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EUROPEAN HOSPITAL Vol 24 Issue 2/15 14 LABORATORY U.S. aims to slow the rise of drug-resistant bacteria Obama’s multi-year, billion-dollar effort Meet Mr Clean H The USA’s President Barack Obama released a comprehensive plan in March to slow the emergence of drug-resistant bacteria, a multi-year, billion-dollar effort that includes getting doctors to stop over-pre- scribing antibiotics, developing new medications and rapid diagnostics, and real-time tracking of infection outbreaks. ‘We’re setting national goals for improving antibiotic use, and we’re asking doctors and hospitals to help us meet them,’ President Obama told Medscape in a March 27 inter- view about the plan. ‘And we’re going to help health departments across the country achieve these goals.’ The overall goal is to reduce the most serious health threats, including carbapenem-resistant Enterobacteriaceae (CRE), methicil- lin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile, which cause approximately 23,000 deaths in the United States alone, according to the USA’s Centers for Disease Control and Prevention. The plan will be overseen by a USA’S Government Task force and includes several strategies: •Getting doctors to prescribe fewer antibiotics and ensuring patients receive the right antibi- otic at the right time. They call him Mr Clean Hand. Professor Didier Pittet MD, Specialist in Infection Prevention and Control at the Hôpitaux Universitaires de Genève and Head of the Clean Care is Safer Care programme of the World Health Organisation (WHO), is known as the ‘Father of Modern Hand Hygiene’. It was Pittet who, in the 1990s, introduced at his hospi- tal the hitherto largest study on the subject of hand hygiene. It was he who defined the ‘five moments for hand hygiene’: before patient con- tact, before an aseptic procedure, after contact with potentially infec- tious material, after patient contact and after contact with the immediate patient environment. Additionally, it was he who thought of the ‘steps for effective hand disinfection: rub- bing the palms, wrists, back of the hands, the spaces between the fingers, linked fingers, thumbs and fingertips with disinfectant within thirty seconds. This March, during the First CEE Conference on Hospital Hygiene and Patient Safety (held in Vienna), Pittet spoke about healthcare associ- ated infections (HAI) and the way to combat these with hand hygiene strategies. Such infections cost around 16 million lives worldwide every year. In developed countries these are the second most com- mon cause of death, Pittet believes. ‘However,’ he adds, ‘there’s a simple remedy for hospital acquired infec- tions – and this is hand washing.’ Unfortunately, however, there is one major problem: compliance, which is usually only around 40%. Between 1994 and 1997 the hand hygiene model that he developed substantially increased willingness amongst Geneva doctors and nurses to carry out regular hand disinfec- tion. The Geneva Model consists of two central cornerstones: an aware- ness campaign as well as monitor- ing and compliance confirmation. At the time, funny cartoons of nasty bacteria and dirty hands adorned the corridors of the Geneva hospital, and all nosocomial infec- tions had to be reported. As a study in The Lancet confirms, the success of this model was repeated between 2002 and 2005 in many other coun- tries, including France, Belgium, the USA, Australia, Belgium, Great Britain and Switzerland. A recent adaption of the Geneva Model helped to reduce infant mortality in hospitals in Vietnam by 80%, Pittet The Genspeed C. diff OneStep test, a CE-IVD certified molecular diag- nostic test to detect nosocomial infections, has been added to the Greiner Bio-One portfolio. The manufacturer reports that the test identifies toxigenic C Clostridium difficile by combining the detection of Glutamatdehydrogenase (GDH), Toxin A, Toxin B and binary toxin in a single, molecular test – and a com- plete analysis, including the detec- tion on the Genspeed R2 Analyser takes under 100 minutes (* Time can vary with validated PCR-cycler used). The new test addresses a lead- ing threat to healthcare systems worldwide; C. diff infection (CDI), believed to be the most common healthcare-associated infection. The disease causes antibiotic-associat- ed diarrhoea (AAD) that may lead to pseudomembranous colitis and even to death. In a 2013 pub- lished report, the Center for Disease Control (CDC) in the USA catego- rised C. difficile infections as ‘Threat Level Urgent’, the highest level avail- able. OneStep – one test – four results The Genspeed C. diff OneStep test avoids the currently used, sequen- tial, two-step diagnostic test pro- cedures, which combine different test systems and assay principles for GDH and the C. difficile toxins. The new provides conclusive results without the need for confirmatory re-testing and enables inter-labora- tory comparisons of test results, the maker reports. ‘Ready-to-use rea- gents and automated dispensing minimise the number of manual process steps within the workflow.’ * All Genspeed products are currently available for sale in the EU and EFTA countries only. •Developing at least two antibiot- ics, or non-traditional therapies, to treat bacterial diseases in humans. •Developing tests that rapidly distinguish between viral and bacterial pathogens, and tests to detect antibiotic resistance. •Creating a network of laborato- ries to detect strains of resist- ant bacteria and a specimen repository that can be accessed by researchers, and providing incentives to healthcare provid- ers to report antibiotic resistance and antibiotic use. •Eliminating the use of medically important antibiotics for growth promotion in food animals and having veterinarians oversee the use of drugs for treatment, con- trol, and prevention of disease in animals. •Working globally — with foreign ministries of health and agricul- ture, and organisations such as the WHO— to control the spread of antibiotic-resistant bacteria. Obama has included the $1.2 billion plan in his proposed 2016 budget. Infectious disease experts applauded the White House for tak- ing the lead and offering practical plans for improved stewardship of antibiotic use in medicine and the development of new drugs and tests, but they worry that the effort doesn’t go far enough to curb the use of antibiotics in animal agri- culture. Lance Price, a microbiologist at George Washington University, says the president’s plan does not offer measurable goals for reducing use of antibiotics in animals raised for food, and also does not address overcrowding and other conditions that cause infections to spread among them. ‘It’s really weak on the animal antibiotics side,’ Price says. ‘You can’t shut off one pipeline and expect the whole thing to be fixed without shutting of this other, huge pipeline.’ Europe has led the way in address- ing the use of antibiotics in animals, says James Johnson MD, profes- sor of medicine and an infectious disease expert at the University of Minnesota. Using antibiotics to promote growth in animals has been banned in Europe since 2006. Johnson also points to recent efforts in the Netherlands where, in 2009, the government directed farmers to cut antibiotic use in meat animals in half, and to Denmark, which has been reducing antibiotic use in ani- mals since the 1990s. ‘I think the US has sort of moved into playing catch-up to Europe in handling antibiotic resistance,’ Johnson says. ‘I see the action plan as the US getting back in the game.’ Johnson also worries about what he considers the shortfalls of the White House plan, including the lack of an authority figure at the federal level to oversee efforts to curb antibiotic resistance. ‘Pulling it all together and making sure it all happens – there has been a glaring lack of that in the past,’ Johnson says. However, the health- care community will likely embrace the effort, Price adds. ‘It seems like the medical community is ready for a change here. I think, with reim- bursement rules changing and these time-bound quantitative goals, this is going to have a benefit for sure, and the medical community will rise up to the challenge.’ Source:TheWhiteHouse Source:Semmelweis Source:CentersforDiseaseControlandPrevention Source: Heade & Dischinger KG ©GreinerBio-One U.S. President Barack Obama Two plates growing bacteria in the presence of discs containing various antibiotics. The isolate on the left plate is susceptible to the antibiotics on the discs and therefore unable to grow around the discs. The one on the right has a CRE that is resistant to all the antibiotics tested and can grow near the discs. One step C. diff testing CE-IVD certified molecular test added to Genspeed Genspeed R2 Analyser and Genspeed C. diff OneStep Test Didier Pittet MD directs the Infection Control Programme and WHO Collabo rating Centre on Patient Safety at Geneva’s University Hospital and is the External Lead of the World Health Organisation’s (WHO) Global Patient Safety Challenge Clean Care is Safer Care and African Partnerships for Patient Safety. He developed the Geneva Hand Hygiene Model, and showed in a big study (1995–1997) the effects of this strategy on healthcare associated infections. He also led the development of the WHO Guidelines for Hand Hygiene in Health Care (pub: 2009).

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