Protective effect of anticholinergic drugs and psyllium in a nosocomial outbreak of Norwalk gastroenteritis

Evaluation of the Impact of the Source (Patient Versus Staff) on Nosocomial Norovirus Outbreak Severity

Objective:

To study the dependence of infection risk and outbreak size on the type of index case (ie, patient or staff).

Methods:

Nosocomial outbreaks were reviewed and categorized into those started by patients and those started by staff. Infection risks and outbreak sizes were evaluated taking into account the index case category.

Results:

Of the 30 nosocomial outbreaks of norovirus with person-to-person transmission, 20 (67%) involved patients as the index cases. Patient-indexed outbreaks affected significantly more patients than did staff-indexed outbreaks (difference in means, 16.25; 95% confidence interval [CI95], 5.1 to 27.0). For the numbers of affected staff, no dependence on the index case category was detectable (difference in means, -1.05; CI95, -9.0 to 6.9). For patients exposed during patient-indexed outbreaks, the risk of acquiring a norovirus infection was approximately 4.8 times as high as the corresponding risk for patients exposed during staff-indexed outbreaks (odds ratio [OR], 4.79; CI95,1.82 to 8.28). The infection risk for exposed staff during patient-indexed outbreaks was approximately 1.5 times as high as the corresponding risk during staff-indexed outbreaks (OR, 1.51; CI95, 0.92 to 2.49).

Conclusions:

Patient-indexed norovirus outbreaks generally affect more patients than do staff-indexed outbreaks. Staff appear to be similarly affected by both outbreak index category groups. This study demonstrates the importance of obtaining complete outbreak data, including the index case classification as staff or patient, during norovirus outbreak investigations. Such information may be useful for further targeting prevention measures.

Reduction of healthcare-associated infections in a long-term care brain injury ward by replacing regular linens with biocidal copper oxide impregnated linens

BACKGROUND

Contaminated textiles in hospitals contribute to endogenous, indirect-contact, and aerosol transmission of nosocomial related pathogens. Copper oxide impregnated linens have wide-spectrum antimicrobial, antifungal, and antiviral properties. Our aim was to determine if replacing non-biocidal linens with biocidal copper oxide impregnated linens would reduce the rates of healthcare-associated infections (HAI) in a long-term care ward.

METHODS

We compared the rates of HAI in two analogous patient cohorts in a head injury care ward over two 6-month parallel periods before (period A) and after (period B) replacing all the regular non-biocidal linens and personnel uniforms with copper oxide impregnated biocidal products.

RESULTS

During period B, in comparison to period A, there was a 24% reduction in the HAI per 1000 hospitalization-days (p<0.05), a 47% reduction in the number of fever days (>38.5°C) per 1000 hospitalization-days (p<0.01), and a 32.8% reduction in total number of days of antibiotic administration per 1000 hospitalization-days (p<0.0001). Accordingly there was saving of approximately 27% in costs of antibiotics, HAI-related treatments, X-rays, disposables, labor, and laundry, expenses during period B.

CONCLUSIONS

The use of biocidal copper oxide impregnated textiles in a long-term care ward may significantly reduce HAI, fever, antibiotic consumption, and related treatment costs.

Fighting nosocomial infections with biocidal non-intrusive hard and soft surfaces

Approximately 7 million people worldwide acquire a healthcare associated infection each year. Despite aggressive monitoring, hand washing campaigns and other infection control measures, nosocomial infections (NI) rates, especially those caused by antibiotic resistant pathogens, are unacceptably high worldwide. Additional ways to fight these infections need to be developed. A potential overlooked and neglected source of nosocomial pathogens are those found in non-intrusive soft and hard surfaces located in clinical settings. Soft surfaces, such as patient pyjamas and beddings, can be an excellent substrate for bacterial and fungal growth under appropriate temperature and humidity conditions as those present between patients and the bed. Bed making in hospitals releases large quantities of microorganisms into the air, which contaminate the immediate and non-immediate surroundings. Microbes can survive on hard surfaces, such as metal trays, bed rails and door knobs, for very prolonged periods of time. Thus soft and hard surfaces that are in direct or indirect contact with the patients can serve as a source of nosocomial pathogens. Recently it has been demonstrated that copper surfaces and copper oxide containing textiles have potent intrinsic biocidal properties. This manuscript reviews the recent laboratory and clinical studies, which demonstrate that biocidal surfaces made of copper or containing copper can reduce the microbiological burden and the NI rates.

Biocidal textiles can help fight nosocomial infections

The rates of nosocomial infections, especially by those caused by antibiotic resistant bacteria, are increasing alarmingly over the globe. Although more rigorous infection control measures are being implemented, it is clear that the current modalities to reduce nosocomial infections are not sufficient. Textiles are an excellent substrate for bacterial growth under appropriate moisture and temperature conditions. Patients shed bacteria and contaminate their pyjamas and sheets. The temperature and humidity between the patients and the bed are appropriate conditions allowing for effective bacterial proliferation. Several studies have found that personnel in contact with contaminated textiles were the source of transmission of the micro-organisms to susceptible patients. Furthermore, it has been reported that bed making in hospitals releases large quantities of micro-organisms into the air, which contaminate the immediate and non-immediate surroundings. Contaminated textiles in hospitals can thus be an important source of microbes contributing to endogenous, indirect-contact, and aerosol transmission of nosocomial related pathogens. We hypothesize that the use of antimicrobial textiles, especially in those textiles that are in close contact with the patients, may significantly reduce bioburden in clinical settings and consequently reduce the risk of nosocomial infections. These textiles should possess broad spectrum biocidal properties. They should be safe for use and highly effective against antibiotic resistant micro-organisms, including those that are commonly involved in hospital-acquired infections, and they should not permit the development of resistant micro-organisms to the active compound.

Fluid therapy with specific mucopolysaccharides. A new approach to control diarrhea

An evaluation is given of the shortcomings of existing oral fluid therapies and their consequences: lack of protection of the intestinal wall and the supply of unabsorbed carbohydrates to the large intestine. The inclusion of specific mucopolysaccharides having a polyxylose backbone and galactose end residues in the side chains seems to offer effective protection of the intestinal wall. A trial conducted in experimentally infected calves (E. coli) shows that this concept of oral fluid therapy limits the number of diarrhea days and induces better growth in calves; a more complete glucose absorption and limitation of the supply of unabsorbed carbohydrates to the large intestine was shown in a trial conducted in human patients with a rotavirus enteritis.

Norwalk-like gastroenteritis epidemic in a Toronto hospital

An epidemic of gastroenteritis in a teaching hospital affected 57 patients and 69 staff over a 26-day period. The index case was a patient admitted with acute abdominal pain and diarrhea two days prior to the outbreak. The epidemic curve indicated person-to-person transmission. The incubation period, duration and types of symptoms were typical of Norwalk gastroenteritis, and Norwalk-like virus particles, serologically different from the prototype Norwalk virus strain, were observed in 17 of 20 fecal specimens examined by immune-electron microscopy.

An outbreak of gastroenteritis in a psycho-geriatric hospital associated with a small round structured virus

An outbreak of gastroenteritis in a psycho-geriatric hospital is described. Small round structured viruses, morphologically similar to Norwalk agent, were seen in stool samples from four patients. Although the illness was mild, 67 patients and 30 nurses on four wards were affected over a period of 4 weeks. Because of shortage of staff and isolation facilities, difficulty was experienced in introducing effective control measures.

Norwalk like viruses: study of an outbreak

An outbreak of acute non-bacterial gastroenteritis is reported, during which a ward had to be closed, and stool samples from 15 patients showed a virus structurally similar to the Norwalk agent.