[Pharmwaste] Hospitals Look To Nursing Homes To Help Stop Drug-Resistant Infections

Tue Apr 2 10:00:59 EDT 2019

https://www.npr.org/sections/health-shots/2019/04/02/707842736/enter-title

[image: NPR logo] <https://www.npr.org/>*Hospitals Look To Nursing Homes To
Help Stop Drug-Resistant Infections*
<https://www.npr.org/sections/health-shots/2019/04/02/707842736/enter-title>

*Public Health
<https://www.npr.org/sections/health-shots/133188449/public-health>*

Hospitals Look To Nursing Homes To Help Stop Drug-Resistant Infections

April 2, 20195:00 AM ET

Anna Gorman

*From *

[image:
https://media.npr.org/assets/img/2019/03/29/superbugs-8_custom-b42a778d133352d5e62c783d043cc4fabc7ace29-s800-c85.jpg]

A certified nursing assistant wipes Neva Shinkle's face with chlorhexidine,
an antimicrobial wash. Shinkle is a patient at Coventry Court Health
Center, a nursing home in Anaheim, Calif., that is part of a multi-center
research project aimed at stopping the spread of MRSA and CRE — two types
of bacteria resistant to most antibiotics.

Heidi de Marco/KHN

Hospitals and nursing homes in California and Illinois are testing a
surprisingly simple strategy to stop the dangerous, antibiotic-resistant
superbugs that kill thousands of people each year: washing patients with a
special soap.

The efforts — funded with roughly $8 million from the federal government's
Centers for Disease Control and Prevention — are taking place at 50
facilities in those two states.

This novel collaboration recognizes that superbugs don't remain isolated in
one hospital or nursing home but move quickly through a community, said Dr.
John Jernigan
<https://blogs.cdc.gov/safehealthcare/authors/john-a-jernigan-md-ms/>, who
directs the CDC's office on health care-acquired infection research.

"No health care facility is an island," Jernigan says. "We all are in this
complicated network."

[image: Medicare Penalizes Hospitals In Crackdown On Antibiotic-Resistant
Infections]
<https://www.npr.org/sections/health-shots/2016/12/22/506489368/medicare-penalizes-hospitals-in-crackdown-on-antibiotic-resistant-infections>

*Shots - Health News <https://www.npr.org/sections/health-shots/>*

*Medicare Penalizes Hospitals In Crackdown On Antibiotic-Resistant
Infections
<https://www.npr.org/sections/health-shots/2016/12/22/506489368/medicare-penalizes-hospitals-in-crackdown-on-antibiotic-resistant-infections>*

At least 2 million people in the U.S. become infected with some type of
antibiotic-resistant bacteria each year, and about 23,000 die from those
infections, according to the CDC.

People in hospitals are vulnerable to these bugs, and people in nursing
homes are particularly vulnerable. Up to 15 percent of hospital patients
and 65 percent of nursing home residents
<https://www.ncbi.nlm.nih.gov/pubmed/30753383> harbor drug-resistant
organisms, though not all of them will develop an infection, says Dr. Susan
Huang <https://www.faculty.uci.edu/profile.cfm?faculty_id=5478>, who
specializes in infectious diseases at University of California, Irvine.

"Superbugs are scary and they are unabated," Huang says. "They don't go
away."

Some of the most common bacteria in health care facilities are
methicillin-resistant Staphylococcus aureus, or MRSA, and
carbapenem-resistant Enterobacteriaceae, or CRE
<https://www.cdc.gov/hai/organisms/cre/>, often called "nightmare
bacteria." *E.Coli* and *Klebsiella* *pneumoniae *are two common germs that
can fall into this category when they become resistant to last-resort
antibiotics known as carbapenems
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195018/>. CRE bacteria cause
an estimated 600 deaths each year, according to the CDC.

[image: A Superbug That Resisted 26 Antibiotics]
<https://www.npr.org/sections/goatsandsoda/2017/01/17/510227493/a-superbug-that-resisted-26-antibiotics>

*A Superbug That Resisted 26 Antibiotics
<https://www.npr.org/sections/goatsandsoda/2017/01/17/510227493/a-superbug-that-resisted-26-antibiotics>*

CRE have "basically spread widely" among health care facilities in the
Chicago region, says Dr. Michael Lin
<https://www.rushu.rush.edu/faculty/michael-lin-md-mph>, an
infectious-diseases specialist at Rush University Medical Center, who is
heading the CDC-funded effort there. "If MRSA is a superbug, this is the
extreme — the super superbug."

Containing the dangerous bacteria has been a challenge for hospitals and
nursing homes. As part of the CDC effort, doctors and health care workers
in Chicago and Southern California are using the antimicrobial soap
chlorhexidine, which has been shown
<https://www.nejm.org/doi/full/10.1056/NEJMoa1207290> to reduce infections
when patients bathe with it.

[image:
https://media.npr.org/assets/img/2019/03/29/superbugs-9_custom-54a78ef189e3a4ddcd0cf9944b643167d63b95d9-s800-c85.jpg]

The Centers for Disease Control and Prevention funds the project in
California, based in Orange County, in which 36 hospitals and nursing homes
are using an antiseptic wash, along with an iodine-based nose swab, on
patients to stop the spread of deadly superbugs.

Heidi de Marco/KHN

Though hospital intensive care units frequently rely on chlorhexidine in
preventing infections, it is used less commonly for bathing in nursing
homes. Chlorhexidine also is sold over the counter; the FDA noted in 2017
it has caused rare but severe allergic reactions
<https://www.fda.gov/downloads/Drugs/DrugSafety/UCM539059.pdf>.

In Chicago, researchers are working with 14 nursing homes and long-term
acute care hospitals, where staff are screening people for the CRE bacteria
at admission and bathing them daily with chlorhexidine.

The Chicago project, which started in 2017 and ends in September, includes
a campaign to promote hand-washing and increased communication among
hospitals about which patients carry the drug-resistant organisms.

The infection-control protocol was new to many nursing homes, which don't
have the same resources as hospitals, Lin says.

In fact, three-quarters of nursing homes in the U.S. received citations for
infection-control problems over a four-year period, according to a Kaiser
Health News analysis
<https://khn.org/news/infection-lapses-rampant-in-nursing-homes-but-punishment-is-rare/>,
and the facilities with repeat citations almost never were fined. Nursing
home residents often are sent back to hospitals because of infections.

In California, health officials are closely watching the CRE bacteria,
which are less prevalent there than elsewhere in the country, and they are
trying to prevent CRE from taking hold, says Dr. Matthew Zahn
<http://nationalacademies.org/hmd/Activities/PublicHealth/microbialthreats/Profiles/Zahn.aspx>,
medical director of epidemiology at the Orange County Health Care Agency

"We don't have an infinite amount of time," Zahn says. "Taking a chance to
try to make a difference in CRE's trajectory now is really important."

The CDC-funded project in California is based in Orange County, where 36
hospitals and nursing homes are using the antiseptic wash along with an
iodine-based nose swab. The goal is to prevent new people from getting
drug-resistant bacteria and keep the ones who already have the bacteria on
their skin or elsewhere from developing infections, says Huang, who is
leading the project.

[image:
https://media.npr.org/assets/img/2019/03/29/superbugs-3_custom-3c516d9877e4b793761c0291f932fdbf9f1c2ab9-s800-c85.jpg]

Enlarge this image

Licensed vocational nurse Joana Bartolome swabs Shinkle's nose with an
antibacterial, iodine-based solution at Anaheim's Coventry Court Health
Center. Studies find patients can harbor drug-resistant strains in the nose
that haven't yet made them sick.

Heidi de Marco/KHN

Huang kicked off the project by studying how patients move among different
hospitals and nursing homes in Orange County — she discovered they do so
far more than previously thought. That prompted a key question, she says:
"What can we do to not just protect our patients but to protect them when
they start to move all over the place?"

[image: My Unlovely Lady Lump: When MRSA Is Ugly, But Not Life-Threatening]
<https://www.npr.org/sections/health-shots/2017/03/18/519217051/my-unlovely-lady-lump-when-mrsa-is-ugly-but-not-life-threatening>

*Shots - Health News <https://www.npr.org/sections/health-shots/>*

*My Unlovely Lady Lump: When MRSA Is Ugly, But Not Life-Threatening
<https://www.npr.org/sections/health-shots/2017/03/18/519217051/my-unlovely-lady-lump-when-mrsa-is-ugly-but-not-life-threatening>*

Her previous research showed that patients who were carriers of MRSA
bacteria on their skin or in their nose, for example, who, for six months,
used chlorhexidine for bathing and as a mouthwash, and swabbed their noses
with a nasal antibiotic were able to reduce their risk of developing a MRSA
infection by 30 percent. But all the patients in that study, published in
February <https://www.nejm.org/doi/full/10.1056/NEJMoa1716771> in the *New
England Journal of Medicine*, already had been discharged from hospitals.

Now the goal is to target patients still in hospitals or nursing homes and
extend the work to CRE. The traditional hospitals participating in the new
project are focusing on patients in intensive care units and those who
already carry drug-resistant bacteria, while the nursing homes and the
long-term acute care hospitals perform the cleaning — also called
"decolonizing" — on every resident.

One recent morning at Coventry Court Health Center, a nursing home in
Anaheim, Calif., 94-year-old Neva Shinkle sat patiently in her wheelchair.
Licensed vocational nurse Joana Bartolome swabbed her nose and asked if she
remembered what it did.

"It kills germs," Shinkle responded.

"That's right — it protects you from infection."

In a nearby room, senior project coordinator Raveena Singh from UCI talked
with Caridad Coca, 71, who had recently arrived at the facility. She
explained that Coca would bathe with the chlorhexidine rather than regular
soap. "If you have some kind of open wound or cut, it helps protect you
from getting an infection," Singh said. "And we are not just protecting
you, one person. We protect everybody in the nursing home."

Coca said she had a cousin who had spent months in the hospital after
getting MRSA. "Luckily, I've never had it," she said.

Coventry Court administrator Shaun Dahl
<https://www.coventrycourt.org/team-member/shaun-dahl> says he was eager to
participate because people were arriving at the nursing home carrying MRSA
or other bugs. "They were sick there and they are sick here," Dahl says.

Results from the Chicago project are pending. Preliminary results of the
Orange County project, which ends in May, show that it seems to be working,
Huang says. After 18 months, researchers saw a 25 percent decline in
drug-resistant organisms in nursing home residents, 34 percent in patients
of long-term acute care hospitals and 9 percent in traditional hospital
patients. The most dramatic drops were in CRE, though the number of
patients with that type of bacteria was smaller.

The preliminary data also show a promising ripple effect in facilities that
aren't part of the effort, a sign that the project may be starting to make
a difference in the county, says Zahn of the Orange County Health Care
Agency.

"In our community, we have seen an increase in antimicrobial-resistant
infections," he says*. *"This offers an opportunity to intervene and bend
the curve in the right direction."
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