Archive | October 2018

QUOTE FOR FRIDAY:

“Create daily and terminal cleaning protocols and checklists for patient-care areas and equipment. Perform daily cleaning using a C. difficile sporicidal agent (EPA List K agent). Clean and disinfect the patient-care environment (including the immediate vicinity around a CDI patient and high touch surfaces) at least once a day, including the toilets.  Clean and disinfect all shared equipment prior to use by another patient.”

CDC Centers for disease control and prevention

 

HEALTH ACQUIRED INFECTIONS (HAIs)-Public Awareness.

The purpose of this article is to help broaden the public in knowing about HAIs including how their family or friend should be cared for when in a hospital with what they can do when visiting a loved one in a health facility for both the patient’s and visitor’s benefit.  

History of HAIs

Let us start with some history. In England in the 1830s, the term hospitalism was coined by Sir James Simpson to describe HAIs. In those days, it was believed that infection was spread because of inadequate ventilation and stagnant air. To prevent infection, windows were opened, and whenever possible care was taken to prevent overcrowding of hospital rooms. Little was known about microbes and their pathogenicity, and consequently little was done about personal hygiene. In Victorian society, the idea of one’s personal hygiene being connected to infection was taken personally and was met with great resistance.

Despite the efforts of medical personnel, many patients died of overwhelming sepsis following preventable infections. In the late 1860s after much persistence, Joseph Lister, a British surgeon, introduced the concept of antisepsis, which significantly decreased death from postoperative infection. After penicillin was introduced in 1941, postsurgical infection rates and deaths from postsurgical pneumonia were both dramatically decreased.

Today, modern medicine has brought a more thorough understanding of pathogens and the epidemiology of the diseases they cause. Unfortunately, in spite of the vast amounts of medical advances that have occurred over the years, the healthcare industry is still faced with the enormous task of preventing and reducing the risk of HAIs.

Today HAIs are defined as nosocomial infections which are infections that are acquired in hospitals and other healthcare facilities (like a nursing home or subacute rehab facility). To be classified as a nosocomial infection the patient must have been admitted for reasons other than an infection. He or she must also have shown no signs of active or incubating infection upon admission.

On average, nosocomial patients stay in the hospital 2.5 times longer than patients without infection. An estimated 40 percent of nosocomial infections are caused by poor hand hygiene (WHO). Hospital staff can significantly reduce the number of cases with regular hand washing. They should also wear protective garments and gloves when working with patients.

Invasive procedures increase the risk of nosocomial infections. Noninvasive procedures are recommended when possible. Most nosocomial infections are due to bacteria. Since antibiotics are frequently used within hospitals, the types of bacteria and their resistance to antibiotics is different than bacteria outside of the hospital. Nosocomial infections can be serious and difficult to treat, especially if it’s a multi-resistant bacteria.

What put’s a person at risk?

Harmful microbes are all around us, and although infection poses a threat to everyone, certain people are more at risk of infection. For example, people in healthcare facilities are more at risk than those in the community simply because they are exposed to others who are infected with disease-causing organisms. These people are exposed to so many other peoples germs and bacteria as opposed to a private home simply puts you at potential for picking up them if not proper prevention is carried out by all that come in contact with you, starting simply with hand washing by the patient and those that see the patient (medical staff to visitors).

Even more at risk are special populations of patients, such as those with compromised immune systems, those who have undergone recent surgery, those with poor nutritional status, and those with open wounds. Patients undergoing certain medical procedures, such as intubations and central lines, are also at increased risk. Medical devices also carry a risk of infection. Urinary catheters, central lines, mechanical ventilation equipment, and surgical drains all put patients at risk for infection. Any foreign object in the body or any unnatural opening of the body (surgical wound or trauma wound) puts that individual at risk for local infection to that area and if left untreated goes to general infection (temp greater than 100.5 or 101 F).

Further, certain medications and various chemotherapies weaken patients’ immune systems, leaving patients more vulnerable to infection. The length of time spent in a healthcare facility also affects the risk of infection: The longer the stay, the longer that person is exposed to much more bacteria than at home putting greater risk of that patient’s chances of acquiring a HAI. Over 25 years ago and further back the doctors kept patients in the hospital longer than needed thinking this was the best care for the patient but now it’s get the patient out as soon as possible when the patient has reached clearance by MD’s to be discharged safely home and either the pt is back to normal or can safely heal at home exposed to less bacteria and germs since the hospital has so much more obviously due to population.

The most common method of transmission is by direct contact with an infectious microorganism. Sputum, blood, and feces are common vehicles for microbe transmission. Healthcare workers and patients spread microbes via droplets generated by talking, sneezing, or coughing. Small particles of evaporated droplets (droplet nuclei) and dust particles carry microorganisms and spread infection over long distances.

Infection can also be spread through inanimate objects known as fomites, such as improperly sterilized medical equipment that is used on more than one patient. Healthcare workers who move from patient to patient carry infectious organisms on their clothes, stethoscopes, and phones. Other modes of transmission include the spread of infectious agents through food and water or through vectors, such as mosquitoes, flies, and rats.

Though hospitals throughout America have this problem to face in all hospitals in America and elsewhere, these facilities have developed infection control people who continuously make policies/procedures in their facilities to prevent the spread of infection through all routes with the knowledge we know today as opposed to 25 years ago and further back regarding infection.

QUOTE FOR THURSDAY:

“The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program estimates that 42,220 new cases of liver and intrahepatic bile duct cancer will be diagnosed in the United States and some 30,200 people are expected to die of primary adult liver cancer in 2018. The five-year survival rate is just 17.7 percent. Having hepatitis B, hepatitis C, or cirrhosis are significant risk factors for adult primary liver cancer.

American Association For Cancer Research (AACR) Foundation

Month for LIver Cancer

liver awareness

liver awareness2

The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you can’t feel the liver, because it’s protected by the rib cage.

The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food.

The liver’s main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

The liver is a vital organ of vertebrates and some other animals. In the human it is located in the upper right quadrant of the abdomen, below the diaphragm. The liver has a wide range of functions, including detoxification of various metabolites, protein synthesis, and the production of biochemicals necessary for digestion.

The liver is a gland and plays a major role in metabolism with numerous functions in the human body, including regulation of glycogen storage, decomposition of red blood cells, plasma protein synthesis, hormone production, and detoxification.[3] It is an accessory digestive gland and produces bile, an alkaline compound which aids in digestion via the emulsification of lipids. The gallbladder, a small pouch that sits just under the liver, stores bile produced by the liver. The liver’s highly specialized tissue consisting of mostly hepatocytes regulates a wide variety of high-volume biochemical reactions, including the synthesis and breakdown of small and complex molecules, many of which are necessary for normal vital functions Estimates regarding the organ’s total number of functions vary, but textbooks generally cite it being around 500.

Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.

Not all cancers that affect the liver are considered liver cancer. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer.

Most people don’t have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

  • Losing weight without trying
  • Loss of appetite
  • Upper abdominal pain
  • Nausea and vomiting
  • General weakness and fatigue
  • Abdominal swelling
  • Yellow discoloration of your skin and the whites of your eyes (jaundice)
  • White, chalky stools

It’s not clear what causes most cases of liver cancer. But in some cases, the cause is known. For instance, chronic infection with certain hepatitis viruses can cause liver cancer.

Liver cancer occurs when liver cells develop changes (mutations) in their DNA — the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.

Factors that increase the risk of primary liver cancer include:

  • Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
  • Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
  • Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson’s disease.
  • Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don’t have diabetes.
  • Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
  • Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops such as corn and peanuts can become contaminated with aflatoxins, which can end up in foods made of these products. In the United States, safety regulations limit aflatoxin contamination. Aflatoxin contamination is more common in certain parts of Africa and Asia.
  • Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase your risk of liver cancer.

MOST IMPORTANT is PREVENTION:

Reduce your risk of cirrhosis

Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of cirrhosis if you:

  • Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no more than one drink a day. For men, this means no more than two drinks a day.
  • Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of exercise you do. Aim to lose weight slowly — 1 or 2 pounds (0.5 to 1 kilograms) each week.
  • Use caution with chemicals. Follow instructions on chemicals you use at home or at work.

Get vaccinated against hepatitis B

You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine, which provides more than 90 percent protection for both adults and children. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.

Take measures to prevent hepatitis C

No vaccine for hepatitis C exists, but you can reduce your risk of infection.

  • Know the health status of any sexual partner. Don’t engage in unprotected sex unless you’re certain your partner isn’t infected with HBV, HCV or any other sexually transmitted infection. If you don’t know the health status of your partner, use a condom every time you have sexual intercourse.
  • Don’t use intravenous (IV) drugs, but if you do, use a clean needle. Reduce your risk of HCV by not injecting illegal drugs. But if that isn’t an option for you, make sure any needle you use is sterile, and don’t share it. Contaminated drug paraphernalia is a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
  • Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop refuse to answer your questions or don’t take your questions seriously, take that as a sign that the facility isn’t right for you.

Ask your doctor about liver cancer screening

For the general population, screening for liver cancer hasn’t been proved to reduce the risk of dying of liver cancer, so it isn’t generally recommended. The American Association for the Study of Liver Diseases recommends liver cancer screening for those thought to have a high risk, including people who have:

  • Hepatitis B and one or more of the following apply: are Asian or African, have liver cirrhosis, or have a family history of liver cancer
  • Hepatitis C infection and liver cirrhosis
  • Liver cirrhosis from other causes, such as an autoimmune disease, excessive alcohol use, nonalcoholic fatty liver disease and inherited hemochromatosis
  • Primary biliary cirrhosis

Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves an ultrasound exam every six months.

Diagnosing liver cancer

Tests and procedures used to diagnose liver cancer include:

  • Blood tests. Blood tests may reveal liver function abnormalities.
  • Imaging tests. Your doctor may recommend imaging tests, such as an ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).
  • Removing a sample of liver tissue for testing. Your doctor may recommend removing a piece of liver tissue for laboratory testing in order to make a definitive diagnosis of liver cancer.

    During a liver biopsy, your doctor inserts a thin needle through your skin and into your liver to obtain a tissue sample. In the lab, doctors examine the tissue under a microscope to look for cancer cells. Liver biopsy carries a risk of bleeding, bruising and infection.

Determining the extent of the liver cancer

Once liver cancer is diagnosed, your doctor will work to determine the extent (stage) of the cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CTs, MRIs and bone scans.

There are different methods of staging liver cancer. One method uses Roman numerals I through IV, and another uses letters A through D. Your doctor uses your cancer’s stage to determine your treatment options and your prognosis. Stage IV and stage D indicate the most advanced liver cancer with the worst prognosis.

Treatment

Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and personal preferences.

Surgery

Operations used to treat liver cancer include:

  • Surgery to remove the tumor. In certain situations, your doctor may recommend an operation to remove the liver cancer and a small portion of healthy liver tissue that surrounds it if your tumor is small and your liver function is good.

    Whether this is an option for you also depends on the location of your cancer within the liver, how well your liver functions and your overall health.

  • Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is only an option for a small percentage of people with early-stage liver cancer.

Localized treatments

Localized treatments for liver cancer are those that are administered directly to the cancer cells or the area surrounding the cancer cells. Localized treatment options for liver cancer include:

  • Heating cancer cells. In a procedure called radiofrequency ablation, electric current is used to heat and destroy cancer cells. Using an ultrasound or CT scan as a guide, your surgeon inserts one or more thin needles into small incisions in your abdomen. When the needles reach the tumor, they’re heated with an electric current, destroying the cancer cells.
  • Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells.
  • Injecting alcohol into the tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol causes the tumor cells to die.
  • Injecting chemotherapy drugs into the liver. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver.
  • Placing beads filled with radiation in the liver. Tiny spheres that contain radiation may be placed directly in the liver where they can deliver radiation directly to the tumor.

Radiation therapy

This treatment uses high-powered energy from sources such as X-rays and protons to destroy cancer cells and shrink tumors. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue.

During external beam radiation therapy treatment, you lie on a table and a machine directs the energy beams at a precise point on your body.

A specialized type of radiation therapy, called stereotactic radiosurgery, involves focusing many beams of radiation simultaneously at one point in your body.

Targeted drug therapy

Targeted drugs work by interfering with specific abnormalities within a tumor. They have been shown to slow or stop advanced hepatocellular carcinoma from progressing for a few months longer than with no treatment.

More studies are needed to understand how targeted therapies, such as the drug sorafenib (Nexavar), may be used to control advanced liver cancer.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

What you can do in being preparred to see your doctor:

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, as well as any vitamins or supplements, that you’re taking.
  • Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

 

QUOTE FOR WEDNESDAY:

“Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common form of liver disease in children and has more than doubled over the past 20 years.  About 100 million individuals are estimated to have NAFLD.”

The American Liver Foundation

QUOTE FOR TUESDAY:

“Non-alcoholic fatty liver disease (NAFLD) is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% – 10% percent of the liver’s weight is fat, then it is called a fatty liver (steatosis).”

American Liver Foundation

QUOTE FOR MONDAY:

“The liver has many functions, including detoxifying of harmful chemicals, breakdown of drugs, filtering of blood, secretion of bile and production of blood-clotting proteins.”

MAYO CLINIC

Why the liver is so vital to our human body!

healthy liver

The liver is like our transmission to the human body—it cleans out end products of what enters our body keeping the essentials we need inside. This is what this organ does for us:

Your liver is your very own chemical processing plant. It receives 30% of the blood circulating in your system every minute – performing chemical reactions to remove harmful toxins and distribute and store essential nutrients. This vital process is called ‘metabolism’ and cells in the liver, known as hepatocytes, are put to work to keep your body working at its best. Essentially, your liver loves and cares for you.

Once carbs have been broken down into glucose in your gastrointestinal tract, the glucose enters the blood stream and is taken straight to your liver to regulate and maintain healthy levels. Your liver also stores excess glucose in the form of glycogen (inactive glucose) and the liver will fill up with this glycogenl (like a gas tank). When the tank of the liver gets full the excess of the sugar floating in your bloodstream is used by our tissues that need it right than.  The sugar that couldn’t go in the liver is extra glucose that now needs a place to store (if the liver is full) than it gets dumped in our fat tissue next. This is how we get obese. This is the logic of eating small meals not 3 large meals a day. The small meals are utilized mostly where there is no extra floating glucose that needs to be stored anywhere like in our case the fatty tissue. The average American doesn’t realize this with knowing that glycogen (inactive glucose) when needed by our body is ready for converting back into glucose when levels drop between meals which usually occurs during exercise or when you’re fasting; which most of us in America don’t do by overall population. For our liver to do these processes of breakdown of our foods (including medications), to convert active glucose to inactive glucose (glycogen), store glycogen in the liver and to do much more the liver has to be working meaning healthy.

And here’s the really clever thing. Your liver can also convert non-sugars, such as amino acids, into glucose to keep levels healthy. It does some pretty impressive things with fats too.

Every time you eat either through food or protein fluid drinks in place of your food, your liver feeds you. Once food is digested, nutrients enters the blood from the stomach after digestion in that organ takes place including the small intestines, which are taken straight to your liver for processing. Depending on how low or plentiful these nutrients are in your body, the liver cells will either release the goodness of these processed broken down nutrient end products to where it’s needed (regarding our tissues of the body) or store they will be stored away for when your body tissues needs a boost later.

And here’s the really clever thing. Your liver can also convert non-sugars, such as amino acids, into glucose to keep levels healthy. It does some pretty impressive things with fats too.

Your liver is your fat processing factory – it breaks down fat and compounds such as lipoproteins, cholesterol and phospholipids. If fat is in excess, the liver combines fatty acids and glycerol to form a storage molecule and transports it to your body’s storage depots, such as the subcutaneous tissue (tissue just under the skin). Then, at times when energy levels are low, between meals and during exercise, this stored fat is converted back into glycerol and the liver turns the remaining fatty acids into an alternative energy supply. To aid absorption of fat and fat-soluble vitamins and flush out unwanted substances from your body, your liver produces bile. It stores the bile in your gall bladder, where it can be emptied into your intestines when needed.

Proteins are also vital for a healthy body, and your liver takes charge of these too. Once proteins are broken down into amino acids in your intestines, they enter the blood stream and flow direct to the liver. Here, the liver cells (hepatocytes) go to work on removing nitrogen from the proteins which rapidly changes into ammonia – a highly toxic substance. Your liver then acts fast to convert this into urea to be excreted into the urine and eliminated from your body. With excess amino acids, your liver converts them into fat for storage or, if your body needs an energy boost, it will use them to create glucose.

Ending line the liver breaks down our Calories & CHOs, Fats, and Proteins that enter our body.

Our liver watches out for us. When harmful toxins and substances enter your blood stream, your liver acts fast to detoxify and destroy them. Some may simply be a by-product of a normal metabolism, others may be ingested or inhaled substances such as drugs and alcohol. Filtering the blood, your liver removes dead cells and invading bacteria, processes nitrogen and cholesterol and neutralises harmful hormones.

The problem comes when the body liver can’t do this function anymore, meaning it can’t break down or do the processing of out nutrients we eat causing toxins to build up in our body. Soon this break down of the liver with no reversal or without treatment will go into liver failure. Liver failure can put a big hold up in your life but if you can reverse it your smart since you addressed the problem in getting cared for by a doctor. You can even be better than this in being healthy to your body which is you taking PREVENTION in allowing yourself never to deal with this headache.

Liver failure or hepatic insufficiency is the inability of the liver to perform its normal synthetic and metabolic function as part of normal physiology. Two forms are recognized, acute and chronic.

Acute liver failure defined as “the rapid development of hepatocellular dysfunction, specifically coagulopathy and mental status changes (encephalopathy) in a patient without known prior liver disease.”.

Chronic liver failure usually occurs in the context of cirrhosis, itself potentially the result of many possible causes, such as excessive alcohol intake, hepatitis B or C, autoimmune, hereditary and metabolic causes (such as iron or copper overload, Steatohepatitis or non-alcoholic fatty liver disease).

CHRONIC can be prevented. How important is your health?

QUOTE FOR THE WEEKEND:

“As the liver plays such a critical part in ridding the body of toxins, and extracting and storing nutrients for the body to use, children born with a congenital liver disease usually become ill as young infants.”

Health24.com