Flu Fatigue

One of the most subtle, yet most dangerous symptoms of the recent H1N1 flu outbreak is Flu Fatigue. Flu Fatigue is weariness brought on by media hype fed through a 24-hour news cycle that is constantly seeking its next crisis. Flu fatigue results in a built-up immunity to care about future epidemics and a general malaise regarding pandemic preparedness. Assuming that this most recent outbreak is over and should be forgotten is dangerous. History has shown that pandemic diseases are likely to quietly die-down, only to emerge more virulent than ever a few months later. This phenomenon is known as the ‘second wave’.

Second Wave
The three major pandemics over the past 100 years have shared a common epidemiology. The Spanish Flu (1918), Asian Flu (1957) and the Hong Kong Flu (1968) each began as mild illnesses in the springtime. Each of the three pandemics emerged in the autumn as much more virulent killers.1,2 Will the recent H1N1 shift into a more deadly strain this Fall? Pandemic experts such as the World Health Organization’s Director General Margaret Chan are preparing for the worst. “We hope the virus fizzles out, because if it doesn’t we are heading for a big outbreak. I’m not predicting the pandemic will blow up, but if I miss it and we don’t prepare, I fail. I’d rather over-prepare than not prepare.”3

Age of Pandemics
Epidemiologist and Chairman of the National Biosurveillance Advisory Subcommittee Lawrence Brilliant says we’re heading into an ‘Age of Pandemics’. “The 2009 swine flu will not be the last and may not be the worst pandemic that we will face in the coming years. Indeed, we might be entering an Age of Pandemics. In our lifetimes, or our children's lifetimes, we will face a broad array of dangerous emerging 21st-century diseases, man-made or natural, brand-new or old, newly resistant to our current vaccines and antiviral drugs. You can bet on it.”4

Betting on the outcome of a particular epidemic is risky. But amidst the uncertainty, experts agree that humanity will face a deadly pandemic in the future. Hospitals, and especially Emergency Departments, will be inundated by the sick and their families. The time to prepare is now, and several measures must be integrated to provide the maximum protection against transmission of pandemic disease.

Clearing the air
Increasingly, scientists are unraveling the secrets of viral disease transmission. New research has determined that air plays an important role in how we ‘catch’ respiratory diseases.5,6,7 Exhaustive studies following the SARS outbreak in 2003 indicate that this virus was airborne and that it is likely to have spread via a ventilation system within an apartment building.8,9

Recognizing the role air plays in disease transmission, architects, engineers, hospital administrators and building managers are looking to VIGILAIR® technology to reduce airborne pathogens. Installed within a building’s Heating Ventilation and Air Conditioning (HVAC) system, VIGILAIR® technology incorporates Ultraviolet Germicidal Irradiation (UVGI) and filtration to inactivate and remove pathogens within the HVAC air stream. UVGI damages the DNA/RNA of viruses, bacteria and fungi, preventing the microorganisms from reproducing and becoming infectious.

By disinfecting the air as it passes through the HVAC system, VIGILAIR® significantly reduces the amount of infectious microorganisms that are circulated throughout the building. Multiple hospital studies verify VIGILAIR® drastically reduces microbial contamination resulting in reduced infection rates.

VIGILAIR Systems, Inc. is the only UVGI manufacturer that has performed UVGI irradiation tests with live infectious agents including Anthrax, Avian flu (H5N1) and the SARS virus. The VIGILAIR® Biodefense system is the only UVGI technology to earn the Department of Homeland Security’s ‘designation’ as a Qualified Anti-terror Technology.

Fighting Flu Fatigue
Complacency can be costly--the time to make pandemic preparations is now. While no single measure can prevent disease transmission, VIGILAIR® is a technology that is proven to significantly reduce airborne pathogens. VIGILAIR® can play an important role in your comprehensive pandemic preparations. More information on pandemic preparations can be found at www.VIGILAIRsystems.com .

References

1. Pandemics and Pandemic Threats since 1900. PandemicFlu.gov. Retrieved May 6, 2009 from http://www.pandemicflu.gov/general/historicaloverview.html
2. .Hellerman, C. April 30, 2009. Scientists dig for lessons from past pandemics. CNNHeath.com. Retrieved May 6, 2009 from http://www.cnn.com/2009/HEALTH/04/30/swine.flu.1918.lessons/index.html
3. Jack, A.. May 3, 2009. Chan hits back at WHO critics. Financial Times. Retrieved May 6, 2009 from http://www.ft.com/cms/s/0/e6260d9a-37d4-11de-9211-00144feabdc0,dwp_uuid=819fc44c-33e2-11de-9eea-00144feabdc0.html?nclick_check=1
4. Brilliant, L. May 2, 2009. The Age of Pandemics. The Wall Street Journal. Retrieved May 6, 2009 from http://online.wsj.com/article/SB124121965740478983.html
5. Li Y, et al. Role of ventilation in airborne transmission of infectious agents in the built environment—a multidisciplinary systematic review. Indoor Air 2007; 17: 2-18.
6. Tellier, R. Review of aerosol transmission of influenza A virus. Emerging Infectious Diseases 2006; 12: 1657-1662.
7. Beggs, CB. The airborne transmission of infection in hospital buildings: fact or fiction? Indoor and Built Environment 2003; 12: 9-18.
8. Li, Y, et al. Multi-zone modeling of probable SARS virus transmission by airflow between flats in Block E, Amoy Gardens. Indoor Air 2004; 15: 96-111
9. Yu, I. Evidence of airborne transmission of the severe acute respiratory syndrome virus. New England Journal of Medicine 2004; 350, 1731–1739
Flu Chart- Taubenberger, J, Morens, D. 1918 Influenza: the Mother of All Pandemics. Emerging Infect Dis. Volume 12, Number 1, January 2006. Retrieved from http://www.cdc.gov/ncidod/eid/vol12no01/05-0979-G1.htm

Doctors Frustrated over Acinetobacter Infections

All the healthcare professionals that I know are good hearted people with a great capacity for compassion and a desire to heal. Doctors are, at heart, 'fixers'. So you can understand the frustration infection control professionals feel when they run out of treatment options. Consider the plight of physicians dealing with drug resistant Acinetobacter, as referenced in this article fron the UK's Telegraph:

"Pandemic fear over resistant superbug

By Stephen Adams

Last Updated: 2:20am BST 02/04/2008

Doctors have warned that if a superbug which is known to be even more resistant to antibiotics than clostridium difficile and MRSA takes hold in hospitals, the country could face a pandemic.

The acinetobacter bug is being treated with older antibiotics because newer ones do not work. There are fears that injured soldiers returning from Iraq and Afghanistan have passed the infection on in civilian hospitals.

Prof Matthew Falagas, an expert in hospital-acquired infections, said: "In some cases, we have simply run out of treatments and we could be facing a pandemic with public health implications."

He warned delegates at the Society for General Microbiology conference in Edinburgh: "Doctors in many countries have gone back to using old antibiotics that were abandoned 20 years ago because their toxic side-effects were so frequent and so bad.

"But superbugs like acinetobacter have challenged doctors all over the world by becoming resistant to these older medicines.

"Even Colistin, an antibiotic discovered 60 years ago, has recently been used. But now it occasionally fails as the bacteria has become resistant."

There are more than 1,000 reports of acinetobacter infections every year in the UK, according to the Health Protection Agency (HPA). Some strains can cause death through blood poisoning and pneumonia."

Acinetobacter is particularly difficult to remove from the environment of care because it is hearty and can survive for nearly a month in dry conditions. Healthcare providers will do their best to fight this bacterium, but turning back the clock to use older antibiotics is not a good long term strategy.

Because Acinetobacter has been proven to be transmitted via the air in several hospital studies, it is prudent to consider that the airborne route of transmission may play a role. While UVGI systems designed by VIGILAIR can help reduce environmental contamination, they are not a silver bullet. Like antibiotics, VIGILAIR is one part of a multi-faceted infection control strategy. VIGILAIR's strength lies in its ability to eliminate environmental reservoirs where microorganisms proliferate.

A VIGILAIR white paper on Acinetobacter is available here.

The war on hospital acquired infections, fighting on two fronts

Ok, so it's an old analogy, but it works. Imagine being at war. You're a general tasked with disrupting the enemy's supply chain. The enemy has trains, boats and trucks that carry supplies, but it also has factories where supplies are built and depots, camps and ports where large quantities of supplies are stored.

What is your bombing strategy? Do you hit the individual vessels of supplies, or do you attack where the supplies are produced and stored?

The answer is you bomb both.

And so it goes for infection control. Enforcing hand washing protocols is a good start. Hands are like the boats and trains; they're vessels that deliver supplies (infections). But if you only attack the supply carriers, some are likely to get through and new routes will open as soon as the old ones are closed.

That's why it is important to also attack the factories and staging places for supplies. For infection control, this means looking at the source of pathogens and the reservoirs in which they hide. Individually each of these tactics are good, but together, their strategic value is much greater.

I thought of this tired analogy after reading a study (1) that says previous contamination of a hospital care area is an excellent predictor of future infection. Here's an overview of the study from infectious disease dot com:

Patients may be at an increased risk for vancomycin-resistant enterococci in health care settings if they are treated in areas where contamination with vancomycin-resistant enterococci has previously occurred, according to the results of a new study, which were published in Clinical Infectious Diseases.

Prior room contamination is highly predictive of vancomycin-resistant enterococci (VRE) acquisition, according to the study’s researchers, who stressed that increased attention to environmental disinfection is warranted to help reduce the risk for VRE infection.

“Everyone on the health care team — from doctors, to nurses, to medical students, to technicians — needs to take personal responsibility for preventing infections,” Marci Drees, MD, from the Center for Outcomes Research at Christiana Care Health System in Newark, Del., and one of the study’s researchers, told Infectious Disease News. “I think for too long we’ve had the attitude that these infections ‘just happen’ and are bad luck, but we now know that many are preventable. Preventing infections comes down to the basics: universal handwashing, wearing gowns and gloves when appropriate and thorough environmental cleaning. It’s easy to cut a corner here and there when you’re busy taking care of patients, but that’s how these infections happen.”
(snip)
Three of the most significant factors associated with the risk for a VRE infection included sharing a room with a VRE-colonized patient, being treated in a room where a VRE-colonized patient had been treated within the past two weeks and being treated in a room with previous positive culture results.

To put a fine point on it, infection control professionals are fighting on several fronts. Hand washing is an important tactic. We should remember, however, that hands don't produce many pathogens--although they do a fine job of transporting them.


Where are the microorganism 'factories'? Among the places in a hospital where microorganisms are produced is the Heating Ventilation and Air Conditioning (HVAC) system. Our staff members have hundreds of data points taken from microbial swabbing of hospital HVAC surfaces. We find that the same microorganisms that cause infection are found thriving on cooling coils, drain pans and water inside hospital air handlers. Pathogens that are commonly cultured on hospital cooling coils include:

• Pseudomonas
• Acinetobacter
• Staphylococcus

VIGILAIR is like a carpet bomber for these pathogens. But unlike bombing, whose effects are transitory, VIGILAIR eliminates reservoirs for microbial growth and prevents them from returning.

Now, onward infection control soldier!



1. Drees M, Snydman DR, Schmid CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis. 2008;46:678-685.

Killer in the NICU

From my adopted college town of Manchester, the sad story of a NICU death likely caused by airborne aspergillus:

"Baby ward hit by fatal infection

A Greater Manchester hospital has temporarily closed its neo-natal unit after a baby died and another suffered a potentially fatal infection. A premature baby developed an infection from aspergillus, a common airborne fungus, and died in December at Salford Royal Hospital. A second pre-term baby tested positive for skin aspergillus last week. The hospital said it had closed the ward as a precaution to establish any "common contributory factors". The aspergillus fungus is very common and can be found in homes and buildings everywhere, but can cause infections."

Many studies have shown that aspergillus is ubiquitous in the environment. Healthy people can be exposed to it without serious consequences. That is not true for immune compromised patients in ICU areas. So, what to do about it?

How about filtering the air? Hospitals already do that and yet aspergillus persists. How about letting in more fresh air? This strategy will introduce more and potentially different types of aspergillus into the hospital. What about cleaning the HVAC frequently to get rid of pathogens?

Studies have shown that traditional cleaning is not effective, as this report(1) from the ECMM shows:

"It appears that fungal spores are not necessarily removed by cleaning the fans. Even scratching and painting them, to eliminate rust and restore a smooth surface on which fungal spores cannot be retained, does not permit decontamination."

In fact, servicing the HVAC can exacerbate the problem(2):

"Our observations suggest that localized, short-term exposures resulting from disturbance of (aspergillus) reservoirs are comparable to or may even greatly exceed maximum expected routine exposures. Further, these reservoirs may be disturbed not just during construction or renovation, but even during routine maintenance activities (telecommunications cabling, HVAC filter replacement) that require access to ceiling spaces."

It is clear that the unique needs of ICU areas need unique solutions. That's where VIGILAIR® comes in. VIGILAIR® Systems combine filtration and the germicidal effect of UVC. Rather than just trapping aspergillus spores, VIGILAIR® is designed to provide enough UVC exposure (dose) to destroy aspergillus. UV technology disinfects HVAC surfaces and then keeps those areas clean by continuously radiating the reservoirs where microorganisms can thrive.

Once again, we need to be aware than Infection Control is an environmental issue. Diligent IC professionals must recognize and remove all reservoirs for pathogen growth within the hospital. Unfortunately, the HVAC system is frequently overlooked as a reservoir despite the fact that it houses the largest untreated water supply within a health care facility.

1. European Confederation of Medical Mycology Conference 1996. S. Heinemann, G. Van. houte, N. Nolard. Contamination of indoor environment and air conditioning.

2. European Confederation of Medical Mycology Conference 2008. Khan M, Gonsoulin T, Simpson S, Horner WE. Exposure levels of aspergillus fumigatus from various indoor reservoirs in health care facilities.

Hand washing just one part of infection control, medical experts say

An excellent common sense approach to the hype surrounding hand washing hygiene. This article is excerpted from the Grand Island Independent, a newspaper published in Nebraska:

"Widespread use of antibacterial hand gels has helped make it easier for healthcare workers to comply with hand hygiene policies, which is especially important during cold and flu season. The gels, which have been proven as effective at killing germs as soap and water, are also less drying to the skin an important quality for those who work in the medical field and may cleanse their hands up to 50 times per day. Recent studies and local experience have proven, however, that increasing compliance to hand-washing policies is not always enough to reduce the rates of hospital-acquired infections. A study published by the University of Nebraska Medical Center this month showed that while use of antibacterial hand gels in two UNMC adult intensive care units helped the units increase their hand-washing rate from 38 percent to 70 percent, there was no corresponding reduction in hospital-acquired infections. But a similar experiment at St. Francis Medical Center has had different results. At St. Francis, the use of hand sanitizer and the creation of a hand hygiene improvement committee has nearly doubled the rate of hand-washing policy compliance for the entire hospital, said Laura Mader, St. Francis infection control coordinator. The hospital's current 76 percent compliance rate is above the national average. It has also led to a decrease in St. Francis' incidence of hospital-acquired infections, Mader said. While UNMC and St. Francis had different results in similar experiments, officials from both facilities agree that hand washing, while highly important, is only one component of infection control. "There are many factors that influence the development of hospital-acquired infection," said Dr. Mark Rupp, professor of infectious diseases at UNMC. "It would be naive to think that a single, simple intervention would fix this problem." The lack of a correlation between increased hand hygiene and lower incidence of infections could be attributed to many factors, including UNMC's already low infection rate in the ICU."

Infection Control professionals fight disease transmission on many fronts. While hand washing has drawn much attention, it is merely one weapon in the arsenal. We believe that a comprehensive approach to infection control should include air disinfection, especially in critical care units.

Case Fatality Rate for Avian Flu is 80.6% in Indonesia

Disturbing news from the Indonesian Ministry of Health that says 80% of the people who contract H5N1 Avian Influenza (AI), will die from from the infection:

"Four AI New Cases at the End of January

29 Jan 2008

Entering last week in January 2008, there are 4 more AI cases, based on RT PCR (Real Time Polimerase Chain Reaction) test in laboratories of National Institute of Health Research & Development (Balitbangkes) MOH and Eijkman Molecular Biological Institute. Those 4 cases are Nas (Tangerang District, Banten), MIY (Depok, West Java), and Res and Vir (both from East Jakarta).

Since the first case found in mid July 2005, number of AI cases in Indonesia by January 28, 2008 reaches 124 cases with 100 of them dead. The Case Fatality Rate (CFR) is 80.6%."

Some have argued that the CFR for AI is skewed because there may be many instances where nonfatal AI is not reported or mistakenly diagnosed as seasonal influenza. Dr. Niman @ Recombinomics has stated that high CFR rates for AI are not inflated and presents an elegant argument here.

Putting these numbers in perspective:

• A 2003 study of SARS in Hong Kong (1,755 SARS cases and 299 deaths) says that the CFR for SARS was approximately 17%.
• A recent WHO report that analyzed H5N1 infections from December 2003 thru April 2006 found a CFR of 56% (203 cases, 113 deaths).
• The total WHO CFR for all H5N1 cases confirmed since 2003 is 63%.

How does this relate to a possible pandemic? Nobody knows for sure, but informed calculations project that assuming a clinical attack rate of 25%, a pandemic could kill 1.7 million Americans. The assumed CFR for this projection is 2.3%.

Reporting Live From AHR EXPO 2008

The AHR Expo is in full swing here in New York City. We are among 1,800 exhibitors that are presenting booths at this show. The technical programs have been outstanding, especially the programs dealing with Ultraviolet light.
As a whole the industry seems to be maturing. As compared to previous years when people asked, “What is UV?”, this year they know what it can do and are asking more questions regarding applications. The field of UV manufacturers is well represented here at the Expo and at the technical committee level. Although we are competitors there is an agreement that we have shared interests as an industry.
This spirit was evident at a symposium entitled, ‘Applying UV Without Getting Burned’. Moderated by Steve Martin, the forum discussed the safety implications of applying UV to HVAC. Altru V’s VP of Technology Dave Witham demonstrated how his company is testing the effects of UV on HVAC components such as filters, insulation and wiring. His company has created a testing chamber to help quantify those effects.
Richard Vincent, the author of many journal articles on UVGI, also touched upon the safety aspects of applying UV. Dr. Vincent is a recognized expert in the field and discussed the conclusions of a 7 year study on the effects of UV in homeless shelters.
The always entertaining Dave Marciniak of the GSA round-out the forum. His use of humor livened the sometimes dry details of government safety guidelines and regulations. Being the last speak in a forum is always tough but Dave did it with memorable style. My kind of bureaucrat!
Another highlight was a presentation made by Kathryn Worrilow Ph.D of Leigh Valley Hospital. Her talk was part of the TC 2.9 (thanks for the update, Mr. Bahnfleth) series, AKA Control of Infectious Diseases with UVGI. Dr. Worrilow, an embryologist, explained how the use of UVGI air disinfection led to better clinical outcomes in her lab. Her study, The Impact of UVC Radiation on Clinical Pregnancy and Miscarriage Rates in ISO 5 Cleanroom In Vitro Fertilization Laboratory was well received and is the latest in a growing body of evidence linking UV air sanitation with positive clinical outcomes.
Among the contacts VIGILAIR made at AHR is Ponkamon Aumpansub, a graduate student at Penn State. Her studies at the prestigious Penn State Indoor Environment Center deal with the complex issues surrounding the modeling and mitigation of contaminants in large buildings. AHR is first and foremost an expo to promote business. It is also important to recognize that tomorrow innovations will come from today’s engineering students such as Ms. Aumpansub. It is imparative for commercial entities to foster the relationship between research and commercial applications as their goals are connected.
The theme that seemed to resonate throughout the 1,800 exhibits this year is the emerging importance of IAQ in all aspects of HVAC. There is an awareness from front line mechanical contractors to multi-national manufacturers that HVAC is all about creating an environment of comfort and safety indoors. VIGILAIR and our partners at Steril-Aire are at the vanguard of implementing UV to meet those goals.

ASHRAE Meeting off to great start

It's cold here in New York City as the annual winter meeting ASHRAE lives up to its name. With so many forums to attend, where do you begin.
This morning we attended an excellent seminar titled, "Hazardous Biological Agents in Hospital Air: When the HVAC Plant exacerbates rather than mitigates against HAI". Dr. Bob Scheir of Steril-Aire led the discussion on why Health Care Facilities pose unique challenges to HVAC engineers. The seminar was well attended reflecting the increased interest in airborne transmission of disease.
Tim Keane, a consulting engineer to Health Care clients, talked about the importance of maintenance programs, and how simple measurements can indicate if your system is fouled by microorganisms.
William McCoy, PhD of the life sciences company Phigenics, focused on Legionella in the Health Care setting. Dr. McCoy enlightened us on the unique relationship between protozoa and legionella. He also said that while our understanding of this pathogen has increased, much more research needs to be done.
The afternoon was spent in a lively technical meeting (TC 9.6-the subcommittee on Infectious Diseases). A spirited discussion ensued, led by Mike Keen. While much ground was covered, the meeting also highlighted how much more science is needed. But the good news is that the engineering community is starting to accept the idea that HVAC can prevent/cause nosocomial infection. The seminar was a good mix of experienced members and many younger engineers who are interested in this emerging topic.
That's all for tonight!

Hand washing no panacea

I was delighted to hear the ABC song drifting from my bathroom last night.  It meant that my five year old son was following the instructions he learned in school to properly guage the amount of time he should wash his hands with soap and water.  Will he do this everytime? Probably not, but it is important to try.

The situation in my house is much like the situation in many healthcare facilities, according to an LA Tines article on the MRSA Watch blog site:

30 studies show hand washing neglect

Link: Beating the staph superbug - Los Angeles Times.

But, with a few exceptions, hospitals and public agencies have been slow to gear up against MRSA. More than 30 studies have shown, for example, that healthcare workers wash their hands about half as often as they're supposed to, even though washing before and after seeing each patient would drastically cut down on infection rates. Hospital surfaces and equipment aren't cleaned as often as they should be, and careless habits -- like touching potentially contaminated surfaces after hands have been washed but before touching the patient -- contribute to the spread. The first order of business should be to get a clear picture of MRSA. Where is it and how prevalent? An upcoming bill by state Sen. Elaine Alquist (D-Santa Clara) would make MRSA a reportable disease and require hospitals and nursing homes to report their infection rates. In Tennessee, which tracks MRSA, it quickly became the third most common reportable disease in the state, behind chlamydia and gonorrhea. A similar bill was vetoed in 2004 by Gov. Arnold Schwarzenegger, but the recent news from the CDC should make him rethink his position, despite the almost certain opposition of hospitals.

http://tahilla.typepad.com/mrsawatch/2008/01/30-studies-show.html

I bring this to your attention to demonstrate that infection control is dynamic.  There is no silver bullet.  Infection control requires multi-layers and some redundancies.  Our technology, VIGILAIR®, does not replace other sanitary efforts--it complements and enhances them.  Like hand washing, VIGILAIR® is not a cure all.  It is a prudent and effective way to reduce the airborne environmental pathogens within your facility.

Brits love a healthy debate...

From Britain's Telegraph, news on a new government program to reduce antibiotic prescriptions as a way to reduce the superbug cycle. I've included a snippet of the article. It is the responses to the article that are just as interesting. In response to this topic, readers blame doctors, politicians and patients for the problem. These comments show the complexity of the issue and the passion of those seeking a solution. My favorite response is listed below in which the writer tells people to stop being wimps, suck it up and go to the doctor's office less.

Stop giving antibiotics for colds, doctors told

By Rebecca Smith, Medical Editor
Last Updated: 12:09pm GMT 09/01/2008

Doctors are to be told to stop prescribing antibiotics for coughs, colds and sore throats because over-use of the drugs is fuelling the spread of killer hospital superbugs. Alan Johnson, the Health Secretary, says it is time to end the unnecessary use of penicillin and other commonly-prescribed pills, which cost the NHS £1.7 billion a year. Using antibiotics too liberally has led to bugs such as MRSA becoming resistant to treatment with the drugs. Most colds, coughs and flu are caused by viruses, which cannot be treated with antibiotics anyway, Mr Johnson points out. Announcing a £270 million campaign against superbugs, to be launched next month, he says it is vital that doctors adopt "less of a knee-jerk reaction to prescribing". The campaign, called Clean, Safe Care, will also include an extra £45 million for hospitals to spend on infection control nurses or antibiotic specialist pharmacists. All patients going into hospital will be screened for MRSA by 2009.

COMMENTS:

Antibiotics fight "bugs", not viruses, so the basic premise is absolutely correct. Do not give antibiotics merely for colds or flu. BUT post viral conditions such as chest infection, infected sinuses and catarrh (and real sore throats) DO need antibiotics and I hope this will not change under the new guidelines. Perhaps doctors could prescribe a placebo antibiotic to anyone insisting on antibiotics who merely has a viral infection.
Posted by graham wagner on January 9, 2008 9:59 AM

Antibiotics are not the cure for superbugs, cleanliness is - and the hospitals simply aren't clean enough in the UK. Accountability is needed, not money, run a hospital like a fast food joint. "Clean as you go" and it is all staff's responsibilty to clean up, not delegated to the lowest bidder.
Posted by Craig Douglas on January 9, 2008 9:55 AM

So what is Alan Johnson's next big idea? Now wash your hands? Make sure you're wearing your face-mask? Or is he going to go round every surgery and tell the doctors what medicine to prescribe? What a joke! The trouble is this joker is in charge of the health service! That is more frightening than any superbug.
Posted by Pinkie on January 9, 2008 9:27 AM

The best solution for colds and viruses is to stop giving them to everyone else!
If people stayed at home and looked after themselves when they became ill there would be a lot less general illness in the community, rather than battling on and infecting all and sundry.
Surely we all know by now that antibiotics are not given out by GPs for colds - that has been common knowledge for decades - hence the barrage of cold 'cures' on the shelves.
Posted by Annie on January 9, 2008 9:25 AM

I am a GP and we know that we should not give antibiotics in the circumstances described; the patients do not always know this and it does not matter how many times we inform them they will keep coming back until they get them, in these circumstances another approach needs to be adopted and a debate needs to be taken on what this might be.
Posted by Jonathan Allcock on January 9, 2008 8:50 AM

Simple - don't go to your doctor - it's dangerous. I've been telling my patients this for years. The whole ludicrous thing is compounded by several factors: the great unwashed believe it's their god given right to be ill on a regular basis, a health service that is free at the point of delivery (if you offer free beer there's a queue that stretches round the corner and up the road), and a partially educated, disinterested and overpaid workforce.
Posted by Andrew Renaut, Associate Professor of Surgery, Brisbane on January 9, 2008 8:36 AM

The crux of the issue lies in the fact that many people are greedy and want immediate satisfaction. I have wrestled with people who demanded antibiotics for simple viral illnesses. The the patient wants to leave with something in his/her pocket and they are willing to go to any means to acquire it.
There are also legal implications that are caused by the system. If a patient complains of not receiving the desired medication or a rationalized "standard of care", the legal system automatically demonizes the medical practitioner.
I am all for placebo's in this instance.
Posted by James on January 9, 2008 7:51 AM

Yes suck it up. It is called illness. We are made of flesh and blood and mortal. It is normal for people to get sick off and on. You must endure illness sometime. If you find yourself going to the doc everytime you feel unwell then you likely are a mental case ie "nervous nelly". Anxiety /depression are a big reason why folks can't cope w/ minor illnesses. Quick being a wimp
Posted by ER doc on January 9, 2008 6:59 AM

Again the real cause of hospital infection is ignored. Unsustainable bed occupancy ratios, and out- sourcing of hospital cleaning. Blaming GPs is an irrelevant political ploy. Fight the real battle please.
Posted by John Powell on January 9, 2008 6:47 AM

Most experts talk around the Problem of Antibiotic Resistance. Your article headlines should say "ALL COLDS ARE VIRUSES, ANTIBIOTICS DO NOT KILL VIRUSES, THEREFORE YOU(DOCTORS) MUST NOT USE/ ANTIBIOTICS and start from there. Bacteria and viruses are as different as Gold and Lead. It is possible that a virus can make a person sick and that because of a compromised Immune System bacterial Infections can follow which can then require antibiotics to heal, It should also be pointed out that antibiotics tend to kill many neccessary bacterial species in the body and so lead to further problems-(example,life on the toilet) and Candida infections
Posted by declan mansfield on January 9, 2008 6:13 AM

Source: http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/09/nbiotic109.xml

H5N1 Beautiful and Deadly

New images of the H5N1 virus were released this week. The images are the work of science photographer Lennart Nilsson, who is well known for his imaging of human conception and development of the baby within the womb. These images were first printed in Swedish daily Dagens Nyeter. Nilsson originally asked the US government for H5N1 virus samples but was turned away. He was able to obtain the virus from the World Health Organization and used a scanning electron microscope to make the images. The virus is strangely beautiful in these images, seen as blue orbs attacking healthy pink cells. But keep in mind that it is deadly, as the samples came from a father and daughter in Hong Kong who died after being infected two years ago. I combined the images with a photo of Nilsson (credit Jacob Forsell) and a music bed by Silvermay.

Is Ebola Airborne?

World Health Organization (WHO) officials are rushing to the Democratic Republic of Congo, desperately trying to contain the spread of the Ebola virus. As of this writing, five people are known to have died from Ebola in the southern province of DR Congo, and the WHO says 166 more deaths since April may be linked to the virus.

Among the problems facing health care workers is the virus’ ability to remain asymptomatic for up to 21 days. Furthermore, researchers do not know why some people recover from Ebola hemorrhagic fever, while most do not. There is no standardize treatment for Ebola and researchers do not yet know the natural reservoir for the virus.

Is Ebola transmitted via the air? In primates the Ebola virus was transmitted through the air in a research facility in Reston, Virginia. Apparently the mutations that allowed the virus to easily transmit via the air also changed its effect on humans. Tests showed that four lab workers tested positive for Ebola Reston virus, but this strain of the virus caused only minor health problems (although all the monkeys in the Reston facility were destroyed to prevent the outbreak from spreading).

According to existing literature, Ebola does not spread through the air in natural settings, although it can be spread via aerosols in lab experiments. How the virus knows when it is in a lab, I’m not certain. Viruses rely on sugars and proteins that allow them to bind to cells they’d like to infect. Small changes, such as the mutation that permitted airborne transmission, probably changed the lethality for humans infected by Ebola Reston, even though it retained its virulence in monkeys.

There are claims, however, that airborne human to human transmission of Ebola occurred in 1976. Reports say that Mayinga N'Seka (seen as the patient in the image to the right), a nurse in Zaire may have contracted the virus via the air. Evidence is thin, and even if it was true, Nurse Mayinga did not infect any other humans before she died.

Ebola is a mysterious and deadly microorganism. We’ve come far in understanding this killer, but as with so many viruses, we are just one shift, drift or mutation away from a potential pandemic.

(This 1976 photograph shows two nurses standing in front of Kinshasa case #3 (Nurse Mayinga) who was treated and later died in Ngaliema Hospital, in Kinshasa, Zaïre - CDC/Dr. Lyle Conrad)

Taking the fight against hospital acquired MRSA into your own hands

Think of it as a ‘Do it Yourself’ kit for preventing hospital acquired infections (HAI). The kit is a collection of disinfecting wipes, hand rubs and other products designed to prevent patients from catching a bug while they’re in the hospital.

The “PatientPak’ is marketed in the UK for about $43. The web site for the product is long on promises short on specifics (www.patientpak.com). Consider this text from the company’s press release:

“The PatientPak Hand Sanitiser and Sanitising Wipes are the only products available that are tested and proven to kill and clean away MRSA and at least 99.999% of all bacteria, including dangerous viruses, Norovirus and Bird Flu. Combining a cleaning detergent and bacteria-killing disinfectant in one, harmful bacteria are killed in just 10 seconds. PatientPak’s Hand Sanitiser and Sanitising Wipes, the most extensively tested products on the market, are also the only MRSA-killing products that are hand safe with just 5% alcohol, meaning that food can be eaten after application with no need to re-wash hands.”

Maybe I’m reading this wrong, but the first sentence indicates that viruses are a subset of bacteria (see bold text). A quick scan of the web site reveals no corroborating case studies or published data on germicidal efficacy. If the products are indeed the most, “…extensively tested…” shouldn’t the test results be available?

I’d like to know how the sellers know that the products ‘kill’ bird flu? Was it tested against H5N1, or was it a surrogate? Or does it work against Influenza A, and therefore it is assumed to likely be effective against bird flu?

I’m also sceptical of the germicidal effects of a detergent that is used for 10 seconds. To the best of my knowledge, detergents do not ‘kill’ or deactivate microorganisms. Detergents help water remove and dilute contaminants. It is generally accepted that washing your hands with a detergent (soap) requires a good 20 seconds or so. I may be wrong, but since the company does not provide an explanation of their technology or other scientific studies, we are forced to use the information that we have.

On the positive side, I like the idea of empowering people to actively participate in their healthcare. Bringing the PatientPak to the hospital is not necessarily a sign that a hospital is not doing its job. To me it is an indication that HAIs are environmental issues requiring a broad-based strategy. While hospitals need to do more, I wouldn’t bet my life on it.

So, would I buy the PatientPak? No, not based upon what I know of the kit so far. I do not believe, however, that it will cause any harm. It might actually help. There’s a lot of sizzle in this product promotion, but not much science. It is always wise to remember that there are no panaceas for HAI.

New study shows UV effective against H5N1

One of the things that differentiates my firm from others doing the same thing is that we are committed to real science. When concerns began to mount over the potential of pandemic influenza, many competitors jumped on the bandwagon and claimed they could 'kill' the H5N1 virus.

That's until you read the small print and determined that they tested their systems against a 'surrogate' virus. Why a surrogate? It's a lot cheaper and easier to test a pathogen that is 'like' highly pathogenic H5N1. But when you cut corners in this manner, it prevents you from truly designing your system to provide the proper dose of UV needed to deactivate the target microorganism.

That's why I am proud to announce the results of our testing involving UVGI deactivation of H5N1. Yes, it took extra time and resources, but the pursuit of predictable outcomes makes all our efforts worth while. In a nutshell, VIGILAIR was effective in deactivating live H5N1 viruses (the Vietnam strain). Although we are unable to share all the results at this time, we can say that the real H5N1 virus differs from influenza A, in respects to UV-C. This is the first time that such testing has been performed. VIGILAIR has also successfully deactivated SARS and anthrax...the real stuff, not just surrogates.

Healthcare takes a new look at airborne pathogens

The concept of airborne disease transmission was well accepted in the early to mid 1900's. It was frequent that you would see UV lights in hospital wards for upper air disinfection. UV lights were a standard form of infection control in TB wards.
But then times changed. Aggressive measures helped to eradicate TB from our country. Drugs such as vaccines proved effective and immediate. Hospitals, like all buildings, began to have ventilation to exhaust contaminated air while bringing in fresh air. Scientists and researchers turned away from studying airborne transmission and moved on to newer issues.
Since the advent of SARS, pandemic influenza and a resurgence in TB, scientists are once again turning their attention to airborne transmission. We've prepared a new white paper that examines some of the findings of these new studies. Like all good research it answers some questions and raises some more! Hopefully this spark new interest in studying airborne transmission.

South Africa Fights XDR-TB with UVGI

Multi and Extreme Drug Resistrant TB strains are ravaging parts of Africa, mainly preying upon HIV+ patients whose immune systems are weakened. While TB was nearly eradicated from Western countries, it is a serioud health threat elsewhere, especially in South Africa.
Because TB is airborne, UVGI systems are an effective way to stop transmission of the disease. The article below mentions how UV is used in a new TB unit in a hospital about 2 hours north of Pretoria.

The Minister of Health, Dr Manto Tshabalala-Msimang and Limpopo Health MEC Seaparo Sekoati visited a newly upgraded Tuberculosis (TB) unit at the FH Odendaal Hospital in the town of Modimolle in Limpopo today.

The visit comes after the Department of Health spent about R2, 5 million to upgrade the unit to accommodate more drug-resistant TB patients.

The unit is designed to prevent hospital acquired TB infection and improves patient care and treatment outcomes.

The hospital has 38 beds, 17 Multi-Drug (MDR) TB patients and three Extreme Drug Resistant (XDR) TB patients are accommodated in the hospital.

The unit is fitted with extractor fans and ultraviolet light filters which remove and kill bacteria and thereby prevent cross infection in the hospital.

"For extra protection, respirator masks are issued to all health workers and visitors in the hospital and patients are provided with surgical masks," Dr Tshabalala-Msimang.

She said MDR TB Units are being improved countrywide to deal with infection control.

UV systems were routinely used in this country to treat TB, starting in the 1930's. As more effective drugs were crafted, and TB's threat waned in the US, so did the use of UV in hospitals. It now appears that UV technology is once again needed to help stop the TB killer from spreading.