifix.org/safec/pages/antibiotic.html

Thanks to Antibiotic for the helping us bring in massive changes in understanding and advances in the quality of life possible in the western world. Bacterial infections - in wounds, gut, lungs & brain killed most people in the pre-antibiotic era in the west. Secondary Bacterial infection (Staphylococcus aureus) was the reason millions died during "The Flu Epidemic of 1918". Change in weather helped to avert he problem as virus stopped spreading as the crowds dispersed and was not due to miracle drug. Inflenza epidemic

The present generation of doctors and patients are not familiar with common bacterial infections that produce osteomylitis, epiglottis, tetanus, anthrax, syphilis, scarlet fever, pneumonia and rheumatic fever. These conditions were not common in the last 20 years because the antibiotics reduced the duration of infections and prevented secondary illness.

It looks as if we are heading towards "Pre-Antibiotic era". This is because the bacterias have now developed resistance to the very antibiotic invented by chance in 1940s. The doctors & patients have abused them for conditions they should not have. These antibiotics have been prescribed to animals, plants and poultry making them useless to kill bacteria that infect us all. Unless we develop another treatment soon, we see no future to mankind and certainly not for medical profession.

People who develop, and control pharmaceutical industry, equipments, and medical device manufacturers need to have woken up and start thinking about this happening. They abandoned R&D and had assumed their investment on drugs that offer symptomatic relief (arthritis, epilepsy, hypertension etc) is going to give them the handsome reward which they are hoping for. There are more people dying with infections in this world than people suffering from pain, yet they ignored plea from doctors and statesmen asking their help. This antibiotic resistant bacterial invasion is likely to bring in an abrupt halt to all advances in healthcare, "The very technology we invented has turned around to haunt us"

Computers revolutionised medical research but let our brain stagnate resulting in rapid progress since 1980. One hundred years of advances in medicine was compressed, packed in a box in the last decade and ready to be buried in a time capsule.

Now I wonder how other doctors like me, who have published papers and warned the healthcare professionals against abusing antibiotics, performing irrelevant investigations and un-necessary procedure are now thinking?

I feel sad to some extent but at the same time feel sorry for those who are aspiring to be the doctors of tomorrow, "We have been instrumental in bringing an end to our own profession". I personally thank the pharmaceutical giants & medical equipment manufactures for their contribution.

The world will be a better place for few who could weather the storm and survive this swamp of bugs that are gathering momentum for a major assault in this planet.

History

In 1928, Alexander Fleming noticed that a patch of the mould Penicillium notatum had grown on a plate containing the bacteria Staphylococcus aureus and that around the mould there was a zone where no Staphylococcus could grow. He named the active substance penicillin but was unable to stably isolate it.

Several years later, in 1939, Ernst Chain and Howard Florey developed a way to isolate penicillin and used it to treat bacterial infections during the Second World War. The new drug came into clinical circulation in 1944 and made a huge impact on public health. Their discovery and development revolutionized modern medicine and paved the way for the development of many more natural antibiotics.

Antibiotics paved the way for doctors to develop new technologies (IVF, plastic surgery, hip replacement, minimally invasive surgery, stents, total parentral nutrition's, transplant surgery and cardiac surgery). These technologies have made some doctors rich and famous but now the very technology is threatening our existence in this universe.

Identifying a fungus like Penicillium notatum and extracting the enzyme to produce penicillin commercially took more than 20 years. Now we have this bacteria, armed with some eight toxins, mastered genetic manipulation and knows very well how to change and adopt to survive.

Investing in Antibiotic research and development was not profitable to satisfy the investors in pharmaceutical companies so was abandoned in 1970s.

Now its too late and they are unlikely to find a new treatment and so are now busy investing in rapid testing kits to help identify the bacteria. This makes sense to insurance companies, hospitals who are striving to keep infection rate low and investors. As doctors we must not forget the basic rule & ethics of performing a diagnostic test is to identify and offer treatment. We must not perform a test knowing there is no cure, this is likely to produce more distress than comfort.

Some drug companies are raising our hope by fast tracking publication in the media and some are also cashing in giving us the wrong information. We don't think any of these will help as we know the vaccination developed was found to have short term immunity.

Using Germicidal Wipes can spread bacteria because they were found not to kill and antiseptic soap was found to increase colonization of antibiotic resistant bacteria on our skin.

Most of us think we will have immunity to these bacteria,. Yes we would have but the genetic make up of this is different, they know how to kill the army of white cells in our body. White cells are necessary to defend us from invading predators.

These drugs were also used in veterinary medicine to treat infections. Small dose of antibiotics were widely used to promoting growth of farm animals and in various food industries. Now the pigs are said to be colonized with the same bacteria which infect us. Over use of antibiotics, inadequate dose and patients not completing the course as advised has given the bacteria to gradually develop resistance.

In general, healthy people are not at risk of MRSA infection in hospital. Factors that increase the risk include length of stay in hospital, use of multiple antibiotics, severity of illness, recent surgery, and use of invasive procedures and presence of medical devices (e.g. catheters, cannulae, and tubes).

"The time may come when penicillin can be bought by anyone in the shops. Then there is a danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. " Dr Alexander Fleming, Dec. 11, 1945

* Germicidal Wipes can spread bacteria
* Promoting growth of farm animals
* Bacteria to gradually develop resistance
* Antibiotic Resistance and Similar Phenomena
* Staphylococcus aureus
* R&D not profitable enough to meet their obligation to shareholders

Antibiotic Use:

Inappropriate, under dosing, patients not taking prescription as advised and overuse, contributes to resistance. If your skin infection isn't improving after a 2-3 days of taking an antibiotic, contact your doctor.

Taking antibiotics for common cold, viral infections leads to staphylococcus developing resistant strains in your body. When you're prescribed an antibiotic, make sure you take all of the doses, even if the infection is getting better. Don't stop until your doctor tells you to stop.

Don't share antibiotics with others or save unfinished antibiotics for another time.

Up-Date About Antibiotics

Tomasz and colleagues found a new antibiotic called Ceftobiprole annihilated colonies of MRSA. Like penicillin – one of the first and still one of the most widely used antibiotic agents – Ceftobiprole binds enzymes crucial to making bacterial cell walls, ultimately killing the bacteria. Although Tomasz is excited about this new potential weapon against MRSA, he cautions that bacteria are true survivors and capable of finding a way around any drug, even Ceftobiprole. So the war against Staphylococcus aureus continues.

The general claim put forth goes something like this: bacteria, insects, rodents and other undesirables (as far as we're concerned) are encountering manmade toxins such as antibiotics, and toxic chemicals such as DDT and warfarin, designed to kill off the offending nasties. In response, some of these creatures are adapting, changing and achieving capabilities that enable them to resist the toxins threatening to destroy them. These drug-resistant strains, we are told, are evolving. According to some doomsayers we are now faced with plagues of untreatable "supergerms" that will wreak havoc among Western civilization, striking down innumerable people as doctors watch helplessly, unable to prescribe an effective cure.

According to standard (monophyletic) evolutionary theory, all life on earth is descended from an original population of very simple single-celled organisms, perhaps something like algae. One of the inescapable conclusions of evolution, therefore, is that organisms have attained additional capabilities, additional functional structures, and greater complexity over time. This is unavoidable. No matter how one fudges, somewhere between algae and man all of the structures, systems, and abilities we see in the human body must have developed through the interplay of non-sentient natural processes.

* Journal Antimicrobial Agents and Chemptherepy; Aug 2008.
* Extract from Article By Eric Blievernicht

Download Articles

Malaria meds have knock-on effect in bacteria

* How Antibiotic Resistance Occurs in Bacteria (PDF 73)
* Download the leaflet in "Without Antibiotics" (PDF, 32K)
* Get better without using antibiotics - Frequently Asked Questions
* Download Poster 'Get rid of your cold' (PDF, 19K)
* Download Poster 'Under the weather' (PDF, 22K)
* Download Poster 'Won't help your defences' (PDF, 31K)

Searching for a cure

Read about Influenza 1918 and the American experience to understand the gravity of this situation. People infected with Influenza virus were immune-compromised, developed secondary infection with Staphylococcus aureus which killed them.

Estimated potential worldwide death toll ranges from 7.4 million to 180 million to 360 million, extrapolating 1918’s deaths to today’s population. Given global air travel, the virus could spread swiftly, possibly reaching all continents in three months, the WHO asserts. The federal government fears that 9 million Americans may become sick; most experts now assess the potential mortality rate at 1.5 percent to 2 percent. An index of how overtaxed health-care resources might become is the Centers for Disease Control and Prevention’s estimate of roughly 200 million outpatient visits and 2 million to 5 million hospital admissions.

Keeping with the belief that doing anything to fend off influenza was better than sitting idly by, waiting to become a statistic.

* Spanish flu 1918
* Coming to grips with a pandemic

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Intra-Vascular Cannula - http://www.medifix.org/safec/pages/cannula.html

All invasive procedures, operations, plastic surgery, transplant surgery, hip or knee replacement, open heart surgery, bypass and minor surgical procedures will come to a grinding halt. This is the year we learn that the very technology we’ve created to help us live more comfortable and, yes, often healthier lives will turn around and bite us-hard.

World Health Organization doesn't mince words: some diseases, it says, "we will have no effective therapies within the next ten years." Indeed, more than 70% of the bacteria that cause hospital-acquired infections are resistant to at least one of the antibiotics commonly used to treat them, and it's only going to get worse. These bacteria is also educating other bacteria by donating their gene, transfer (plasmid) technology and helping other harmless bacteria to develop resistance to antibiotics.

Intra-Vascular Device

Since 1989, we have been warring about this impending threat to major corporations, politicians and publishing articles in medical journals. We feel the main contributor to this rapid change in bacteria has been Intra-venous Cannula (small plastic tube placed in the vein)

Our hypotheis was proved by Winchester and Eastleigh Healthcare NHS Trust, UK for eliminating bacteraemia by taking meticulous care of insertion and monitoring IV Cannula. Since the introduction last November there have been no new cases of MRSA infections. This figure covers all forms of MRSA, including bloodstream infections (also known as bacteraemia) and wound infections. This compares to 2007/08 when there was 11 reported bloodstream infections.

Intra venous Cannula (IVC) – as well as word ‘venfon’ – is hated by all, especially patients and house officers. The former dislike it because it is painful, whereas the latter are repulsed more by the fact that inserting cannulae on regular basis is such a sub-cortical job (GMC Today).

Of all vascular access devices, peripheral venous cannula is the most frequently used in healthcare. The number of staphylococcal infection has rapidly increased since 1960s and this trend parallels the increased use of intravenous cannula. This is the only device that can "Save Life", but must be inserted into blood vessels with care and meticulously monitored. Germicidal Wipes used to clean skin is also said to spread infections,

Doctors and nurses claim the veins are bad and cannula manufacturers claim doctors and nurses find it hard to locate a vein, but we have found this claim is not true. The number of attempts taken to be successful is 2-3 attempts.

MRSA was an antibiotic-resistant type of Staphylococcus Aureus, a common bacteria present on the skin and in the nostrils of many healthy people. "MRSA often colonises hospital patients to no ill effect but, if present in a surgical wound or carried to the bloodstream by an intravenous catheter, it can cause serious infection and possibly the death of the patient," 10% Higher risk of you getting infection in A&E / ER, How are you going to protect your family and you from this life threatening infection ?

white blood cells

We must work hard to bring in changes to reduce contaminated hospital waste in hospitals and establishing a clinic to reduce children visiting hospitals.

New research on the threat of community-acquired MRSA (CA-MRSA) in primary care (UK) shows that as many as one in five patients who contract MRSA in the community are dead within a year.

This is a not a virus and you cannot fight this infection like a common cold or flu. Bacteria is a living cell with nucleus, genes and other structures similar to our body cells. Virus only has genes and is not said to be a living organism. There is a new bacteria which is smaller than virus is now known as Nanobacta.

The bacteria is commonly carried on the skin around 30% of the healthy people (adults and children). This bacteria has now become immune to all known antibiotics and antiseptics, so its sad if you get local infection but lethal if they enter your bloodstream. This bacteria kills in 12-24 Hours, we have not seen any like this before. This bacteria will wipe out medical profession and most of us.

The bacteria has various toxin which can destroys infection-fighting white blood cells (immunity), produce shock, DIC, Bleeding disorder and enter brain, liquefy tissue. This bacteria kills fit, young, healthy people - including children and babies - MRSA uses complex mechanisms to avoid destruction by neutrophils, (human white blood cells that ingest and destroy bacteria).

MRSA senses danger when it is exposed to the killer chemicals released by neutrophils-such as hydrogen peroxide, hypochlorous acid (the active component of household bleach) or antimicrobial proteins. The bacterium escapes harm and turns the tables on the white blood cells, destroying them.

Panton-Valentine Leukocidin, or PVL - produced by the CA-MRSA, which also destroys white blood cells and thus the body's immune system in five minutes. Healthy person can die within 24 hours of spread to the lungs due to a form of pneumonia in which the flesh is rapidly eaten away by enzymes - the Fifty per cent of victims with necrotising pneumonia die within the first 12-24 hours

New strains have been reported, Flu-MRSA which is likely to spread this winter and USA300 has also been isolated from spinal fluid similar to Meningitis.

Ethical Dilemma: “To Treat or Not to Treat”.

By treating patient who are carrier we (doctors) could dangerously harm that patient by introducing systemic infection (when performing practical procedures) and death. Not treating these patients, we may leave this agonized sick patient to suffer pain and discomfort in isolation.

We hope the healthcare providers & insurance companies, pharmaceuticals companies and medical device manufacturers will make alternative arrangements to address this issue and provide adequate care and support to both staff and MRSA positive patients.

This is complex, as your life may depend on it, and we don't want to lose you or see our children suffer in isolation.

Reference

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Invasive procedures
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Bacteria is also educating other bacteria
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Intra-venous Cannula (small plastic tube placed in the vein)
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Peripheral venous cannula is the most frequently used
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This trend parallels the increased use of intravascular devices
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Germicidal Wipes
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CA-MRSA is c arried to the bloodstream by an intravenous catheter
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Bacteria are living cell with nucleus
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Winchester and Eastleigh Healthcare NHS Trust, UK for eliminating bacteraemia by taking meticulous care of insertion and monitoring IV Cannula
*

venfon

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Staphylococcus Aureus - http://www.medifix.org/safec/pages/Index_staph.html

Staph aureus are normally found on the skin or in the nose of about one-third of the population. They are also present in soil, animals and have been existing in the environment for centuries. If you have staphylococcus on your skin or in your nose but aren't sick, you are said to be "colonized" but not infected. Healthy people can be colonized and have no ill effects. However, they can pass the germ to others.

Staphylococcus bacteria are generally harmless unless they enter the body through a cut or other wound, and even then they often cause only minor skin problems in healthy people. However, staph infections used to cause serious illness in older people who have weakened immune systems, usually in hospitals and long term care facilities.

Staphylococcus aureus is the major bacterial cause of skin, soft tissue and bone infections, and one of the commonest causes of healthcare-associated bacteraemia. About one-quarter of healthy people carry one or more strains asymptomatically at any given time and infections are commonly caused by the patient’s colonizing strain.

Staph aureus acquired during exposure to hospitals and other healthcare facilities, caused a variety of serious healthcare associated infections. Common infections you are familiar with are post-operative wound infections, infected cuts and bruises, impetigo producing straw coloured secretions and pus. This was treated with flucloxacilin / Methicilline or local antiseptic creams.

Antibiotics and surgical drainage are the basis of treatment of staphylococcal infections, but the emergence of multiple resistance to isoxazoyl penicillin such as methicillin, oxacillin and flucloxacillin. MRSA are cross-resistant to all currently licensed β-lactam antibiotics. and other agents has compromised therapy.

Symposium Index

* STAPHYLOCOCCAL INFECTIONS:
* CONTAINING METHICILLIN-RESISTANT S AUREUS:
* HOW CLOSE IS A STAPH VACCINE?:
* STAPHYLOCOCCAL TOXIC SHOCK SYNDROME:
* COAGULASE-NEGATIVE STAPHYLOCOCCI:
* Pictures of some skin infections
* Flu Epidemic 1918

MRSA hospitalizations have doubled since 1999, a new study says, another indication that the drug-resistant “superbug” is becoming an urgent public health issue. The study, which appears in the December issue of the Journal Emerging Infectious Diseases, is the first to examine the recent magnitude and trends related to methicillin resistant

Staphylococcus aureus, or MRSA, infections.

MRSA is a bacterium that causes staph infections on various parts of the body. Most often, it causes mild infections on the skin, causing pimples or boils. But it can also lead to more serious skin infections or infect surgical wounds, injection sites, cuts, through IV cannula enter the bloodstream, the lungs and also through urinary catheters. Depending on where the MRSA infection occurs, it can be life threatening. MRSA is difficult to treat, because it is resistant to many common antibiotics. The Centers for Disease Control (CDC) say MRSA infections kill about 250 people each day. About 90,000 Americans come down with drug resistant MRSA every year, and of that about 19,000 die from the infection.

According to this latest MRSA study, hospitalizations caused by MRSA more than doubled between 1999 and 2005, soaring from 127,000 to nearly 280,000. The study concluded that MRSA and staph infections are now “endemic, and in some cases epidemic” in many U.S. hospitals, long-term care facilities and communities.

The researchers who conducted the MRSA study also found that patterns of infection have changed as well. Traditionally, MRSA infections were problems in hospital and other patient settings. However, in the past several years, there has been a dramatic increase in the number of MRSA infections acquired outside of hospital settings.

At the same time, there was no change, up or down, in the number of deaths from hospital-associated staph or MRSA infections. The study’s authors say this means that antibiotic-resistant infections are spreading more rapidly in the community while the epidemic of drug-resistant infections in hospitals continues unabated. The end result of this, the study authors wrote, is an increase in patient suffering and the length of time patients spend in the hospital - in addition to direct health care costs, estimated to be more than $6 billion annually.

And as MRSA infections become more frequent, in other word giving them an opportunity to survive by introducing them into blood stream will make them resist antibiotic stronger and their population increases. The upsurge in MRSA has increased demand for vancomycin, a powerful antibiotic often used when other antibiotics fail. However, as the use of this drug has increased, public health officials are now reporting the deadly form of vancomycin resistant

MRSA, (VRSA) now called CA-MRSA has made the epidemic of drug resistant staph even worse. Invasive MRSA infection initially affected certain populations disproportionately. It is now a major public health problem primarily related to health care but no longer confined to intensive care units, acute care hospitals, or any health care institution. (JAMA. 2007;298(15):1763-1771)

What is Methicillin?

Methicillin is an antibiotic only used to test bacterial sensitivity to flucloxacillin in laboratory. UK hospitals reported 0.2 per 1000 occupied bed-days in 2001. Number of infections caused by MRSA was increasing every year and has caused 60% rise in death from staphylococcus infection in 5 years before 2001. IV Vancomycin and Teicoplanin or local Mupirocin were used.

What’s new?

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) SSTIs have become epidemic and are now the most common type of SSTI in most outpatient settings. Invasive CA-MRSA infections among healthy, community-dwelling adults and children have also emerged as a significant infectious disease. Historically, virtually all MRSA infections had been classified as nosocomial, or hospital-associated (HA-MRSA). In 2002, however, US sentinel hospital data revealed that a significant number of MRSA SSTIs-between 8% and 20%-were community associated.

CA-MRSA infections have distinct clinical, epidemiologic, and bacterial characteristics. These differences have significant implications for treatment, especially in the outpatient setting.

Why is this important?

CA-MRSA infections commonly do not resolve—and may worsen—if they are treated with traditional antibiotics.

The term CA-MRSA is used to refer to any MRSA infection with community onset in a person without established

risk factors for HA-MRSA; these risk factors include recent hospitalization or surgery, presence of invasive medical devices, dialysis, or residence in a long-term care facility.

The term CA-MRSA has also been used to describe MRSA strains with genotypes and antimicrobial susceptibility

considered typical of CA-MRSA. CA-MRSA and HA-MRSA appear to cause similar types of infections. CA-MRSA

SSTIs can run the gamut from mild, superficial infections to deep infections requiring hospital admission for incision and drainage (I&D) and/or for treatment with parenteral antibiotics.

CA-MRSA appears to be separate and distinct from HA-MRSA, with CA-MRSA seeming to be resistant to fewer

classes and different classes of antimicrobials. Most CA-MRSA infections are minor SSTIs, but severe invasive disease has been reported.

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Flu epidemic 1918 killed more people than World War I & II due to secondary Staphylococcus infection

Where is this happening?

CA-MRSA SSTIs are epidemic virtually everywhere and in every community. One of the first pockets of high prevalence was documented in 2002 in an urban California emergency department (ED), where 61 of 79 consecutive staphylococcal SSTIs (77%) were due to CA-MRSA.

Researchers in a large Atlanta public hospital in 2003 identified 389 cases of S aureus SSTIs; 72% of these infections were caused by CA-MRSA. In another prospective study of 422 patients with SSTIs presenting to 11 urban EDs throughout the United States in 2004, S aureus was isolated in 321 cases (76%); 81% of these patients had abscesses, 11% had infected wounds, and 8% had cellulitis. While the prevalence of CA-MRSA varied widely, CA-MRSA was the single most common cause of infection in 10 of 11 EDs. Populations at high risk for CA-MRSA infection are merging. In an urban HIV clinic in Dallas.

Toxic Staphylococcal Shock Syndrome (TSS)

The incidence of staphylococcal toxic shock syndrome (TSS) has decreased steadily since the 1980s, when it was first linked with use of super absorbent tampons by menstruating women. Nonetheless, the disorder still occurs and sometimes is overlooked as a possible cause of acute illness. TSS now is recognized as a toxin-mediated, multisystemic illness that strikes primarily in healthy people of any age. It is characterized by early onset of shock with multiorgan failure and continues to be associated with high morbidity and mortality.

TSS was first reported by Todd and associates in 1978 in seven children who had high fever, erythroderma,

confusion, profuse diarrhea, and shock with organ failure. Desquamation of the skin on the palms, soles, and trunk was noted during convalescence. Phage group I S aureus was isolated from five of the children, and it was thought that a new staphylococcal epidermal toxin may have been the cause.

In 1980, Shrock observed a similar syndrome in menstruating women and postulated that herpes infection could be playing a role. Later that same year, another report confirmed the association of TSS with menstruation, S aureus, and super absorbent tampons, which were quickly withdrawn from the market. The highest incidence of TSS was reported in 1980 (3 to 14.4 cases per 100,000 menstruating women per year). The greatest risk was in white women less than 30 years of age. A novel toxin called toxic shock syndrome toxin 1 (TSST-1) was found in more than 90% of S aureus strains isolated from menstruating women who had TSS.

No menstrual cases of TSS were also reported in the early 1980s and were associated with a variety of surgical procedures (eg, rhinoplasty, nasal packing, and postpartum procedures) and medical conditions (eg, pneumonia, influenza, infection). Nonetheless, the incidence of TSS decreased significantly after hyper absorbable tampons were removed from the market and federal regulations for tampons were put in place. Currently, the number of cases of menstrual TSS is estimated to be about 1/100,000, and the case-fatality ratio is 3.3% (compared with 5.6% initially). The incidence of no menstrual TSS now exceeds that of menstrual TSS. A review of surveillance data for 1979 through 1996 confirmed the decline in the incidence of TSS and the increase in the proportion of no menstrual cases.

Clinical presentation

On menstrual TSS is seen more often nowadays than menstrual TSS. The nonmenstrual form is observed in a variety of medical and surgical conditions, mainly in surgical wound infection with S aureus, postpartum infections, and rhinoplasty in which stents or nasal packing is used. Among the nonsurgical focal infections associated with TSS are cellulitis, subcutaneous abscesses, infected burns, suppurative hidradenitis, bursitis, and pneumonia with or without an antecedent influenza infection.

Predisposing factors include nasal packing, influenza infection, and prior use of antibiotics, nonsteroidal antiinflammatory drugs (NSAIDs), or barrier contraceptives. Postsurgical TSS usually occurs 2 days after the procedure and is associated with a benign-appearing wound in 40% of cases. It is crucial to suspect TSS in these circumstances and to obtain cultures from the wound. Delay in recognizing the early signs of TSS is associated with increased morbidity and mortality.

Malaise, myalgia, diarrhea, and chills often precede the onset of the other physical manifestations of staphylococcal TSS. Fever, confusion, and lethargy develop soon after the prodromal syndrome, which is associated with symptoms of hypovolaemia (eg, palpitations, light-headedness, orthostatic) related to capillary leakage and diarrhea. Fever, hyperventilation, hypotension, tachycardia, and erythematous rash are often evident on physical examination. The rash is described as diffuse macular erythroderma that is confluent or scarlatiniform in most of the cases but also could be patchy in distribution.

Other signs include strawberry tongue, conjunctival hyperemia, and erythema and edema of palms and soles.

Hematological, hepatic, muscular, renal, gastrointestinal, and central nervous system involvement is common.

Desquamation usually occurs 1 to 2 weeks after the onset of illness. In nonmenstrual TSS, classic signs of localized infection at the surgical site may be absent, which makes clinical diagnosis challenging.

Complications of TSS include acute renal failure, adult respiratory distress syndrome, disseminated intravascular coagulation, electrolyte disturbances (hypocalcaemia, hypophosphataemia, and hypomagnesaemia), cardiomyopathy, encephalopathy, and hair and nail loss. Nonmenstrual TSS is associated with more renal and nervous system complications than menstrual TSS. In addition, the case-fatality rate is higher with the nonmenstrual form of the disorder, possibly because of delay in making the appropriate diagnosis.

When TSS is treated appropriately, full recovery is the rule, although some patients may have persistent neuropsychological dysfunction (eg, memory loss, lack of concentration), mild renal failure, late-onset rash, or onset of new allergies. For epidemiologic purposes, a clinical case definition of TSS was developed by the Centers for Disease Control and Prevention in 1980, and it still plays an important role in diagnosis (table 1). However, milder cases of TSS that do not fulfill all the criteria certainly are likely to occur.

Case definition of staphylococcal toxic shock syndrome developed by the CDC and Prevention

Major criteria (all 4 must be met)

* Fever: temperature >38.9°C (102°F)

* Rash: diffuse macular erythroderma

* Desquamation: 1 to 2 wk after onset of illness, particularly of palms and soles

* Hypotension: systolic blood pressure <90 mm Hg for adults or <5th percentile by age for children <16 yr of age, or orthostatic syncope

* Multisystem involvement (3 or more must be met)

* Gastrointestinal: vomiting or diarrhea at onset of illness

* Muscular: severe myalgia or creatine kinase level twice upper limit of normal for laboratory

* Mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia

* Renal: blood urea nitrogen or creatinine level at least twice upper limit of normal for laboratory, or 5 white blood cells per high-power field in absence of urinary tract infection

* Hepatic: total bilirubin, aspartate aminotransferase, or alanine aminotransferase at least twice upper limit of normal for laboratory

* Hematological: platelets <100,000/mm3

* Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent

Normal results on the following tests

* Blood, throat, or cerebrospinal fluid cultures (blood culture may be positive for S aureus)

* Rise in titer in antibody tests for Rocky Mountain spotted fever, leptospirosis, or measles

Adapted from Greenman RL, Immerman RP. Toxic shock syndrome: what have we learned? Postgrad Med

1987;81(4):147-60.

How Did We Get To This Stage?

In 1980s MRSA infections were reported from various pediatric departments in UK hospitals. During this period, HIV was also becoming a major problem and attracted media attention. Staphylococcus was not seen as a major threat by doctors and often dismissed blood culture results as normal commensal. Some babies were very ill and so were treated with vancomycin. These babies should have been treated in isolation but the guidelines were not strictly followed.

We initially noticed an increased infection rate in babies who were very ill, very preterm or when multiple punctures to introduce cannula or catheters. After lengthy discussion with our seniors about the association of higher infection rate in babies and multiple punctures due to difficult to cannulate, we could not organize a study to prove our hypothesis. We decided to identify reasons we fail to cannulate in the first attempt, and hoped we could reduce the number of attempts. After studying the video recordings and close observation we identified two important mistakes resulting in failure rate. The operator was either moving the needle forward (double puncture) or withdrawing (premature withdrawal) prior to cannula entering the lumen of blood vessels.

We constructed the first cannula introducing device to help ease the forward movement of cannula to reduce double puncture. We managed to get permission to tryout our cannula introducing technique in babies. We were allowed to try the cannula introducer only after SHO & Registrar failed to cannulate. We could not prove our hypothesis about infection rate as the babies were subjected to multiple attempts prior to me trying my cannula introducer.

The results of this study were published and the video recording of the technique was presented to cannula manufacturers. We had hoped the cannula manufacturers will understand and help produce spring-loaded cannula to test the hypothesis and prove the device will reduce the number of attempts to cannulate and result in reducing the rate of spreading MRSA infection in hospital. The cannula company was initially keen to produce the spring loaded cannula decided to abandon the project due to fear of de-skilling doctors and nurses. They invested large amount of their R&D funds to bring in Safety cannula that only offer safety features to protect staff from needle stick injury and not cater to patient’s safety.

Various hospitals started using nurses as phlebotomy and cannula introducing technicians. These nurses were trained and have resulted in doctors not often getting an opportunity to introduce cannula. Nursing Association (UK) published paper recommending their member to pass on the responsibility to cannulate in emergency situation and if the patient is said to be critical or the nurse felt the technique will be difficult.

TRANSMISSION:

Staph is spread by contact MRSA is transmitted by touching someone who is carrying the bacteria, or by touching something they have touched. According to the Centers for Disease Control (CDC) the most common ways to spread MRSA are:

* Close skin-to-skin contact

* Openings in the skin, like cuts or abrasions

* Crowded living conditions, like in hospitals or prisons

* Poor hygiene

In health care centers people infected with MRSA are often kept separate from other patients to reduce the risk of the bacteria spreading.

PREVENTION:

There are several preventative measures that can be taken to stop the spread of MRSA. The CDC recommends:

* Wash your hands with soap for as long as it takes you to recite the alphabet. When washing hands isn’t possible, use alcohol based hand sanitizer.

* Cover all cuts and scrapes with a clean bandage.

* Don’t ever touch another person’s wounds or bandages.

* Don’t share personal items like towels or razors?

* Dry clothes, sheets and towels in a dryer rather than hanging them out to dry.

Flu or common cold is common during the winter months but it’s really not a big threat. CA-MRSA will be a major problem in children with runny nose because the often develop dryness and soreness around their nostrils due to repeated claming using dry paper towels. Nose and the hands are said to be colonized with CA-MRSA and so likely infected cuts and cracked skin around the nose.

As children, are told to cover our mouths and noses when we cough and sneeze. This puts the CA-MRSA into their hands. Then when they touch things: papers, doorknobs or other people’s hands. By touching noses or eyes they put the bacteria right where they can begin to cause infection. Eyes are connected to our noses by a duct that drains tears so touching our eyes is a risk and rapid spread of infection to eyes.

Hand Washing To be effective, hands should be rubbed together vigorously with soap and warm water for at least 15 - 30 seconds. Brief rubbing or simply rinsing under running water is not enough. Contaminants are stuck in oils that adhere to the skin. Agitation by rubbing loosens the dead skin cells, and soap keeps the contaminants and germs suspended in the water so they rinse off. Soap does not kill the bacteria. In fact, germicidal soaps must remain in contact with the skin for several minutes to kill germs. Anti-bacterial soaps may give a false sense of security that could lead to less vigorous washing.

This technique also removes bacteria and viruses that can cause intestinal diseases. Cruise lines have made the news in recent times when large numbers of passengers have been sickened by infectious diarrhea and vomiting.

Hepatitis A can be passed on by food handlers at home or in restaurants. Even bacteria from raw meat can be spread to others without proper hand washing.

Methicillin-resistant Staphylococcus aureus (MRSA) infections have made the news due to some deaths from the bacterium. While the existence of the bacteria is partly due to the widespread use of antibiotics, the organism is no more infectious than others people can have on their skin or in their noses. It’s just harder to eliminate once an infection is present. Preventing infection is the first line of defense against hard to treat infections. Medical personnel must be the leaders in this movement to reduce infections cleaning or sanitizing hands before and after each patient encounter.

If washing with soap is not an option, alcohol gel sanitizers are a good option. These alcohol-based sanitizers have been shown to kill pathologic bacteria in seconds. They can be kept close at hand to eliminate walking to a sink.

With their introduction, non-medical people also may benefit. Research has shown significant reductions in illness in schools where hand sanitizers have been used because they can be kept in the classroom so sinks are not needed.

Visible dirt should still be removed by washing, but hand sanitizers can eliminate germs that cause colds and other illnesses.

The bacterial elimination effort can be carried a bit too far, though. Some scientists believe that our immune systems learn to distinguish bad germs from good germs by being exposed to dirt and bacteria early in life. Studies are ongoing, but many doctors think that excessively clean environments may not be a good idea. It may not be necessary to maintain a completely antiseptic environment for children, but teaching children to wash their hands before eating and after using the bathroom is important.

Skin Antisepsis

Skin cleansing and antisepsis of the insertion site is considered one of the most important measures for Preventing infections associated with vascular access devices (Evidence-Based Practice in Infection Control (EPIC), 2001a, 2001b; LeBlanc & Cobbett, 2000; Pearson, 1996a, 1996b). Skin must be clean; that is, free of soil, dust, and organic material prior to applying the antiseptic (CDC, 2002; Health Canada, 2003).

Organisms responsible for catheter-related infections originate mainly from the client’s own skin flora (Crow, 1996; Jackson, 2001; RCN, 2003) or from the hands of the health care professional inserting or handling the device (Hadaway, 2003b; Jackson, 2001). These organisms can be introduced along with the catheter or can gain access while the catheter is in place. Catheter movement in or out of the insertion site (known as “pistoning”) can also allow for skin organisms to migrate into the tract and potentially cause infections (Hadaway, 2003b).

Disinfect clean skin with an appropriate antiseptic before catheter insertion and with each dressing change. The antiseptic solution must be compatible with the catheter material (Hadaway, 2003a). Acetone products should be avoided as they may cause irritation and affect the integrity of the catheter (O’Grady, et al., 2002; Pearson, 1996a, 1996b) and alcohol-based solutions are not recommended for certain devices.

Studies have shown that 2% chlorhexidine gluconate solution significantly lowers catheter-related Bloodstream infection rates when compared with 10% povidone-iodine and 70% isopropyl alcohol (LeBlanc & Cobbett, 2000; Maki, Ringer & Alvarado, 1991; Mimoz, et al., 1996; Rosenthal, 2003; Zitella, 2004). Chlorhexidine gluconate offers a broad spectrum of antimicrobial activity and long-term microbacteriocidal action after application (Hadaway, 2003a). Antiseptics should remain on the insertion site and be allowed to air dry before catheter insertion and/or dressing change. Table 1 describes the required drying time needed for particular solutions in order to prevent skin breakdown as a result of chemical reaction between the solution and the dressing.

Drying Times

Client tolerance and preference may influence the use of antiseptic solutions. Where alternative antiseptic solutions are not indicated in a procedure, the nurse should consult the appropriate health care practitioner to determine the best solution for the client.

Antiseptic Cleaning Solutions Drying Time

* Chlorhexidine gluconate 2% with Alcohol 30 seconds – 1 minute

* Chlorhexidine gluconate without Alcohol 2 minutes

* Poviodine-Iodine 2 minutes

* Isopropyl Alcohol 70% Kills bacteria only when applied Dries quickly, No lasting Bactericidal effect

Vaccination

Genetically engineered vaccine has been shown to protect against life-threatening Staphylococcus aureus infections, a major risk among hospitalized patients. In a recent interview, Henry Shinefield, MD, co director of the Kaiser Permanente Vaccine Study Center in Oakland, California, stated that "the potential for this vaccine is very exciting. It could well be a major breakthrough in protecting patients from these serious infections."

Among patients receiving the vaccine, S aureus antibody levels peaked at 10 to 14 days, plateau until about 40 weeks, and then dropped to baseline as the vaccine lost its effectiveness. At 40 weeks, 26 patients in the placebo group had had S aureus infections, compared with 11 in the vaccine group. This represented a 57% reduction in the infection rate and was considered statistically significant.

"These patients were at very high risk," Dr Shinefield pointed out. "The fact that the vaccine prevents infection, rather than stopping it after it starts, offers new avenues for prophylaxis in many high-risk situations. This is especially important because of increasing resistance of bacteria to antibiotics."

The vaccine was created at the National Institutes of Health and is one of several S aureus vaccines in

development. None of the other products have reached the advanced clinical trial stage at this time.

How Can Our Contribution Help?

We have organized trial, observation study of this very important life saving most common minor surgical procedure performed in hospitals. In UK the 16 million cannula were used last year. On average, doctors take 3 attempts to introduce a cannula in patients. The figures published claim 60% success but do not show the number of attempts taken.

Our hypothesis to reduce number of patients contracting MRSA in hospitals is because the cannula needle is inserted without adequate care of skin preparation. Multiple punctures reduce care of skin preparation and increase chances of infection.

We hope the two devices we designed to reduce the time taken, attempts, discarded waste and needle tip protection will be available for us to conduct further investigation. This change in technique will improve successful rate and reduce the spread of MRSA.

The annual cost in the US to treat hospitalized patients with methicillin resistant Staphylococcus aureus (MRSA) infections is estimated to be $3.2 billion to $4.2 billion, according to a new analysis presented at the annual meeting of the "International Society for Pharmacoeconomics and Outcomes Research" (ISPOR) in Washington, D.C. Prolonged hospital stays, including time spent in intensive care units, primarily drive the high costs of treating infections caused by MRSA, a serious, multi-drug resistant pathogen.

Link to this website: http://www.safecannula.com