Unlike the brilliant ESKAPE acronym, I cannot (at least
in the 20 minutes I gave myself) come up with a catchy acronym for
Acinetobacter, Clostridium difficile, MRSA, Norovirus, Pseudomonas and
VRE. ACMNPV is simply the first letter
of each. Perhaps PNAVCM of VACNMP would be better?
Regardless, according to the December 2013 Primer on Hospital Pathogens published by ICT, these are the pathogens most prevalent in
the hospital environment. These are the
pathogens that should be of significant concern to Infection Preventionists
(IPs). But why?
Acinetobacter baumannii is a lovely gram negative bacterium that can inflict a
wide range of diseases - bacteraemia, wound infections or pneumonia to name a
few. While it poses very little risk to
healthy individuals, those with suppressed immune systems (e.g. patients in
ICUs, Burn Units) or chronic underlying diseases (e.g. diabetes or COPD etc)
present the perfect target for this opportunistic little bugger. From an environmental impact perspective,
Acinetobacter is transmitted via contact (e.g. person to person or indirect via
contact with fomites) and is believed to survive in the environment for several
days and perhaps up to months.
Clostridium difficile is a spore forming gram positive
bacterium. It's the spore forming or
suit of armor creating characteristic that has caused many a grey hair for IPs
around the world. In fact, C. diff
accounts for 15 - 25% of all cases of antibiotic-associated diarrhea. The suit of armor helps increase the length
of survival in the environment making the need for diligent cleaning and
disinfection all the more important and by diligent, I in no way mean that you
try to nuke all surfaces with a sporicidal agent, I mean that we need to do a
thorough job in cleaning and physically removing soils and spores from
environmental surfaces and patient care equipment. But don't just blame the environment or the
housekeeper, antibiotics are the primary cause for development of C.diff
Diarrhea - be sure to look at and question antibiotic prescription practices by
doctors.
Methicillin Resistant Staphylococcus aureus or MRSA to
those in the know, is a gram positive bacterium that is resistant to many
different antibiotics. At any given
time, between 20 and 30 per cent of the general population carry Staph bacteria
and /or MRSA on their hands or in their noses, but are not ill. This is particularly concerning as
researchers have shown that MRSA can survive on environmental surfaces for up
to 56 days! Similar to Acinetobacter,
MRSA can be transmitted via both direct and indirect contact so environmental
hygiene (e.g. cleaning and disinfection) cannot be underestimated in its
importance for keeping MRSA off the surfaces to stop transmission. The good news is that according to U.S.
health officials, MRSA infections have fallen by nearly 30 percent in the last
decade.
Norovirus - a wonderful winter weight loss program - is a
non-enveloped virus that is quite resistant to many of our commonly used
day-to-day disinfectants. It does not
take much of hardy little terrorist to cause infection and can live in
virtually any environment (including at freezing temperatures to 60C/140F). Transmission is primarily caused by eating
poop (the less technical way of stating fecal-oral) and can survive on surfaces
for up to 14 days. While we often panic
over the antibiotic resistant bacteria, we cannot underestimate the economic
burden of Norovirus as it is estimated to cause up to 21 MILLION cases of
gastroenteritis (aka puking and pooping) per year in the US. Best of all you just have to "ride"
it out - viruses are not susceptible to treatment with antibiotics. Focusing on cleaning and disinfection with a
disinfectant that is effective against Norovirus and judicious hand hygiene are
the best means to deal with this bad guy.
Pseudomonas aeruginosa (most commonly referred to as
Pseudo) is a gram negative bacterium that is widely found in the environment
and particularly found on water and moist conditions and accounts for about 10%
of all HAIs. Like MRSA and Acinetobacter
it can be transmitted by both direct and indirect contact and is more concerning
to patient with weakened immune systems.
While, Pseudo loves moist environments, it has been found to survive on
dry surfaces for up to 16 months and can cause all sorts of infections
(bacteraemia, pneumonia, UTIs etc) depending on its portal of entry (e.g. how
it got into you). As you've likely
guessed, cleaning and disinfection and hand hygiene will help stop the spread.
Lastly, VRE or Vancomycin Resistant Enterococci are a group of gram positive bacteria that
are naturally present in our intestines, in the female genital tract and the environment. As the name would imply, they are resistant
to some classes of antibiotics and as expected is more concerning with people
who have weakened immune systems. VRE
is a hardy little pest that can survive for extended periods of time in the
environment and can be transmitted by both direct and indirect
transmission. Because of its ability to
survive in the environment, if cleaning and disinfection is not completed with
utmost care researchers have shown there is a VERY strong chance of the next person
admitted into a room or bed previously occupied by someone with VRE.
I would expect the organisms we just reviewed are already
on your hit list for infection prevention programs and intervention
strategies. The key (or theme) I hope
you picked up is the association with transmission from contaminated
surfaces. Cleaning saves lives, but
cleaning is not something that can be rushed because short cuts will cost
lives.
Bugging Off!
Nicole
