A simple and soapy solution to prevent Superbug infections

Hospitals and retirement homes in California and Illinois in the United States are testing a surprisingly simple strategy to fight against dangerous and antibiotic-resistant superbugs that kill thousands of people every year: washing patients with soap special.

Efforts – funded with approximately US $ 8 million (33 million rand) from the US Federal Government's Centers for Disease Control and Prevention (CDC) – are taking place in 50 facilities in both states.

This innovative approach recognizes that superbugs do not remain isolated in a hospital or retirement home, but move quickly from one community to another, said Dr. John Jernigan, director of the US CDC's Office for Research on Diseases. infections contracted in health facilities.

"No health facility is an island," he said. "We are all in this complicated network."

In the United States, at least two million people are infected each year with an antibiotic-resistant bacterium, and about 23,000 people die from it, according to the US CDC.

Hospitalized people are vulnerable to these insects, and people living in retirement homes are particularly vulnerable.

According to Dr. Susan Huang, an infectious disease specialist at the University of California (UC) -Ivrin, up to 15% of hospitalized patients and 65% of nursing home residents harbor drug-resistant organisms, although not all develop an infection. , US.

"The superbugs are scary and they do not falter," she said. "They do not leave."

Some of the most common bacteria in health care settings are methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE), often referred to as "nightmarish bacteria".

The two common germs that can become resistant to last-resort antibiotics, carbapenems, are: Escherichia coli and Klebsiella pneumoniae.

CRE bacteria cause about 600 deaths a year, according to the US CDC.

They have "spread" widely among health facilities in the Chicago area, said Dr. Michael Lin, an infectious disease specialist at Rush University Medical Center, who leads the CDC-funded mission in the United States.

"If MRSA is a super-bacterium, it's the extreme – the super-super-bacterium."

Targeting retirement homes

Containing dangerous bacteria has been a challenge for hospitals and retirement homes.

As part of CDC efforts in the US, doctors and health professionals in Chicago and Southern California use chlorhexidine antimicrobial soap, which has helped reduce infections when patients bathe with it.

Although chlorhexidine is frequently used for baths in intensive care units (ICUs) in hospitals and as a mouthwash for dental infections, it is less used for baths in nursing homes.

In Chicago, researchers are working with 14 retirement homes and long-term care hospitals, where staff are examining people to detect CRE bacteria at admission and bathing them daily with chlorhexidine.

The Chicago project, which began in 2017 and ends in September, includes a campaign to promote handwashing and increased communication between hospitals where patients carry drug-resistant organisms.

The work of infection control was new in many retirement homes, which do not have the same resources as hospitals, said Dr. Lin.

In fact, according to an badysis by Kaiser Health News, three-quarters of nursing homes in the United States have received citations for infection control problems over a four-year period, and facilities with repeated citations do not have the same effect. have almost never been fined.

Residents of retirement homes are often sent back to hospitals because of infections.

In California, health officials are closely monitoring CRE bacteria, which are less present there than elsewhere in the country, and are trying to prevent CRE from setting up there, said Dr Matthew Zahn, Medical Director of Epidemiology at the Orange County Health Care Agency. .

"We do not have an infinite duration," he said. "It is very important to try to change the trajectory of CRE now."

The US-funded CDC project in California is based in Orange County, where 36 hospitals and nursing homes use antiseptic washing with an iodine-based nasal swab.

The goal is to prevent new people from contracting drug-resistant bacteria and prevent infections from developing those that already have them on the skin or elsewhere, said Dr. Huang, who is leading the project.

She initiated the project by studying patient movements in various hospitals and retirement homes in Orange County and discovered that they were doing much more than they expected.

This sparked a key question: "What can we do to protect not only our patients, but also to protect them when they begin to move everywhere?", She recalled.

His previous research had shown that MRSA patients who used chlorhexidine to wash and rinse their mouths and dabbed their noses with a nasal antibiotic could reduce their risk of getting MRSA by up to 30%.

But all patients in this study, published in February 2019 in the New England Journal of Medicine, had already been released from hospitals.

The goal now is to target patients still in hospitals or retirement homes and extend the work to the CRE.

Traditional hospitals participating in the new project are focusing on patients in intensive care units and those already carrying drug-resistant bacteria, while nursing homes and long-term care hospitals are cleaning – also called "Decolonization" – of each resident.

Promising start

A recent morning, at the Coventry Court Health Center, a retirement home in Anaheim, California, 94-year-old Neva Shinkle sat patiently in her wheelchair.

Joana Bartolome, a nurse specialized in vocational training, was wiped her nose and asked if she remembered what had happened.

"It kills germs," ​​Shinkle replied.

"It's true, it protects you from infection," Bartolome replied.

In a nearby room, Raveena Singh, UC-Irvine project coordinator, spoke with Caridad Coca, 71, who recently arrived on the site.

She explained that Coke would wash herself with chlorhexidine rather than with ordinary soap.

"If you have some kind of open wound or cut, it protects you from infection," Raveena said.

"And we do not just protect you, a person. We protect everyone in the retirement home. "

Coke told that she had a cousin who had spent months in the hospital after contracting MRSA. "Fortunately, I never had it," she says.

Coventry Court Administrator Shaun Dahl said he was eager to attend because people were arriving at the nursing home carrying MRSA or other insects.

"They were sick there and they are sick here," he said.

The results of the Chicago project are pending. Preliminary results from the Orange County project, which ends in May, show that it seems to work, said Dr. Huang.

After 18 months, researchers found a 25% decrease in drug-resistant organisms among nursing home residents, 34% in long-term care hospital patients and 9% in traditional hospital patients.

The most dramatic decreases were observed in CRE, although the number of patients with this type of bacteria was smaller.

Preliminary data also shows a promising training effect in facilities that are not part of the effort, a sign that the project may be starting to make a difference in the county, said Dr. Zahn.

"In our community, we have seen an increase in antimicrobial resistant infections," he said.

"It provides an opportunity to step in and move the curve in the right direction." – Kaiser Health News / Tribune News Service