Written by: Dr. Helene Paxton, MS, MT(ASCP), PhD, CIC, Infection Preventionist, Bio Guidance, LLC.
A recent article suggest that the golden age of antibiotics is ending due to increase patterns of resistance seen in common pathogens. Quoted from a Los Angeles Times article below:
“golden age of antibiotics appears to be coming to an end, its demise hastened by a combination of medical, social and economic factors. For decades, these drugs made it easy for doctors to treat infections and injuries. Now, common ailments are regaining the power to kill.”
Harvard University infectious disease epidemiologist William P. Hanage cautions that “we will not be flying back into the dark ages” overnight. Hospitals are improving their infection control, and public health experts are getting better at tracking new threats. But in a race against nature, he said, the humans are losing ground.
“We’re seeing more drug-resistant infections,” Hanage said. “And people will die.”
A few years ago a list of emerging pathogens was detailed by CDC, it did not include Zika virus…we are now faced with a pandemic of incredible proportions. If the failure of antibiotics is so eminent, why are people not raising their heads in concern? Do people understand the concept of resistance and how it might affect them?
Can We Learn from the HIV Epidemic? When There is No Cure.
Certainly at the start of the HIV epidemic no drugs were available to treat the Immunodeficiency Virus. Few antivirals were available and many of us were involved in trialing known chemicals and cleared drugs for their possible efficacy through the NIH Aids Clinical Trial Group known as the ACTG’s. This was a difficult task with many disappointments and many deaths as the epidemic spread. Eventually when a drug was formulated the virus soon outfoxed the anti-viral in as few as 6 weeks in some patients.
In disbelief, over many months, researchers were forced to consider that multiple drugs needed to be used to keep the HIV virus in-check; hence the concept of HART therapy was developed. The development of combination therapy took many years and was driven by the fear associated with HIV as well as the eminent death of millions. We rarely think of bacterial infections in terms of millions of deaths except with Malaria and most recently with Ebola.
The effects of infections are generally associated with specific types of infections often associated with devices such as Foleys, Vents, Central lines and surgical sites. We talk about thousands of infections and attributable mortality and associated costs. Is innovation as seen with HIV drug development only driven by fear? Antibiotics are used in combination but more often are given as a single agent or attempts at determining synergistic relationships of drug combinations are made. This is not a simple task sometimes and is often affected by the patient’s ability to metabolize the antibiotic either in single or in combination. Side effects often limit dosage and length of therapy.
Further, antibiotics are only given for a shorter time, 10 days to six weeks in most cases, as compared to HIV where the treatment is a for a lifetime. The return on investment for antibiotics is not often realized, so we haven’t developed a new class of antibiotics since 1987 largely because the companies cannot realize profits for shareholders. So what is a possible solution, what approach should be taken?
Controlling the Spread of Infectious Pathogens
As Dr. Hanage indicated in his article, not all is lost as we have other options to control the spread of infection. Some of these include:
- We can stop using antibiotics in our chicken and egg production. The use of antibiotics to get faster and greater yields should be prohibited by the FDA and discouraged by the consumer.
- Since 80% of infections are usually associated with viruses, we can take the lead to not ask for antibiotics when we know it is not appropriate.
- If antibiotics are required, cultures should drive the antibiotic choice to prevent broad-spectrum antibiotic usage. This is not simple as this requires breaking prescribing habits, it takes time and follow-up. The patient and the physician have to understand the consequences of not doing the right thing especially in the out-patient arena.
- Long term care patients and nursing home patients have to be better managed to avoid over-use of antibiotics, getting rid of Foleys, preventing decubitus and sacral wounds, maintaining appropriate nutrition, etc.
- We can employ better provider habits such as handwashing and in-dwelling device maintenance…remembering that “prevention” is much easier and cheaper than treatment. Should we accept that handwashing has less than a 40% compliance rate nationally among our health care providers? And…
- We can improve our environmental disinfection capabilities.
Learn How Our Hospital Increased Infection Control and Patient & Staff Confidence.
Once implemented, we found SteraMist™ powered by Binary Ionization Technology® (BIT™) to be both novel and simple. As an Infection Preventionist my goal was to simplify the whole disinfection thing. Why did we have to use so many agents to do environmental cleaning? Too many agents add confusion and also add risk factors to the employees’ health and the environment. We needed rapid turnaround times and we needed efficacy in killing pathogens to prevent infection of patients occupying a particular space. We needed to stop transmission of certain MDRO’s such as MRSA, VRE, CRE, or C,diff. Data suggests that 35% of hospital acquired infections are associated with the environment. This is an unacceptable situation. Human nature, boredom, lack of time, and lack of knowledge all contribute to inefficiencies in environmental cleaning.
We were fortunate to be able to obtain SteraMist™ through a State Ebola grant. We developed protocols for disinfection when doffing PPE, after emergency transport in ambulances, isopod disinfection, and others. Used throughout the State of Delaware through Ebola drills for patient transport, patient mobilization from Dover Air Force base, etc. we developed confidence in the flexibility and efficacy of the product. With Ebola subsiding, we started using SteraMist™ to disinfect our C. diff rooms; disinfection of the OR’s and drug preparation areas, nursing units during the influenza epidemic and in outpatient areas. We responded to scabies, and bed bug situations with SteraMist™ and our EVS staff became “stars”.
As our NHSN reportable data improved most markedly in the C. diff arena our staff insisted in SteraMist™ being used in any high risk situations. As the units were used other State entities noticed the level of confidence gained by the EMS and other responders. Our numbers have met the national benchmarks and we continue to lower the endemic pathogen load throughout the environment. The emphasis on antibiotic stewardship, interactive exchanges with providers for proper hand hygiene, and device maintenance with SteraMist™ support has given our patients a higher level of safety and positive outcomes. The EVS staff has gained recognition and the ability to know that they do make a difference. The simplicity of the application and compatibility with the environment, electronics and other equipment makes SteraMist™ an indispensable addition to our tool box to reduce infections and hence reduce the use of antibiotics overall.
What can you do with A SteraMist™ System?
NIH: National Institutes of Health
CRE: Carbopenem resistant Enterobacterioceae
VRE: Vancomycin Resistant Enterococcus
- diff: Clostridium difficile
MRSA: Methicillin Resistant Staphylococcus aureus
NHSN: National Health Safety Network