Next Generation Antibiotics on the Horizon

Jan 03, 2007: Theravance, Inc. announced today that the first patient was dosed in a Phase 2 clinicalstudy of TD-1792, an investigational heterodimer antibiotic, for the treatment of complicated skin and skin structure infections (cSSSI) caused by Gram-positive bacteria, including resistant strains such as methicillin-resistant Staphylococcus aureus (MRSA).

The goal of this program is to develop a next-generation antibiotic that is more efficacious than vancomycin, the current standard of care for the treatment of serious infections caused by MRSA, and which has an improved resistance profile relative to other available antibiotics.

TD-1792 is a unique heterodimer antibiotic discovered by Theravance that combines the antibacterial activities of a glycopeptide and a beta-lactam in one molecule. Theravance initiated the Phase 2 program based upon favorable data from preclinical studies and Phase 1 studies completed during 2006. In randomized, double-blind, placebo-controlled, single- and multiple-ascending dose Phase 1 studies, which enrolled a total of 51 healthy volunteers, TD-1792 was generally well tolerated and displayed linear pharmacokinetics and exposure profiles consistent with once-daily dosing. In preclinical in-vitro studies, TD-1792 demonstrated marked bactericidal activity and was approximately 30-fold more potent than vancomycin against MRSA and approximately 100-fold more potent than oxacillin against methicillin-sensitive Staphylococcus aureus (MSSA).

The Phase 2 randomized, double-blind, active-controlled study is designed to evaluate the safety and efficacy of TD-1792 in patients with cSSSI due to Gram-positive bacteria such as MRSA. Patients will be randomized to receive either TD-1792 dosed once daily or vancomycin dosed twice daily for up to 14 days. The Phase 2 study will be conducted in the United States with a goal of enrolling approximately 200 patients.

"We are excited about the potential of this compound as a next-generation treatment for serious Gram-positive infections, including those caused by MRSA," said Michael Kitt, MD, Senior Vice President of Development at Theravance. "MRSA is a worldwide health problem. We are striving to provide the best medicines to treat the increasing number of patients who are infected with MRSA."

Theravance is a biopharmaceutical company with a pipeline of internally discovered product candidates. Theravance is focused on the discovery, development and commercialization of small molecule medicines across a number of therapeutic areas including respiratory disease, bacterial infections and gastrointestinal motility dysfunction.

Study Finds Simple Steps Reduce CV Catheter Infections by 66%

Simple and inexpensive steps taken by 108 intensive care unit teams reduced infections related to central venous catheters by 66% in Michigan hospitals, according to a new study published in The New England Journal of Medicine. The dramatic results reported by researchers from the Johns Hopkins University’s School of Medicine were achieved by nurses and doctors taking a team approach to adhering to safety protocols by following checklists and meeting daily performance goals, according to The Baltimore Sun.

The precautions the teams followed were basic but consistently applied: rigorous hand washing; careful cleaning of the skin around the catheters; use of sterile gowns, masks, and gloves; removing catheters quickly; and avoiding inserting catheters in the groin area. The collaborative approach to following safety guidelines can also be applied to reducing other hospital-acquired infections. “We think this model really helps to advance the science of patient safety,” lead author Peter Pronovost, MD, told the Sun. “It shows what’s possible. We no longer have to accept the infections as inevitable.”

Of ICU patients that develop infections from catheters each year around 35% die as a result. The average cost of treating a patient with a catheter-related infection is $45,000.

The above was an excerpt from, "An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU"
Peter Pronovost, M.D., Ph.D., Dale Needham, M.D., Ph.D., Sean Berenholtz, M.D., David Sinopoli, M.P.H., M.B.A., Haitao Chu, M.D., Ph.D., Sara Cosgrove, M.D., Bryan Sexton, Ph.D., Robert Hyzy, M.D., Robert Welsh, M.D., Gary Roth, M.D., Joseph Bander, M.D., John Kepros, M.D., and Christine Goeschel, R.N., M.P.A.

Doctors' Apparel Tied to Spread of Infection

Doctors are not known for making fashion statements especially in the type of neck ties they wear but you now have to look at their neck wear in a new way - as potentially dangerous.

A study at Queens Hospital, New York, discovered that 47% of the 42 ties worn by medical staff at the hospital harbored illness causing bacteria. Clinicians ties were eight times more infectious than security guards ties but does give cause for concern in a job were it is so important to minimize the microbes.

The study isolated some nasty bugs being carried around with them, 12 of the staff's ties carried staphylococcus aureus, five gram-negative bacteria, one tie carried aspergillus and two ties carried multiple pathogens. Out of the 10 security guard's ties, only one carried staphylococcus aureus.

The study backs up previous research findings where stethoscopes, pagers, pens and other doctors everyday equipment and work wear were tested and found to be harboring dangerous pathogens. And it is not just doctors. It said that all care staff in general need to change their habits.

So should doctors stop wearing a tie, a symbol of professionalism and efficiency? Well maybe so. This research is tying doctors to the spread of infection.

10/28/2005 About.com ARTICLE

Old Bugs Learn New Tricks

When antibiotics arrived 60 years ago, many experts thought it was the beginning of the end for infectious diseases. Sadly, they were wrong. Infections caused by viruses, fungi and other assorted critters never respond to antibiotics. As special drugs are developed for some of them, new foes such as bird flu crop up. And even bacteria, the true targets of antibiotics, have found ways to beat the rap. In most cases they change their genes to thwart antibiotics. Smart scientists fight back by creating new drugs—but, more often than not, the bugs find a way to give them the slip.

To see how it works—and what we can do about it—consider three important bugs that have recently found new ways to make us sick. The first is staph aureus, which has been part of the human condition since the beginning of recorded history. The bacterium's natural habitat is the human nose; at any one time, at least 25 percent of us harbor the germ. In most, it's a harmless fellow traveler, but it often travels from nose to hand to skin, where it causes pesky boils and infects "ingrown" hairs and nails. In an unlucky few, staph causes devastating infections of the blood and organs. These were highly lethal until penicillin came along. The drug was dramatically effective, but the bug rapidly changed its genes to produce penicillinase, an enzyme that chews up the antibiotic. Penicillin-resistant strains appeared first in hospitals, then spread to the community. By now, 95 percent of staph shrug off penicillin.

In response to the growing problem, researchers developed penicillinase-proof antibiotics. The first, in 1959, was methicillin, and a family of related drugs soon followed. But by 1960, methicillin-resistant staph aureus (MRSA) began to crop up in hospitals; by now it constitutes the majority of strains in some hospitals and has also exploded in the community.

Hospitals try to contain the spread of MRSA by handling infected patients with latex gloves and other precautions. At home, we should stress hand washing with soap and water as well as alcohol-based rubs. So far, community strains of MRSA are reassuringly susceptible to certain older oral antibiotics, but major infections should be treated with the same injected drugs used for hospital patients.

Compared with staph, Clostridium difficile (C. diff) is a newcomer. It was first diagnosed in 1978, when it appeared as an occasional cause of diarrhea in patients who were taking a particular antibiotic (clindamycin). By now, though, it is clear that virtually any antibiotic can trigger the problem. C. diff strikes at least 300,000 people in the United States each year, even some who haven't taken antibiotics. Many healthy people harbor a few C. diff among the millions of bacteria in the colon. When C. diff hangs out in the form of inert spores, it's harmless. But if antibiotic therapy knocks off the normal bacteria, C. diff springs to life, producing two toxins that attack the colon. Doctors can treat most cases by stopping the offending drug and prescribing metronidazole or vancomycin, oral antibiotics that target C. diff. But spore forms of the bug defy even these drugs, and diarrhea often recurs when treatment stops.

The next threat is a novel, highly virulent strain of C. diff that produces 16 to 23 times more toxin than its predecessors. Because the bug is so new, doctors have not yet determined if revised treatment guidelines are warranted. This new and dangerous form of C. diff makes it even more urgent that people with diarrhea, or people caring for people with diarrhea, scrupulously wash their hands with soap and water after any possible contact with the infected material to avoid spreading the germ or becoming infected themselves.

Finally, there's tuberculosis—a historic scourge of humankind. Even now, it is the leading infectious cause of death in the world, accounting for more than 2 million deaths a year. We've been much luckier in this country. As a result of improved social and economic conditions, the incidence of TB began to decline around 1900 and nearly disappeared with the discovery of anti-TB drugs in midcentury. But in 1984, an alarming upturn developed. It was fueled by HIV and homelessness, and it featured a rise in multidrug-resistant (MDR) TB. Ordinary TB can be cured by six months of combination therapy. But MDR strains defy the standard drugs.

In this country, TB plateaued in 1992 and has declined steadily since because of aggressive diagnosis and strict isolation of cases. Still, there's no room for complacency. In 2006, doctors in South Africa identified a new, extensively drug-resistant (XDR) strain of TB. So far it has been confined to AIDS patients in South Africa, but it's a small world, and infections respect no borders. We need new drugs for TB. But we also need to use the resources that we already have to deliver medical care to the developing world. If we fight the war against TB on that turf, we may not have to fight it on our own turf.

By Harvey B. Simon, M.D.
Newsweek, Dec. 11, 2006 issue

JaniceCarr / CDC-Reuters

Overuse of Antibiotics Strengthens Bacteria

Your nose is dripping green and yellow fluid, your sinuses are plugged and your child has an ear infection, so you need antibiotics. Right? Wrong, say public health officials, alarmed at the growing number of antibiotic-resistant infections such as MRSA and C-difficile.

Overuse of antibiotics means bacteria, which have the single-minded purpose of surviving and multiplying, will start to develop an immunity.

"Eventually, if you give enough antibiotics, with enough germs around, some of them will become resistant," said Dr. Richard Stanwick, Vancouver Island chief medical officer. "We have some absolutely magic bullets to deal with infection," he said, "and we shouldn't squander them."

The ultimate horror movie for medical practitioners is a world where bacteria have become resistant to all antibiotics.
"There's not a lot of research and development going into new antibiotics," said Dr. Bonnie Henry, epidemiologist with the B.C. Centre for Disease Control. "As we haven't developed new ones, we should be careful to better use the ones we have."
The major problem is over-prescribing, sometimes for viral infections, which cannot be helped by antibiotics. Most coughs and colds are caused by viruses, not bacteria. Patients often pressure general practitioners to prescribe antibiotics for problems that can be addressed by other means, Henry said.

The Center for Disease Control in the U.S. uses an innovative website (www.dobugsneeddrugs.org) to get the message out to the public and doctors.

The website, with sections for everyone from children to health professionals, hammers home the message that many infections do not need antibiotics and gives tips on how to avoid picking up bugs.

There is also growing concern over the amount of antibiotics used in commercial food industries, and the Center for Disease Control is one of the leaders in a collaborative project called Farm to Fork, looking at antibiotic use in feed animals.
"We're not yet sure what the link is," Henry said.

Judith Lavoie, Times Colonist, Monday, January 08, 2007

Clostridium Difficile Infection

Clostridium difficile, or C. difficile (a gram-positive anaerobic bacterium), is now recognized as the major causative agent of colitis (inflammation of the colon) and diarrhea that may occur following antibiotic intake. C. difficile infection represents one of the most common hospital (nosocomial) infections around the world. In the United States alone, it causes approximately three million cases of diarrhea and colitis per year. This bacterium is primarily acquired in hospitals and chronic care facilities following antibiotic therapy covering a wide variety of bacteria (broad-spectrum) and is the most frequent cause of outbreaks of diarrhea in hospitalized patients. One of the main characteristics of C. difficile-associated colitis is severe inflammation in the colonic tissue (mucosa) associated with destruction of cells of the colon (colonocytes).

The disease involves, initially, alterations of the beneficial bacteria, which are normally found in the colon, by antibiotic therapy. The alterations lead to colonization by C. difficile when this bacterium or its spores are present in the environment. In hospitals or nursing home facilities where C. difficile is prevalent and patients frequently receive antibiotics, C. difficile infection is very common. In contrast, individuals treated with antibiotics as outpatients have a much smaller risk of developing C. difficile infection. Laboratory studies show that when C. difficile colonize the gut, they release two potent toxins, toxin A and toxin B, which bind to certain receptors in the lining of the colon and ultimately cause diarrhea and inflammation of the large intestine, or colon (colitis). Thus, the toxins are involved in the pathogenesis, or development of the disease.

Transmission Factors - An important characteristic of C. difficile-associated diarrhea and colitis is its high prevalence among hospitalized patients. Thus, C. difficile contributes significantly to hospital length of stay, and may be associated in some elderly adults with chronic diarrhea, and occasionally other serious or potentially life-threatening consequences. One study demonstrated that 20% of patients admitted to a hospital for various reasons were either positive for C. difficile on admission or acquired the microorganism during hospitalization. Interestingly, only one-third of these patients developed diarrhea while the remainder were asymptomatic carriers serving as a reservoir of C. difficile infection. The organism and its spores were also demonstrated in the hospital environment, including toilets, telephones, stethoscopes, and hands of healthcare personnel.

While patient-to-patient spread and environmental contamination can be some of the reasons of cross-infection in C. difficile-associated diarrhea and colitis, antibiotic therapy is the major risk factor for this disease. Thus, antibiotic use only when necessary is the most effective measure of preventing C. difficile infection.

Clinical Features - A wide range of conditions is associated with C. difficile infection. Most cases develop 4 to 9 days after the beginning of antibiotic intake. It should be noted, however, that some patients develop diarrhea after antibiotics are discontinued and this may lead to diagnostic confusion. Although nearly all antibiotics have been implicated with the disease, the commonest antibiotics associated with C. difficile infection are ampicillin, amoxicillin, cephalosporins, and clindamycin.

The most common presentation is either mild colitis, or simple diarrhea that is watery and contains mucus but not blood. Examination by sigmoidoscopy usually reveals normal colonic tissue. General symptoms are commonly absent and diarrhea usually stops when antibiotics are discontinued. C. difficile can also cause non-specific colitis quite reminiscent of other intestinal bacterial infections such as Shigella or Campylobacter. This is a more serious illness than simple antibiotic-associated diarrhea; patients experience watery diarrhea 10 to 20 times a day and lower, crampy abdominal pain. Low-grade fever, dehydration, and non-specific colitis are common manifestations.

Pseudomembranous colitis represents the characteristic manifestation of full-blown C. difficile-associated colitis. Sigmoidoscopic examination reveals the presence of characteristic plaque-like pseudomembranes, scattered over the colonic tissue. The presence of these plaques is a distinctive indicator of C. difficile infection in patients with diarrhea following antibiotic treatment.

The most serious manifestation of C. difficile infection, fulminant colitis (severe sudden inflammation of the colon), is frequently associated with very serious complications. This can be a life-threatening form of C. difficile infection and occurs in 3% of patients; most are elderly and debilitated from other diseases. Patients with this form of the disease experience severe lower abdominal pain, diarrhea, high fever with chills, and rapid heart beat. Timely treatment of fulminant colitis is essential; this condition can be life threatening.

C. difficile infection in patients with other intestinal diseases - It is well documented that C. difficile may complicate the course of ulcerative colitis or Crohn's disease and it is responsible for 4 to 12% of diarrhea in AIDS patients. In this case, patients develop the typical symptoms of C. difficile colitis, including diarrhea, abdominal pain, and fever reminiscent of exacerbation of inflammatory bowel disease. The reason for this complication is not entirely clear. It may be that the frequent hospitalizations and exposure to antibiotics of patients with inflammatory bowel disease or AIDS places them at increased risk for the infection. So far there is no evidence to indicate that C. difficile can complicate the symptoms associated with irritable bowel syndrome (IBS).

Laboratory Diagnosis - The laboratory diagnosis of C. difficile infection is primarily related to the demonstration of C. difficile toxins in the stool of suspected patients. The detection of C. difficile toxins in the stool can be made by a laboratory test (cytotoxicity assay) where the toxins can be easily observed in the microscope. This tissue culture assay is considered the gold standard because of its high sensitivity and specificity. Since there is no correlation between levels of C. difficile toxins in the stool and severity of the disease, the results are reported simply as "positive" or "negative." However, time is a drawback of this assay since it requires 24 to 48 hours to read the results.

Over the past few years several rapid tests that take just a few hours, and which do not require specialized personnel to run, have been developed (immuno-enzymatic assays) for the detection of C. difficile toxins in the stool. These tests are commercially available in the form of diagnostic kits. Although they are relatively less sensitive and demonstrate lower specificity compared to the laboratory tests, they are very useful not only in the every day practice when specialized personnel is not available, but also in emergency situations and in rapid screening of patients during spreading of the disease in hospitals.

Therapy - Therapy of C. difficile is directed against eradication of the microorganism from the colonic microflora. No therapy is required for asymptomatic carriers. In noncomplicated patients with mild diarrhea, no fever, and modest lower abdominal pain, discontinuation of antibiotics (if possible) is often enough to alleviate symptoms and stop diarrhea. When severe diarrhea is present and in cases of established colitis, the patients should receive the antibiotics, metronidazole or vancomycin, for 10 to 14 days. Several clinical trials have shown that these antibiotics are equally effective in cases of mild to moderate C. difficile infection and more than 95% of patients respond very well to this treatment. Diarrhea following treatment with either vancomycin or metronidazole is expected to improve after 1 to 4 days with complete resolution within 2 weeks. However, some patients do not respond despite aggressive medical therapy and require surgical intervention.

Therapy for relapsing C. difficile infection - Although C. difficile infection usually responds well to treatment with metronidazole or vancomycin, approximately 15 to 20% of patients will experience re-appearance of diarrhea and other symptoms weeks or even months after initial therapy has been discontinued. The usual therapy for relapse is to repeat the 10 to 14 day course of either metronidazole or vancomycin and this is successful in most patients. However, a subset of patients continues to relapse whenever antibiotics are discontinued and this represents a therapeutic challenge. Some authorities recommend switching to the alternative antibiotic from the one used initially. A variety of other therapies have also been described for relapsing disease. It is hoped that development of vaccines against C. difficile toxins may someday control the problem of C. difficile infection in hospitals.


Article by: Charalabos Pothoulakis, M.D., Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

The SHEA Guideline Approach

A highly promising new strategy to help prevent and control hospital acquired infections is the use of “Active Surveillance Cultures” (ASCs) to screen patients for otherwise hidden nasal carriage of MRSA (methicillin-resistant Staphylococcus aureus).

ASC, in conjunction with “Contact Isolation" of known and suspected colonized or infected patients + Vigilant Hand Hygiene is known as “The SHEA Guideline Approach”.

When hospitals insist on universal compliance by its staff, The SHEA Guideline Approach leads to a significant reduction of morbidity and associated healthcare costs.

The SHEA Guideline Approach is authored by Carlene A. Muto; MD, John A Jernigan, MD, MS; Belinda E. Ostrowsky, MD, MPH; Herve’ M. Richet, MD; William R. Jarvis, MD; John M. Boyce, MD and Barry M. Farr, MD, MSc.

First Do No Harm

While there's plenty of controversy out there as to the best way to beat MRSA and other dangerous hospital acquired infections, one thing is for certain - good hand hygiene is an important component of the Physicians Credo, "First Do No Harm". Here are the CDC Hand Washing and Hand Antisepsis Recommendations for doing just that.

I. Indications for Hand-washing and Hand Antisepsis:

A. When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a non-antimicrobial soap and water or an antimicrobial soap and water.

B. If hands are not visibly soiled, use an alcohol based hand rub for routinely decontaminating hands in all other clinical situations described in items I C-J. Alternatively, wash hands with an antimicrobial soap and water in all Clinical Situations described in items I C J.

C. Decontaminate hands before having direct contact with patients.

D. Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter.

E. Decontaminate hands before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure.

F. Decontaminate hands after contact with a patient’s intact skin (e.g., when taking a Pulse or blood pressure, and lifting a patient).

G. Decontaminate hands after contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings if hands are not visibly soiled.

H. Decontaminate hands if moving from a contaminated body site to a clean body site during patient care.

I. Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.

J. Decontaminate hands after removing gloves.

K. Before eating and after using a restroom, wash hands with a non antimicrobial soap and water or with an antimicrobial soap and water.

L. Antimicrobial impregnated wipes (i.e., towelettes) may be considered as an alternative to washing hands with non antimicrobial soap and water. Because they are not as effective as alcohol based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of HCWs they are not a substitute for using an alcohol based hand rub or antimicrobial soap.

M. Wash hands with non antimicrobial soap and water or with antimicrobial soap and water if exposure to Bacillus anthracis suspected or proven. The physical action of washing and rinsing bands under such circumstances is recommended because alcohols, chlorhexidine iodophors, and other antiseptic agents have poor activity against spores.

N. No recommendation can be made regarding the routine use of non-alcohol based hand rubs for hand hygiene in health care settings. Unresolved issue.

II. Hand Hygiene Technique:

A. When decontaminating hands with an alcohol based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Follow the manufacturer’s recommendations regarding the volume of product to use.

B. When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet. Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis.

C. Liquid, bar, leaflet or powdered forms of plain soap are acceptable when washing hands with a non-antimicrobial soap and water. When bar soap is used, soap racks that facilitate drainage and small bars of soap should be used.

D. Multiple use cloth towels of the hanging or roll type are not recommended for use in health care settings.

III. Surgical Hand Antisepsis:

A. Remove rings, watches, and bracelets before beginning the surgical hand scrub.

B. Remove debris from underneath fingernails using a nail cleaner tinder running water.

C. Surgical hand antisepsis using either an antimicrobial soap or an alcohol based hand rub with persistent activity is recommended before donning sterile gloves when performing surgical procedures.

D. When performing surgical hand antisepsis using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the manufacturer, usually 2 6 minutes. Long scrub times (e.g., 10 minutes) are not necessary.

E. When using an alcohol based surgical hand scrub product with persistent activity, follow the manufacturer’s instructions. Before applying the alcohol solution, pre-wash hands and forearms with a non antimicrobial soap and dry hands and forearms completely. After application of the alcohol based product as recommended, allow hands and forearms to dry thoroughly before donning sterile gloves.

IV. Selection of Hand-Hygiene Agents:

A. Provide personnel with efficacious hand hygiene products that have low irritancy potential, particularly when these products are used multiple times per shift. This recommendation applies to products used for hand antisepsis before and after patient care in clinical areas and to products used for surgical hand antisepsis by surgical personnel.

B. To maximize acceptance of hand hygiene products by HCWs, solicit input from these employees regarding the feel, fragrance, and skin tolerance of any products under consideration. The cost of hand-hygiene products should not be the primary factor influencing product selection.

C. When selecting non antimicrobial soaps, antimicrobial soaps, or alcohol based hand rubs, solicit information from manufacturers regarding any known interactions between products used to clean hands, skin care products, and the types of gloves used in the institution.

D. Before making purchasing decisions, evaluate the dispenser systems of various product manufacturers or distributors to ensure that dispensers function adequately and deliver an appropriate volume of product.

E. Do not add soap to a partially empty soap dispenser. This practice of “topping off” dispensers can lead to bacterial contamination of soap.

V. Skin Care:

A. Provide HCWs with hand lotions or creams to minimize the occurrence of irritant contact dermatitis associated with hand antisepsis or hand washing.

B. Solicit information from manufacturers regarding any effects that hand lotions, creams, or alcohol-based hand antiseptics may have on the persistent effects of antimicrobial soaps being used in the institution.

VI. Other Aspects of Hand Hygiene:

A. Do not wear artificial fingernails or extenders when having direct contact with patients at high risk (e.g., those in intensive care units or operating rooms).

B. Keep natural nails tips less than ¼ inch long.

C. Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, and non-intact skin could occur.

D. Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient, and do not wash gloves between uses with different patients.

E. Change gloves during patient care if moving from a contaminated body site to a clean body site.

F. No recommendation can be made regarding wearing rings in health care settings. Unresolved issue.

VII. Health Care Worker Educational and Motivational Programs:

A. As part of an overall program to improve hand-hygiene practices of HCWs, educate personnel regarding the types of patient care activities that can result in hand contamination and the advantages and disadvantages of various methods used to clean their hands.

B. Monitor HCWs’ adherence with recommended hand hygiene practices and provide personnel with information regarding their performance.

C. Encourage patients and their families to remind HCWs to decontaminate their hands.

VIII. Administrative Measures:

A. Make improved hand hygiene adherence an Institutional priority and provide appropriate administrative support and financial resources.

B. Implement a multidisciplinary program designed to improve adherence of health personnel to recommended hand hygiene practices.

C. As part of a multidisciplinary program to improve hand hygiene adherence, provide HCWs with a readily accessible alcohol based hand rub product.

D. To improve hand hygiene adherence among personnel who work in areas in which high workloads and high intensity of patient care are anticipated, make an alcohol based hand rub available at the entrance to the patient’s room or at the bedside, in other convenient locations, and in individual pocket sized containers to be carried by HCWs.

E. Store supplies of alcohol based hand rubs in cabinets or areas approved for flammable materials.

Performance Indicators:

The following performance indicators are recommended for measuring improvements in HCWs’ hand hygiene adherence:

A. Periodically monitor and record adherence as the number of hand hygiene episodes performed by personnel/number of hand hygiene opportunities, by ward or by service. Provide feedback to personnel regarding their performance.

B. Monitor the Volume of alcohol based hand rub (or detergent used for handwashing or hand antisepsis) used per 1,000 patient days.

C. Monitor adherence to policies dealing with wearing of artificial nails.

D. When Outbreaks of infection Occur, assess the adequacy of health care worker hand hygiene.

HAI Facts

FACT: In the United States, every minute of every day an average of 4 people become contaminated with a hospital acquired infection. Not only that, more people in our country die from bacterial infections they caught in the hospital than from AIDS, Breast Cancer and automobile accidents combined. It’s a disgrace that more than 90,000 people annually never survive the infections they accidentally catch while being cared for as patients in American hospitals, originally admitted for totally unrelated health care procedures.

FACT: The Center for Disease Control says that over 2,000,000 people in the U.S. are catching hospital-acquired infections every year. That’s 5,400 daily. Of those, approximately 250 people per day fail to survive - the number is unthinkable.
If the reality of this figure is ever properly communicated to the American public as a daily lump sum death toll, the associated outrage for answers and a solution to end these avoidable deaths immediately would be powerfully overwhelming. Why not here, now?

FACT: There is an urgent need for people to be re-educated about the hospital experience. When we enter a hospital, we are engaging a completely different environment than the one existing outside of those glass doors. Within these walls there are new strains of bacterial enemies and new rules we must learn to follow in order to help to produce a healthy, acceptable outcome for the patient we are there to visit. The need for an entire culture change is quickly becoming evident throughout all health care.

FACT: The Center for Disease Control says that if health care providers and visitors will simply sanitize their hands prior to touching the patient or objects in the room, they can effectively reduce bacterial infections by as much as 30-40%. Is vigilant hand washing really all that hard to do?

FACT: It has been estimated that the average cost of a hospital stay for patients who acquired infections was approximately $50,000 more than for those who did not acquire infections; even if we pare that figure to say, $10,000 per incident, that equates to at least $20 Billion Annually. Health insurance companies partnering with SAFE CARE CAMPAIGN can not only help save precious lives but can also cut the costs of unnecessarily increased length-of-care payouts.

FACT: According to the Mayo Clinic, alcohol-based hand sanitizers are an excellent alternative to hand washing, particularly when soap and water aren't available. Alcohol-based hand sanitizers are actually proven to be more effective than soap and water in killing bacteria and viruses that cause disease. Commercially prepared hand sanitizers contain ingredients that help prevent skin dryness. Using these products can result in less skin dryness and irritation than hand washing.