Prevent Colds and Flu: Wash Your Hands

Washing your hands with soap and water is one of the best ways to avoid getting sick and spreading germs to others, especially during cold and flu season. Handwashing can prevent 1 in 5 respiratory infections, such as colds and flu, and 1 in 3 diarrhea-related sicknesses.

Wash Your Hands Often

Wash your hands with soap and water at these key times to prevent the spread of germs and stay healthy during cold and flu season:
• Before, during, and after preparing food
• Before eating food
• Before and after caring for someone at home who is sick with vomiting or diarrhea
• After blowing your nose, coughing, or sneezing
• After using the toilet
• Wash Your Hands the Right Way

Washing your hands the right way removes more germs, like those that cause cold and flu. Help prevent the spread of colds, flu, and other diseases by washing your hands with soap and water and scrubbing for at least 20 seconds each time.


Washing your hands correctly is the best way to stop the spread of infections

Eighty percent of common infections are spread by hands. Washing your hands at least five times a day has been shown to significantly decrease the frequency of colds, influenza (the “flu”) and other infections. Not only will it help keep you healthy, it will help prevent the spread of infectious diseases to others.

Handwashing & infection prevention

Even if your hands appear to be clean, they may carry germs. Hands pick up micro-organisms (germs) in a number of ways. When people who are sick sneeze or cough, the germs that are making them sick are expelled into the air in tiny droplets. If these droplets get onto your hands, and then you touch your mouth, eyes or nose without washing away the germs, you can pick up the infection. You can also get sick if you don’t wash your hands before and after preparing food, after handling raw meat and after using the toilet.

Washing your hands not only prevents you from getting sick, it reduces the risk of infecting others. If you don’t wash your hands properly before coming into contact with others, you can infect them with the germs on your hands. Other people can also get sick from the germs that unwashed hands leave on shared objects such as doorknobs, keyboards and other equipment in the home or workplace.

When to wash your hands

• Before and after eating or feeding someone else
• Before preparing food
• After handling raw meat
• After using the washroom or helping someone use the washroom
• Before and after changing diapers
• After sneezing, coughing or using a tissue
• After helping someone with a runny nose
• Before and after caring for someone who is sick
• Before performing first aid or applying a bandaid
• After handling pets or other animals
• After handling animal waste
• After handling shared objects
• After playing with toys shared with other children
• After playing outside or in the sandbox
• After cleaning or handling garbage
• Before inserting and removing contact lenses
• Before flossing your teeth
• Before breastfeeding

Proper methods of handwashing

Although hand washing might seem like a simple task, you should follow these steps to thoroughly rid your hands of germs.

What kind of soap to use

• Use plain soap that does not contain antibacterial agents. Plain soap will remove the dirt and grease that attract bad bacteria.
• Plain soap will not kill the good bacteria that live on the hands.
• Using antibacterial products unnecessarily increases the concentration of antibiotics in the water supply and in the environment and may contribute to antibiotic resistance.

Steps when using soap

• Remove any hand or arm jewellery you may be wearing.
• Wet your hands with warm water.
• Apply plain soap to your hands and rub together for 20 seconds (the length of time it takes to sing Twinkle Twinkle Little Star or Happy Birthday)
• Wash the front and back of your hands, as well as between your fingers and under your nails.
• Rinse your hands well for 10 seconds under warm running water, using a rubbing motion.
• Wipe and dry your hands gently with a paper towel or a clean towel. Drying them vigorously can damage the skin.
• Turn off the tap using the paper towel so that you do not re-contaminate your hands. When using a public bathroom, use the same paper towel to open the door when you leave.
• If skin dryness is a problem, use a moisturizing lotion.

Steps when using alcohol-based hand rubs

• These products need to be at least 60% alcohol to be effective, so check the label.
• Alcohol-based hand rubs do not cause antibiotic resistance.
• Alcohol-based hand rubs kill many bacteria and viruses, but are not effective against some of the germs that cause diarrhea.
• Alcohol-based hand rubs are quick to use. They are especially convenient when soap and water are not available.
• Alcohol-based hand rubs don’t work if your hands are greasy or visibly dirty. • These products don’t clean your hands and are not a substitute for handwashing. If your hands are visibly soiled, it is best to use soap and water.
If it’s not possible to wash with soap and water, use towelettes to remove the soil, then use an alcohol-based hand rub.
• Make sure your hands are dry, as wet hands will dilute the alcohol-based hand product.
• Use enough of the product to cover all the surfaces of your hands and fingers.
• Rub your hands together until the product has evaporated.
• If dry skin is a problem, use a moisturizing lotion.
• Alcohol-based hand rubs are safe for children if used with supervision. Alcohol-based hand rubs are poisonous if ingested. Children should not put their hands in their mouths until the alcohol evaporates (about 15 seconds).
• Wall dispensers and containers of alcohol-based hand rubs should be placed so they cannot be reached by small children.
• Alcohol-based hand rubs are flammable and should not be stored near a source of heat.

Minimizing your risks

Here are further steps you can take to protect yourself and your family:

• When you cough or sneeze, use a tissue or raise your arm up to your face and aim for your sleeve. Do not sneeze into your hand. Throw away tissues as soon as you use them
• Keep the surface areas in your home and office free of germs by cleaning them. Doorknobs, light switches, telephones, and keyboards are especially important to keep clean.
• If you have children, teach them good hygiene and how to wash their hands properly. Young children should be supervised while washing their hands.
• If you use bar soap, keep it in a self-draining holder that can be cleaned thoroughly before a new bar is added.
• Use individual damp cloths to wash each child’s hands when a sink with warm running water is unavailable
• Use fresh running water to rinse your hands rather than using a standing basin of water.
• Use individual hand towels and avoid sharing towels.
• Change cleaning cloths daily and launder them using detergent. Germs thrive on moist surfaces.

 

This information is taken from the Do Bugs Need Drugs? handwashing page and from The Benefits of Hand Washing (Health Canada).


Antibiotics cannot treat the flu or the common cold

The only common illness that affects children and requires an antibiotic every time is strep throat. Doctors won’t prescribe antibiotics if your child is sick with the flu or a cold because the treatment would be useless for those conditions.

Taking antibiotics when they’re not necessary can lead to antibiotic resistance in the body, one of the most urgent threats to public health, according to the Centers for Disease Control and Prevention (CDC).

“Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result,” according to the CDC. “Many more die from complications from antibiotic-resistant infections.”

Antibiotics are used to treat serious infections such as pneumonia and life-threatening conditions such as sepsis. Sometimes people at high risk for developing infections also need antibiotics, such as patients who have end-stage kidney disease, patients undergoing surgery or those receiving chemotherapy treatment, according to the CDC.

But viruses that cause colds, the flu, bronchitis or runny noses cannot be treated with antibiotics.

When are antibiotics appropriate?

In short, antibiotics only work on bacteria and not on viruses.

“Using an antibiotic when you don’t need it is a problem because these drugs don’t just kill off harmful bacteria; they also take a toll on the beneficial bacteria inside your body that help to help keep you healthy,” according to Harvard Medical School.

But even some bacterial infections get better without antibiotics, according to the CDC. “Antibiotics aren’t needed for many sinus infections and some ear infections,” reports the CDC. “Antibiotics save lives, and when a patient needs antibiotics, the benefits usually outweigh the risk of side effects and antibiotic resistance. When antibiotics aren’t needed, they won’t help you, and the side effects could still cause harm.”

When children need antibiotics

For children with the common cold, the flu or an upset stomach, antibiotics are not the answer. In fact, they could cause more harm than good down the road when the body actually does need these life-saving drugs.

According to Memorial Regional Health, strep throat is really the only common illness that affects kids that requires an antibiotic every single time. For other illnesses, MRH doctors will likely tell you to keep your child home from school to rest and drink plenty of fluids.

Taking unnecessary antibiotics doesn’t just affect the person taking them — including raising the risks of side effects that could cause harm such as nausea, dizziness, rash, diarrhea and yeast infections — but they also could cause harm to the community at large. When people become resistant to these drugs, the risk of the spread of certain diseases increases, such as tuberculosis, gonorrhea, typhoid fever and Group B streptococcus, reports the World Health Organization.

So, how do you avoid getting bacterial infections in the first place? Practice good hygiene, make sure you and your children receive recommended vaccinations, reduce your risk of foodborne illness by cooking foods properly and washing your hands. And finally, don’t take antibiotics when you don’t need them.


November 13, 2019

By Lauren Glendenning/
Brought to you by Memorial Regional Health
Link to article


Wash Your Hands in the Kitchen and the Bathroom

The most dangerous antibiotic-resistant strains of E. coli are transmitted not through food but through contact with human feces.

While it’s important to wash your hands carefully after handling raw chicken, it may be even more important to wash them after going to the bathroom.

The most dangerous antibiotic-resistant strains of E. coli, called ESBLs, are transmitted not through food, according to new research, but through contact of human feces with human mouths.

British researchers examined many strains of ESBL-E. coli in human blood and feces, sewage, farm slurry, live animals, and raw meat, fruits and vegetables.

They found that one multidrug-resistant strain, ST131, responsible for a mortality rate as high as 35 percent in humans, was found in more than 60 percent of human bloodstream infections, but was extremely rare in live animals and nonexistent in foods.

The study, in Lancet Infectious Diseases, concludes that many of the E. coli strains that make people seriously ill come from other humans, not food or animals (though foods can also contain dangerous strains).
The senior author, David M. Livermore, a professor of microbiology at the University of East Anglia, explained that there are some strains of E. coli that are harmless and just live in your gut. Others cause mild food poisoning. And finally there are the E. coli that are antibiotic resistant and often lead to serious illness and death.

“Good kitchen hygiene remains important,” he said, “but with these antibiotic-resistant E. coli, toilet hygiene becomes vitally important.” For many of the strains that are causing major disease, “food is not the source. It’s humans.”

By By Nicholas Bakalar
Published Nov. 7, 2019
Updated Nov. 11, 2019
https://www.nytimes.com/2019/11/07


Hand Sanitizer Won't Kill Norovirus?

Hand sanitizer is a daily staple for parents on diaper duty, commuters who hold those rarely-cleaned handle bars on buses and subways, and many other people in between. In fact, according to global information company NPD Group, hand sanitizer sales in the United States shot up 37 percent from 2017 to 2018 alone. And while it’s perfectly fine to turn to this bottled product as a last resort, you shouldn’t opt for hand sanitizer over washing your hands in the sink if there’s clean water and soap available to you.

As it turns out, there’s a reason why most hand sanitizer companies don’t claim to kill 100 percent of germs and bacteria: Because they don’t. Some of the viruses and germs you’re leaving on your hands every time you opt for hand sanitizer instead of soap and water.

According to the Centers for Disease Control and Prevention (CDC), norovirus is a “very contagious virus” that can be spread via direct contact, contaminated food or drinks, and contaminated surfaces. And while thoroughly washing your hands (and your produce) is a good way to ensure your safety, using alcohol-based hand sanitizer isn’t quite as effective.

In one 2011 study published in the American Journal of Infection Control, researchers analyzed data from health departments in three states and found that the facilities that relied on hand sanitizer were more likely to experience a norovirus outbreak than those that favored hand-washing.


Effect of gloved hand disinfection on hand hygiene before infection- prone procedures on a stem cell ward

From February 2017 to April 2018, a tri-phase study was performed with the intervention ‘gloved hand disinfection’ at the stem cell unit of the University Medical Center, Goettingen, a tertiary care centre.

The stem cell ward comprises 16 beds in 10 patient rooms. The staff consisted of eight physicians and 18 female/male nurses, of whom five physicians and nine nurses were present each day. The ward had already been sufficiently equipped with alcohol-based hand rub (ABHR) dispensers; only alcoholic disinfectants were used.

During phase I (February to August 2017) baseline observation was performed to determine baseline hand hygiene compliance. During phase II (September 2017 to January 2018) gloved hand disinfection was strongly advised for predefined situations, but not enforced. Because gloved hand disinfection makes work easier, HCWs were keen to try this tool. If the HCW preferred regloving with proper hand rub instead of disinfecting gloves, the infection control professional (ICP) documented correct behaviour. During phase III (February to May 2018) gloved hand disinfection was restricted to discriminate intervention effects from time trends and learning effects. The gloved hand disinfection was restricted to workflows including at least one infection-prone procedure only within one patient. Examples were (not restricted to):

– preparing and handling with intravenous medication and/or blood products;

– manipulations at central or peripheral lines including blood sampling procedure.

The primary endpoint, on which the power analysis was based, was full hand hygiene compliance determined by direct observation (reference standard) according to the WHO protocol [18]. Hand hygiene compliance was defined by the number of performed hand rubs divided by the number of observed hand hygiene opportunities. Observation was performed by three ICPs. Inter-observer agreement was ≥90% after a six-week training period. The secondary endpoints were: (i) WHO indication-specific hand hygiene compliance, notably compliance ‘before aseptic tasks’, defined by the number of hand rubs performed divided by the number of observed indications for specific opportunities [18, 19]; (ii) incidence density of severe infection (defined by healthcare-associated primary bloodstream infection (HABSI; no. per 1000 patient days (PD)) and healthcare-associated pneumonia (HAP; no. per 1000 patient-days);(iii) incidence density (occurrence) of healthcare-acquired multidrug-resistant (micro-)organism (HA MDRO; no. per 1000 patient-days).

Severe infections (HABSI and HAP) were determined according national reference protocol designed for allogeneic stem cell transplant patients and adjusted at 1000 patient-days [20]. This protocol addressed patients undergoing allogeneic stem cell transplants and evaluated sepsis and pneumonia. HA MDROs were defined as meticillin-resistant Staphylococcus aureus (MRSA), extended spectrum β-lactamase (ESBL) r carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci. HA MDROs were defined according to the US Centers for Disease Control and Prevention guidelines for MDRO management [21, 22]. Specimens from outpatients and inpatients of less than four days were excluded. Patient specimens included samples taken routinely for screening and for investigation of possible infection. All data, obtained from the laboratory information system, were analysed and assessed daily by ICPs. Length of stay (patient-days) was determined using the patient management system. Hand hygiene observations were made during day shifts; one observation period lasted 30–90 min and a range of five to 25 opportunities was observed in each. An additional secondary endpoint, HCWs acceptance of gloved hand disinfection, was assessed using a standardized questionnaire, using an ordinal scale, applied to 10 selected HCWs (Appendix A, including Supplementary Figure S1).

The investigation was approved by the local ethics committee (Reference No. COMTRA-12/12/16).

For the study, nitrile-polymer gloves were used [17]. These were Purple-nitrile-xtra® (Halyard Health, Inc., Alpharetta, GA, USA; manufacturer’s specifications: ISO 374-1/5 2016 Type C, ISO 10993-1/2/5/10/12; EN 16523-1, EN 455, 420, 374-2/4) and Nitrile LG PF® (Maimed GmbH, Neuenkirchen, Germany; manufacturer’s specifications: EN420, 374, 455, ASTM 6319, CAT III) [17]. Hand rubs were performed using standard hand rub solutions used at each hospital: Desderman pure® (Schülke & Mayr GmbH, Nordstedt, Germany; pharmaceutical ingredients 78.2 g ethanol 96%, 0.1 g biphenyl-2-ol, povidone 30, isopropylmyristate, 2-ethylhexanoate, sorbitol, 2-propanol, purified water) and Softa-Man® (B. Braun Melsungen AG, Melsungen, Germany; pharmaceutical ingredients: 45% ethanol, 18% 1-propanol, purified water, diisopropyladipate, macrogol-6-glycerolcaprylocaprate, dexpathenol, bisabolol, lemon- and linalool-flavour, allantoin).

Gloved hand disinfection may have risks (e.g. skin damage, transmission of microbes), if HCWs perform gloving inappropriately, e.g. changing between patients with gloved hands, wearing gloves for too long, and inappropriate glove–ABHR combinations. However, disinfectability and stability of medical examination gloves has been recently demonstrated in vitro [17, 23]. Moreover, gloved hand disinfection is in line with the national guidelines and recommendations of the Clean Hands campaign (ASH) which was founded initially by the German Coalition for Patient Safety (APS) and the German National Reference Center for Surveillance of Nosocomial Infections (NRZ Surveillance).

To minimize the remaining risks, we defined the following rules before starting the study:

– All HCWs were informed individually and in detail about the design, timeline and aim of the study, and were given appropriate training on gloved hand disinfection.

– HCWs were warned about the risk of premature loss of integrity of gloves and were asked to report any event of suspicious alteration, e.g. stickiness, fragility, sacculation, or colour change of gloves when disinfected. Pretesting of several glove and ABHR combinations was used to determine the best combinations for the study.

– The number of consecutive gloved hand disinfections was restricted to a maximum of five.
The duration of glove usage was shortened to 20 min (in contrast to the ASH statement).

– Gloves had to be changed immediately whenever dirty or damaged.

– The same gloves could only be worn for contact with an individual patient.

– The study was supported by the occupational health service.

– The trial was overseen by ICPs, who were empowered to interrupt the study if any rules were broken.

Statistical analysis

Power calculation and expected increase in hand hygiene compliance of 40% were applied according to previous intervention strategies supposing 80% power with a given two-sided α error level of 5% [14, 24]. Computation of odds ratio (OR); 95% confidence interval (CI); P-values and χ2-statistics were performed using PSPP® 1.0.1 (GNU General Public License version 2), R 3.5.1 (GNU General Public License version 2) with Yates’ correction and Medcalc® 18.6 (MedCalc Software bvba) [25, 26, 27, 28, 29, 30]. To avoid errors by zero values of the odds ratios, values were slightly modified by adding 0.5 to all contingency cells [31, 32]. Statistics were supported by the Department of Medical Statistics.

Our hypothesis of an improvement in hand hygiene compliance by ntroducing gloved hand disinfection was confirmed, with a significant increase from 31% (baseline) to 65% (post-interventional) before infection-prone procedures. This is especially impressive because we offered no training on general infection control or hand hygiene either before or during the study. Thus, gloved hand disinfection may be an effective single strategy for improving hand hygiene compliance before infection-prone procedures.

According to WHO’s requirements a hand rub must be performed before gloving and after removing gloves, e.g. when moving from dirty to clean tasks or when aseptic activities are interrupted and continued afterwards. This scenario is complex, time-consuming, and in a real-life setting not always realized [23, 33].
Achieved compliance of 31% (indication 2; phase 1) in our study seems to be low compared to hand hygiene compliance with other indications, e.g. 81% (indication 4), 56% (indication 3). Compared to other studies aiming at hand hygiene compliance, the improvement in our study represents a major improvement without increasing the workforce or costs. This is of great importance, since the most often self-reported and currently proven reason for HCWs’ non-compliance is lack of time and a forced workload, and this is in line with previous results for another strategy, namely process optimization [12, 13, 14, 15, 16]. Indication 2 is regarded as the most important for patients, is associated with the lowest compliance rates in most studies, and is least improved by most hand hygiene improvement strategies. Thus, gloved hand disinfection could help to improve patient safety in a resource-neutral, easy implementable way.

During the study the incidence density of severe infections decreased
(6.0 per 1000 vs 2.5 per 1000 patient-days) by trend. This is in line with the improvement for hand hygiene especially before infection-prone procedures. However, this is no definite proof of reduction of infections.

Notably, power calculation did not primarily address this secondary endpoint. Investigation of severe infections during gloved hand disinfection in a roll-out setting is warranted.

Hand hygiene compliance with indications 3 and 4 (after contact with body fluid or patient) were not expected to improve by gloved hand disinfection in this setting. This hypothesis was proven by our study, since hand hygiene compliance improvement in this case was not driven by the intervention itself. Interestingly, our study showed an increase in hand hygiene compliance after contact with patients’ surroundings. HA MDRO remained constant during all study phases independently from outpatients’ incidence. Thus, we infer that gloved hand disinfection did not represent a patient risk when safety rules were followed. On the contrary, gloved hand disinfection improved hygiene in those situations most relevant for patients.

Different strategies may influence hand hygiene compliance. System-related (e.g. ABHR dispenser availability and localization, implementation of standardized procedures, process simplification and optimizing or automated monitoring) and individual patient-related (individual training, feedback audits) strategies differ in implementation workforce and probability of sustained effectiveness [2, 15, 34, 35, 36, 37, 38]. Thus, as a system-related strategy, disinfection of gloves is probably a sustainable component of a multi-faceted infection control strategy.

Support by the staff is a basic requirement of implementation. HCWs rated the release of the gloved hand disinfection as an improvement or alleviation of personal working conditions. In fact, gloved hand disinfection was not perceived as a burden, but as a tool that made work easier.

There were limitations to this study. It was a single-centre study only on one stem cell ward. The data shown cannot easily be extrapolated to other settings. However, the study was initiated as a proof-of-principle study. At baseline, hand hygiene compliance was only at a moderate level, thus the effect could be overestimated with regard to settings starting at higher baseline levels. The study was designed to correct potential time and training effects from the ‘glove effect’. However, the significant ‘glove effect’ shown in phase 2 is no definite proof. The direct observation was intended to be performed in a completely anonymous manner without HCW anonymization. ICPs were asked to rotate HCW sequence when observing. Thus, observation bias cannot be excluded completely. Although direct observation is widely accepted as a reference standard to calculate hand hygiene compliance, there is no method to ensure compliance with gloved hand disinfection beyond the observation period.
Every entity of infection belongs to different transmission events and those that are related to hand hygiene compliance according to the WHO indications have not been investigated in detail. However, according to the national surveillance programmes we used the combined infection parameter as secondary endpoint. It may be useful to distinguish different entities in further studies to compare their responses to the hand hygiene compliance.

In conclusion, this study is the first to investigate gloved hand disinfection in real-work scenarios, demonstrating an improvement in hand hygiene compliance. Hand hygiene compliance was even improved before infection-prone pro-cedures, the situations with the highest impact on infections, and thus infection control. Notably, severe infections decreased by trend.
Taken together, gloved hand disinfection could be an easy implementable, resource-neutral tool as a new component within the infection control bundles. Settings with a high number of aseptic procedures and unsatisfactory baseline levels would benefit most, especially in times of HCW shortage.

Read the full article:  https://www.journalofhospitalinfection.com/article/S0195-6701(19)30258-0/fulltext?dgcid=raven_jbs_etoc_email

© 2019    P. Fehlinga,∗,’Correspondence information about the author P. FehlingEmail the author P. Fehling, J. Hasenkampb, S. Unkelc, I. Thalmanna, S. Horniga, L. Trümperb, S. Scheithauera


Epidemiology and impact of norovirus outbreaks in Norwegian healthcare institutions, 2005–2018

Outbreaks in healthcare settings affect vulnerable populations, disrupt normal routines and may spread to other healthcare institutions (HCIs). Outbreaks can be limited in extent by good routines for detection, management of cases and other infection-control measures [1]. Norovirus infection is most often seen in the winter months and is a common cause of outbreaks in HCIs [2] as it has a low infectious dose, short incubation period, and symptoms such as diarrhoea and vomiting which facilitate spread. Symptoms normally lasts around one to three days, but can be longer in hospital patients [3]; and in this type of setting, infection can lead to slower recovery from other illness and even death [4]. Norovirus can be divided into several genogroups and genotypes [5]. Genogroup II genotype 4 is the most prevalent genotype globally [6] as well as in the Nordic countries [6]. There is no vaccine and immunity is not well understood; at best it is strain-specific but probably only partial and shortlived as the virus readily undergoes mutation [7, 8]. Humans are the only reservoir of the virus and spread of the infection in outbreaks is particularly difficult to control because of the low infectious dose, its stability in the environment and efficient transmission by person-to-person contact and exposure through contaminated surfaces [9]. Norway has national recommendations on norovirus infection in long-term-care facilities (LTCFs) in which the most important measure is isolation or cohort nursing of sick residents. Exclusion of sick staff until 48 h after they are symptom free is also recommended [10]. In a hospital setting, the infection-prevention-control unit will have local procedures. There are around 60 hospitals and 950 LTCFs in Norway [11]. The responsibility for management of local outbreaks lies within the hospital or with the community medical officer (one in each of the 422 municipalities) for outbreaks in LTCFs. All suspected outbreaks in Norwegian HCIs, regardless of the causative pathogen, should be alerted by law to relevant actors, including the Norwegian Insititute of Public Health (NIPH), to facilitate communication and response [12, 13]. The aim of this study was to describe, for the first time, the epidemiology and impact of these outbreaks in order to identify areas which may improve outbreak response.

This study shows that norovirus outbreaks pose an important burden for HCIs all over Norway, especially in the winter months. In addition to affecting an already vulnerable population, this study shows that these outbreaks indeed also impact on the internal workflow and resources, with a conservative estimate of around 1800 days of absenteeism per year due to these outbreaks, during which staff would have to be covered for by other internal or external healthcare staff.

Surveillance of norovirus outbreaks exists in Germany and Scotland. In Germany, reporting of norovirus outbreaks in HCIs has been mandatory since 2001. In contrast to what is seen in Norway, outbreaks were smaller (median nine cases vs 15 in this study) and around 80% of norovirus outbreaks were reported from hospitals (vs 23% in this study) during the first 12 months after introduction of the system [15]. Varying ways of counting interdepartmental outbreaks, better collaboration with the local level or under-reporting from hospitals may explain this. In Scotland, surveillance of ward closures due to norovirus infection has been in place since October 2017. From then until week 26, 2018, 219 wards or bays have been closed due to confirmed or suspected norovirus [16]. This is markedly more than the 16 reported outbreaks in hospitals in Norway 2017/18, in a population of similar size. The occurrence of norovirus outbreaks has also been studied prospectively; Curran et al. [17] aimed to identify the index cases of norovirus outbreaks in the UK and Ireland in 54 acute and non-acute healthcare centres; only five out of the 54 included centres did not experience any outbreak during one winter. Also, Lopman et al. found that 171 inpatients units, had on average 1.3 gastroenteritis outbreaks in the 1-year follow-up period. Of these, 63%were caused by norovirus [2].

It was seen that a small proportion of residents at LTCFs were admitted to hospital during norovirus outbreaks. This may be necessary in severe cases despite the risk of spread from one institution to the next. Our results suggest that hospitals are affected by norovirus outbreaks earlier in the epidemiological year than LTCFs. Potentially because there is a greater influx of patients from the community, where norovirus circulates, to and from hospital than between the community and LTCFs as also suggested by Sadique et al. [18]. This finding, however, could only be evaluated on the national level, as the number of reported outbreaks is low. That the start of the outbreak season seemed to start earlier in hospitals than in LTCFs, at least at the national level, suggests an opportunity that with improved communication, hospitals could alert LTCFs within the same area in order to prepare for the outbreak season and limit the extent of further outbreaks.

Slightly more cases were seen amongst healthcare staff in hospitals compared to LTCFs, though no information about the number of healthcare staff at risk during the outbreaks is available. The patient or resident:healthcare-staff ratio varies with the level of care needed and type of department and will most often be higher in hospitals. Whether this explains the slightly higher proportion of staff affected in hospital outbreaks is unknown. Nevertheless, healthcare staff do represent a big proportion of cases in the reported outbreaks, indicating a need for improved compliance with infection prevention and control measures. Outbreaks are an economic burden for HCIs, both as infected staff need to be covered for during illness and ‘quarantine’ and cohort nursing may require extra staff.

The relatively high number of people infected during an outbreak underscores the infectiousness of norovirus and norovirus can serve as a worst-case scenario for introduction of other, more virulent, person-to-person transmitted pathogens into HCIs. With the current information captured in the alert system, it was not possible to assess the extent to which national recommendations were followed and/or which infection prevention control procedures are in place locally. But the high number of people infected do suggest a potential for limiting spread, for example by having systems and routines in place before outbreaks happen, as advised in the national recommendations.

Even though NIPH routinely promotes the web-based outbreak alert system and teaches outbreak management, both at the regional and national level, in order to strengthen local capacity and encourage the use of the alert system, under-reporting is still apparent. If the under-reporting of outbreaks reflects a lack of awareness concerning outbreak management, or a lack of communication between the LTCF and the municipal doctors about ongoing outbreaks, it is worrying. The alert system serves to alert relevant stakeholders so that outbreak support and advice can be given in an early phase. The alert system can also be used for statistical purposes to get a national overview of outbreaks which will facilitate targeted capacity building, guideline development and communication messages in order to increase awareness and investigate whether there are any changes in trends.

Limitations
This study has three main limitations: the sensitivity of the norovirus outbreak definition and under-reporting of number of outbreaks and number of cases in each outbreak. Classification as a norovirus outbreak is dependent on local definitions. The infection prevention measures for diarrhoea and vomiting are the same for all the common pathogens in this setting. Samples were submitted for testing in two thirds of the outbreaks and most were confirmed as norovirus at the time of reporting or updating. Information about the genotypes of the isolated strains from each outbreak or of dominant strain of the season was not available. For this reason, it was not possible to evaluate the effect of the genotype.

Concerning under-reporting, the number of outbreaks notified through the outbreak alert system and reported here, most likely represent only a proportion of all norovirus outbreaks occurring in Norwegian HCIs. Although outbreaks were reported from all parts of Norway, some areas had not reported any outbreaks of any kind during the 13-year study-period.

The alert system is used for the mandatory alerting of suspected outbreaks. Reporting should happen as soon as the outbreak is suspected and before the full extent of the outbreak is known. Even though the system sends a reminder to update the details about the outbreak, including the case numbers, three weeks after the initial alert, some under-reporting of the extent of each outbreak is expected.

This is the first comprehensive description of norovirus outbreaks in HCIs in Norway. Even though the analyses revealed under-reporting that is unlikely to reflect the real epidemiology, this study clearly shows that these outbreaks affect both hospital and LTCFs all over Norway. Norovirus infection may delay medically important procedures and recovery, but also presents a major challenge to the functional ability of an HCI and its resources as up to one-half of cases were healthcare personnel.

It is recommended that NIPH promotes the outbreak alert system to increase reporting and improve the quality of the data and strengthen local capacity for outbreak management and general infection control. It is also recommended to investigate possibilities for improving communication between hospitals and LTCFs regarding when the norovirus season starts and progresses, for hospitals and LTCFs to be prepared and to take early action to prevent and limit further spread.

Read full article: https://www.journalofhospitalinfection.com/article/S0195-6701(19)30268-3/fulltext?dgcid=raven_jbs_etoc_email

© 2019 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society.


WHO: Ten threats to global health in 2019

The development of antibiotics, antivirals and antimalarials are some of modern medicine’s greatest successes. Now, time with these drugs is running out. Antimicrobial resistance – the ability of bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis.

 

The world is facing multiple health challenges. These range from outbreaks of vaccine-preventable diseases like measles and diphtheria, increasing reports of drug-resistant pathogens, growing rates of obesity and physical inactivity to the health impacts of environmental pollution and climate change and multiple humanitarian crises.

To address these and other threats, 2019 sees the start of the World Health Organization’s new 5-year strategic plan – the 13th General Programme of Work. This plan focuses on a triple billion target: ensuring 1 billion more people benefit from access to universal health coverage, 1 billion more people are protected from health emergencies and 1 billion more people enjoy better health and well-being. Reaching this goal will require addressing the threats to health from a variety of angles.

Here are 10 of the many issues that will demand attention from WHO and health partners in 2019.

READ THE FULL ARTICLE AT WHO’s site here:
https://www.who.int/emergencies/ten-threats-to-global-health-in-2019


A Breeding Ground for a Fatal Scourge: Nursing Homes

From The New York Times:

Drug-resistant germs, including Candida auris, prey on severely ill patients in skilled nursing facilities, a problem sometimes amplified by poor care and low staffing.

https://www.nytimes.com/2019/09/11/health/nursing-homes-fungus.html

“They are caldrons that are constantly seeding and reseeding hospitals with increasingly dangerous bacteria,” said Betsy McCaughey, a former lieutenant governor of New York who leads the nonprofit Committee to Reduce Infection Deaths. “You’ll never protect hospital patients until the nursing homes are forced to clean up.”

Resistant germs can then move from bed to bed, or from patient to family or staff, and then to hospitals and the public because of lax hygiene and poor staffing.

A recent inquiry by the New York State Department of Health found that some long-term hospitals grappling with C. auris were failing to take basic measures, such as using disposable gowns and latex gloves, or to post warning signs outside the rooms of infected patients. At one unnamed facility, it said, “hand sanitizers were completely absent.”

https://www.ncbi.nlm.nih.gov/pubmed/30753383