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Saturday, April 2, 2011

Latest hands-free electronic water faucets found to be hindrance, not help, in infection control

A study of newly installed, hands-free faucets at The Johns Hopkins Hospital, all equipped with the latest electronic-eye sensors to automatically detect hands and dispense preset amounts of water, shows they were more likely to be contaminated with one of the most common and hazardous bacteria in hospitals compared to old-style fixtures with separate handles for hot and cold water.

"Newer is not necessarily better when it comes to infection control in hospitals, especially when it comes to warding off potential hazards from water-borne bacteria, such as Legionella species," says senior study investigator and infectious disease specialist Lisa Maragakis, M.D., M.P.H. "New devices, even faucets, however well intentioned in their make-up and purpose, have the potential for unintended consequences, which is why constant surveillance is needed," says Maragakis, director of hospital epidemiology and infection control at Hopkins Hospital and an assistant professor at the Johns Hopkins University School of Medicine.
Although the high-tech faucets cut daily water consumption by well over half, Johns Hopkins researchers identified Legionella growing in 50 percent of cultured water samples from 20 electronic-eye faucets in or near patient rooms on three different inpatient units, but in only 15 percent of water cultures from 20 traditional, manual faucets in the same patient care areas. Weekly water culture results also showed half the amount of bacterial growth of any kind in the manual faucets than in the electronic models.
While the precise reasons for the higher bacterial growth in the electronic faucets still need clarification, the researchers say it appears that standard hospital water disinfection methods, which complement treatments by public utilities, did not work well on the complex valve components of the newer faucets. They suspect that the valves simply offer additional surfaces for bacteria to become trapped and grow.
The Johns Hopkins researchers will present their findings at the annual meeting of the Society for Health Care Epidemiology (SHEA) in Dallas on April 2.
Infection control experts behind the latest study, believed to be the first detailed analysis to show how and why these new fixtures pose a problem in preventing Legionella infections in hospitals, say the electronic devices were widely introduced in patient care and public areas of hospitals across the United States, including in The Johns Hopkins Hospital, more than a decade ago. The idea was to prevent bacterial spread from people touching the faucet's water handles with their dirty hands. 
As a result of the study, conducted over a seven-week period from December 2008 to January 2009, Johns Hopkins facilities engineers removed all 20 newer faucets from patient care areas and replaced them with manual types. A hundred similar electronic faucets are also being replaced throughout the hospital, and hospital leadership elected to use traditional fixtures – some 1,080 of them – in all patient care areas in the new clinical buildings currently under construction at Johns Hopkins' East Baltimore campus. The new buildings are set to open in 2012.
Lead study investigator Emily Sydnor, M.D., a fellow in infectious diseases at Johns Hopkins, says Legionella bacteria, commonly found in water supplied from public utilities, rarely cause illness in people with healthy immune systems, but pose a real risk of infection in hospital patients whose immune systems are weakened from cancer chemotherapy, anti-rejection drugs after organ transplant, or from diseases such as HIV/AIDS.
Sydnor says this is why some hospitals, including Johns Hopkins, treat water supplied from public utilities with chlorine dioxide or other methods to keep Legionella levels low.
Indeed, the original goal of the research team, says co-investigator Gregory Bova, senior engineer at Johns Hopkins, was to test the new faucets to determine how often and for how long treated water needed to be flushed through the hospital's taps to keep Legionella and any other bacteria at nearly undetectable levels.
"We were surprised by the initially high bacterial counts," says Bova. Study results showed Legionella bacteria levels between 0 and 3,000 bacterial colony forming units per milliliter of water from electronic faucet samples.
High Legionella and overall bacterial counts were detected in tests of the newer faucets after the hospital's water flow from the city was briefly interrupted for a few hours before and immediately after the study began. The double interruptions produced a fresh influx of Legionella and other bacteria, requiring Bova and his staff to perform additional disinfecting water treatments, prompting the latest study investigation.
As part of the study, Bova and his team disassembled four of the electronic faucets and their component parts, two before the water was treated and two afterward, with swab culture tests showing Legionella and other bacteria on all of the main component valves and other parts, very few of which, if any, exist in manual faucets.
"Our findings show us that standard hospital water treatment practices are not effective at disinfecting these more complex, electronic-eye faucets of Legionella and other potentially harmful bacteria, even after remediation and additional treatment," says Bova, who has reported his findings to the faucet manufacturer, the Chicago Faucet Co., in Des Plaines, Ill. "We would have to take apart, clean and disinfect the entire faucet assembly, every time, which is simply not practical or cost-effective."
Among the study team's other observations were that the electronic faucets were used continuously, between seven and 110 times per day. Such continuous flushing, says Sydnor, helps suppress bacterial growth.
"It's good for infection control purposes that staff are actually washing their hands so frequently," says Sydnor, "but these faucets may not be the best option to aid our staff in protecting our patients from potential risk of infection."
Bova says actual water usage for the new faucets, which have electronic control settings for precise volumes, averaged over 18 gallons per day, or roughly a quarter of what he estimates was used by the manual faucets, which have no precise volume measurements. He says the electronic variety can actually be programmed to consume as little as a fifth of traditional models, down to as little as a half-gallon per minute.
Researchers say their next steps are to work with manufacturers of electronic and manual faucets to help remedy their flaws and to design components that can be cleaned more easily and save water. They have also notified infection control staff at other hospitals of their latest findings.
Provided by Johns Hopkins Medical Institutions

Friday, April 1, 2011

Trial to test laser acupuncture treatment for osteoarthritis

( -- The potential for laser acupuncture to provide painless and effective treatment for osteoarthritis knee pain is being put to the test in a clinical trial beginning in Sydney.

Traditional Chinese medicine practitioner Meikin Li Rees is recruiting 60 participants for the trial, being undertaken as part of her PhD research at UTS.
"Osteoarthritis (OA) is the most common form of arthritis and the major cause of musculoskeletal pain and immobility in elderly people worldwide," Ms. Rees said.
"In Australia, arthritis affects some 3.4 million people – nearly 17 per cent of the population.
"Of the proportion of Australians affected, 60 per cent are women and 60 per cent of all people living with arthritis are of working age.
"If the current trend continues, one in five people, or around 4.6 million Australians, are forecast to be living with  by 2020."
Ms. Rees said the  Research Society International already recommends needle  among treatments for the management of OA of the knee or hip.
"The UTS study will involve the use of the comparatively new derivative of needle acupuncture that involves the irradiation of acupuncture points with a low-intensity ," she said.
"Laser acupuncture is painless and ideal for people who have a fear of needles, particularly the elderly.
"We want to find out whether the physiological effects of laser offer some advantages over needle-based acupuncture and medication."
The randomised, double-blind, placebo-controlled trial has been approved by the UTS Human Ethics Research Committee.
Subject to meeting certain criteria for selection for the trial, all treatments provided will be free and participants will receive a small payment to cover the cost of getting to and from the place of treatment in the Sydney CBD or Western Sydney.
Provided by University of Technology, Sydney

Thursday, March 31, 2011

Medical News: Angio Cath Pulled for Particulate Debris - in Public Health & Policy, FDA General from MedPage Today

By Cole Petrochko, Staff Writer, MedPage Today
Published: March 25, 2011
The maker of an angiographic catheter recalled the product because of debris in the lumen that may cause MI, stroke, limb ischemia, or death.
The high-speed injection feature of the Human Use High Injection Angiographic Catheter may increase the number of potentially lethal particles entering the bloodstream, according to a statement from device manufacturer Millar Instruments.
The recall includes 965 units sold internationally and 115 sold in six states -- California, Massachusetts, Michigan, Minnesota, New York, and Pennsylvania -- and the District of Columbia.
All devices with model numbers SPC-454D and SPC-454F are affected by the recall.
The FDA has been notified of the recall, the company said, although no adverse events related to the recall have been reported.

Wednesday, March 30, 2011

Medical News: Drugmaker Gets New Headache from Defective Motrin - in Product Alert, OTC from MedPage Today

By John Gever, Senior Editor, MedPage Today
Published: January 12, 2011
Johnson & Johnson's "phantom recall" of defective ibuprofen (Motrin) caplets in 2009 has brought more pain to the beleaguered company, in the form of a civil suit filed by the state of Oregon.
The state is charging that J&J, in delaying a publicly announced recall in favor of secretly buying up the defective products from stores, put Oregon residents at risk.
J&J's McNeil consumer products unit had discovered in late 2008 that some Motrin caplets, packaged in eight- and 24-count containers, failed to dissolve properly, so that patients excreted the caplet before it could release the full ibuprofen dose.
Although the company notified the FDA of the issue, it did not alert wholesalers, retailers, or consumers to the problem until February 2010, according to Oregon Attorney General John Kroger.
Instead, beginning in early 2009, McNeil hired contractors to pose as customers, going into stores to secretly buy up the defective packages, the suit charges.
According to Kroger, the contractors were told not to mention a recall if questioned. "Simply state that your employer is checking the distribution chain of this product and needs to have some of it purchased for the project," according to their written instructions.
Authorities learned of the buy-back plan in mid-2009, according to Kroger. One of the company's hired shoppers in Oregon became uncomfortable with the secrecy and informed the state Board of Pharmacy, which, in turn, alerted the FDA, Kroger said in a statement.
The "phantom recall" became public knowledge last spring when it was disclosed by an FDA official at a congressional hearing.
This newest headache for J&J follows a string of recalls involving other OTC products including its big-selling Tylenol, Benadryl, and Rolaids brands.
The company underwent a management shakeup last year and it is still facing a criminal inquiry from the FDA over its manufacturing woes.
The Oregon civil suit seeks $25,000 for each violation of Oregon's Unlawful Trade Practices Act, which prohibits "unconscionable tactics" and requires public disclosures of certain information. The suit also demands reimbursement for customers who bought Motrin caplets prior to the publicly announced recall.
According to the suit, 787 Motrin packages remained unaccounted for, despite the recall and the hired shoppers' efforts

Medical News: Plug Pulled on Surgical Drains - in Product Alert, Devices and Vaccines from MedPage Today

By Cole Petrochko, Staff Writer, MedPage Today
Published: March 26, 2011
Johnson & Johnson subsidiary Ethicon recalled a number of surgical drains, kits, and associated products after the company received a number of complaints about potentially compromised sterility.
The sterile barrier on the Blake Silicone Drain, Blake Silicone Drain Kit, Blake Cardio Connector, J-Vac Reservoir, and J-Vac Drain Adapter may be compromised on 341 product lots distributed from May 10, 2010 to Feb. 28, 2011, a company statement said.
The full list of product codes and lot numbers, as well as locations of these identifying characters are available in the original recall notice.
Customers with any of the affected products should stop using them and return them in a prepaid shipping label mailed to customers, the statement said.
No adverse events related to the recall have been reported.
The recall, the latest in a host of such actions by Johnson & Johnson and its subsidiaries, is being carried out with the knowledge of the FDA

Tuesday, March 29, 2011

Medical News: AAPM: At Any Age Depression Dx Tracks Opioid Use - in Meeting Coverage, AAPM from MedPage Today

WASHINGTON -- Teens and young adults with mental health disorders may be more likely to become chronic users of opioid drugs, according to results of a large study reported here.
The study of more than 59,000 chronic pain patients (ages 13-24) found that overall, 17.1% of chronic opioid users had a mental health or substance use diagnosis, compared with 10.6% among non-chronic users, and 8.2% for those who did not use opioids, Mark Sullivan, MD, professor of psychiatry and behavioral sciences at the University of Washington in Seattle, and colleagues reported.
Their findings were presented in a poster session at the annual meeting of the American Academy of Pain Medicine.
It is well-known that adults with mental health problems have a higher risk of suffering from chronic opioid use and abuse compared with those without mental health issues. Sullivan's group wanted to find out more about younger opioid users.
"Since the group of adolescents are at the highest risk for opioid abuse, we felt it was important to focus on how these individuals get prescribed opioids for chronic pain," Sullivan told MedPage Today.
The investigators looked at data from the HealthCore Integrated Research Database involving claims for 59,077 patients ages 13-24 years seen for a non-cancer related chronic pain condition (back/neck pain, headache, or arthritis/joint pain) from January 1, 2001 to June 30, 2008.
Chronic opioid use was defined as receiving more than 90 days of opioids within a six-month period, with no gap in use of more than 30 days.
The researchers found that 351 patients (0.5%) met criteria for chronic opioid use, while 6,172 (27.4%) had some opioid use but did not meet criteria for chronic opioid use, and 42,584 (72.1%) had no opioid use.
The average age of the chronic users was around 20; and a little over half were male.
Anxiety disorders and depression were the most common mental health diagnoses among chronic opioid users, at 8.1% and 5.9%, respectively.
After controlling for demographic and clinical factors, patients with any mental health diagnosis had a more than two-fold increased risk for receiving chronic opioids compared to no opioids (OR 2.36, 95% CI 1.73 to 3.23) and a 1.8-fold increased risk for receiving chronic opioids versus some opioids (OR 1.83, 95% CI 1.34 to 2.50), Sullivan and colleagues reported.
They also found that there were demographic predictors of chronic opioid abuse, including living in areas with lower education and a higher percentage of white residents.
"It's consistent with overall substance abuse literature ... prescription drug abuse tends to be focused in rural, low-income, low-education white communities," said Sullivan.
The researchers plan to expand their research and analyze the effects of various policy initiatives that are underway to help adolescent and young adult patients, including health system quality improvement, state-based prescription drug monitoring programs, and forthcoming Risk Evaluation and Mitigation Strategies for opioids from the FDA, he added.
The results of the study carry an important message for physicians, Sullivan stressed.
"We've documented that mental health diagnoses are predictive of opioid use, and I imagine that a lot of times opioid-prescribing physicians didn't even know about the mental health problems because they haven't asked about them. Doctors need to be inquiring about whether these patients have concurrent mental health problems, and if so they need independent treatment," he said.
The study was funded by the National Institute on Drug Abuse and the Alcohol and Drug Abuse Institute at the University of Washington. Sullivan and the other authors made no financial disclosures.

Monday, March 28, 2011

Medical News: AAPM: RF Zaps Some Low Back Pain - in Meeting Coverage, AAPM from MedPage Today

Medical News: AAPM: RF Zaps Some Low Back Pain - in Meeting Coverage, AAPM from MedPage Today

WASHINGTON -- Low back pain caused by degenerative spondylolisthesis can be successfully treated by minimally-invasive radiofrequency therapy, researchers reported here.

In 67 cases of degenerative spondylolisthesis, greater than a 50% reduction in pain was achieved in 64.2% of the patients, said Stephan Klessinger, MD, a neurosurgeon at Nova Clinic, Biberach in Baden-Wurttemburg, Germany, at the annual meeting of the American Academy of Pain Medicine.

In a retrospective chart review of 1,470 patients who underwent radiofrequency therapy for low back pain over a three-year period, 83 of whom had spondylolisthesis -- abnormalities of the zygapophysial joints.

"Degenerative spondylolisthesis is one of the major causes for low back pain," he told MedPage Today at his poster presentation. "Radiofrequency neurotomy seems a rational therapy. Our objective was to determine if radiofrequency neurotomy is effective for patients with low back pain and degenerative spondylolisthesis."

The treatment involves inserting needles through the skin under imaging guidance to locations near the lower back vertebrae. Radiofrequency waves are then used to destroy impinged nerves in the lumbar region believed to be causing the patients' pain.

Klessinger said that, to his knowledge, the study was the first attempt "to determine the effect of radiofrequency neurotomy in patients with degenerative spondylolisthesis."

Because the treatment does not require surgery, "it is worth trying radiofrequency neurotomy because if it doesn't work, you can still do surgery if there are no other options," he said.

However, his study showed that, for the majority of patients, radiofrequency nerve ablation was effective in markedly reducing pain.

All of the patients included in his analyses had undergone magnetic resonance imaging of the spine. Patients with previous spinal surgeries and those with neurological deficits were excluded.

For the purposes of the study, patients were considered successfully treated with radiofrequency neurotomy if the treatment produced at least a 50% reduction in self-reported pain and patients also said they were satisfied with the outcome of the procedure.

"This procedure is greatly underutilized for treating low back pain," Craig Cartia, MD, an anesthesiologist with the Sacred Heart Medical Group in Pensacola, Fla., told MedPage Today.

"This is a fairly common procedure that can be performed pretty accurately with success. We can see these patients get better and achieve long-term pain relief with this procedure," he remarked.

Cartia said he believes that with careful patient selection, the percentage of patients with spondylolisthesis might also be higher.

In his report, Klessinger noted that patients who appeared to have abnormalities within the zygapophysial joint did better than patients with osteoarthritis and stenosis in the same area. Most of the patients -- 52 of in the study group -- were between ages 60-79.

Using the 5-Grade Meyerding Grading System, Klessinger found that 42 of the patients had Meyerding Grade 1 abnormality -- up to a 24% "slip" of the disc; and 25 patients were classified as Meyerding Grade 2 -- a 25% to 49% slip.

In his study group, Klessinger also identified 16 patients who were diagnosed with spondylolytic spondylolisthesis who were also treated with radiofrequency neurotomy.

"The etiology and the mechanisms of pain are different in patients with spondylolytic spondylolisthesis," he noted in his poster presentation. "Patients are younger; there are less degenerative changes and seldom a spinal stenosis."

"However, our number of patients with this condition were small, so more research will be required to determine how effective this treatment may be," he added.

Klessinger and Cartia had no disclosures.