Maureen Spencer, RN, BSN, M.Ed,CICInfection Control Manager

New Baptist Hospital, Boston, Ma.Mpspence@nebh.org

Infection What causes infection?

Virulence of organism versus host defenseMind-Body Medicine research shows negative mind

state depletes immune system, increases viral growthBeing run down, after a loss, being chronically stressed,

fighting and extreme emotional distress decrease immune function

Poor nutrition – high sugar intake intake and alcohol have been shown to decrease immune function

Infection Control in Ancient Times

Back thousands of years - infection control measures were used to treat or prevent infection with basic mind-body approaches.

Some of these cultures were very advanced technologically and used many natural remedies:Herbs and medicinal plantsGem elixirsCrystalsEssential oilsMassage, enemas and emetics to

remove illness.

Mind Body

Spirit

Self

Ancient Times….infection controlSumerians of Babylon–2900-1800 B.C.

Beer to clean wounds and poured wine on dressings

hygienic ideas of an astonishingly high level , such as drain pipes to carry sewage

suppositories, poultices, mustard plasters, compresses, salves, eye washes, ointments, liniments

Recommended fresh air, exercise, massage, herbs and medicinal plants for health

Egyptian Priests and Physicians2-2700-2635 BC

Priests and “physicians” were closely associated

The priests set hygiene standards: frequent baths (3-4/ day for purification)body shaving at 3-day intervals spotless white clothing.

They knew the value of fresh, clean air administering emetics and enemas for 3

consecutive days each month to detoxify the body

Herbs, gem elixirs, essential oils and flower essences, medicinal plants

Greece: Empedocles - Greek Physician– 490 BC

Developed the important principle: health depends upon harmony of the

elements within the body, disease depends on its discord.

Regarded the heart as the center of the body system and blood was the life and seat of innate heat.

Four Elements: fire, air, water, earthTaught that these four elements are

eternally brought into union which creates health and harmony.

Ignaz Phillipp Semmelweis - 1847Ignaz Philipp Semmelweis (1818-

65), a Hungarian obstetrician introduced antiseptic prophylaxis into medicine

In the 1840s, puerperal or childbirth fever

Affected ~ 30% of women who gave birth in hospitals.

He enforced antiseptic practices and reduced the death rate from puerperal fever to 0.85%

Florence Nightingale – 1863 – U.K.

The “Lady-in-Chief”Crimean War - organized

a team of 38 nursesSubstantially reduced

mortality rate by applying strict sanitary routines

Hand washing stressed

Louis Pasteur – germ theory – 1864

Pasteurization: kill germs by boiling and then cooling the liquid

Pasteur and British doctor Edward Jenner developed vaccination against smallpox.

He recommended that surgical instruments be boiled before an operation to kill any germs on them

Most surgeons ignored this advice. This had to wait until aseptic surgery

developed in the 20th century.

Joseph Lister – Concepts of Antisepsis – 1865

Lister developed the use of antiseptics (carbolic acid)

Principles:

destruction of germs by carbolic acid

prevent germs entering the wound or spreading after surgery.

Lister's work on antisepsis was based on Pasteur’s germ theory of disease.

Discovery of Penicillum 1928, Fleming noticed a

mold – a Penicillium species had contaminated an

old culture plate It killed off surrounding

bacteria. Worked on purifying the

active chemical –

penicillin.

Howard Florey and Ernst Chain

Howard Florey and Ernst Chain work on Fleming’s culture

material late 1930s sufficient amounts showed

its dramatic ability to cure infections.

The trio were awarded the Nobel Prize for their efforts in 1945

Infection Control in the US

1960’s Outbreaks of Staph aureus SSI and nurseries – need for surveillance of nosocomial infections

Early programs were based on environmental sampling 1965 – Darling vs Charleston Community Memorial

Hospital – lawsuit won by a college student who developed a

healthcare associated infection of a fracture that required amputation.

strengthened guidelines and regulations for standardizing infection control.

Outbreaks helped promote need for Infection Control

1976 - Nationwide outbreak of intravenous related sepsis with Enterobacter agglomerans (Abbott Laboratories) helped to promote the ICN role in hospitals.

Outbreaks of Staph aureus in nurseries and after surgery

Hospitals required to hire infection control professionals to detect and prevent infections

Full Circle…….need for infection control in community settings

CA-MRSA Spider bites Sports teams Locker rooms/gyms Day Care Centers Prisons Drug users Animals-Pets

HA-MRSA Obese Diabetes Elderly Surgery

Staphylococcus aureusStaphylococcus aureus,

often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people.

They are gram positive (purple colored) cocci in clusters on gram stain

Can survive on surfaces for weeks to months

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What is MRSA?MRSA is the term used for bacteria of the

Staphylococcus aureus group (S. aureus) that are resistant to the usual antibiotics used in the treatment of infections with such organisms.

It stands for Methicillin Resistant Staph aureus (MRSA)

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TermsCA-MRSA Community-acquired Methicillin

resistant Staph aureusUnique microbiologic and genetic properties compared with

the traditional hospital-based MRSA strains, suggesting some biologic properties (e.g., virulence factors) may allow the community strains to spread more easily or cause more skin disease

HA-MRSA Healthcare-acquired Methicillin resistant Staph aureus

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Differences in StrainsHA-MRSA.

Pulse field gel electrophoresis (PFGE) USA 100 and 200

Less mobilePanton valentine

leucocidin (PVL) gene rare

More resistant to antibiotics

CA-MRSAPulse field gel

electrophoresis (PFGE) USA 300 and 400

More mobilePVL gene more common

Less resistant to abxClindamycin resistance

developing in USA 300 strains

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Proteins in CA-MRSADrug-resistant strains of the Staphylococcus aureus - members of

the phenol-soluble modulin (PSM) protein family

Attract and then destroy protective human white blood cells - eliminates immune defense mechanisms against CA- MRSA

Identification of novel cytolytic peptides as key virulence determinants of community-

associated MRSA. Wang, Otto et al.Nature Medicine 2007 Nov 11 epub.

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Risk Factors for Acquiring HA-MRSAHospitalized patients who

undergo surgeryThe elderly or very sickOpen wound (such as a bedsore) Tube inserted into the body (such

as a urinary catheter or intravenous [IV] catheter)

Exposure to certain antibiotics

Charbonneau P, Parienti J, Thibon P, Ramakers M, Daubin C, du Cheyron D, Lebouvier G, Le Coutour X, Leclercq R (2006). "Fluoroquinolone use and methicillin-resistant Staphylococcus aureus

isolation rates in hospitalized patients: a quasi experimental study". Clin Infect Dis 42 (6): 778-84

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Other Risk FactorsCertain factors can put some patients at higher risk for CA-

MRSA including Carrying MRSA in the nose (colonization) without

developing illness

Close contact situations: sports teams, daycare centers, prisons, IV drug users, military and other settings

Spa industry – very conducive environment for cross contamination and outbreaks due to skin contact, handling contaminated water and liquids, equipment

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Health Status of AmericansInflammatory diseases

ArthritisFibromyalgiaChronic FatigueDiabetesObesityAlzheimersDepressionHeart disease

Sugar, CHO and MicroorganismsCarbohydrates serve as carbon

sources for many microorganisms, while sugar alcohols(alditols), glycols (glycerol), and alcohols (methanol and ethanol) are metabolic products

Too much sugar, fat, carbs Inactive lifestyles and lack of

exercise, breathing, fresh air, good nutrition are leading to obesity and serious health problems

Fuel Source: Increase Sugar Consumption

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48 grams: the recommended daily limit of grams of sugar.189.5grams: the number of grams of sugar the average American consumes each day

152 lbs: the number of lbs of sugar the average American consumes each year.

High-Calorie Beverages

Nationwide Food Consumption Surveys

From 1965 through 2002, the total daily per capita intake of calories from beverages increased 94%, which translates into an average of 21% of daily energy intake or an additional 222 calories from all beverages daily among U.S. adults.

Article: Duffey K, Popkin B, "Shifts in patterns and consumption of beverages between 1965 and 2002" Obesity 2007.

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Sugar and Immune Function Excess sugar depresses immunity. Studies have shown that consuming 75 to 100 grams of a

sugar solution (about 20 teaspoons of sugar, or the amount that is contained in two average 12-ounce sodas) can suppress the body's immune responses.

Sugar has a very significant impact on the immune system by suppressing many immune cells, particularly macrophages and NK cells.

1. Sanchez, A., et al. Role of Sugars in Human Neutrophilic Phagocytosis, American Journal of Clinical Nutrition. Nov 1973;261:1180_1184. Bernstein, J., al. Depression of Lymphocyte Transformation Following Oral Glucose Ingestion. American Journal of Clinical Nutrition.1997;30:613

2. Ringsdorf, W., Cheraskin, E. and Ramsay R. Sucrose, Neutrophilic Phagocytosis and Resistance to Disease, Dental Survey. 1976;52(12):46_48.

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• Quantum Based - Energy

• Identifies Energy Interrupters

• Preventive Based

• Ignores Effects of Technology

Newtonian - Reductionistic

Names Diseases

Crisis Based

Ignores Quantum Theory

Complementary Therapies

Relaxation BreathingYoga, Tai ChiMeditation, QiGongGuided ImageryIntercessory PrayerHypnosisEnergy work (reiki,

therapeutic touch, massage, reflexology)

Spa ServicesNature – OrganicHealth Clubs & Integrated Health Care

Infection Control in Complementary Therapies

Direct ContactIndirect Contact

Possible Droplet and Airborne

Modes of Transmission:Direct contact with blood and bodily fluids (HIV, HBV)

Indirect contact with contaminated items and patient care equipment and the environment (MRSA, VRE, C.difficile)

Droplet nuclei (Influenza, Pertussis, Bacterial Meningitis, SARS)

Airborne route (TB, Chickenpox, Measles)

Vector (West Nile Virus, Malaria, Ebola Virus)

Sources for TransmissionHands during massage therapies and other touch therapies Hands during personal training, private therapy and adjustmentsShared equipment, such as yoga mats, yoga blocks, exercise balls,

stationary equipment, pilates transformers, massage tables and chairs, meditation cushions and benches, yoga straps, hand weights and stones used for massage

Essential oils, massage oil, hand lotions, liquid soapHeated yoga rooms incubating mildew and moldBathrooms, especially with colon hydrotherapyShowers, locker rooms, steam rooms , hot tubs, foot and hand detox

baths, paraffin bathsHerbal preparations, chelation therapy, home-made aromatherapy

products

Direct and Indirect Contact

Direct and Indirect Contact

Most Important Control Measure

HAND HYGIENE

Wash hands often

Use Cal Stat Alcohol Based Hand Rub

Hand Cultures – before and after the use of alcohol sanitizer

Environmental Disinfection

Sani Cloths for low level disinfection – they are bactericidal, virucidal, tuberculocidal – Chlorox wipes are sufficient for environmental disinfection

Wash tables, bathrooms, surfaces touched by clients on a daily basis

Wipe equipment used between clients – yoga mats, blocks, surfaces, etc. Have wipes available for students to clean equipment after use – especially in health clubs

The Environment

Disinfectant handling procedures –freshly prepared disinfectant Least expensive is 1:10 preparation of bleach – but corrosive to surfaces and hazardous fumes

Silver Disinfectant Spray that kills organisms up to 24 hrs on surfaces (Agion Silverclene 24)

Overview of study conducted with Staph aureus and E.coli and Agion spray

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Infection Prevention Measures

1. Do not share any invasive devices or equipment that comes in contact with blood. Examples are needles, syringes, multi-dose vials, vacutainer holders,

2. Use single use, sterile intravenous therapy tubing and other items used to administer intravenous therapies.

3. Sanitize hands before touching a client with an alcohol based hand rub.

4. Wash hands after having prolonged contact with a client’s body, such as after a Reiki session, massage or foot reflexology.

Infection Prevention Measures

5. Clean shared exercise equipment at the end of the day with an effective germicide that has activity against common pathogens, such as staphylococcus aureus. Germicidal wipes to CLEAN surfaces and silver spray to DISINFECT surfaces for up to 24 hrs.

6. Have students purchase their own yoga mats, blocks, towels and straps and encourage them to wash them often, especially after heated yoga practice. Recommend silver impregnated yoga mats.

7. Clean environmental surfaces (tables, counters, chairs, face rests) at the end of the day with an effective germicide that has activity against common pathogens, such as staphylococcus aureus.

Infection Prevention Measures8. Wash blankets often (at least weekly) when used on clothed clients.9. Change sheets between each patient after a treatment. 10. Place paper towels over pillows during a session.11. Place a tissue over an eye pillow between each client/student use.12. Make sure prepared solutions, such as aromatherapy spray, energized

water and spritzers are used within a short period (3-6 months) of time to prevent bacterial growth in the bottles. Date them! Clean the bottles by rinsing with dishwashing soap and water, then rinse with alcohol and allow to dry thoroughly. (Organisms breed in dark moist areas and multiple every 20 minutes – tap water is not sterile)

Use your dishwasher – it reaches high temperatures and kills germsUse small autoclave sterilizers for instruments

Infection Prevention Measures

13. Use individual bottles of hand soap for handwashing – never refill a container or top it off since this can cause bacterial growth in the bottom of the container.

14. Use only sterile individual use acupuncture needles.15. Use only sterile individual use colon hydrotherapy tubing.16. Do not share towels or other absorbing materials that are exposed to

sweat and other body fluids.

What Hospitals Are Doing

Staff CredentialingConsider:

Annual TB skin testWork restrictions if showing signs of skin infections,

diarrhea, conjunctivitis, flu or other severe respiratory infections causing frequent coughing on clients

Require physician clearance to return to work

Questions?