Prevention Matters

Alcohol-based hand cleaners shown to reduce common infections and number of workdays lost was named the “Best News for Prevention” while the risky behavior of driving with pets was named the “Worst News for Prevention.”

BEST

Hand Cleansers Cut Absenteeism

Putting alcohol-based hand cleansers in work places slashed the incidence of several common infections and reduced the number of workdays lost, a randomized trial showed.

Access to the disinfectants was associated with odds ratios of 0.35 to 0.45 (P<0.05) for reported colds, fevers, and coughs in an unblinded trial with 129 participants, according to Nils-Olaf Hübner, MD, of the Institute of Hygiene and Environmental Medicine in Greifswald, Germany, and colleagues.

The researchers also found that putting disinfectants on employees' desks helped reduce absenteeism. The effect was modest overall, but workdays lost because of diarrhea were cut dramatically, they reported in the online open-access journal BMC Infectious Diseases.

WORST

Study: Driving under influence of pets a danger


Safety experts have a new pet peeve related to distracted driving. In addition to texting or talking on a cell phone while driving, lap dogs and other pets left unrestrained inside moving vehicles pose a major distraction that could be deadly, a new study released Wednesday warns motorists.

About two-thirds of dog owners surveyed by the AAA organization said they routinely drive while petting or playing with their dogs, sometimes even giving them food or water while maneuvering through traffic.

It has been a common sight for many years to see dogs hanging their heads out of open car windows with their ears flapping in the breeze. But in the cocoon that the automobile has become, more drivers are nonchalantly cradling their dogs atop their laps or perching the animals on their chests with the pet's front paws clutching the driver's neck or shoulders. It's risky behavior for the driver and dangerous for the pets, too.


The “Best and Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best and Worst News for Prevention” is based on a purposive sample of expert staff members who each week choose to share their opinions on the best and worst news for prevention. More information is available at http://www.prevent.org/.

Decline in Hospital Staph Infections, Increased Rate of Early Onset of Puberty for Girls named “Best/Worst News for Prevention”

The drop in dangerous hospital staph infections in the United States was named the “Best News for Prevention” while girls beginning puberty at ages 7 and 8 was named the “Worst News for Prevention.”

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best/Worst News for Prevention” polls are snapshots taken during a brief period of time that reflect the views of Partnership for Prevention staff. The polls are not designed or intended to reflect a statistically valid representation of the population and should not be used as such. More information is available at http://www.prevent.org/.


BEST

US sees drop in dangerous hospital staph illnesses

Aggressive, drug-resistant staph infections caught in hospitals or from medical treatment are becoming scarcer, another sign of progress in a prevention effort that has become a national public health priority.

The decline was seen in a federal study of methicillin-resistant staph, or MRSA. The bug often causes only a boil or skin infection. But researchers in the study focused on invasive cases that can become deadly, invading the bloodstream, flesh, lungs and bones.

Researchers found that in nine metro areas, cases of MRSA fell about 16 percent between 2005 and 2008. That translates to a drop from about 32 cases per 100,000 to 26 cases per 100,000 people.

The results suggest aggressive efforts to stop the germ from spreading are working, researchers said. Such efforts include better hand-washing by doctors and nurses, and testing for MRSA when patients are admitted to the hospital. "We're very encouraged by the results," said Dr. Alexander Kallen of the Centers for Disease Control and Prevention, the study's lead author. But he added, "It's still too early to celebrate. A lot of work needs to be done about better ways to eliminate MRSA."

WORST

Many Girls Now Begin Puberty at Age 7, 8


The onset of puberty is continuing to drop among American girls, with many girls as young as 7 and 8 now showing the beginnings of breast development, new research shows. Among 7-year-olds, about 10.4 percent of white girls, 23.4 percent of black girls and almost 15 percent of Hispanic girls had started developing breasts, the team report in the September issue of Pediatrics. Among 8-year-olds, 18.3 percent of white girls, about 43 percent of black girls and just under 31 percent of Hispanic girls showed evidence of breast development.

Rising rates of childhood obesity -- long linked to earlier sexual development -- may be to blame, experts say.

Experts called the findings alarming. In terms of women's health, early puberty, including younger ages at menarche, or first menstrual cycle, is associated with a higher risk of breast cancer throughout the life span, Biro said. In addition, developing early is associated with psychological and social pressures that young girls may be ill-equipped to handle, including sexual advances from older boys and men, said Dr. Marcia Herman-Giddens, adjunct professor of public health at the University of North Carolina, Chapel Hill.

A study showing that children benefit from laws that regulate locations where smoking is allowed was named the “Best Prevention Idea of the Week,” while a study that found that loose infection practices are contributing to problems with infection control at same-day surgery centers was named the “Worst Prevention Idea of the Week."

BEST

Smoke-Free Laws Benefit Kids, Too

Kids benefit from laws that regulate locations where smoking is allowed, a new study shows.

Smoke-free-air laws have already been shown to reduce exposure to secondhand smoke among adults. Now a study shows that such laws benefit children and adolescents, too, as long as they don't live with a smoker.

Researchers analyzed data from the 1999-2006 National Health and Nutrition Examination Survey and found that youngsters who live in a county with extensive smoke-free-air laws had a 39% lower prevalence of cotinine in their blood. Cotinine, an alkaloid found in tobacco, is a major metabolite of nicotine and a common biomarker of secondhand smoke exposure. It is detectable in blood for a minimum of several days after exposure to tobacco smoke.

WORST

Poor infection control at many surgery centers


A new federal study finds many same-day surgery centers — where patients get such things as foot operations and pain injections — have serious problems with infection control. Failure to wash hands, wear gloves and clean blood glucose meters were among the reported breaches. Clinics reused devices meant for one person or dipped into single-dose medicine vials for multiple patients. The findings, appearing in last Wednesday's Journal of the American Medical Association, suggest lax infection practices may pervade the nation's more than 5,000 outpatient centers, experts said.

Toronto’s ban on smoking in restaurants that led to a major decline in heart and lung hospital admissions was named the “Best Prevention Idea of the Week,” while the lack of progress in eliminating infections that can harm or kill patients in U.S. hospitals was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

Best

Smoking Ban Cut Hospital Admissions

Toronto's ban on smoking in restaurants led to a major decline in heart and lung hospital admissions, a Canadian medical research study said Tuesday. Smoking in restaurants was banned by the city in 2001. The research published in the Canadian Medical Association Journal said within three years, hospitalizations for heart conditions fell 39 percent and 32 percent for respiratory conditions, the Globe and Mail reported. Using data from two other regions in Ontario that didn't have smoking bans, the rate of admissions for heart attacks jumped by almost 15 percent during the same time period, the report said.

Worst

U.S. Hospitals Get Low Marks on Curbing Infections

U.S. hospitals are making little progress in eliminating infections that can harm or kill patients, according to reports released April 13 by the federal Agency for Healthcare Research and Quality. Researchers found that rates of bloodstream infections after operations (postoperative sepsis) increased by 8 percent, rates of catheter-associated urinary tract infections following surgery increased by 3.6 percent, and rates of certain infections due to medical care increased by 1.6 percent. However, rates of pneumonia that developed after surgery (postoperative pneumonia) fell by 12 percent.

New Yorkers’ efforts to curb salt use and the widespread presence of bacteria linked to feces at soda fountains were named the Best and Worst Prevention Ideas of the week.

The “Best/Worst” awards are given by “Prevention Matters,” the blog of Partnership for Prevention. Nominees are suggested by Partnership staff and the general public, and voted on by the staff. For more information about Partnership for Prevention, go to www.prevent.org .


BEST


NYC Seeks National Effort to Curb Salt Use

New York City officials plan to unveil a broad new health initiative aimed at encouraging food manufacturers and restaurant chains across the country to curtail the amount of salt in their products. The plan, for which the city claims support from health agencies in other cities and states, sets a goal of reducing the amount of salt in packaged and restaurant food by 25 percent over the next five years. Public health experts say that would reduce the incidence of high blood pressure and should help prevent some of the strokes and heart attacks associated with that condition. The plan is voluntary for food companies and involves no legislation. It allows companies to cut salt gradually over five years so the change is not so noticeable to consumers.


WORST

Bacteria Linked to Feces Found on Soda Fountains

A team of microbiologists from Hollins University found that 48% of the sodas they tested from fast food soda fountains had coliform bacteria. Coliform is typically fecal in origin. On top of that, the study found that most of the bacteria were resistant to antibiotics. The team tested 90 beverages from 30 fountains, and published their findings in the International Journal of Food Microbiology.

The recent revelation of the first U.S. case of an especially drug-resistant form of tuberculosis is the result of a six-month study by the Associated Press of the "soaring global challenge of drug resistance."

"Today, all the leading killer infectious diseases on the planet — TB, malaria and HIV among them — are mutating at an alarming rate, hitchhiking their way in and out of countries," write AP reporters Margie Mason and Martha Mendoza. "The reason: Overuse and misuse of the very drugs that were supposed to save us."

Business executive David Goldhill writes a passionate piece in the current edition of The Atlantic entitled "How American Health Care Killed My Father." Goldhill, whose father died of a hospital-borne infection at New York City institution, says the perverse sets of incentives within the current system aren't worth keeping.

"Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results," Goldhill writes. "Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value."

Goldhill recalls Dr. Peter Pronovost 's attempts to reduce the incidence of fatal hospital-borne infections by using a simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures.

"Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption," he said. "But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them.

"My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals," Goldhill says.

"How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people."

There have been a couple of really good items this week on how efforts to prevent hospital infections are being inadvertantly undermined here and abroad, even though they cause 10,000 deaths a year in the U.S. and add $20 billion to the country's health care bill.

Laura Landro over at WSJ's "Health Blog" cites a poll by the Association for Professionals in Infection Control in which 41% of nearly 2,000 professionals reported cuts in their budgets, including money for technology, staff, education, products and equipment. Of those, nearly 40% had layoffs or reduced hours, and a third experienced hiring freezes. Nurses who staff many of the departments say they are being asked to take on extra duties that distract them from infection control.

Meanwhile, the BBC reports on a British Medical Association report that says infection control practices there have been damaged by overcrowding and understaffing in NHS facilities. "...the BMA says polices promoting higher patient throughput "have led to many services constantly operating close to full capacity. This has led to overcrowding, understaffing, higher bed occupancy, and increased movement of patients between hospital wards. All of these factors have made it difficult to implement measures such as hand washing, and screening of at-risk patients."