Archive | August 2022

QUOTE FOR WEDNESDAY:

“Sometimes when patients are admitted to the hospital, they can get infections. This is a hospital-acquired infection. In the case of either MRSA or VRE, this may mean that symptoms begin 72 hours after admission to the hospital.”

Cornwall Community Hospital (https://www.cornwallhospital.ca)

MRSA and VRE=Types of Hospital Acquired Resistant Infections

1-MRSA Infection

Methicillin-resistant Staphylococcus aureus (MRSA), also known as multidrug resistant S. aureus, includes any strain of S. aureus that has become resistant to the group of antibiotics known as beta-lactam antibiotics. Included in this group are the penicillins (methicillin, amoxicillin, oxacillin) and cephalosporins. Staphylococcus aureus includes gram-positive, nonmotile, non-spore-forming cocci that can be found alone, in pairs, or in grapelike clusters.

Methicillin-resistant Staphylococcus aureus.

When penicillin was first introduced in the early 1940s, it was considered to be a wonder drug because it reduced the death rate from Staphylococcus infection from 70% to 25%. Unfortunately, by 1944, drug resistance was beginning to occur, so methicillin was synthesized, and, in 1959, it became the world’s first semisynthetic penicillin. Shortly thereafter in 1961, staphylococcal resistance to methicillin began as well, and the name “methicillin-resistant S. aureus” and the acronym MRSA were coined. Although methicillin was discontinued in 1993, the name and acronym have remained because of MRSA history.

MRSA is now the most common drug-resistant infection acquired in healthcare facilities. In addition to becoming more problematic as a top HAI in recent years, transmission of MRSA has also become more common in children, prison inmates, and sports participants. Community-associated MRSA (CA-MRSA) most often presents in the form of skin infections (see Figure 5). Hospital-acquired MRSA (HA-MRSA) infections manifest in various forms, including bloodstream infections, surgical site infections, and pneumonia. Although approximately 25–30% of persons are colonized in the nasal passages with Staphylococcus, less than 2% are colonized with MRSA.

MRSA are extremely resistant and can survive for weeks on environmental surfaces. Transfer of the pathogen can occur directly from patient contact with a contaminated surface or indirectly as healthcare workers touch contaminated surfaces with gloves or hands and then touch a patient.

Risk factors for healthcare-acquired MRSA infection include advanced age, young age, use of quinolone antibiotics, and extended stay in a healthcare facility. Those with diabetes, cancer, or a compromised immune system are also at increased risk of infection.

Symptoms of MRSA infection vary depending on the type and stage of infection and the susceptibility of the organism. Skin infections may appear as painful, red, swollen pustules or boils; as cellulitis; or as a spider bite or bump. They can be found in areas where visible skin trauma has occurred or in areas covered by hair. Patients may also have fever, headaches, hypotension, and joint pain. Complications of MRSA-related skin infections include endocarditis, necrotizing fasciitis, osteomyelitis, and sepsis.

Patient history of admission to a healthcare facility is useful in diagnosing HA-MRSA. Definitive diagnosis of MRSA is made by oxacillin/methicillin resistance that is shown by lab culture and susceptibility testing. Specimens submitted for testing vary depending on the site of suspected infection and may include tissue, wound drainage, sputum, respiratory secretions, and blood or urine cultures.

Treatment for MRSA infections varies based on site of infection, stage of infection, and age of the individual. Treatment includes drainage of abscesses, surgical debridement, decolonization strategies, and antimicrobial therapy with antibiotics such as vancomycin #1 in alot of cases, clindamycin, daptomycin, linezolid, rifampin, trimethoprim-sulfamethoxazole (TMP-SMX), quinupristin-dalfopristin, telavancin, and tetracyclines (limited use). MRSA is rapidly becoming resistant to rifampin; therefore, this drug should not be used alone in the treatment of MRSA infections. Consultation with an infectious disease specialist is recommended for treatment of severe MRSA infections.

The CDC recommends healthcare personnel follow these guidelines to help prevent MRSA infections:

  • Follow procedures to recognize previously colonized and infected patients.
  • Follow appropriate hand hygiene practices and isolation precautions (see discussion on hand hygiene and isolation precautions later in this course). The CDC has not made a recommendation on when to discontinue contact precautions. Healthcare workers should check with their individual institution’s infection control policies.
  • Place patients in single rooms, or, if a single room is not available, cohort patients with the same MRSA in the same room or in the same patient care area. If cohorting patients with the same MRSA is not possible, place MRSA patients in rooms with patients who are at low risk for acquisition of MRSA and are likely to have short lengths of stay.
  • Keep skin wounds of MRSA patients clean and covered until healed.
  • Handle equipment and instruments/devices used for MRSA patients appropriately, with care and attention to disinfection according to institution infection control policy. Ensure that equipment is properly cleaned and disinfected before being used with another patient.

2-VancoResistantEnterococci


Vancomycin-Resistant Enterococci Infection (VRE)

Enterococci (formerly known as Group D streptococci) are non-spore-forming, gram-positive cocci that exist in either pairs or short chains. They are commonly found in the human intestine or the female genital tract. The most common organism associated with vancomycin-ressistant enterococci (VRE) infection in hospitals is Enterococcus faecium. Enterococcus faecalis is also a cause of human disease. VRE infections can occur in the urinary tract, in wounds associated with catheters, in the bloodstream, and in surgical sites. Enterococci are a common cause of endocarditis, intra-abdominal infections, and pelvic infections.

VRE was first reported in Europe in 1986, followed in 1989 by the first report in the United States. Since then it has spread rapidly. Between 1990 and 1997, the prevalence of VRE in hospital patients increased from less than 1% to 15%.

VRE, which is found predominantly in hospitalized or recently hospitalized patients, are difficult to eliminate because they are able to withstand extreme temperatures, can survive for long periods on environmental surfaces, and are resistant to vancomycin. Transmission of VRE occurs most commonly in the form of person-to-person contact by the hands of healthcare workers after contact with the blood, urine, or feces an infected individual. VRE is also spread from contact with environmental surfaces, or through contact with the open wound of an infected person.

People most at risk for infection with VRE include the elderly and those with diabetes, those with compromised immune systems, and those who are already colonized with the bacteria. Prolonged hospitalization, catheterization (urinary and intravenous), and long-term use of vancomycin or other antibiotics also increase a person’s risk of infection.

Symptoms of VRE infection vary depending on the site of infection and may include erythema, warmth, edema, fever, abdominal pain, pelvic pain, and organ pain. Definitive diagnosis is made by culture and susceptibility testing with specimens obtained from suspected sites of infection. Treatment of VRE infection may include drainage of abscesses; removal of prosthetic devices, IV lines, or catheters; and antibiotic therapy with one or more appropriate antibiotics that show activity against VRE. Consultation with an infectious disease specialist is recommended for treatment of patients with serious infections or VRE that is resistant to other antibiotics.

To prevent infection from VRE, the CDC recommends healthcare professionals use vancomycin prudently and promptly detect and report VRE infections. Healthcare providers in direct contact with patients should follow steps for proper hand hygiene and contact precautions.

 

QUOTE FOR TUESDAY:

“Why a have a medic alert?  In an emergency, you may be unable to communicate the details of your medical conditions, medications you take, or any severe allergies you have. Medical alert bracelets/necklaces speak on your behalf and share vital information that may be able to save your life. First response personnel will look for medical identification on your body before moving forward with treatment. They do not recognize tattoos as a form of medical ID.”

Hemophilia Foundation of Michigan  (hfmich.org)

 

Medic Alert Awareness!

There are advantages to having a medic alert button and medic alert ID tags!

It is comical to some with “Help me, I fell and I can’t get up.” regarding the commercial but we all know there are many that really have experienced this terrible disaster and did need this medic alert button for their health.

While the Medic Alert name is synonymous with medical identification bracelets; not all bracelets are created equal. That is why, this August, its celebration Medic Alert Awareness Month. This celebration is designed to educate the public about Medic Alert Foundation and the extra life-saving benefits that set foundation who sell this product apart from general medical jewelry providers (medic alert bracelets or necklaces).

The collection of services found behind every Medic Alert medical ID bracelet is how shoppers can distinguish Medic Alert Foundation from all other medical ID providers in today’s market. Only Medic Alert continues to deliver 24/7 life-saving services that other providers simply can’t match.

Medic Alert Awareness Month is a special event to recognize that, for over 50 years, the foundation has continued to protect the health and well-being of millions of members’ worldwide. We do this by ensuring you receive proper medical treatment and care during an emergency.

Medic Alert’s foundations trusted 24/7 emergency support network, offers peace of mind for both you and your loved ones. If unresponsive; your personalized engraved MedicAlert medical ID will work for you, immediately connecting first responders and medical personnel to your up-to-date medical information.

These medic alert foundations are a charity whose team members and services work 24/7; in order to ensure there customers to receive exceptional medical care in the event of an emergency (from a fall to chest pain experiencing a heart attach or experiencing a collapse due to a stroke).  With that medic alert on the individual has seconds on their bracelet or necklace medic alert button to push to get immediate help to their home with police and a ambulance with EMTs or Paramedics.

If your mom, dad or family member needs help like this may be the ideal thing for them it was for my mom.  Check out medic alert foundations on the internet and you may love just what the offer.

Don’t get this blog wrong medical bracelets are good to have also.  Your medical ID provides for a quick recognition of your medical conditions, allergies, medications, or treatment wishes; this leads to faster and more effective medical treatment.

Medical ID bracelets reduce treatment errors which may result from not having a patient’s health record during an emergency situation or upon hospital admission.

A medical ID speaks for you in the event of an emergency if you become unresponsive.

First responders and medical personnel are trained to first look for medical identification jewelry in an emergency. Medical IDs will immediately alert emergency medical professionals to your critical health and personal information.

There are unlimited reasons for you and your loved ones to wear a medical ID when living with common or unusual medical ailments. A medical ID will save your life and the lives of those you love.

 

QUOTE FOR MONDAY:

“National Immunization Awareness Month (NIAM) is an annual observance held in August to highlight the importance of vaccination for people of all ages”

Centers for Disease Control and Prevention

“Vaccines work by stimulating the body’s immune system to safely provide protection against viruses or bacteria that cause infection. After vaccination, the immune system is prepared to respond quickly when the body encounters the disease-causing organism.”.

Federal and Drug Administration FDA

National Immunization Awareness Month

National Immunization Awareness Month (NIAM) is an annual observance held in August to highlight the importance of vaccination for people of all ages. NIAM was established to encourage people of all ages to make sure they are up to date on the vaccines recommended for them. Communities have continued to use the month each year to raise awareness about the important role vaccines play in preventing serious, sometimes deadly, diseases.

Diseases that vaccines prevent can be dangerous, or even deadly if not prevented via a vaccine.  Understand ALL vaccines greatly reduce the risk of infection by working with
the body’s natural defenses to safely develop immunity to disease.
Also to understand how vaccines work, it is helpful to first look at how the body fights illness in more detail. When germs, such as bacteria or viruses, invade the body, they attack and multiply. This invasion is called an infection, and the infection is what causes the illness. The immune system uses several tools to fight infection. Blood contains red blood cells, for carrying oxygen to tissues and organs, and white blood cells or immune cells, for fighting infection. These white blood cells consist
primarily of B-lymphocytes, T-lymphocytes, and macrophages:
In simpler terminlology this means building antibodies to the diseases or eating up the disease or fighting the disease that spread in the body but getting it under control (meaning killing it off).  So vaccines fight off and prevent infection from growing in the human body including in our dog or cat (Ex. rabies vaccine for example).
How is this done, well let us explain:
Macrophages-  are white blood cells that swallow up and digest
germs, plus dead or dying cells. The macrophages leave behind
parts of the invading germs called antigens. The body identifies
antigens as dangerous and stimulates the body to attack them.
Antibodies- attack the antigens left behind by the macrophages.
Antibodies are produced by defensive white blood cells called
B-lymphocytes.
•T-lymphocytes- are another type of defensive white blood cell. They attack cells in the body that have already been infected.
The first time the body encounters a germ, it can take several days to make and use all the germ-fighting tools needed to get over the infection. After the infection, the immune system remembers what it learned about how to protect the body against that disease.
The body keeps a few T-lymphocytes, called memory cells that go
into action quickly if the body encounters the same germ again. When the familiar antigens are detected, B-lymphocytes produce antibodies to attack them.
Vaccines help develop immunity by imitating an infection. This type of infection, however, does not cause illness, but it does cause the immune system to produce T-lymphocytes and antibodies. Sometimes, after getting a vaccine, the imitation infection can cause minor symptoms, such as fever. Such minor symptoms are normal
and should be expected as the body builds immunity. Once the imitation infection goes away, the body is left with a supply of “memory” T-lymphocytes, as well as B-lymphocytes that will remember how to fight that disease in the future. However, it
typically takes a few weeks for the body to produce T-lymphocytes and B-lymphocytes after vaccination.
Therefore, it is possible that a person who was infected with a disease just before or just after vaccination could develop symptoms and get a disease, because the vaccine has not had enough time to provide protection.

Types of Vaccines:

Scientists take many approaches to designing vaccines. These approaches are based on information about the germs (viruses or bacteria) the vaccine will prevent, such as how it infects cells and how the immune system responds to it. Practical considerations, such as regions of the world where the vaccine would be used, are also important because the strain of a virus and environmental conditions, such as temperature and risk of exposure, may be different in various parts of the
world. The vaccine delivery options available may also differ geographically. Today there are five main types of vaccines that infants and young children commonly receive:
Live, attenuated vaccines fight viruses. These vaccines contain a version of the living virus that has been weakened so that it does not cause serious disease in people with healthy immune systems. Because live, attenuated vaccines are the closest thing to a natural infection, they are good teachers for the immune system.
Examples of live, attenuated vaccines include measles, mumps, and rubella vaccine (MMR) and varicella (chickenpox) vaccine. 
Inactivated vaccines also fight viruses. These vaccines are made by inactivating, or killing, the virus during the process of making the vaccine. The inactivated polio vaccine is an example of this type of vaccine. Inactivated vaccines produce immune responses in different ways than live, attenuated vaccines. Often, multiple doses are necessary to build up and/or maintain immunity.
•Toxoid vaccines prevent diseases caused by bacteria that produce
toxins (poisons) in the body. In the process of making these
vaccines, the toxins are weakened so they cannot cause illness.
Weakened toxins are called toxoids. When the immune system
receives a vaccine containing a toxoid, it learns how to fight off
the natural toxin. The DTaP vaccine contains diphtheria and
tetanus toxoids.
Subunit vaccines include only parts of the virus or bacteria, or subunits, instead of the entire germ. Because these vaccines contain only the essential antigens and not all the other molecules that make up the germ, side effects are less common. The pertussis (whooping cough) component of the DTaP vaccine is an example of a subunit vaccine.
Conjugate vaccines fight a different type of bacteria. These bacteria have antigens with an outer coating of sugar-like substances called polysaccharides. This type of coating disguises the antigen, making it hard for a young child’s immature immune system to recognize it and respond to it. Conjugate vaccines are effective for these types of bacteria because they connect (or conjugate) the polysaccharides to antigens that the immune system responds to very well. This linkage helps the immature immune system react to the coating and develop an immune response. An
example of this type of vaccine is the Haemophilus influenzae type B (Hib) vaccine.
Vaccines that require more than one dose.
There are four reasons that babies—and even teens or adults for that
matter—who receive a vaccine for the first time may need more
than one dose or every year like the flu shot or every 5 years like pneumonia shot:
•For some vaccines (primarily inactivated vaccines), the first dose does not provide as much immunity as possible. So, more than one dose is needed to build more complete immunity. The vaccine that protects against the bacteria Hib, which causes meningitis, is a good example.
•In other cases, such as the DTaP vaccine, which protects against diphtheria, tetanus, and pertussis, the initial series of four shots that children receive as part of their infant immunizations helps them build immunity. After a while, however, that immunity begins to wear off. At that point, a “booster ” dose is needed to bring immunity levels back up. This booster dose is needed at 4 years through 6 years old for DTaP. Another booster against these diseases is needed at 11 years or 12 years of age. This booster for older children—and teens and adults, too—is called Tdap.
•For some vaccines (primarily live vaccines), studies have shown that more than one dose is needed for everyone to develop the best immune response. For example, after one dose of the MMR vaccine, some people may not develop enough antibodies to
fight off infection. The second dose helps make sure that almost everyone is protected.
•Finally, in the case of the flu vaccine, adults and children (older than 6 months) need to get a dose every year. Children 6 months through 8 years old who have never gotten the flu vaccine in the past or have only gotten one dose in past years need two doses
the first year they are vaccinated against flu for best protection. Then, annual flu shots are needed because the disease-causing viruses may be different from year to year. Every year, the flu vaccine is designed to prevent the specific viruses that experts
predict will be circulating.
The Bottom Line Some people believe that naturally acquired immunity—immunity
from having the disease itself—is better than the immunity provided by vaccines. However, natural infections can cause severe complications and be deadly. This is true even for diseases that most people consider mild, like chickenpox. It is impossible to predict who will get serious infections that may lead to hospitalization. Vaccines, like any medication, can cause side effects. The most common side effects are mild. However, many vaccine-preventable disease symptoms can be serious, or even deadly. Although many of these diseases are rare in this country, they do circulate around the world and can be brought into the U.S., putting unvaccinated children at risk.

Even with advances in health care, the diseases that vaccines prevent can still be very serious – and vaccination is the best way to prevent them; Including COVID!

QUOTE FOR THE WEEKEND:

“There are a number of things that may contribute to or cause gastroparesis. In the majority of people with gastroparesis, the cause is unknown and is termed “idiopathic.” This is the most common subset of gastroparesis. The term idiopathic simply means that there is no known cause of the disease. An average of 30% to 50% of patients with gastroparesis have a diagnosis of idiopathic gastroparesis. “.

Campbell County Health  https://www.cchwyo.org

Part II Gastroparesis August Awareness Month

How is Gastroparesis Treated?
The treatment for gastroparesis in an individual depends on the severity of symptoms. Treatments are aimed at managing symptoms over a long-term.

Treatment approaches may involve one or a combination of:

  • dietary and lifestyle measures,
  • medications, and/or
  • procedures that may include surgery, such as
  • enteral nutrition,
  • parenteral nutrition,
  • gastric electrical stimulation (Enterra), or
  • other surgical procedures

Some people with gastroparesis have mild symptoms that come and go, which can be managed with dietary and lifestyle measures.

Others have moderate to more severe symptoms that additionally may be treated with medications to stimulate motility and/or reduce nausea and vomiting.

Some people have severe symptoms that are difficult to treat or do not respond to initial treatment approaches. They may require additional procedures to maintain nutrition and/or reduce symptoms.

Goals of Treatment
The goals of treatment are to manage and reduce symptoms, maintain quality of daily living, and minimize related problems such as:

  • Severe dehydration due to persistent vomiting
  • Bezoars (solid collections of food, fiber, or other material), which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form
  • Difficulty managing blood glucose levels in people with diabetes
  • Malnutrition due to poor absorption of nutrients or a low calorie intake

Manage Risk and Benefit
No single treatment helps all persons with gastroparesis. All drugs and procedures have inherent risks, some more than others. Some of the risks are unavoidable, while others can be avoided and managed. For patients and families it is important to talk to the doctor or health care team about both benefit and risk.

As a patient, in the context of your personal illness status, consider:

  • How severe is your own condition – what effect is it having on your life
  • What is the possible benefit from the treatment suggested or prescribed to you
  • What are the chances that you will receive benefit from the treatment
  • How much benefit should you reasonably expect
  • What possible side effects or complications might there be from the treatment
  • What are the chances that you will experience a side effect or serious adverse event from the treatment
  • What can you do to reduce the chances of side effects or complications
  • How will you know when a side effect occurs
  • Exactly what should you do if a side effect or complication occurs

How to live with Gastroparesis:

Gastroparesis is a long-term condition that can impair quality of life and well-being. Living with gastroparesis affects not only those who suffer but also many others, especially family members and friends. It also touches on relationships in the classroom, in the workplace, or in social interactions.

It takes skills and strengths to deal with a challenging digestive condition like gastroparesis. It means being a kind of active researcher, always looking for what does and does not help, hurt, and work best.

It is important to understand the condition and to advocate for better health. If you or a friend or loved one has gastroparesis, it is also important to understand that you are not alone with this diagnosis.

QUOTE FOR FRIDAY:

“​August is Gastroparesis Awareness Month, which is dedicated to improving understanding and management of the disease. Gastroparesis, also known as delayed gastric emptying, is a chronic condition that affects the stomach muscles and prevents proper movement of food from the stomach to the small intestine.”.

Capital Digestive Care

Part I Gastroparesis August Awareness Month

 

Should focus attention on important health messages about gastroparesis diagnosis, treatment, and quality of life issues. The goals include improving understanding of gastroparesis to help patients and families manage the condition, and encouraging preventive strategies.

The number of people with gastroparesis appears to be rising. Yet gastroparesis is poorly understood. More community awareness is needed about the condition.

The more awareness for gastroparesis, the greater the ability to impact positive outcomes, such as additional research and improved patient care for the functional GI and motility disorders.

Gastroparesis is also called delayed gastric emptying. The term “gastric” refers to the stomach.

Normally, the stomach empties its contents in a controlled manner into the small intestines. In gastroparesis, the muscle contractions (motility) that move food along the digestive tract do not work properly and the stomach empties too slowly.

Gastroparesis is characterized by the presence of certain long-term symptoms together with delayed stomach emptying in the absence of any observable obstruction or blockage. The delayed stomach emptying is confirmed by a test.

Signs and Symptoms:

The signs and symptoms of gastroparesis may differ among persons with the condition. Symptoms usually occur during and after eating a meal.

Symptoms that are characteristic of gastroparesis include:

  • Nausea and/or vomiting
  • Retching (dry heaves)
  • Stomach fullness after a normal sized meal
  • Early fullness (satiety) – the inability to finish a meal

Diagnosing Gastroparesis:

The symptoms of gastroparesis are similar to those that occur in a number of other illnesses. When symptoms persist over time or keep coming back, it’s time to see a doctor to diagnose the problem. An accurate diagnosis is the starting point for effective treatment.

Diagnosis of gastroparesis begins with a doctor asking about symptoms and past medical and health experiences (history), and then performing a physical exam. Any medications that are being taken need to be disclosed.

Tests will likely be performed as part of the examination. These help to identify or rule out other conditions that might be causing symptoms. Tests also check for anything that may be blocking or obstructing stomach emptying. Examples of these tests include:

  • a blood test,
  • an upper endoscopy, which uses a flexible scope to look into the stomach,
  • an upper GI series that looks at the stomach on an x-ray, or
  • an ultrasound, which uses sound waves that create images to look for disease in the pancreas or gallbladder that may be causing symptoms.

If – after review of the symptoms, history, and examination – the doctor suspects gastroparesis, a test to measure how fast the stomach empties is required to confirm the diagnosis.

Slow gastric emptying alone does not correlate directly with a diagnosis of gastroparesis.

There are several different ways to measure the time it takes for food to empty from the stomach into the small intestine. These include scintigraphy, wireless motility capsule, or breath test. Your doctor will provide details of the one chosen.

Gastric Emptying Study (Scintigraphy)
The diagnostic test of choice for gastroparesis is a gastric emptying study (scintigraphy). The test is done in a hospital or specialty center.

It involves eating a bland meal of solid food that contains a small amount of radioative material so that it can be tracked inside the body. The abdomen is scanned over the next few hours to see how quickly the meal passes out of the stomach. A radiologist will interpret the study at periodic intervals after the meal.

A diagnosis of gastroparesis is confirmed when 10% or more of the meal is still in the stomach after 4 hours.

Other methods for measuring gastric emptying include a wireless motility capsule and a breath test.

Wireless Motility Capsule
The ingestible wireless motility capsule (SmartPill) is swallowed and transmits data to a small receiver that the patient carries. The data collected is interpreted by a radiologist. While taking the test, people can go about their daily routine. After a day or two, the disposable capsule is excreted naturally from the body.

Breath Test
The breath test involves eating a meal that contains a nonradioactive component that can be tracked and measured in the breath over a period of hours. The results can then be calculated to determine how quickly the stomach empties.

Stay tune for Part II tomorrow!