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Combatting C. Diff & CRE in the Workplace

Posted by Barry Greenberg on Wed, May 22, 2013 @ 16:05 PM

Combatting C. Diff & CRE in the Workplace

Cruise ships have the infamy of numerous Norovirus gastroenteritis outbreaks, in one situation affecting 6 consecutive cruises. The viral transmission mode was feco-orally through food and water, directly from person to person and by environmental contamination.

Disease transmission, although not as well revealed, as in the case of cruise ships, happen frequently in health care, schools, industrial and institutional environments.

Executive Housekeeping and supervisory personnel at hospitals, nursing homes and other healthcare facilities are clearly cognizant and highly responsive to the progression of superbugs in the workplace.

With the onslaught of countless pathogenic microorganisms & lethal viruses throughout the last two decades, the accountability factor has risen, in the quest to maintain a healthy environment. SARS, Avian Flu Strains, MRSA, Norovirus, C. Diff., Acinetobacter and numerous other antibiotic resistant strains, have become all too familiar. VRE (vancomycin-resistant enterococci) infections have increased over the last five years. These VRE infections usually occur in hospitalized patients with serious underlying illnesses such as cancer, blood disorders, kidney disease or immune deficiencies. People in good health are not typically at risk of infection, but health care workers may play a role in transmitting the organisms, especially if careful hand washing and other infection control precautions are not practiced.                     

VRE, like many bacteria, can be spread from one person to another through casual contact or through contaminated objects.

Watch out for CRE the newest superbug to cause mayhem. The CDC reports the following:

Drug-resistant germs called carbapenem-resistant Enterobacteriaceae, or CRE, are on the rise and have become more resistant to last-resort antibiotics during the past decade, according to a new CDC Vital Signs report.  These bacteria are causing more hospitalized patients to get infections that, in some cases, are impossible to treat. 

CRE are lethal bacteria that pose a triple threat:

  • Resistance: CRE are resistant to all or nearly all, the antibiotics we have - even our most powerful drugs of last-resort.
  • Death: CRE have high mortality rates – CRE germs kill 1 in 2 patients who get bloodstream infections from them.
  • Spread of disease:  CRE easily transfer their antibiotic resistance to other bacteria.  For example, carbapenem-resistant klebsiella can spread its drug-destroying weapons to a normal E. coli bacteria, which makes the E. Coli resistant to antibiotics also. That could create a nightmare scenario since E. coli is the most common cause of urinary tract infections in healthy people.

Once again, the majority of CRE infections occur in people receiving significant medical care.  CRE are usually transmitted from person-to-person, often on the hands of health care workers. CRE is also spread through contact with open wounds or stool.

What’s truly alarming is CRE’s ability to share its resistance with common bacteria, which could make afflictions such as diarrhea and urinary tract infections untreatable. In addition, CRE infections have a high mortality rate — up to 50 percent — so this superbug is a lot deadlier than C. diff or MRSA.


As with any superbug, it’s paramount that doctors, nurses and visitors wash their hands (and for the recommended 30 seconds). Hand sanitizer dispensers should be well stocked and conveniently in-place. In addition, rooms with CRE-infected patients need to be cleaned and disinfected more often and custodians should focus on touch points, including light switches, faucets, bed rails, charts, door handles and privacy curtains.

While antibiotics cannot always treat these infections, good cleaning and hygiene can prevent them from spreading. It’s safe to say when it comes to CRE and C. Diff, the best offense is a good defense.

If you hear the language “cleaning with bleach” as a methodology to disinfection, you should question that practitioner. Paramount is that bleach has no cleaning efficacy and the EPA clearly states that a surface must be cleaned, prior to disinfection.

(There are Pre-Mixed, Ready-to-Use Hospital Grade Cleaners/Disinfectants with Bleach Available - e.g. "DISPATCH". This item is registered to kill C. Diff spores in five minutes.

Beware of using regular bleach as bleach can be highly corrosive to surfaces and may cause severe irritation or damage to eyes, skin, and mucous membranes.

In addition, remove intravenous lines & catheters as early as possible in order to remove the risk of infection.

Hand washing, hand washing and more hand washing… Proper disinfection of surfaces is critical because C. diff & these superbugs, not only live on surfaces, but they can spread to and thrive on hands. As soon as clean hands touch contaminated surfaces they are not clean anymore. Hand washing using soap & water is quite effective, as the physical act of washing/scrubbing, actually removes bacteria from skin surfaces.

Many of the new superbugs are not killed off by alcohol sanitizers. –so, hand washing is the prime requisite.

Become cognizant of materials entering patient rooms and surgery centers. Often the mopping buckets themselves are highly contaminated, as are the mops, which can be loaded with mold, if not previously laundered and dried properly. Purses, attaché cases, cell phones, boxed gifts, etc. that may have been in contact with floor surfaces or other contaminated areas are highly suspect.

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Safe Disinfectant to Combat a New SARS-Type Virus

Posted by Barry Greenberg on Fri, Sep 28, 2012 @ 18:09 PM
From Reuters Health Information- By Kate Kelland

Sep 24 - A Qatari man struck down with a previously unknown coronavirus related to the virus associated with the SARS outbreak of 2002 is critically ill in hospital in Britain, the World Health Organisation said on Monday.

The U.N. health body put out a global alert on Sunday about the 49-year-old man who had recently travelled to Saudi Arabia - where it said a second patient with an almost identical virus had already died.

A senior British health official said there was no immediate cause for concern although experts were watching out for any signs of the virus spreading.

Any suggestions of a link between the virus and Saudi Arabia will cause particular concern in the build-up to next month's Muslim haj pilgrimage, when millions of people arrive in the kingdom from across the world, then return to their homes.

Coronaviruses are a large family of viruses that includes causes of the common cold but can also include more severe illness such as the virus responsible for SARS, or Severe Acute Respiratory Syndrome, which appeared in China in 2002 and infected more than 8,000 people worldwide, killing around 800 of them before being brought under control.

"This is now an international issue because we have a case in the UK and one in Saudi," WHO spokesman Gregory Hartl said.

"The (Qatari) patient is still alive but, as we understand, in critical condition," he said.

The Qatari man first showed symptoms of an acute respiratory infection and kidney failure while he was in Qatar, the WHO said.

He spent some time in intensive case in Qatar and was later flown to the UK where he was being treated in a London hospital, said authorities, declining to say which one.

Laboratory tests on the Qatari man showed his virus was almost identical to one that killed a Saudi patient earlier this year, the WHO said. The Saudi man's virus was not identified as a new kind of infection at the time of his death.


The WHO said it was in touch with health authorities in Britain, Qatar, Saudi Arabia and at the Stockholm-based European Centre for Disease Prevention and Control (ECDC)

"We're asking for information from whoever might have seen such cases, but as of the moment we haven't had any more notifications of cases," said Hartl.

Britain's Health Protection Agency (HPA) said it had conducted lab testing on Qatari case and found a 99.5% match to a virus that killed a 60-year-old Saudi national earlier this year.

"This new virus ... is different from any that have previously been identified in humans," the HPA said.

John Watson, head of the HPA's respiratory diseases department, added there was no evidence of ongoing transmission.

"In the light of the severity of the illness that has been identified in the two confirmed cases, immediate steps have been taken to ensure that people who have been in contact with the UK case have not been infected, and there is no evidence to suggest they have," added Watson

Peter Openshaw, director of the Centre for Respiratory Infection at Imperial College London said virus was unlikely to prove a major concern and experts hoped the two cases would turn out to be "just a highly unusual presentation of a generally mild infection".

The HPA is not recommending any specific action for members of the public or tourists and travellers, but said it would issue further advice as more information became available.


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C. Diff Infections Reach All-Time High

Posted by Barry Greenberg on Mon, Jul 30, 2012 @ 13:07 PM

The U.S. Centers for Disease Control & Prevention (CDC) has reported that Clostridium difficile (C. diff) infections have reached an all-time high. In fact C. diff is linked to roughly 14,000 deaths between 2006 and 2007, up from the 3,000 deaths between 1999 and 2000.

"C. diff", is a species of Gram-positive bacteria of the genus Clostridium that causes severe diarrhea and other intestinal disease when competing bacteria in the gut flora have been wiped out by antibiotics.

Clostridia are anaerobic, spore-forming rods (bacilli).C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to pseudo membranous colitis, a severe inflammation of the colon, often resulting from eradication of the normal gut flora by antibiotics.

Patients in medical facilities are at the most risk for infection. According to the CDC, 25% of C. diff infections first appear in hospitalized patients, while 75 % occur either in nursing homes residents or in people recently treated in doctors offices or clinics.

C. difff spreads in two ways. Sometimes doctors use broad-spectrum antibiotics when they're not necessary, killing not only the bacteria they target but healthy bacteria in the intestines that keep C. diff at bay. The second route is the easy spread of C. diff spores from infected patients through fecal contamination. The hard-to-kill spores are carried, often by hospital personnel, from bathroom fixtures to light switches, doorknobs, bedrails and other high-touch surfaces.

Effective cleaning is a key solution. The use of disinfectants that kill C. diff spores and new cleaning methods, such as ultraviolet lights or vaporized chemicals, can prevent its spread. At the Mayo Clinic in Rochester, Minn., daily cleaning of all high touch surfaces in rooms with disinfectant wipes cut infection rates by more than 30% in two units with the highest incidence of C. diff.

What's particularly problematic, is that hand washing and many disinfectants and sanitizers being used, including hand sanitizers, do NOT kill C. diff.

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