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Friday, January 17, 2014

ACMNPV - the new, but not so catchy HAI acronym!

Unlike the brilliant ESKAPE acronym, I cannot (at least in the 20 minutes I gave myself) come up with a catchy acronym for Acinetobacter, Clostridium difficile, MRSA, Norovirus, Pseudomonas and VRE.  ACMNPV is simply the first letter of each.  Perhaps PNAVCM of  VACNMP would be better? 

Regardless, according to the December 2013 Primer on Hospital Pathogens published by ICT, these are the pathogens most prevalent in the hospital environment.  These are the pathogens that should be of significant concern to Infection Preventionists (IPs).  But why? 

Acinetobacter baumannii is a lovely  gram negative bacterium that can inflict a wide range of diseases - bacteraemia, wound infections or pneumonia to name a few.  While it poses very little risk to healthy individuals, those with suppressed immune systems (e.g. patients in ICUs, Burn Units) or chronic underlying diseases (e.g. diabetes or COPD etc) present the perfect target for this opportunistic little bugger.  From an environmental impact perspective, Acinetobacter is transmitted via contact (e.g. person to person or indirect via contact with fomites) and is believed to survive in the environment for several days and perhaps up to months.

Clostridium difficile is a spore forming gram positive bacterium.  It's the spore forming or suit of armor creating characteristic that has caused many a grey hair for IPs around the world.  In fact, C. diff accounts for 15 - 25% of all cases of antibiotic-associated diarrhea.  The suit of armor helps increase the length of survival in the environment making the need for diligent cleaning and disinfection all the more important and by diligent, I in no way mean that you try to nuke all surfaces with a sporicidal agent, I mean that we need to do a thorough job in cleaning and physically removing soils and spores from environmental surfaces and patient care equipment.  But don't just blame the environment or the housekeeper, antibiotics are the primary cause for development of C.diff Diarrhea - be sure to look at and question antibiotic prescription practices by doctors.

Methicillin Resistant Staphylococcus aureus or MRSA to those in the know, is a gram positive bacterium that is resistant to many different antibiotics.  At any given time, between 20 and 30 per cent of the general population carry Staph bacteria and /or MRSA on their hands or in their noses, but are not ill.  This is particularly concerning as researchers have shown that MRSA can survive on environmental surfaces for up to 56 days!  Similar to Acinetobacter, MRSA can be transmitted via both direct and indirect contact so environmental hygiene (e.g. cleaning and disinfection) cannot be underestimated in its importance for keeping MRSA off the surfaces to stop transmission.  The good news is that according to U.S. health officials, MRSA infections have fallen by nearly 30 percent in the last decade. 

Norovirus - a wonderful winter weight loss program - is a non-enveloped virus that is quite resistant to many of our commonly used day-to-day disinfectants.  It does not take much of hardy little terrorist to cause infection and can live in virtually any environment (including at freezing temperatures to 60C/140F).  Transmission is primarily caused by eating poop (the less technical way of stating fecal-oral) and can survive on surfaces for up to 14 days.  While we often panic over the antibiotic resistant bacteria, we cannot underestimate the economic burden of Norovirus as it is estimated to cause up to 21 MILLION cases of gastroenteritis (aka puking and pooping) per year in the US.  Best of all you just have to "ride" it out - viruses are not susceptible to treatment with antibiotics.  Focusing on cleaning and disinfection with a disinfectant that is effective against Norovirus and judicious hand hygiene are the best means to deal with this bad guy.

Pseudomonas aeruginosa (most commonly referred to as Pseudo) is a gram negative bacterium that is widely found in the environment and particularly found on water and moist conditions and accounts for about 10% of all HAIs.  Like MRSA and Acinetobacter it can be transmitted by both direct and indirect contact and is more concerning to patient with weakened immune systems.  While, Pseudo loves moist environments, it has been found to survive on dry surfaces for up to 16 months and can cause all sorts of infections (bacteraemia, pneumonia, UTIs etc) depending on its portal of entry (e.g. how it got into you).  As you've likely guessed, cleaning and disinfection and hand hygiene will help stop the spread.

Lastly, VRE or Vancomycin Resistant Enterococci  are a group of gram positive bacteria that are naturally present in our intestines, in the female genital tract and the environment.  As the name would imply, they are resistant to some classes of antibiotics and as expected is more concerning with people who have weakened immune systems.   VRE is a hardy little pest that can survive for extended periods of time in the environment and can be transmitted by both direct and indirect transmission.  Because of its ability to survive in the environment, if cleaning and disinfection is not completed with utmost care researchers have shown there is a VERY strong chance of the next person admitted into a room or bed previously occupied by someone with VRE. 

I would expect the organisms we just reviewed are already on your hit list for infection prevention programs and intervention strategies.  The key (or theme) I hope you picked up is the association with transmission from contaminated surfaces.  Cleaning saves lives, but cleaning is not something that can be rushed because short cuts will cost lives.


Bugging Off!



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