Nightmare Bacteria: Superbugs, Shoes, and Public Transportation

 

October 29, 2018

CEO, USA Decon

 

Introduction

Cities across the nation have acted to improve their transportation systems for the better. Modern transportation options now include bike sharing, trolleys, and improved local bus routes connecting to light rail systems that feed into the city areas.

 

Tragically, the same cities that are enjoying the benefits from improved transportation options are also suffering from a superbugs infection in hospitals, nursing homes, and schools (CDC example: CRE, MRSA and C. difficile). 

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• Introduction

• University of Houston C.diff Study

• Public Transportation in Proximity to Hospitals, Nursing Homes, and Schools

• Conclusion and Recommendations

• References and Notes

 

The proximity of public transportation in relation to hospitals, clinical facilities, and schools begs for attention in infection control considerations for expansion planning and maintenance of existing routes. 

 

Hospital and community surveillance of C.diff contamination provides vital feedback to researchers in the form of infection rates by origin, see University of Houston C.diff study results discussion below. 

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Also discussed are improved materials infused with copper that have assisted in lowering Healthcare Associated Infection (HAI), such as CRE and C.diff, rates in hospital sections outfitted with this new material as well as garments infused with antimicrobial and bactericidal substances.

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This piece is not written with an alarmist approach, but rather with an intention to recognize best practices employed by those directly in charge of infection control and provide recommendations on improvements towards lowering superbugs infection rates.

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University of Houston C. diff Infection Rates Study

In the Department of Pharmacy Practice and Translational Research, professor and chair, Kevin W. Garey performed a study on Clostridium difficile (C.diff.) contamination rates, recurrent disease, antibiotics treatment and consideration of many other factors. Beginning around 2011, the University of Houston started to test surfaces and collect stool samples from patients with C.diff hospitalized in the Texas Medical Center and the results are displayed a little further below. 

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What is Clostridium difficile?

 

“Antibiotic resistance is one of the biggest public health challenges of our time.”

Centers for Disease Control and Prevention

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Clostridium difficile is an antibiotic resistant bacteria that causes diarrhea and colitis and is life-threatening to many. These superbugs infections leave more than 2 million sick and cause at least 23,000 deaths annually. The CDC ranked the top 18 antibiotic-resistant threats into 3 categories, Urgent Threats, Serious Threats, and Concerning Threats, see graphic below. 

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Carbapenem-resistant Enterobacteriaceae (CRE), also known as Nightmare bacteria, Clostridium difficile, and Drug-resistant Neisseria gonorrhoeae are all considered Urgent Threats, the highest measure in the CDC Antibiotic resistance scale (19).

 

Studies show much as 50% of antibiotics prescribed in hospitals are unnecessary or incorrect. When a patient is given a broad-spectrum antibiotic, the beneficial bacteria commonly present in the human gut are suppressed for up to months afterward. Patients may get sick during this time from C.diff picked up from contaminated surfaces due to a lack of defense against it (18).

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Where do the infections come from?

The results were rather easy to read once after reading through the refresher on ribotyping and the tracking of what C.diff strain you are dealing with. This tracking shows where a C.diff strain may have come from based on testing for superbugs in other areas. In summary, strains produce band patterns based on the size variation of the 16S-23S rDNA intergenic spacer region. 

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Simply, in the way I believe I understand it, ribotyping the Clostridium difficile (example: ribotype 027) presents a unique identifier that can then be compared to infections in other places to map the origin of infection or outbreak. 

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The Centers for Disease Control (CDC) generated a Press Release in 2015 stating that C. difficile affected almost half a million patients in a single year (2014).

 

At least 100,000 nursing home patients are infected with C.diff yearly and the CDC showed that “Unnecessary antibiotic use and poor infection control may increase the spread of C. difficile within a facility and from facility to facilitywhen infected patients transfer, such as from a hospital to a nursing home.”

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“C. difficile infections cause immense suffering and death for thousands of Americans each year.”​, CDC Director.

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One limitation in the data of this study above was the lack of inpatient health care exposure in the statistics of those with a C.diff diagnosis. Another, separate CDC study showed 82 percent of patients infected with C.diff had visited an outpatient facility, such as doctor or dentist, in the 12 weeks prior to diagnosis.

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The statistics regarding multi-drug resistant organisms are grim. Previous studies have shown that C. difficile has become “the most common microbial cause of healthcare-associated infections in U.S. Hospitals and costs up to $4.8 billion each year in excess health care costs for acute care facilities alone.” The CDC showed that a recurrence of C.diff occurred in 1 out of 5 patients and that 1 out of 11 patients over age 65 with a healthcare-associated C.diff infection died within 30 days of the diagnosis (18).

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In addition to improvements in refining antibiotics prescriptions, hospitals are now deploying new technology to fight infections such as materials infused with copper and other microbial substances. New copper oxide-infused materials and a new EPA-Registered whole room disinfection process are part of the effort to reduce HAIs. 

 

Whole-Room Disinfection

At least 700 hospitals were penalized during 2016 due to patient injuries including hospital associated infection rates. These penalties totaled over $430 million in fines enforced by Medicare and Medicaid to motivate hospitals in proactively preventing infections (8).

 

In an effort to reduce HAIs, hospitals are now using an EPA-Registered whole-room disinfection process that produces a dry mist that can be used around electronics, it’s nontoxic, and there is no need to wipe because the residue evaporates. 

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Commercial facilities, ambulance companies, schools, apartments, and residential properties also use this hospital-grade process to rid their units and vehicles of superbugs infection such as Nightmare bacteria CRE, MRSA, and C.diff (“kills 99.9999% of bacteria”) with this whole-room fogging of bactericidal solution.

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Antimicrobial, Bactericidal Copper-Infused Materials for Surfaces

In additional to whole-room disinfection, hospitals are also built and retrofitted with microbial materials such as copper alloy and copper-infused materials including cloth and plastic for infection control.

 

With an infection-control-centric approach, hospital rooms are now outfitted with “bed rails, toilet flush levers, grab bars, soap dispenser push plates, light switches, IV poles and other high touch” surfaces made of copper-infused materials (3).

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The Sentara Leigh Hospital Study looked at the performance of copper-infused materials at Sentara Leigh Hospital in Norfolk, Sentara Princess Anne Hospital Virginia Beach, and Sentata Va Beach General Hospital in 2015.

 

This study measured the expansion of copper-infused material in patient gowns, linens and hard surfaces from half to all inpatient rooms and the results were a reduction in healthcare associated infection at the Sentara hospitals, specifically a 28% reduction in C.diff and MDRO infections (32). 

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New Public Transportation Examples

An example of close coordination in between government and industry is the city of El Paso in deploying a 4.8-mile, 27 stop streetcar system. This streetcar route will be run the for the first time In El Paso, TX since 1974.

 

Camino Real Regional Mobility Authority is managing the construction of the project using Texas Department of Transportation funding with the City of El Paso providing the design. Once opened, Sun Metro will operate and maintain the restored vintage streetcars that are the same vehicles that operated on El Paso’s streets until 1974 (27). 

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