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The Economic Burden of Hospital Acquired Infection
The worldwide issue of increasing antibiotic resistance is presenting healthcare professionals with significant challenges. In less than 100 years the development and use of antibiotics, a massive benefit to human health is creating an array of highly resistant organisms against which we currently have no effective treatment. The impact upon human health may be devastating and the direct financial costs to both healthcare organisations and government are significant.
In Europe, healthcare acquired infections (HAI) cause 16 million extra-days of hospital stay, 37,000 attributable deaths, and contribute to an additional 110,000 every year. The world health organisation (WHO) estimates 1:3 surgical patients contract a surgical site infection, 40% of them being methicillin resistant Staph aureus (MRSA), reducing this is critical to the antimicrobial resistance agenda. The annual financial losses are estimated at approximately €7 billion of direct costs. In the United Kingdom every case of hospital acquired MRSA is said to cost the NHS £8,000 and overall the cost of HAIs to the NHS is around £900million per annum.
In 2001 carbapenen resistant enterobacteriaceae (CRE) were deemed the 'nightmare bacteria’ an ‘urgent threat' to human health by Centre for Disease Control. That year in the United States reports were made to CDC of CRE infection from only 1 US state, in 2016 it was found in 48. Concerns have been raised that CRE may disseminate in foods and eventually contaminate fresh retail meat products. and genes that confer resistance to colistin and carbapenem have been found in several farmyard bacteria. Now there have been reports that one in four supermarket bought chickens have been shown to contain highly resistant strains of E coli. It’s not just an issue for healthcare establishments.
The patient environment
One area of concern within the mix of key infection control challenges facing healthcare staff is contamination of surfaces and devices. Organisms such as MRSA, clostridium difficile (CDI) and vancomycin resistant enterococci (VRE) are capable of surviving for days to months in the patient environment.
The use of mobile devices such as phones, personal digital assistants (PDA) and tablet PCs is increasing rapidly. Several software systems that enable clinical staff to collect vital signs, link with data from pathology or radiology, that provide huge benefits to patient safety and clinical efficacy, are driving their uptake.
For many years hospitals have embraced use of antibacterial keyboards and mice because of potential cross infection risks. Some studies have shown MRSA isolates on keyboards to have the same antibiotic resistance patterns and DNA identity as patients with clinical infections in the same ward.
The new keyboards, mobile devices that are used every day also similarly carry pathogens on their surfaces and in your pocket. Protective cases that are not designed for the task can conceal pathogens and exacerbate this problem.
These devices as well as stethoscopes, pressure cuffs, gloves and keyboards are frequently colonised with bacteria. Commonly contamination is skin flora such as Staph epidermidis, but significant contamination of MRSA/MSSA, E Coli, Pseudomonas, Klebsiella and other antibiotic resistant strains are frequently reported on up to 95% of mobile devices tested. Smart-Phones seem to show greater levels of contamination than conventional phones. Both the London School of Tropical Medicine & Hygiene and University of Surrey have reported bacterial contamination of smart phones with a variety of skin, environmental and faecal organisms.
Up to 82% of disposable gloves have been shown to be contaminated with pathogens, 59% the patient's infectious organism, 64% were not changed between patients. Reducing unnecessary use of gloves and proper hand hygiene are key programs to help reduce hospital cross-infection being driven by the WHO and infection prevention specialists worldwide. Hand hygiene is not just about touching the patient!
A NHS healthcare care assistant recently told me about a isolated & barrier nursed patient with confirmed CRE, she then explained how the same PDA used to record routine patient observations is taken in and out of the side room and normal ward without it being cleaned.
Cleaning mobile equipment with iso-propyl alcohol, bleach, hydrogen peroxides and peracetic acid is not recommended by electronic mobile equipment manufacturers and will certainly invalidate equipment warranties. The manufacturer of the world's leading tablet PC simply recommends using a lightly moist microfibre cloth only.
Decontamination with healthcare approved disinfectant wipes may only be a temporary measure, until next handled and may also damage the equipment, connectors or electronics. Wouldn't it be better if a permanent ‘always-on’ approach were available as the first line of defence?
Bacteria moulds and fungi have a weakness; silver. Hippocrates first described its antimicrobial properties in 400 BC and it has been used to fight infection for thousands of years. The privileged believed that eating from a silver spoon protected them from harm hence the saying ‘born with a silver spoon in your mouth’. Many patients report the benefits of using colloidal silver to treat recurrent bladder or fungal infections without having to use antibiotics.
Dissolved silver ions attack bacterial cells in three main ways: it makes the cell membrane more permeable, it interferes with the cell’s metabolism, leading to the overproduction of toxic oxygen compounds. Silver also interferes with bacterial DNA preventing replication. These mechanisms have the potential to make today’s antibiotics more effective against resistant bacteria.
Many antibiotics are thought to kill their targets by producing reactive oxygen compounds, James Collins and his team (Boston USA) showed that when boosted with a small amount of silver these drugs could kill between 10 and 1,000 times as many bacteria. The increase in membrane permeability also allows more antibiotics to enter the bacterial cells.
Silver has also been shown to have effects against viruses and fungi; it may destroy norovirus on fabrics and kills aspergillum, candida and other potentially harmful moulds.
A Whole System approach
We need a whole system approach to combat microbial contamination that includes innate forms of control using appropriate agents that are not subject to genetic resistance mechanisms that are transferred between bacteria.
Silver may be used in healthcare to help provide overall microbial contamination in the patient environment, for example in surface coverings, fabrics and equipment. Products specifically designed for and incorporating antimicrobial materials are another part of the overall strategy for combating surface contamination and HAI in healthcare. Such products provide a 24/7/365 ‘always-on’ first line of defence to enhance other infection control measures. When incorporated correctly into products designed for the task harmful bacteria on their surfaces are destroyed or inactivated in minutes.
Tough-PAC® are cases and docking systems specifically designed for healthcare use for iPad and iPod mobile devices. Tough-PAC® incorporates silver-ion antimicrobial technology shown to actively kill more than 99.9% of MRSA and 99.6% EColi contaminants in the ISO22196 standard, so reducing the risk of device borne cross infection in hospitals when using these mobile computers.
About the author:
Keith Smith qualified as a Chartered biomedical scientist, and Fellow of the Institute of Biomedical Science. He holds Masters degrees in Immunology for Disease Control and in Business Administration. He has worked extensively in clinical pathology, research & development and eHealth in hospitals and world class research establishments for over 38 years. Keith now is Managing Director of Inner-Vision Technology Ltd.