Hes fall '16 final 2 by Downing and Associates

healthcare

Environmental solutionsnews Covering infection prevention, medical waste management & sustainable practices

VOL. XII NO. 3

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fall 2016

The Nose Knows

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Dog to Sniff Out C. Difficile at Canadian Hospital

By P.J. Heller

ancouver General Hospital’s newest staff addition has his work cut out for him: nosing around to track down potentially deadly bacterium in the medical facility. But Angus, a 2-year-old English springer spaniel, is up to the task, according to his trainer, Teresa Zurberg. The cute floppy-eared dog is expected to start work sniffing out Clostridium difficile (also called C. difficile or C. diff) at Vancouver General, Canada’s second largest hospital, before the end of September. “We strive to continue to find ways to provide better care, and sometimes the answer is not more technology, but instead, man’s best friend,” said Terry Lake, the British Columbia health minister.

Angus will be the only active dog in the world to be used to sniff out reservoirs of C. diff and the first in Canada. A 2-year-old beagle named Cliff was previously used in a 2012 study to identify C. diff on 300 patients in two large Dutch teaching hospitals. C. diff is a highly contagious bacteria that cannot be seen with the naked eye. It causes diarrhea and other intestinal conditions and can be life-threatening. The number of C. diff infections in Canada has risen over the last decade — particularly among those who are taking antibiotics, the elderly in hospitals and nursing homes and those undergoing chemotherapy for cancer — and is linked with an increase in illnesses and

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Healthcare Environmental Solutions news

healthcare

Environmental solutionsnews Covering infection prevention, medical waste management & sustainable practices

PUBLICATION STAFF Publisher / Editor Rick Downing Contributing Editors / Writers P.J. Heller Sandy Woodthorpe Production & Layout Barb Fontanelle Christine Pavelka Advertising Sales Rick Downing Subscription / Circulation Donna Downing Editorial, Circulation & Advertising Office 6075 Hopkins Road Mentor, OH 44060 Ph: 440-257-6453 Fax: 440-257-6459 Email: downassoc2@oh.rr.com For subscription information, please call 440-257-6453. Healthcare Environmental Solutions news (ISSN #1557‑6388) is published quarterly by Downing & Associates. Reproductions or transmission of Medical Waste Management, in whole or in part, without written permission of the publisher is prohibited. Annual subscription rate U.S. is $19.95. Outside of the U.S. add $10.00 ($29.95). Contact our main office, or mail-in the subscription form with payment. ©

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The Nose Knows; Dog to Sniff Out C. Difficile at Canadian Hospital Continued from page 1

sometimes death, according to HealthLink BC. waiting for a contract to be signed before Angus An estimated 700 cases a year are treated by formally begins working at the hospital sniffing hospitals in the Vancouver area; 70 percent of out environmental C. diff. He has already been the cases are related to healthcare facilities. issued his hospital ID and was the star in a PR The Centers for Disease Control and rollout at the hospital in July. Prevention estimates that in the United States “We’re thrilled to have Angus join our there are some 453,000 cases of C. diff annually infection fighting team in the battle against C. resulting in 29,300 deaths. About two-thirds of diff,” says Dr. Elizabeth Bryce, regional medical the cases were linked to a stay in a hospital or director infection control at Vancouver Coastal nursing home. Most of those who died were Health. “We recognize Angus is still young and 65 or older and died within 30 days of their building up his stamina, so we’re exploring diagnosis. several options for his deployment.” Zurberg, who had been training Zurberg says she expects Angus will bomb- and drug-detecting dogs, initially work two days a week at contracted C. diff in 2013 after the hospital and will eventually “Although being treated with antibiotics work full time there and at C. diff in some for a gash on her leg. other Vancouver Coastal “I was on heavy duty Health facilities. cases can be smelled by antibiotics and ended Angus will search humans, by then it is way up getting C. diff and for environmental C. too late. Just because you can almost died,” she says. diff, as opposed to Her husband, testing patients. He will smell C. diff doesn’t mean you Markus Zurberg, a check sites including can tell me where it’s coming quality and patient common areas, waiting safety coordinator for rooms, hallways and from. When the dog comes in, Vancouver Coastal rooms where C. diff it can find those reservoirs Health, recalled seeing patients were located of C. diff before they an article about Cliff the and were subsequently beagle and suggested she cleaned to ensure there become a big consider training a dog to were no remaining hidden issue.” detect the superbug. He also reservoirs of C. diff. approached officials at Vancouver Although C. diff in some cases Coastal Health, which serves more can be smelled by humans, “by then it is than 1 million people in British Columbia and way too late,” Zurberg says. “Just because you operates 13 hospitals including Vancouver can smell C. diff doesn’t mean you can tell me General, who encouraged the effort. where it’s coming from. When the dog comes in, “ T h e Va n c o u v e r C o a s t a l H e a l t h it can find those reservoirs of C. diff before they administration was really quite open to the idea become a big issue. and quite curious to see what we could do with “You can test patients. You cannot test the it and what would happen,” Teresa Zurberg says. environment,” she adds. “It’s just logistically That led Zurberg in 2014 to Angus, a fieldimpossible. You can’t go around and swab and bred springer spaniel. She got him when he was culture absolutely everything. It’s just logistically 10 weeks old. Between working at her other job impossible to test everything and the cost would as a cardiologist technologist and other issues, be incredible, you’d have to swab and culture it took Zurberg a year to train Angus to sniff everything and by the time you got the results out C. diff. The training, based on a reward back, it’s days later. system, included the use of food, toys and C. “The beauty of having a dog is you can do diff scent pads, which did not contain actual a very large area very quickly and I can get my bacteria spores. findings back to the cleaning team,” she says. Eventually, “we take away the food or toy “It’s just an easier way for them to triage their and he learns that just finding C. diff all by itself resources.” gets him what he really wants,” Zurberg says. When Angus finds C. diff, he signals by “We used the same methods that we use with either sitting down or laying down in the area. bomb dogs and drug dogs. Basically it’s a game If bacterium is detected, the area will then be to them. They honestly in the end don’t care disinfected by a robot using ultraviolet-light about C. diff or ammonia nitrates or cocaine . that removes 99.9 percent of the C. diff spores, . . to them it’s just a way to get what they want, according to hospital officials. which is their toy or their food.” Zurberg says that while some people have Angus started clinical training in the expressed concern about Angus’ health while hospital in July 2015 and finished his last sniffing out the bacteria, there is little risk of validation in late spring of this year with a 95 him contracting C. diff. percent to 100 percent success rate. Zurberg is Continued on next page

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

fall 2016

Healthcare Environmental Solutions news Continued from previous page “First of all, he’s my best friend,” she says. “You really think I’m going to put my best friend at a high risk? “Because he’s not auto-immune compromised and he’s young and healthy, the chance of him getting C. diff is very, very minimal,” she adds. “It’s the same as when you’re working in the ER and you have unknown patients come in and you don’t know what they have and they haven’t put isolation precautions on them. Medical staff are exposed to C. diff all the time and very rarely do they ever get sick. It’s the same sort of thing with Angus.” Dogs like Angus are well-suited to such search tasks, whether sniffing out drugs, explosives, cadavers, people trapped in rubble or even cancers before they can be detected through clinical testing. “Their sense of smell is beyond anything that we can comprehend,” Zurberg says. “What we can use a dog for is just limited by our imagination.” Depending on who you ask, a dog’s sense of smell is said to be hundreds, thousands or even a million times better than that of a human. A dog has as many as 300 million olfactory receptors in its nose, while humans have about 6 million. “We might notice if our coffee’s been sweetened with a teaspoon of sugar; a dog can detect a teaspoon of sugar diluted in a million gallons of water: two Olympic-sized pools full,” says Alexandra Horowitz in her book Inside of a Dog: What Dogs See, Smell, and Know. Horowitz

heads the Dog Cognition Lab at Barnard College. An oft-cited study by Dr. James Walker, former director of the Sensory Research Institute at Florida State University, puts it another way: “If you make the analogy to vision, what you and I can see at a third of a mile, a dog could see more than 3,000 miles away and still see as well.” Angus is already attracting attention and interest worldwide and Zurberg says she is willing to work with other hospitals to set up their own programs. She is already working to train another springer spaniel, Dodger, to detect C. diff. “I’m happy to share Angus’ story especially if it starts to help save lives,” she says. Selecting a good detection dog is key; maybe one out of 100 dogs will be selected for training. Zurberg says she is partial to springer spaniels because of their size and agility. “He (Angus) has to get into some tight places sometimes, where a bigger dog would have a little more trouble doing that. He can go under the beds. He doesn’t get tangled up in the equipment so much because he is so agile. It comes down to the individual dog. “When you pick a detection dog, you pick one that’s high drive, that just wants to work and that’s what kind of differentiates them from a companion dog,” she says. “Angus, if it was up to him, he’d be like, ‘You go sit in the waiting room. I’ll go to work. I’ll let you know if I find something.”

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

News Briefs

CDC Releases Detailed History of the 2014-2016 Ebola Response in MMWR

he Centers for Disease Control and Prevention (CDC) recently released a detailed account of the agency’s work on the largest, longest outbreak response in the agency’s history: the Ebola epidemic of 2014-2016. The series of articles, in a special supplement to CDC’s Morbidity and Mortality Weekly Report (MMWR), comes on the second anniversary of the official activation of the agency’s emergency response to Ebola. “The Ebola epidemic in West Africa killed thousands and directly or indirectly harmed millions of people living in the region,” said CDC Director Tom Frieden, M.D., M.P.H. “The resilience of those affected; the hard work by ministries of health and international partners; and the dedication, hard work, and expertise of mission-driven CDC employees helped avoid a global catastrophe. We must work to ensure that a preventable outbreak of this magnitude never happens again.” The 2014-2016 Ebola epidemic was the first and largest epidemic of its kind, with widespread urban transmission and a massive death count of more than 11,300 people in Guinea, Liberia, and Sierra Leone. The epidemic took a devastating toll on the people of West Africa. Ending it took an extraordinary international effort in which the U.S. government played a major role. CDC’s response was directed simultaneously at controlling the epidemic in West Africa and strengthening preparedness for Ebola in the United States. The new MMWR Ebola special supplement primarily focuses on the agency’s work during the first year and a half of the response. CDC activated its Emergency Operations Center (EOC) for the Ebola response on July 9, 2014. On August 5, 2014, CDC elevated the EOC to a Level 1 activation, its highest level. On March 31, 2016, CDC officially deactivated the EOC for the 2014-2016 Ebola response.

Medical Waste Management Association Launch Announced

hoenix, AZ – The interim Board of Directors of the Medical Waste Management Association (MWMA), a non-profit trade group for the biohazard and medical waste disposal industry, officially announced its launch on July 1, 2016. The organization was formed to promote operating standards, research, education and regulatory advocacy for organizations that transport, process, store or dispose of biological and medical waste. It also welcomes membership from healthcare professionals charged with their organization’s medical disposal logistics and compliance. Rob Marshall, owner of San Antonio, Texas-based Medsharps and MWMA president, says the time is right for the creation of such an organization. “Up to now, the medical waste disposal industry has not had a strong independent trade organization to promote its interests,” says Marshall. “There are hundreds of companies across the United States, and far more around the world, providing this critical service that will benefit from having a strong, unifying voice.” Marshall also believes healthcare organizations using medical waste disposal services will benefit from the MWMA and invites their participation. “Philosophically, we feel that creating a well-informed customer is the best way to assure proper disposal of biologically hazardous materials,” says Marshall. “In that regard, the association will also focus on customer education and has created a specific membership category for those responsible for medical and biological waste disposal compliance for their employer.” Initially, MWMA will focus its energies on member outreach but expects to advance a forward-looking agenda that not only confronts current industry challenges but addresses emerging issues such as the eventual classification of human biological waste as Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA).

Because it’s time… . . . It’s time for medical waste transporters, processors and the decision makers they serve to form an organization dedicated to promoting education, compliance and ethics. Thankfully, that’s now a reality. The newly formed Medical Waste Management Association (MWMA) invites you to demonstrate support for these ideals by joining today. Membership is open to service providers, healthcare institution decision makers and industry suppliers. Join today! It’s time to be part of this historic moment in the medical waste disposal industry. Visit the www.medwasteonline.org to join, learn more, or locate a service provider in your area dedicated to these high ideals. MWMA and the MWMA logo are trademarks of the Medical Waste Management Association – All rights reserved.

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

fall 2016

News Briefs

ashville, TN – A MedicalnewsToday.com article reports that improving efficiency of blood management by hospitals can save money and help prevent shortages. Led by Barbara J. Martin, MBA, RN, a study was conducted at Vanderbilt University Medical Center in Nashville, Tennessee to evaluate evidence-based guidelines around certain types of blood transfusions. By changing blood ordering practices, Vanderbilt reduced usage of red blood cells from 675 units per 1,000 discharges in 2011 to 432 units per 1,000 discharges in 2015. A multidisciplinary study team looked at the medical center’s entire blood management system, first delving into Vanderbilt’s blood ordering process. Standard practice for surgeries, as suggested by insurance providers, is to order two units of blood, and many hospitals commonly order a transfusion based on habit, rather than individual patient assessment. The team suggested ordering one unit then following up with a further order if needed. After the new guideline was implemented, the Medical Center reduced blood use by 30 percent and saved $2 million. Surgeries that were included in the study were colectomy, proctectomy, ventral hernia, and appendectomy. The team found that data collected on general and vascular surgery patients who underwent National Surgery Quality Improvement Programtargeted procedures showed a reduction from 11 percent transfused with an average of 4.6 units of blood per patient in 2011, to 5-6 percent transfused with an average of 2.4 units per patient in 2015. Other process improvements ranged from delivering blood in coolers rather than pneumatic tubes; reconfiguring coolers to ensure blood transported at optimum temperature; designating “ownership” to specific members of staff, which encouraged greater responsibility for returning unused product to the blood bank; and implementing a monthly review of blood usage. The collective effect of these measures reduced blood wastage at Vanderbilt from 300 units in 2011 to 80 units in 2015. The improvements go beyond the hospital - they also affect how blood donations are viewed. Using blood more effectively reassures donors that best use is made of their donations.

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UK Researchers Find New Way to Protect Patients from Superbugs

heffield, England – A breakthrough discovery may prevent skin wounds such as bedsores and ulcers from becoming infected with “superbugs,” reports MedicalNewsToday.com. Scientists from the University of Sheffield have been experimenting with a family of proteins called tetraspanins that play a role in many cellular processes, including immune functions. TSPANs live in membranes of humans and other mammals and have “sticky” properties that allow harmful bacteria, including antibiotic resistant varieties, to be removed. Using patches of “engineered” skin, the Sheffield research demonstrated how the proteins prevented bacterial infections, and indicated that the treatment was both safe and effective for use in humans. “This development is a huge breakthrough in the fight against antibiotic-resistance,” announced Dr. Pete Monk from the University’s Department of Infection, Immunity and Cardiovascular Science, the study’s lead investigator. “We hope that this new therapy can be used to help relieve the burden of skin infections on both patients and health services while also providing a new insight into how we might defeat the threat of antimicrobial drug resistance.” Dr. Monk adds that the therapy could be administered in the form of a gel or cream, and could also work well as a dressing. The researchers hope to conduct clinical trials within five years.

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fall 2016

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

News Briefs

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

fall 2016

isposing of unwanted prescription and over-the-counter medications just got a little easier in some parts of Illinois, according to a ChicagoTribune.com article. Illinois already has 320 official sites, such as police departments where people can dispose of pills and other medications. Now, Walgreens has installed “drug take back” kiosks, 45 in all, at stores throughout the state. The retailer has kiosks in more than 300 of its stores in 24 states and plans to place more of the receptacles in 500 stores around the country. The move comes amid concerns about opioid abuse, as well as environmental issues related to pharmaceuticals. In Illinois, 1,700 people died of drug overdoses in 2014, up from 1,579 in 2013, according to the Illinois Department of Public Health. Environmental impacts occur when people flush medications down the drain or toss them away in the trash. Biologists are studying fish, mollusks and other species that are affected by pharmaceutical waste that ends up in waterways and landfills.

Federal Agencies Launch New Infectious Disease Response Training Program

esearch Triangle Park, NC – Four federal agencies are working together to coordinate and support comprehensive training for first responders and waste management workers who may come into contact with infectious disease, according to SafetyandHealthMagazine.com. The Ebola Biosafety and Infectious Disease Response Training Program has been launched by the National Institute of Environmental Health Sciences, the Centers for Disease Control and Prevention, OSHA, and the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response. The program is aimed at approximately 35,000 workers in health care, waste management, transportation, mortuaries and other industries whose jobs put them at risk for infectious disease exposure. “Ensuring training and competency of workers in a variety of settings is a critical safety net in preparing for emerging infectious disease threats,” CDC National Center for Emerging and Zoonotic Infectious Diseases Director Beth Bell said in a press release. The NIEHS Worker Training Program, which has provided training for more than 160,000 employees annually for more than 25 years, will oversee the operation.

CMS’ Hospital Rating System Methods Questioned

ccording to an AJMC.com article, the American Hospital Association (AHA) and other groups want the Centers for Medicare and Medicaid Services’ to review its hospital rating methods, which they claim are unfair to safety net and teaching hospitals. The CMS’ Hospital Compare “Star” system ranks hospitals based on quality. “Star” ratings are a composite of 64 individual quality measures, which count how often patients have to wait in the emergency department, infection rates, readmission rates after a heart attack, and whether patients receive too many CT or MRI scans. Critics say the CMS “Star” scoring system penalizes safety net and teaching hospitals, which depend on federal funding. Such hospitals tend to have more patients in low income brackets admitted for acute health problems, often related to higher rates of chronic disease and smoking. According to a Medicare statement, the agency has defended its methodology and says the data is sound and the reviews are unbiased. Further, CMS says its analysis showed “hospitals of all types are capable of performing well on star ratings and also have opportunities for improvement.”

News Briefs

HHS awards $5.1 million to InBios to advance Zika diagnostic

blood test that may reduce from days to hours the time needed to diagnose patients with recent Zika virus infections will receive advanced development support from the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR). The test being developed by InBios International, Inc. of Seattle, Washington, may be able to return results in about four hours and could be used in commercial and health care facility laboratories. The diagnostic is known as a serological test, which detects a Zika virusspecific Immunoglobulin M, or IgM, which are antibodies produced by the body’s immune response to the virus. These antibodies can be detected approximately one week after infection and persist in blood for up to three months. Currently, the only serological test available to detect Zika in people with recent infections is a test that was developed by the Centers for Disease Control and Prevention (CDC) and is being used under an emergency use authorization issued by the U.S. Food and Drug Administration (FDA). The CDC-developed test requires two to three days for results and must be conducted in qualified laboratories designated by CDC. Providing a faster, easy-to-run, commercially available test to clinical laboratories would increase Zika testing capacity significantly nationwide. “The situation in Puerto Rico, the increasing number of Zika cases in the continental United States, and the potential for local transmission are of great concern,” said Assistant Secretary for Preparedness and Response Dr. Nicole Lurie. “Doctors and patients need Zika test results quickly so that health care providers can offer appropriate guidance and treatment to their patients, particularly pregnant women and their partners.” Continued development of InBios’ diagnostic will be funded under a two-year, $5.1 million contract with ASPR’s Biomedical Advanced Research and Development Authority (BARDA). This funding will support the

www.gient.net

refinement of the test’s design, manufacturing preparations and clinical studies, all of which are necessary for the company to receive approval or marketing authorization from FDA. The agreement can be extended to fund additional work through 2021 and up to a total of approximately $9.5 million. While advanced development work including manufacturing improvements are underway, the company could apply to the FDA to allow the test to be used under emergency use authorization prior to FDA’s full approval or market authorization of the test. “Most people with Zika virus infections do not have symptoms which makes diagnostics critical in identifying cases, treating patients, and protecting public health,” said BARDA Acting Director Dr. Richard Hatchett. “We are collaborating with other federal and industry partners to identify additional promising candidates for development so that diagnostics and other medical products needed in this public health crisis become available as quickly as possible.” The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis, or red eyes. The illness usually is mild with symptoms lasting for several days to a week. People typically do not get sick enough to go to the hospital. For this reason, many people might not realize they have been infected. However, Zika virus infection can cause Guillain Barre Sydrome or during pregnancy can cause a serious birth defect called microcephaly. In addition to the InBios diagnostic, BARDA is supporting development of tests that screen for Zika virus in the blood supply and is helping to assure the availability of blood samples developers need to test the accuracy of Zika diagnostics. The division also is working with federal partners on vaccine development to protect against Zika virus infections. With this award, ASPR/ BARDA has obligated $37.2 million of HHS reprogrammed Ebola funds to develop Zika vaccines, diagnostics, blood screening tests, and pathogen reduction technologies through private sector partners.

info@gient.cn fall 2016

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

News Briefs

MAUSER Announces Acquisition of Daniels Healthcare

AUSER Group, a worldwide leading company in rigid industrial packaging based in Bruehl, Germany, recently announced the acquisition of Daniels Healthcare Group. Based in Kidlington, Oxfordshire, UK, Daniels Healthcare manufactures and markets medical waste containers for hospitals, surgeries, needle exchange schemes, councils and the clinical waste industry. This acquisition further demonstrates MAUSER’s commitment to invest in medical waste container capabilities in Europe to provide a broader geographic footprint and to better serve their customer as the preferred choice for medical waste containers and sharps containers. “As one of the European market leaders with our MAUSER®WIVA Medical Waste Container System we are more than delighted to offer now the well-established sharps container brand SHARPSGUARD® to our customers,” said Dr. Jürgen Scherer, Head of the MAUSER SBU Europe. Daniels Healthcare is widely known for safety, service and support in the handling of infectious waste like needles, syringes and other sharps. The products are commonly used in hospitals, ambulances and laboratories. Howard Simler, Managing Director of Daniels Healthcare said, “We have a long standing relationship with MAUSER as one of their main distributors in the United Kingdom for the MAUSER®WIVA Medical Waste Container System and are looking forward to the integration into the global MAUSER family.”

Norwegian Study: Preventive Measures Cut Sepsis Deaths by Almost Half

ord-Trøndelag, Norway – Researchers at The Norwegian University of Science and Technology (NTNU) have found that increased staff training and patient monitoring can cut bloodstream infections dramatically, reports a ScienceDaily.com article. Known as sepsis, bloodstream infections are somewhat common and can be caused by pneumonia, appendicitis, urinary tract and skin infections such as cellulitis. Sepsis is a killer than can be prevented with simple measures, according to the study that was conducted at two hospitals in Trondheim, Norway. Sepsis has a mortality rate of more than 10 percent, and is among the seven most common causes of death in North America and parts of Europe. The Norwegian study involved a new training and monitoring program which reduced mortality by 40 percent (from 12.5 percent to 7.1 percent). Hospital stays due to the bloodstream infection were reduced by 30 percent and the number of days in intensive care decreased an average of 3.7 days per patient. Because the illness can evolve rapidly from being relatively mild to lifethreatening, prevention and early detection are crucial. The risk of death compounds every hour the patient goes without treatment in the form of antibiotics and fluids, and that is why it is important to identify sepsis early and begin treatment fast, the study found. Erik Solligård, the senior author of the study and head of the MidNorway Centre for Sepsis Research, says that rates of sepsis are expected to increase in the future as a result of higher incidence of lifestyle diseases and antibiotic-resistant bacteria that make many patients vulnerable to opportunistic infections. The Norwegian study employed use of two types of charts, a flow chart to help caregivers identify signs of sepsis and an observation chart to score severity. Information packets, a four-hour training course, and a standardized treatment course with clear guidelines for doctors and nurses were found to be effective measures. The study was carried out by scientists from Nord University, Levanger Hospital, and the Mid-Norway Centre for Sepsis Research at the Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital in Trondheim, Norway. The study report, “Early identification of in-hospital sepsis by ward nurses increases 30-days survival” was published in the journal Critical Care. 8

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

fall 2016

SC Johnson Announces Acquisition of STERIS Applied Infection Control Business

acine, WI – SC Johnson recently announced that it has completed an acquisition with STERIS for its Applied Infection Control (AIC) business. STERIS is a leading provider of infection prevention and surgical procedural products and services, focused primarily on healthcare, pharmaceutical and research and medical device companies. This acquisition adds a full range of commercial skin care, surface cleaning products and surgical prep brands, including Alcare Plus®, Alcare®, Kindest Kare®, Cal Stat®, Soft ‘N Sure®, CV®, BactoShield® and Lotion Soft® to SC Johnson’s Deb Group professional skin care portfolio. “AIC’s many respected products are an excellent fit for the Deb Group portfolio and will complement our trusted Deb brands,” said Fisk Johnson, Chairman and CEO of SC Johnson. “Adding these brands will enable us to significantly expand our offerings to the U.S. market.” The AIC business will be integrated into DebMed, the healthcare division of the Deb Group. The acquisition of the AIC business will allow Deb Group to introduce its full array of hand hygiene and skin care innovation to U.S. hospitals, building upon the existing AIC dispensing platform. “With this acquisition, we can now more widely deploy the DebMed electronic hand hygiene monitoring system in the U.S. healthcare market,” said Bryan Anderson, CEO of Deb Group. “We expect this will also impact the widespread adoption of monitoring technology in the coming years.” The Deb Group was acquired by SC Johnson in 2015. It is the world’s leader in away-from-home skincare consisting of 21 companies operating in 16 countries offering skin care regimens for all types of workplace and public environments, spanning industrial, commercial, healthcare and food sectors. As a private company, SC Johnson does not disclose details regarding financial or business transactions.

Hand Washing Compliance: Always Room for Improvement

hapel Hill, NC – The findings of a study begun in 2013 show that even where handwashing compliance levels have been high, ongoing monitoring and improvement programs can decrease hospital acquired infections, reports a BeckersAsc.com article. Researchers at the University of North Carolina Medical Center in Chapel Hill tracked hand hygiene compliance after the 853-bed facility implemented a new initiative, Clean In, Clean Out. The initiative involved having participants wash their hands when entering and leaving patient rooms. Over the 17-month period during which the study was conducted, participants recorded their hand hygiene activity and provided feedback to one another. That data then was correlated with HAI counts for each nursing unit. At the start of the program the baseline compliance level was considered high according to Centers for Disease Control guidelines (>80 percent). When compliance rose to a >95 percent level, HAIs were found to be reduced by six percent. The team found that Clostridium difficile infections decreased by 14 percent. Clean In, Clean Out was patterned after a successful pilot handwashing program that was implemented in the hospital’s pediatric intensive care unit. The new initiative was expanded to include patient areas and healthcare personnel (physicians, advanced practice providers, nurses, nursing assistants, hospital unit coordinators, housekeeping, radiology, occupational/physical/recreational therapists, nutrition and food services staff, phlebotomists, and respiratory therapists). The research team noted that their study findings revealed something else significant – that self-observations and peer feedback are more effective than covert observations by preventionists and designated nursing staff.

News Briefs

More Medical Waste Means More Energy for Oregon

Advocate Health Fined a Record $5.5 Million for HIPAA Breach

arion County, OR – An energy-from-waste plant here will be taking in medical waste from the two neighboring states to make up for a shortfall in local collections, reports Waste360.com. Covanta Marion WTE will be accepting additional medical waste from California and Washington at its Brooks, OR treatment site. The imported waste will allow the plant to continue operating at full capacity, according to a county press release. Covanta and Marion County share in the sales revenues from the facility’s renewable electricity generation and from recycling metals recovered at the facility. Owned and operated by Covanta Marion Inc., the facility is equipped to treat 550 tons of waste per day and supply 13.1 megawatts of renewable energy to Portland General Electric. The electricity powers a nearby town of population 24,000 with electricity. Covanta WTE was first permitted by the State to generate power from medical and solid waste in 1987. The importation solution is timely and represents significant savings. The county had begun purchasing approximately 15,000 tons per year of solid waste from adjacent areas. Annual shipments of more than 3500 tons of medical waste from the state of Washington are expected to generate approximately $789,000 for the county. Last June, the county approved an increase in amount of medical waste treated at the plant from 1,500 tons to 15,000 tons annually. Revenues from an estimated 11,700 tons of blue and grey bin waste from California will make up the lion’s share of the total $3.4 million the county expects to reap annually. The revised contract specifies a “must combust” designation for the waste. Ash is delivered to the Coffin Butte landfill in Corvallis for use as daily ground cover. A maximum of 25,000 tons of medical waste will be allowed under the current permit. Covanta Marion WTE is a subsidiary of Covanta Energy Inc., which owns and/or operates over 40 EfW facilities in the U.S.

dvocate Health Care Network has agreed to pay a $5.5 million settlement to the U.S. Department of Health and Human Services’ Office of Civil Rights for data breaches that compromised the records of roughly 4 million people, reports MSPMentor.net. The settlement follows investigation of three separate data breaches that occurred in 2013. Among the security lapses OCR listed in its report are: failure to conduct mandatory risk assessments, not properly safeguarding laptops containing ePHI and failure to obtain a required business associate agreement with a third-party contractor that handled medical billing. The ePHI of more than 2,000 Advocate patients was compromised when an unauthorized third party gained access to Blackhawk Consulting Group, the company provided billing services to Advocate Health Care. “Advocate failed to obtain satisfactory assurances in the form of a written business associate contract that its business associate would appropriately safeguard all ePHI in its possession,” federal officials said in a media release. The other two breaches involved separate thefts of laptop computers containing private information of nearly four million people. According to federal documents, Advocate Health Care Network is the largest fully integrated health care system in Illinois. The latest penalty brings the total amount of settlements for HIPAA security violations to $20.3 million this year, up sharply from $6.2 million in all of 2015. you have an article idea, or a big announcement about GOT Ifyour business or healthcare facility, please email it to: NEWS? downassoc2@oh.rr.com. Our next issue closes Oct. 21st.

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

News Briefs

Santa Cruz Becomes First U.S. City to Require Drug Manufacturers and Retailers to Collect and Dispose of Unwanted Prescription Drugs

anta Cruz, CA – On Aug. 9, 2016 Santa Cruz became the first U.S. city to adopt an ordinance requiring that the responsibility of safe and orderly disposal of drugs and sharps waste be placed on the manufacturers and/or producers of the products, while encouraging product design that minimizes negative impacts on human health and the environment at every stage of the product’s lifecycle. The new Extended Producers Responsibility Ordinance requires manufacturers and retailers to develop programs to dispose of unneeded medications and unwanted hazardous medical products, such as needles and syringes. The ordinance goes into effect 30 days from adoption when each of the 30+ pharmacies located in Santa Cruz will have to present a plan to the city for how they intend to meet the new requirements. “Until now, our sharps and drug take back program was based on an environmental benefits analysis,” said City of Santa Cruz Environmental Compliance Manager Akin Babatola. “But the new ordinance brings a social justice component. Since 2007, the City has budgeted $7-10,000 annually in program costs to keep our rivers and ocean clean from these chemical wastes. From now on, we will have the manufacturers and distributors pick up the tab; the new ordinance incorporates the shared responsibility of the producer at the post-consumer stage of their products’ life cycle.” Alameda was the first U.S. county to enact such an ordinance in 2012. In 2015 the U.S. Supreme Court denied the pharmaceutical industry’s petition for certiorari in a challenge against Alameda County’s ordinance. This ruling validated this model for control at county and municipal levels. A total of 9 counties nationwide have enacted similar ordinances to Santa Cruz. All of these ordinances prohibit the manufacturers and/or producers of the products from charging any visible fee at point of sale or point of collection. “We are excited that local governments like the City of Santa Cruz are taking action to ensure the producers of medicines and needles will design and fund convenient collection systems so that these chemical and hazardous wastes are safely disposed of as they are in Canada,” said Heidi Sanborn, Executive Director of the National Stewardship Action Council. “We will continue to see cities and counties across the country adopt policies to mandate their participation, but our hope is that soon we can collaborate to find a national solution that we can all support.”

CDC Awards $60 Million to Help States and Territories Battle Zika

he Centers for Disease Control and Prevention (CDC) will begin making awards totaling nearly $60 million to states, cities, and territories to support efforts to protect Americans from Zika virus disease and adverse health outcomes that can result from Zika infection, including the serious birth defect microcephaly. The funding, distributed through CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement (ELC), will support activities to protect the health of the American public, especially pregnant women, including epidemiologic surveillance and investigation, improving mosquito control and monitoring, and strengthening laboratory capacity. It will also support participation in the U.S. Zika Pregnancy Registry to monitor pregnant women with Zika and their infants, as well as Zika-related activities in U.S.-Mexico border states. 10

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

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TSRI Scientists Pinpoint Ebola’s Weak Spots New Study Illuminates Structure of Mystery Protein

a Jolla, CA – Scientists at The Scripps Research Institute (TSRI) now have a high-resolution view of exactly how the experimental therapy ZMapp targets Ebola virus. The new study is also the first to show how an antibody in the ZMapp “drug cocktail” targets a second Ebola virus protein, called sGP, whose vulnerable spots had previously been unknown. “This sGP protein is tremendously important,” said TSRI Professor Erica Ollmann Saphire, who co-led the study with TSRI Associate Professor Andrew Ward. “This is the roadmap we need to target the right molecules in infection.” “Determining the proper balance in targeting these two Ebola proteins will be key to building improved therapeutics,” added Ward. The study was published August 8, 2016 in the journal Nature Microbiology. Zooming in on ZMapp: Scientists need detailed images of Ebola virus’s molecular structure. Like enemy reconnaissance, structures can show where Ebola is vulnerable and how medical treatments can neutralize it. TSRI scientists are harnessing an imaging technique called cryo-electron microscopy (in which a sample is pelted with electrons) to create highresolution, 3-D images of Ebola virus and the antibodies that fight it. “We’re at the cutting edge of our ability to resolve high-resolution protein complexes,” said TSRI Research Associate C. Daniel Murin, co-first author of the new study with TSRI Research Associate Jesper Pallesen. In the new study, the researchers used cryo-electron microscopy to see exactly how Ebola virus interacts with the three antibodies in the ZMapp experimental therapy produced by Mapp Biopharmaceutical, also a study collaborator. The researchers had imaged these interactions at a low resolution in a 2014 study, but the new study revealed substantially more details, including the exact angles the antibodies use to approach the molecule on the surface of the virus, termed its surface glycoprotein (GP), and the individual amino acid contact points at which the antibodies bind GP. This information provides new clues to researchers trying to make the antibodies even more effective. “The three components of ZMapp, now resolved at high-resolution, can be further engineered in a structure-based manner for improved potency,” said Ward. Solving an Elusive Structure: Next, the researchers took a closer look at one of the three antibodies that make up ZMapp, called 13C6. This antibody is unique because it can also target the soluble Ebola protein sGP. sGP’s role in infection is a mystery. Ebola virus makes the protein profusely, indicating that it is important, but then sGP appears just to float in a person’s blood serum. One theory is that sGP may be essential in the natural host “reservoir.” “Eighty to ninety percent of what Ebola virus makes in infection is this shed molecule,” said Saphire. “It’s like a smoke screen, and we need to know where it is similar to our target GP and where it is different.” To add to the mystery, Ebola makes GP and sGP using the same gene. A small difference in the way the gene is read changes how the molecules are shaped and changes their roles. One obstacle to understanding sGP is that it is too small to be seen with cryo-electron microscopes. To solve this problem, the researchers added “bulk” by pairing sGP with antibodies, including 13C6. This allowed them to kill two birds with one stone—they could see sGP’s structure while also studying how antibodies interact with it. The new image shows the binding sites, or “epitopes,” the antibody targets. “We can see hot spots on this virus that we can hit,” said Pallesen. This study is the latest research from the Viral Hemorrhagic Fever Consortium, an international partnership of research institutes led by Saphire. The researchers said collaboration with the consortium was key to this study, allowing scientists to share samples and data, including viral genetic sequences isolated from patients in the most recent Ebola outbreak. This study was supported by the National Institutes of Health (NIH, grant R01 AI067927), the NIH’s National Institute of Allergy and Infectious Diseases (grant U19AI109762 and U19AI109711) and the National Science Foundation.

News Briefs

Saving Patients from Sepsis is a Race Against Time

CDC calls sepsis a medical emergency; encourages prompt action for prevention, early recognition

ccording to a new Vital Signs report released by CDC, about 7 in 10 patients with sepsis had used health care services recently or had chronic diseases that required frequent medical care. These represent opportunities for healthcare providers to prevent, recognize, and treat sepsis long before it can cause life-threatening illness or death. “When sepsis occurs, it should be treated as a medical emergency,” said CDC Director Tom Frieden, M.D., M.P.H. “Doctors and nurses can prevent sepsis and also the devastating effects of sepsis, and patients and families can watch for sepsis and ask, ‘could this be sepsis?’” Certain people with an infection are more likely to get sepsis, including people age 65 years or older, infants less than 1 year old, people who have weakened immune systems, and people who have chronic medical conditions (such as diabetes). While much less common, even healthy children and adults can develop sepsis from an infection, especially when not recognized early. The signs and symptoms of sepsis include: shivering, fever, or feeling very cold; extreme pain or discomfort; clammy or sweaty skin; confusion or disorientation; shortness of breath and a high heart rate. According to the Vital Signs report, infections of the lung, urinary tract, skin, and gut most often led to sepsis. In most cases, the germ that caused the infection leading to sepsis was not identified. When identified, the most common germs leading to sepsis were Staphylococcus aureus, Escherichia coli (E. coli), and some types of Streptococcus. Health care providers, patients and their family members can work as a team to prevent sepsis. Health care providers play a critical role in protecting patients from infections that can lead to sepsis and recognizing sepsis early. Health care providers can:

•

Prevent infections. Follow infection control requirements (such as handwashing) and ensure patients to get recommended vaccines (e.g., flu and pneumococcal). • Educate patients and their families. Stress the need to prevent infections, manage chronic conditions, and, if an infection is not improving, promptly seek care. Don’t delay. • Think sepsis. Know the signs and symptoms to identify and treat patients earlier. • Act fast. If sepsis is suspected, order tests to help determine if an infection is present, where it is, and what caused it. Start antibiotics and other recommended medical care immediately. • Reassess patient management. Check patient progress frequently. Reassess antibiotic therapy 24-48 hours or sooner to change therapy as needed. Determine whether the type of antibiotics, dose, and duration are correct. CDC is working on five key areas related to sepsis: • Increasing sepsis awareness by engaging clinical professional organizations and patient advocates. • Aligning infection prevention, chronic disease management, and appropriate antibiotic use to promote early recognition of sepsis. • Studying risk factors for sepsis that can guide focused prevention and early recognition. • Developing tracking for sepsis to measure impact of successful interventions. • Preventing infections that may lead to sepsis by promoting vaccination programs, chronic disease management, infection prevention, and appropriate antibiotic use. To read the entire Vital Signs report visit: www.cdc.gov/vitalsigns/sepsis.

Product/Equipment Profiles CleanCore™, The Green Cleaning No Chemical Alternative

leanCore™ is an innovative cleaning technology that infuses cold water with oxygen to create aqueous ozone, a natural and robust cleaning solution. Along with being effective, aqueous ozone is viewed as a more “natural” cleaning agent because ozone is naturally found in the atmosphere. The CleanCore™ Aqueous Ozone Fill Station is a green alternative to using conventional cleaning chemicals. Perfect for everyday cleaning, the system connects directly to a water pipe, and with its unique and patented mixing chamber, combines the natural elements of water and oxygen. This creates aqueous ozone which can be used to clean restroom fixtures, counters, walls, carpets, floors - even fruits and vegetables thoroughly, effectively, safely, and quickly. Once applied to surfaces, the aqueous ozone returns to oxygen or evaporates leaving no chemical residue. For more information, contact Matt Montag at 877-860-3030 or inquiry@cleancoretech.com.

New APHIS Approved Technology Offers On-Site Solution for International Waste Disposal at FBOs and Airports

ecent approval of patented Sterilis technology from the U.S. Department of Agriculture, Animal and Plant Health Inspection Service (APHIS) makes it easier, safer and less costly for U.S. airports and FBOs to treat and dispose of waste on site from arriving international flights as required by APHIS regulations that seek to prevent the spread of insects and pests and protect public health. About the size of a photocopy machine, the Sterilis combines a steam sterilizer with a grinder, allowing international waste to be treated in about 60 minutes, after which it can be thrown out with the regular trash. It is used in a variety of regulated medical waste settings including fire stations, community needle-drop centers, dialysis and surgery centers, dermatology and ophthalmology practices, health clinics, prisons, clinical labs, nursing homes and acute care facilities. Additionally, it uses cloud-based reporting technology, eliminating the need for hand-written reporting procedures, which takes time and can be less accurate. For more information, contact Mike Ferris, Senior Vice-President, at 508-875-1070 ext. 117 or mferris@sterilismedical.com.

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