Locker room conditions make athletes susceptible to infection

dressing roomWhat began as a seemingly routine injury quickly turned scary last October for Daniel Fells, a member of the New York Giants football team. A toe and ankle injury went south in a hurry for Fells. He landed in intensive care, suffering from Methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a staph infection resistant to many antibiotics. The aggressive infection became so bad that amputation to control it became a real possibility. He has since made significant progress after multiple surgeries and amputation appears highly unlikely, though the future of his career remains in doubt because of the damage to his foot and leg.

It’s unclear where the highly-contagious infection came from in Fells’ case, but the National Football League team was quick to enlist the help of infectious disease experts. The Giants’ locker room, training rooms and meetings rooms were scrubbed and sanitized and players were briefed on precautions and how to prevent the spread of MRSA. While more extreme than most, Fells’ infection is hardly unique among athletes. Locker rooms – warm and often unsanitary – are an ideal place for MRSA to thrive.

Locker Rooms Front Line Of MRSA Defense at YouTube, a report from KOCO News in Oklahoma City, takes you inside the University of Oklahoma football locker room, which is a front-line of defense against MRSA. Turf burns, shared towels, trainers not washing properly and using whirlpools without showering are named as a few ways the infection is transmitted. Odor is a result of bacteria, and addressing the root cause is essential to break the chain of secondary infection.

Some related pieces:

 

CBRN threats, though rare, warrant innovative, proactive planning

twoChemical, Biological, Radiological and Nuclear Weapons threats globally are a potential threat – that if overlooked – can be a grave mistake. The threat is airborne, fomites and water driven. Use of Chemical, Biological, Radiological and Nuclear Weapons by Non-State Actors Emerging trends and risk factors is a wonderful overview of the global threat. The piece is put out by Lloyd’s, the world’s only specialist insurance and reinsurance market.

Among the topics discussed:

  • CBRN weapons are some of the most indiscriminate and deadly weapons in existence today. Given the potential deadliness and costliness of even a single CBRN attack, and the relative ease with which malicious actors could obtain many of the materials and know-how required to build CBRN weapons, it is important to assess the current global threat of use of these weapons in light of society’s resilience and vulnerabilities, and emerging technologies.
  • The report indicates that the global threat of CBRN weapons use is evolving, driven by three strategic trends: Potential perpetrators, technological and scientific capabilities and dual-use materials.
  • Today’s heightened terrorist and saboteur threat, combined with the significant potential for CBRN weapons to cause widespread disruption and fear, could increase the likelihood of these weapons being used by malicious actors.
  • Emerging technologies are altering the risk landscape for CBRN weapons use in a variety of ways.
  • Although CBRN attacks are rare, the threat is dynamic, and effective risk management requires co-operation, vigilance and innovation.

In part, the conclusion of the report says: The dangers and opportunities presented by rapid technological developments – some of which are so revolutionary that they are not initially understood in policy-making, and therefore cannot be quickly accommodated through changes in the law or to resilience measures – may be worthy of more focused study in the field of CBRN threat assessment.

Mobile devices might require specific infection control measures for safety

oneMore and more doctors rely on iPhones and iPads, but policies to ensure that the technologies don’t spread infection are just beginning to be looked at more closely. Specific infection controls measures might be required for the threat. Do Cell Phones Spread Infections in Hospitals? at Healthline News digs deeper into the potential problems. Dr. Peter Papadakos, an anesthesiologist and critical care specialist at the University of Rochester Medical Center in New York, likens cell phones to pocket-sized Trojan Horses traveling in and out of hospitals and between rooms, spreading germs in the process.

Among the conclusions of Mobile Phones in Hospital Settings: A Serious Threat to Infection Control Practices: Health professionals need to help raise awareness about the health risks of using an unclean cell phone: Patients and doctors alike should be educated by clear guidelines and advised on inpatient mobile phone etiquette, regular cleaning of phones and hand hygiene. Additionally, they should be advised not to share phones or similar equipment to prevent the transmission of bacteria. Everyone should keep their phones clean, but it’s especially important for health care workers whose hygiene has a direct affect on patients’ well-being.

Do mobile phones of patients, companions and visitors carry multi-drug-resistant hospital pathogens? A cross-sectional study conducted to determine bacterial colonization on the mobile phones (MPs) used by patients, patients’ companions, visitors, and health care workers (HCWs) shows that patients’ mobile phones have higher rates of pathogens and multi-drug pathogens compared with health care workers. The findings suggest that “mobile phones of patients, patients’ companions, and visitors represent higher risk for nosocomial pathogen colonization than those of HCWs. Specific infection control measures may be required for this threat.”

 

Infection in pregnant women might be linked to autism in kids

twoIs there a connection between infection during pregnancy and autism in children? MIT researchers find link between autism and infectious disease details why researchers at MIT, the University of Massachusetts Medical School and others know why the results of a study in Denmark in 2010 shows a connection between pregnant women hospitalized with infection and offspring with autism. They found an immune cell in pregnant mice that activates during infection interferes with fetal brain development. With further study, researchers hope their work can lead to a way to reduce changes of autism developing in pregnant women who experience a severe infection during pregnancy.

Maternal infection requiring hospitalization during pregnancy and autism spectrum disorders takes a look at the possibility of a link between kids with autism spectrum disorder (ASD) and secondary infection during pregnancy: One cause of deficiencies in fetal neurodevelopment have been believed to be associated with exposure to prenatal infection. It appears the connection might only be valid during the first trimester. From the study: “No association was found between any maternal infection and diagnosis of ASDs in the child when looking at the total period of pregnancy: adjusted hazard ratio = 1.14 (CI: 0.96-1.34). However, admission to hospital due to maternal viral infection in the first trimester and maternal bacterial infection in the second trimester were found to be associated with diagnosis of ASDs in the offspring.”

Focusing on costs of absenteeism overlooks perils of presenteeism

Empty bank office with desks in rawPresenteeism is more costly than many might imagine. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers makes an attempt to quantify it actual dollars but notes that standardization of future research is needed before the data can be interpreted more singularly. However, that presenteeism comes with negative health and financial implications is difficult to dispute.

Does our body have natural responses to tell us when we need to isolate from other people? There is a body of thought that believes that indeed is the case.  Why Do We Feel Sick When Infected—Can Altruism Play a Role? offers an interesting – albeit debatable – take on the symptoms of illness. Authored by a pair whose chief disciplines are immunology and psychology, it suggests that the more people are genetically related, the more sense it makes that being sick might well be an evolutionary adaption as a means to ensure some of their genes can be passed on. Perhaps not directly but through others with whom they share some genetic ties. They cite a number of symptoms that tend to isolate the sick to support the theory.

As health care costs climb, shrewd companies will develop programs that allow folks to work from home if sick when it’s possible, and perhaps they will allow adequate sick days and encourage workers to use them when ill. Presenteeism can be more costly than absenteeism. When one infection becomes 10, it impacts health, safety and the bottom line.

MRSA is both durable and dangerous, dwells on surfaces for long periods

oneMRSA (Methicillin-resistant Staphylococcus aureus) is a dangerous bacterium that is responsible for a number of hard-to-treat infections in humans. And its resistance to antibiotics is just part of what makes MRSA a threat. Add in that MRSA is extremely hearty and durable, and the threat becomes more ominous. Consider that MRSA:

  • Can live for up to 7 months on dust
  • Can live for up to 8 weeks on a mop head
  • Can live for up to 9 weeks on a cotton towel
  • Can live for up to 203 days (over 6 months) on a blanket
  • Can live on the skin of otherwise healthy individuals, with no symptoms indefinitely

Questions about MRSA provides a nice oversight on MRSA that includes ways that it is contracted, ways to best avoid it and what to do if you think you have a staph infection.

MRSA is everywhere: Sheets. Hands. Air. Surfaces.  Significance of Airborne Transmission of Methicillin-Resistant Staphylococcus aureus in an Otolaryngology–Head and Neck Surgery Unit attempts to “quantitatively investigate the existence of airborne MRSA in a hospital environment.” In its conclusion the study says “Methicillin-resistant S aureus was re-circulated among the patients, the air, and the inanimate environments, especially when there was movement in the rooms. Airborne MRSA may play a role in MRSA colonization in the nasal cavity or in respiratory tract MRSA infections. Measures should be taken to prevent the spread of airborne MRSA to control nosocomial MRSA infection in hospitals.”

Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-ResistantStaphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data looks at some of the reasons that the most deprived communities of a study in London are more susceptible to acquire MRSA.

Facility operations must be part of infection control programs

Emergency Room SignHospitals often mistakenly view their facility operations outside the sphere of infection control. This is misguided because infection control is a multifaceted problem. It requires a multi-disciplinary approach to be effective. Microbiologists, infection control specialists, medical device companies, facility engineers and others must be brought into the equation to communicate and arrive at comprehensive plans to combat the spread of infection.

How to stop and outbreak is a detailed audio report that provides excellent insight the Legionella outbreak last summer in New York City as well as the way it was handled. The broadcast reiterates that infection control is closely tied to HVAC systems and plumbing.

Air also is a major component in infection control. Airborne transmission of disease in hospitals is a splendid study done by engineers, microbiologists and mathematicians that lays out the problem in a clear, methodical method. The study supports the evidence that shows that the maintenance crews should be integral parts of infection control programs.

Cleaning for health and not just appearance helps to fight infection

Bathroom cleaning: wiping toilet seat with rubber and sprayA variety of cleaning approaches and methods are used at businesses and schools. Often, it is cosmetically driven, which makes surfaces appear clean to the naked eye. But what lingers after routine  cleaning is cause for concern. That’s where cleaning for health, which can save money if done correctly, comes into play. It requires the proper technologies and attention to detail. Surfaces – hands and hard surfaces to name a couple – as well as air need to be addressed.

Significance of Fomites in the Spread of Respiratory and Enteric Viral Disease is a compelling piece that shows how a virus can be transmitted rapidly throughout an office, school or hospital. Authored by Stephanie A. Boone and Charles P. Gerba, points out that some studies have shown fomites are a potential mode to transmit disease. They note that proper hand hygiene decreases respiratory and gastrointestinal illness and that “disinfection of fomites can decrease surface contamination and may interrupt disease spread (norovirus, coronavirus, and rotavirus). . . . Generally, research evidence suggests that a large portion of enteric and respiratory illnesses can be prevented through improved environmental hygiene, with an emphasis on better hand and surface cleaning practices.” Treating touch points so that they persistently clean themselves of germs is especially important.

And always the air in rooms needs to be taken into account. Viruses, bacteria, and fungi all move through the air. HVAC systems can be a repository biofilms.  Finding filters that work at the submicron level is a must. Quality filters also capture dust, leading to potential reduced cleaning costs.

EMS services are significant part of infection control chain

inside of an very used greek ambulanceMuch discussion and many studies about infection control focus on hospitals and their procedures. But the chain of infection control begins before a patient arrives when it involves first responders. Some studies clearly show that those transported by ambulance can be put at risk before even arriving at a primary care facility. And they are not alone. The emergency services personnel can be exposed to a variety of infectious diseases because the vehicles are contaminated even when seemingly clean. At least one study indicates that cleaning protocol based on fumigation with a hydrogen peroxide system is insufficient.

Emergency medical services need to address infection control better for all concerned. First responders are at risk, as well as their patients. They all must deal with fomites, airborne infection and hand hygiene practices. Poor hand hygiene in hospitals is well noted, but the problem isn’t contained within hospital walls. The high prevalence of MRSA in Ohio EMS personnel is both an occupational hazard and patient safety concern. Implementing methods to reinforce CDC guidelines for proper hygiene could decrease MRSA found in the EMS setting. Previous literature suggests that a reduction in MRSA colonization can lead to decreases in transmission and improved health for both patients and personnel.

The risk of airborne infection is always present for our first responders.  Particles on surfaces can be and are aerosolized, and patients are shedding both bacteria and viruses in the presence of first-responders. Risk Assessment towards Droplet and Airborne Infections among Ambulance Personnel in a Province of Northeastern Thailand is an enlightening study on droplet and droplet nuclei. The study “supported that ambulance personnel were at moderate to high risk for droplet and airborne infections while working. To reduce the occupational risk, standard precaution practices should be strengthened, and the air ventilation in an ambulance should be improved.”

We recently swabbed an ambulance in the Northern Virginia area. The contamination numbers were very elevated in the “clean” ambulance. These folks are a huge part of our pandemic defense force, and we need to take steps to get a much better handle on infection control.