Although Ebola, the plague, Middle East respiratory syndrome and flesh-eating bacteria have been the big headline-grabbers this year so far, healthcare workers and researchers have continued toiling against the more common — and in many instances more concerning — bacterial "bad guys" that are mainstays in hospitals.
Although causes of hospital-acquired infections don't change rapidly over time, the ways hospitals fight them can. Here are 10 interesting new practices, trends and developments in infection control so far this year.
1. U.S. strengthens virus containment networks after worldwide outbreaks. Following the Ebola outbreak in West Africa that began in late 2013, concerns over containment led the U.S. government to name a series of new Ebola treatment centers across the country. In June, HHS announced the names of nine health departments and associated partner hospitals that will act as regional treatment centers with "enhanced capabilities."
These centers are prepared to accept patients who test positive for Ebola or other highly infectious diseases within eight hours of notification. They are able to quarantine and treat at least two such patients simultaneously, conduct trainings and outbreak exercises each quarter and have the capacity to isolate those with respiratory infectious diseases.
Additionally, HHS funded three hospitals in Atlanta, Omaha, Neb., and New York City, respectively, to form a National Ebola Treatment and Education Center. Over the next five years, the Assistant Secretary for Preparedness and Response and the CDC will provide the hospitals with $12 million so state health departments and healthcare facilities have greater access to clinical expertise and training for infection outbreaks.
2. Global outbreaks spur vaccine development. Instances of viral outbreaks such as MERS in South Korea and Ebola in West Africa have led to federal action on the part of the U.S. government. They have also rallied researchers in the lab.
An experimental MERS vaccine has showed promise in animal studies, leading researchers to believe a similar type of approach could work to inoculate humans against the virus sometime in the near future. One aerosol-based Ebola vaccine was shown to effectively protect primates against the virus. After a human trial, another Ebola vaccine was shown to be 100 percent effective against Ebola after 10 days for more than 4,000 people in Guinea.
3. Hospitals increasingly adopt UV lighting to keep germs under control. Research into the efficacy of UV lighting has shown that the bacteria responsible for Clostridium difficile infections, Staphylococcus infections and many others can be killed on surfaces in hospital rooms in less than 10 minutes with the proper technology. This includes bacteria known to be resistant to antibiotics.
New light fixtures that operate continuously on their own are capable of inactivating wide ranges of microorganisms and pathogens. In addition to these light fixtures, some hospitals are recruiting robots outfitted with the technology to act as roving infection control patrollers.
The use of HAI-fighting robots may offer return on investment opportunities due to fewer staff-contracted infections and loss of work time, according to a report from the ECRI Institute. Hospitals that have implemented robots to perform cleaning and disinfection in rooms and on designated surfaces have, overall, reported positive results.
4. Targeting bacteria in the gut may be key to preventing infection. A study published in the journal PLOS ONE in July reported that patients with burns and other traumatic injuries experience drastic changes in the bacterial populations of their gastrointestinal tracts.
The researchers suspect that when a traumatic injury occurs, the body's immune system mounts an inflammatory response, which causes an imbalance in the microbiome and further boosts the inflammatory response. Probiotics could be a viable way to restore a healthy balance and reduce the risk of sepsis and other serious complications related to infections.
Other research published this year reflects that makeup of the bacteria in the gut plays a role in the likelihood of a patient developing a urinary tract infection and C. diff infection as well. The Defense Advanced Research Projects Agency has gone so far as to fund research aimed at developing genetically engineered bacteria that will "patrol" the gut and detect inflammation or make determinations about imbalances in gut bacteria populations that could leave people vulnerable to infection.
5. New diagnostic tools for age-old infections continue to emerge. U.K. researchers have developed a new diagnostic test for pneumonia. Unveiled in June, the test lets practitioners determine whether a patient has the infection based only on a sample of their breath.
A handful of other interesting new diagnostic tools include the use of a compound that could significantly speed up tuberculosis detection, a procedure that collects a patient's entire viral history with only a drop of blood, the use of an ultrasound device to diagnose bacterial meningitis in babies and a molecular device made of DNA that signals in the presence of an infectious disease or virus.
6. Clinicians clamor for cleanliness in the ongoing dirty scope saga. The Food and Drug Administration is facing a conundrum over duodenoscopes. As of May, 142 instances of patient infection or device contamination in the U.S. have been reported and the FDA now considers the scopes be unsafe; however, banning their use would leave many patients in need of procedures involving the devices without an alternative for treatment.
The U.S. Department of Justice has taken legal action against Olympus and two other major manufacturers of the scopes after it was discovered that the companies allegedly knew of the scopes' capacity to transmit infection and did not warn U.S. hospitals that use the products.
The CDC and FDA have now issued updated protocol for cleaning and disinfecting the scopes. They recommend hospitals use these protocols in addition to meticulously following the guidelines provided by manufacturers. However, a recent study found that even when those guidelines are followed, 92 percent of scopes still contained microbial residue that exceeded allowable benchmarks.
7. Concerns about antibiotic overuse and resistance kick into overdrive. Combating drug-resistant bacteria and enhancing good antibiotic stewardship was the focus of a forum held at the White House in early June. The forum built on a conversation the government hoped to start with the March release of its National Action Plan for Combating Antibiotic-Resistant Bacteria.
Recent studies have shown good reason for increased awareness about antibiotic resistiance and overuse. Providers are a major driver of antibiotic overuse in the U.S., according to a study published in the Annals of Internal Medicine in July. The study reported 10 percent of physicians write antibiotic prescriptions for 95 percent of patients with acute respiratory infections. This is the type of overuse pattern that leads to antibiotic resistance.
In 2013, 23,000 deaths and more than 2 million illnesses in the U.S. were attributed to bacterial infections that did not respond to antibiotics. In addition to overprescription, many believe the overuse of antibiotics in animal agriculture — where the largest volume of antibiotics are used — will need to be addressed before clinicians see a drop in resistance.
The CDC has published new guidelines in the interest of curbing antibiotic-resistant infections, but these focus on improving communication about drug-resistant treatments between facilities, rather than encourgaging clinical measures to address the problem. Judy Stone, a clinical researcher and infectious disease specialist, said the recommendations presented by the CDC are unrealistic and "wishful thinking" in her commentary for Forbes.
8. Antimicrobial surfaces gain a presence in healthcare facilities. Antimicrobial agents, which mitigate the growth of bacteria and other microorganisms, may alter the landscape of disinfection for healthcare facilities.
Some materials, such as copper, have antimicrobial properties on their own, making them increasingly popular choices for use in facility surfaces. Other antimicrobial agents manufactured as coats are applied to existing surfaces, protecting them from transferring bacteria to certain extents.
Orthopedic manufacturer Tyber Medical recently acquired a licensing agreement to apply an antimicrobial surface technology on its implantable products. One company is now touting a smartphone that uses an EPA-registered antimicrobial glass for its touchscreen, a device that could come in handy for healthcare workers since recent studies have suggested germs can hitch a ride into hospitals from workers' portable devices.
9. Surgical site infections decrease through the use of implantable antimicrobials. A procedure presented at the Heart Rhythm Society's 36th Annual Scientific Sessions in Boston in June, found that implanting a cardiac electronic device inside of an antimicrobial "envelope" reduced the risk of SSIs by 80 percent.
Another area with significant infection rates linked to implants is cranial reconstruction, where 15 percent of patients suffer from infection. Naval researchers are currently working to incorporate antimicrobial products into the materials used for these types of surgeries.
Some researchers are aiming to develop implantable antimicrobials geared toward prevention, rather than stopping post-surgical infections. A London-based research group has reported being in the early stages of developing an antimicrobial implant that is the size of a matchstick and will dispense antiretroviral medication on a consistent basis.
10. Phage therapy: the infection-fighting weapon of the future? Phage therapy is the practice of treating infections with viruses called phages that attack bacterial cells but leave human cells untouched. Exploration of phage therapy was in vogue before the development of antibiotics, but has since fallen out of favor.
However, growing concerns about antibiotic resistance have some U.S. researchers experimenting again with microscopic bacterial viruses known as bacteriophages. The therapy has proven effective in countries like Poland and Russia where bacteriophages have been used to fight off infections such as MRSA.
Though phage therapy is not approved by the FDA, researchers at La Jolla, Calif.-based Synthetic Genomics are investigating the treatment, according to a report from The Economist. A group at the Massachusetts Institute of Technology in Cambridge is also investigating the use of synthetic bacteriophages, genetically engineered with specific parameters that may make them both more effective and easily accepted by the FDA.