ARE U.S. HOSPITALS PREPARED FOR POSSIBLE EBOLA BATTLE?

Original Story: usatoday.com

The fact that Dallas health care worker Nina Pham contracted Ebola even though she wore protective gear while treating Thomas Eric Duncan, the first person diagnosed with the deadly disease in the USA, is spurring demands for better training of health care workers and prompting calls for all U.S. Ebola patients to be cared for at one of the nation's four specially designed hospitals with biocontainment units.

But officials from two of those facilities say the super-hospitals won't be able to handle all future Ebola patients. Every hospital in the USA needs to be prepared to diagnose and treat patients with Ebola, said Bruce Ribner, medical director of the infectious disease unit at Emory University Hospital in Atlanta,which treated the first two Ebola patients in the USA, who contracted the disease in West Africa.

"It's not going to be possible, if this outbreak continues in West Africa, for a select number of institutions to care for patients," Ribner said.

Altogether, those four hospitals can accommodate just 8-13 patients, said Phil Smith, medical director of the biocontainment unit at Nebraska Medical Center in Omaha, which has treated a U.S. missionary and is treating a television news cameraman, both of whom contracted the virus in West Africa. He said Nebraska has 1-2 Ebola beds, Emory 2 beds, St. Patrick Hospital in Montana 1-2 beds and the National Institutes of Health in Maryland 4-7 beds. "But I don't know if they (NIH) have the staffing," he said.

Smith said the U.S. State Department decides which patients get beds at the four biocontainment units.

The nation's largest nurses' organization says most registered nurses at hospitals around the USA have not been given adequate training to handle an Ebola patient. Many hospitals have been slow to provide the proper training because it's expensive, said Charles Idelson, spokesman for National Nurses United, which has 185,000 members.

"Part of the problem with relying on the CDC (Centers for Disease Control and Prevention) is that they don't have an enforcement mechanism," he said. "What we see happening is the CDC can issue a thousand guidelines, but hospitals can choose to follow or not follow whatever guidelines they want. That's been a major roadblock to developing a national coordinated response to Ebola. For weeks, we heard assurances that the hospitals were prepared."

But he says his group's survey of more than 2,100 registered nurses at more than 750 facilities in 46 states and Washington, D.C., found that just 15% had received Ebola education where nurses had the ability to interact and ask questions. "What's happening is they're being given a CDC handout and directed to the CDC's website," he said.

The Society for Healthcare Epidemiology of America, which represents more than 2,000 physicians and other health care professionals, says the current Ebola outbreak "illustrates the need for increased funding for hospital epidemiology and infection prevention programs worldwide. ... The complexity of ensuring 100% adherence to infection control practices, particularly around personal protective equipment (PPE), points to the need for improved training of health care workers across all practice settings."

Pennsylvania Sen. Bob Casey, a Democrat, is calling for additional funding for a hospital preparedness program that has been cut by 50% since 2003. "We have to ensure that hospitals and medical facilities have the resources they need to protect public health," Casey said.

CDC director Thomas Frieden said Monday that the agency will "work with hospitals throughout the country to 'Think Ebola' in someone with a fever or other symptoms who has had travel to any of the three (West African) countries in the previous 21 days."

"We will be looking over the coming days at how we can increase training and increase training materials and availability, most urgently for the health care workers caring for the patient in Dallas, but also more generally throughout our health care system."

It's important for hospitals across the nation to be prepared and equipped to handle a potential Ebola patient because people on flights from Africa can end up in many U.S. cities, Smith said. "Every hospital, even small hospitals, have to have a plan in place to deal with a person who may just show up," he said.

He and other experts say that prepping to treat Ebola patients is costly. "I don't know the cost, except it's going to be expensive," Smith said. "Even for a smaller hospital, you need (an Ebola) dedicated staff, special nurses, a special area with a closed door between the surrounding area. Special security. Special waste handling. Every hospital that commits to prepare is going to have to spend a fair amount of money."

Ambreen Khalil, an infectious disease specialist at Staten Island University Hospital in Staten Island, N.Y., says the hospital is in the process of changing its protocol for removing PPEs. "Our protocols now require someone to observe removal of the equipment," she said. "If you don't peel it off very systematically, like layer by layer, and ensure your skin does not ever make contact with the garment, if you don't do that, you can still get Ebola.

"It is definitely challenging," she said.

Michael Guttenberg, chairman of emergency medicine at Forest Hills Hospital in Forest Hills, N.Y., said the most critical step in preparing for an Ebola patient is having a gatekeeper who can recognize such a person. "They have to have in place a person for identifying people who are potentially at risk," he said. "Essentially, they have to have at the front door a mechanism to identify patients who may be at risk."

In addition, hospitals have to partner with emergency medical services in their community so EMS workers can identify at-risk patients before they arrive at the emergency room. There are additional protocols: ensuring the safety of staff, visitors and patients; setting up an isolation room, and training staff in putting on and taking off the personal protective equipment worn when interacting with an Ebola patient.

Guttenberg said that removing the gear, especially, is a precise, exacting process that can take 6-10 minutes. "If there's any soiling of the outer garment, and if they remove it incorrectly and the outer garment comes into contact with their mucous membranes or their skin, that's where the risk lies for health care workers," he said.

There are protocols for contacting the local health department or the CDC to discuss a potential Ebola patient and determine if the patient is high risk. "If the patient is at high risk, the CDC or health department will ask for certain blood tests," he said. "You hold off on blood work until you talk with the health department or CDC, to limit the amount of needle pricks and possible exposure."

There also are protocols for moving an Ebola patient through the hospital; limiting visitors; cleaning equipment, and properly disposing of dirty linens and body waste.

"Hospitals with good infectious disease control programs in place will find this much easier to accomplish," he said. "A lot of this is just enhancement to what we do fairly routinely."

Guttenberg believes that about 50% of the nation's 4,500-5,000 hospitals are prepared to handle a single Ebola patient. "Very, very few of them could handle multiple patients," he said.

New Norovirus Strain and other Clinical Notes

Story first appeared on MedPage Today -


Most norovirus outbreaks seen recently in the U.S. were caused by a novel strain known as GII.4 Sydney, the CDC reported. Also this week: a name change is urged for polycystic ovary syndrome.


New Norovirus Strain Causing Most Outbreaks -

Most norovirus outbreaks seen late last year in the U.S. were caused by a novel strain known as GII.4 Sydney that appears to have largely replaced the previous dominant strain, the CDC reported.

The clinical importance remains uncertain, however, as there is no vaccine to prevent infections nor any ways to treat them other than supportive care.

According to a report in Morbidity and Mortality Weekly Report, 141 of 266 norovirus outbreaks tracked from September to December 2012 were caused by the novel strain.

"Right now, it's too soon to tell whether the new strain of norovirus will lead to more outbreaks than in previous years. However, CDC continues to work with state partners to watch this closely and see if the strain is associated with more severe illness," said CDC epidemiologist Aron Hall, DVM, MSPH, in an agency press release.


Name Change Urged for PCOS -

"Polycystic ovary syndrome" (PCOS) needs a new name, a panel assembled by the National Institutes of Health has recommended.

The four-member committee found that "the name 'PCOS' is a distraction and impediment to progress" because the presence of ovarian cysts "is neither necessary nor sufficient to diagnose the syndrome."

"It is time to expeditiously assign a name that reflects the complex metabolic, hypothalamic, pituitary, ovarian,
and adrenal interactions that characterize the syndrome -- and their reproductive implications," they added. "The right name will enhance recognition of this major public health issue for women, educational outreach, 'branding,' and public relations and will assist in expanding research support."

But their report, stemming from a 2-day workshop held in December 2012 in which panel members heard from more than two dozen speakers, was missing one thing -- a suggested new name for the condition.

It did, however, recommend keeping the Rotterdam criteria for diagnosing the condition as well as more research on the condition's etiology, diagnosis, and management.


Bird Flu Experts End Research Moratorium -

Prominent virologists who agreed last January to a voluntary moratorium on research involving virulence factors in the H5N1 avian influenza virus have now ended it.

In a letter published online in Science and Nature, Ron Fouchier and 39 colleagues around the world indicated that "the aims of this voluntary moratorium have been met in some countries and are close to being met in others."

The concern had been that the work could lead to development in the laboratory of new H5N1 variants that would make it highly infectious in humans (wild-type strains are not) and highly lethal. Such a supervirus might emerge by accident or, in the hands of terrorists, on purpose.

Fouchier and colleagues indicated that during the past year, the World Health Organization and national regulators have set safety standards for such research. The issues are now well understood by governments and the research community.

As a result, "we declare an end to the voluntary moratorium on avian flu transmission studies," they wrote.


Eye Surgery Devices Recalled -

More than 100 lots of Bausch and Lomb's 27G sterile disposable cannulas packed with the company's Amvisc 1.2% and Amvisc Plus 1.6% sodium hyaluronate ophthalmic surgical device kits have been recalled, the FDA said.

The cannulas are prone to leakage or detachment from the syringe to which they are supposed to be attached. They are used in delivery of the gel-like material in front of, or behind the iris, during cataract surgery and other ocular procedures.

"In rare [instances], detachment has resulted in serious patient injury," the FDA said.

Lot numbers covered by the recall were included in the FDA's announcement posted on its website.


Dengue Vaccine Passes Early Test -

A vaccine against the four major strains of dengue virus induced strong antibody responses and appeared to be well tolerated in a phase I clinical trial, according to the National Institute of Allergy and Infectious Diseases, which had developed the vaccine.

Several versions of the tetravalent vaccine were tested in the trial. All were found to be safe, but only one was strongly immunogenic after a single dose.

NIAID said that formulation produced antibody responses to all four virus strains in 45% of participants, with another 45% showing responses to three strains.

The agency added that the vaccine would be relatively cheap to produce, at less than $1 per dose, making it
potentially affordable in less developed tropical nations where the disease is most rampant.

Dengue fever also appears to have gained a foothold in the Florida Keys and there are concerns that, with climate change, its range may extend further into the U.S.

Doctors Target Gun Violence as a Social Disease

by Peak Positions

Story first reported from USA Today

MILWAUKEE – Is a gun like a virus, a car, tobacco or alcohol? Yes say public health experts, who in the wake of recent mass shootings are calling for a fresh look at gun violence as a social disease.

What we need, they say, is a public health approach to the problem, like the highway safety measures, product changes and driving laws that slashed deaths from car crashes decades ago, even as the number of vehicles on the road rose.

One example: Guardrails are now curved to the ground instead of having sharp metal ends that stick out and pose a hazard in a crash.

"People used to spear themselves and we blamed the drivers for that," said Dr. Garen Wintemute, an emergency medicine professor who directs the Violence Prevention Research Program at the University of California, Davis.

It wasn't enough back then to curb deaths just by trying to make people better drivers, and it isn't enough now to tackle gun violence by focusing solely on the people doing the shooting, he and other doctors say.

They want a science-based, pragmatic approach based on the reality that we live in a society saturated with guns and need better ways of preventing harm from them.

The need for a new approach crystallized last Sunday for one of the nation's leading gun violence experts, Dr. Stephen Hargarten. He found himself treating victims of the Sikh temple shootings at the emergency department he heads in Milwaukee. Seven people were killed, including the gunman, and three were seriously injured.

It happened two weeks after the shooting that killed 12 people and injured 58 at a movie theater in Colorado, and two days before a man pleaded guilty to killing six people and wounding 13, including then-Rep. Gabrielle Giffords, in Tucson, Ariz., last year.

"What I'm struggling with is, is this the new social norm? This is what we're going to have to live with if we have more personal access to firearms," said Hargarten, emergency medicine chief at Froedtert Hospital and director of the Injury Research Center at the Medical College of Wisconsin.

"We have a public health issue to discuss. Do we wait for the next outbreak or is there something we can do to prevent it?"

About 260 million to 300 million firearms are owned by civilians in the United States; about one-third of American homes have one. Guns are used in two-thirds of homicides, according to the FBI. About 9% of all violent crimes involve a gun — roughly 338,000 cases each year.

Mass shootings don't seem to be on the rise, but not all police agencies report details like the number of victims per shooting and reporting lags by more than a year, so recent trends are not known.

"The greater toll is not from these clusters but from endemic violence, the stuff that occurs every day and doesn't make the headlines," said Wintemute, the California researcher.

More than 73,000 emergency room visits in 2010 were for firearm-related injuries, the Centers for Disease Control and Prevention estimates.

Dr. David Satcher tried to make gun violence a public health issue when he became CDC director in 1993. Four years later, laws that allow the carrying of concealed weapons drew attention when two women were shot at an Indianapolis restaurant after a patron's gun fell out of his pocket and accidentally fired. Ironically, the victims were health educators in town for an American Public Health Association convention.

That same year, Hargarten won a federal grant to establish the nation's first Firearm Injury Center at the Medical College of Wisconsin.

"Unlike almost all other consumer products, there is no national product safety oversight of firearms," he wrote in the Wisconsin Medical Journal.

That's just one aspect of a public health approach. Other elements:

• "Host" factors: What makes someone more likely to shoot, or someone more likely to be a victim. One recent study found firearm owners were more likely than those with no firearms at home to binge drink or to drink and drive, and other research has tied alcohol and gun violence. That suggests that people with driving under the influence convictions should be barred from buying a gun, Wintemute said.

• Product features: Which firearms are most dangerous and why. Manufacturers could be pressured to fix design defects that let guns go off accidentally, and to add technology that allows only the owner of the gun to fire it (many police officers and others are shot with their own weapons). Bans on assault weapons and multiple magazines that allow rapid and repeat firing are other possible steps.

• "Environmental" risk factors: What conditions allow or contribute to shootings. Gun shops must do background checks and refuse to sell firearms to people convicted of felonies or domestic violence misdemeanors, but those convicted of other violent misdemeanors can buy whatever they want. The rules also don't apply to private sales, which one study estimates as 40% of the market.

• Disease patterns, observing how a problem spreads. Gun ownership — a precursor to gun violence — can spread "much like an infectious disease circulates," said Daniel Webster, a health policy expert and co-director of the Johns Hopkins Center for Gun Policy and Research in Baltimore.

"There's sort of a contagion phenomenon" after a shooting, where people feel they need to have a gun for protection or retaliation, he said.

That's already evident in the wake of the Colorado movie-theater shootings. Last week, reports popped up around the nation of people bringing guns to "Batman" movies. Some of them said they did so for protection.

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Care-Related Infections Going Down

Story first appeared in Fox News.

The United States is making progress in reducing the spread of infections to patients while they are in the hospital, the Centers for Disease Control and Prevention said on Thursday.

Twenty-one states reported reductions in so-called "central line" bloodstream infections from 2009-2010, according to the federal health agency, which used data from a state-by-state tracking system. According to Baltimore Medical Malpractice Lawyers, this reduction shows great progress in reducing the amount of medical malpractice claims.

A central line is a tube inserted into a large vein of a patient's neck or chest for treatment, often while the patient is in intensive care. When not put in correctly or kept clean, the lines can become a freeway for germs to enter the body and cause serious bloodstream infections.

Nationwide, there was a 32 percent decline in central line bloodstream infections from 2009-2010, said the deputy chief of the surveillance branch in the CDC's division of health care quality promotion. The decline was even greater at 35 percent among intensive care patients. The redued number of health-care related infections can be attributed to national and state prevention efforts.

There were smaller reductions in infections caused by other surgical procedures. There's a lot of room for progress with surgical site infection prevention.

With a state-by-state reporting system called the National Health Care Safety Network, launched in 2006, hospitals can compare their own infection rates with similar facilities. More than 5,000 acute-care hospitals now report data to the network.


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Confused by Rare Crawling-Skin Disease

First appeared in USA Today

A half-million-dollar study by the Centers for Disease Control and Prevention has found no obvious medical explanation for a mysterious and controversial skin disease whose sufferers report a crawling sensation on or under their skin and fibers emerging from it. This is not something those suffering from Ringworm complain about.

Although the findings may not mollify those who say they have Morgellons, as the condition has been dubbed by some, CDC’s Mark Eberhard says the findings are useful in that they tell both patients and doctors that the condition is rare and neither contagious nor environmentally based. Perhaps a Ringworm Remedy could help.

The research came about because of intense public interest in the topic beginning around 2002 because of both media attention and sufferers connecting online. Similar conditions have gone by other names, including Ekbom’s syndrome or delusional infestation.

The CDC “was receiving inquiries from a variety of sources, including the public, about this condition,” says Eberhard, who directs CDC’s Division of Parasitic Diseases. “It was clear that these people were suffering from something; the question was what might it be.”

The study was conducted among 3.2 million people whose health care was with Kaiser Permanente in 13 Northern California counties from 2006 to 2008. Researchers identified 115 patients who reported fibers or other solid material coming through their skin as well as skin lesions or the feeling that “something is crawling on top of or under the skin,” according to the paper, which is published in this week’s edition of the journal PLoS ONE.

Doctors found that the condition was rare, with only 3.65% of the Kaiser patients reporting it. Sufferers tended to be white (77%) and female (77%), with a median age of 52. Seventy percent of sufferers reported the material emerging from their skin as fibers, the rest described “specks, granules, dots, worms, sand, eggs, fuzz balls and larvae.”

However, the researchers could not find any evidence of these. Instead, dermatologists found fibers on the edges or under scabs and none in unbroken skin. When examined they proved to be cotton or polyester fibers, or in a few cases the likely remains of fingernail polish. A Ringworm Cure could change that.

“We were able to answer conclusively that they were not living entities,” Eberhard says.

Jason Reichenberg, director of dermatology at the University of Texas Southwestern-Austin, said the paper “confirms what anybody who has ever seen a patient with this knows, which is that these patients are suffering greatly and their suffering is real; they shouldn’t be dismissed.

“This is something that needs to be treated,” says Reichenberg, who will lead a session on the topic at an upcoming dermatology organization meeting in San Diego. “It’s really important to discuss that there might be other ways to approach the disease. Until we can find an exact cause or a cure, it’s important that we try to improve their suffering.”

The skin lesions didn’t appear to be caused by external forces, but primarily by scratching or rubbing. They also appeared only in areas where the sufferer could reach. For example, when lesions appeared on the back, they were in a typical dumbbell pattern made by how far the arm can reach around.

A large number of the sufferers had other health problems as well: 70% reported chronic fatigue and 54% reported their overall health as fair or poor. Many also had high levels of “somatic concerns,” meaning they had preoccupations with their health. The researchers found evidence of illicit drug use in 50% of patients, based on hair sample testing. For comparison, a national survey conducted by the Substance Abuse and Mental Health Services Administration found that 8.9% of the population are current illicit drug users. Eberhard cautioned that the high levels could be related to attempts by sufferers to alleviate their symptoms.  A Ringworm Treatment might help.

There is no doubt that the patients “had something that was impacting their quality of life,” Eberhard says. He says he hopes that their research will allow doctors and patients together to find the most appropriate care for those afflicted.

New Drug-Resistant 'Superbug' Reaches U.S. Shores

Bloomberg / BusinessWeek

But the nation already has its own version of this antibiotic-resistant bacteria, CDC says

 

 

 

 

A new antibiotic-resistant germ that apparently has it origins in India has sickened a handful of people in North America, with three of the cases reported in the United States, health officials said Tuesday.

But the bacterium -- designated New Delhi metallo-beta-lactamase NDM-1 -- is a close genetic cousin of another bacterium that's been present in the United States for many years. Both germs produce an enzyme that makes them resistant to a group of antibiotics called carbapenems, which include drugs such as penicillin and ampicillin.

"NDM-1 is a newly recognized mechanism of resistance that allows certain bacteria to become resistant to certain antibiotics," said Dr. Alexander J. Kallen, a medical epidemiologist and outbreak response coordinator with the U.S. Centers for Disease Control and Prevention's Division of Healthcare Quality Promotion.

"Unfortunately, carbapenem resistance is not uncommon even in the United States," Kallen added. "We have our own homegrown version of NDM-1 that has been recognized for quite a few years."

In the United States, carbapenem-resistant bacteria -- designated carbapenem-resistant carbapenemase (KPC) -- are usually transmitted in health-care facilities such as hospitals and nursing homes, and are typically spread from patient to patient from contaminated surfaces and hands, he said.

While none of the patients in the United States died from their infections with the NDM-1 germ from India, people should be very concerned about this new breed of germs that are showing resistance to carbapenem antibiotics, Kallen said.

"What is new in NDM-1 is a new mechanism that produces a strain [of bacterium] that looks the same as KPC," Kallen said.

NDM-1 appears to have started in India and is now found in countries such as Canada, Pakistan and some nations in Europe. Some people have died from their infections, but Kallen couldn't say how many.

In the United States, three cases have been reported. They were in Massachusetts, Illinois and California, Kallen said. None of the U.S. patients died from their infections, he said.

While NDM-1 is new, carbapenem resistance has been increasing, Kallen said.

How dangerous NDM-1 will become isn't known, Kallen said. But some studies have found the death rate from KPC [the North American bacterium] to be as high as 40 percent, he said.

Most of the transmission of the NDM-1 (Indian) and the KPC (North American) bacteria happen as infected people travel around the world, Kallen added. "These people carry with them all their antibiotic-resistant bacteria and that mechanism [travel] has been recognized lots of times, including with NDM-1 and KPC," he said.

Kallen said routine testing can reveal bacteria resistance. "As far as treating the patient or infection control, it doesn't matter what the mechanism is -- they're all bad and they all need to be controlled in the same way," he said.

Hospitals that identify cases of NDM-1 or KPC infection should isolate the patient before treatment. Hospitals should also check to see if other patients have had contact with infected patients.

One of the most common ways that bacteria become resistant to antibiotics is through the overuse of the drugs, Kallen noted.

Infectious diseases expert Dr. Marc Siegel, an associate professor of medicine at New York University in New York City, said that "the number of [NDM-1] cases is small, but what is concerning about this is this is a new bacteria that is emerging because of a genetic change that is causing a garden-variety bacteria to become resistant to most antibiotics."

Antibiotic-resistant bacteria are emerging because of lack of cleanliness and sterility in hospitals, too many antibiotics being prescribed, and drug companies not developing new antibiotics because they aren't profitable, Siegel said.

Dr. Pascal James Imperato, dean and distinguished service professor at the School of Public Health at SUNY Downstate Medical Center in New York City, explained: "Bacteria with this resistance capability are most likely to pose a problem first in hospitals. Some antibiotics are still effective against NDM-1. The first three cases in the U.S. were successfully treated. It is difficult to predict the future role of NDM-1 bacteria since they were only first detected in December, 2009."