Code Yellow – ‘Superbugs’ Threaten Public Health

Healthcare officials at all levels, from surgeons to infection-prevention professionals, pharmacists, nurses, environmental services (EVS) and others, including textile service providers, must do more to help combat the growing danger of antibiotic-resistant microorganisms that pose a significant danger to hospital patients. … Otherwise, the life of someone’s mother, father, brother, spouse, friend, etc. is at risk.

Ruth Carrico, an associate professor at the University of Louisville School of Medicine, delivered this blunt message during an April 12 dinner meeting of healthcare professionals in Richmond, VA. HandCraft Linen Services of Richmond sponsored this event, and Lynn Moreau,RN, the company’s clinical liaison manager, introduced Carrico as her “IP hero” for her work in the field of infection prevention. Carrico addressed a group of about 40 area healthcare professionals at the Westin Hotel.

A native of the Bluegrass State, Carrico kicked off her presentation with an old “Kentucky story” about two brothers who were enjoying a lazy day of fishing. Then one of them sees a baby in a basket floating by, like the Biblical story of Moses. Soon after another baby floats up, then a third. The brother says to his sibling, “Hey, help … look at all the babies in the baskets, come help me.” His brother throws his pole down and says he’s going to look upstream to see who’s throwing the babies in the water. Carrico used the story to relate the need for healthcare workers to explore the roots of a complex challenge like dealing with antibiotic-resistant microorganisms. “It reminds us that if all you do is get into the water and simply grab the problems that flow your way, you will never be able to resolve the problem,” she said. Carrico noted that the development of “superbugs” that resist most if not all antibiotics pose a huge problem for healthcare, “If we don’t correct that problem, then how are we going to make headway? And that headway means a safer environment for us and for our families and for those generations to come.”

Carrico identified three objectives that healthcare professionals need to pursue to get their arms around this problem:

• Identify elements of an antimicrobial stewardship program relevant to infection prevention
• Review implementation approaches that align with risk assessment, program goals and new partnerships
• Explore likely professional development needs for the infection preventionists.

Part of the problem, she says, is overuse and improper dosing of antibiotics that have made it easier for certain strains of bacteria to survive and multiply. Some strains also develop protective coatings that allow them to survive antibiotic treatments.

Another issue is the fact that pharmaceutical companies aren’t developing new antibiotics the way they did in the 1950s and ’60s. Fewer drug choices encourages greater reliance on existing ones. That, in turn, can fuel the resistant strains. “Now we have infections for which we have no drugs,” Carrico said. “We are now on the verge of a terrible problem.”

A lack of discipline by hospital staffs and/or patients in following dosing procedures has added to the problem of drug resistance, she said. If the patient is supposed to take the medication three times a day, but only gets it twice a day, the microorganisms may survive and as they reproduce they’ll pass on their strengths to their progeny. Healthcare leaders must put staff on notice that this kind of behavior can have serious consequences. “When you take that approach and you are in a leadership role, you expect to get high value, high reliability, high quality in the provision of care. That’s what I expect. If you are on the other side of that bed rail, is it going to be OK if you ‘sort of’ get your medicine?”

Meanwhile, expanded immigration and limited healthcare resources in some parts of the world are adding to the problem by bringing new strains of microorganisms into the U.S., she said. Despite talk in political circles of “building a wall” to keep out immigrants from Mexico or other countries, the reality is that America is likely to grow more diverse over time. That means the lack of public health expertise in certain countries increases the likelihood that diseases, such as Ebola, for which few if any treatments exist, will likely reach this country. “It will impact us even if we stay in the U.S.,” she said.

Healthcare professionals can fight back through enhanced collaboration and attention to the problem, she said. In some cases that will require significant investment, such as research on new drugs, but healthcare providers also can make significant progress through better focus and communication. For example, EVS staffs need to closely monitor the cleaning of rooms to ensure that the disinfectant/sanitizing agents used to kill germs are applied as directed. Carrico told a story about a hospital where an EVS official was out for an extended period and staff were wiping down rooms with plain water because a container of antiseptic wasn’t replaced in a timely fashion.

Communication between departments with a focus on collaborating to prevent the spread of infection is another important step. Carrico illustrated this point with an anecdote about a surgeon who didn’t change out his cover gown often enough. After extended discussions, she learned that the surgeon needed a larger-size gown, and that few replacements were available. An adjustment to the gown order fixed the problem and reduced the risk that a soiled gown could serve as a vector for microorganisms.

Healthcare professionals need to understand that individual efforts – both large and small – can make a difference in infection prevention, and help America jump-start the effort to address the problem of drug-resistant microorganisms, she said.

“When we think about reducing the problems that we have with multidrug resistance, this has to be a personal thing,” Carrico said. “We have to think, ‘That person that may develop that illness could be you, it could be my child, it could be my mother, my father, my sister, my brother.’ When you begin to think about how that can happen, then that changes your perspective. And it gives you a new willingness perhaps to look at problems differently.”