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

VOL. XIV NO.43 XII NO.

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Study Into Recycling Medical Plastics Could Provide Cure for Hospitals

study into creating a single waste stream of flexible plastics from hospitals and converting that material into new products – rather than shipping it off as waste to bulging landfills – could, if successful, provide medical facilities nationwide with a new viable recycling alternative. “This is an opportunity to find viable solutions to remove more plastics from our landfills,” says Zac Conaway, manager of waste, recycling and training for Waste Management and Environmental Services at DartmouthHitchcock Medical Center. “All of us are looking at our environment and how we affect our environment from a healthcare standpoint,” says Conaway, who also serves as coordinator of the Environmental Sustainability Council at the Lebanon, NH, medical center. “One of the big things from a waste standpoint is we’re running out of landfill space and the cost to dispose of our waste is going to be exponentially growing over next number of years. The goal of the study is to look at innovative ways to reduce what we send to the landfill and pulling out material that can be used in another form.”

By P.J. Heller Dartmouth-Hitchcock, along with the Cleveland Clinic in Ohio and Lehigh Valley Health Network in Pennsylvania, are participating in the study under the auspices of the Healthcare Plastics Recycling Council (HPRC). Although recyclers have been willing to accept used clean blue sterilization wrap -- a polypropylene material which the U.S. Environmental Protection Agency estimates accounts for 19 percent of all operating room waste -- they have generally balked at taking in other flexible plastics used in packaging for disposal medical supplies from hospital operating rooms. Some of the flexible plastic has been shipped overseas, including to Southeast Asia, China,

Taiwan, Vietnam and India, but Conaway says those countries and others have tightened up on what they will accept for recycling or have stopped accepting the flexible plastic materials entirely. “I think that’s what brings this project into relevance,” he says. “With fewer and fewer avenues internationally being created, generating avenues for recycling within the U.S. would be even better. We need to find innovative solutions to create viable recycling streams domestically.” Peylina Chu, executive director of the plastics council, says the flexible packaging materials are especially challenging for recyclers because the type of plastic used is often not known. “Is it polyethylene? Is it polypropylene? Is it PVC? Some of the packaging is multi-laminate, so it’s got multiple materials sandwiched between plastic. There might be a nylon film. There might be a polyester film. You can’t readily tell by just looking at it whether it’s a multi-laminate or not,” Chu says. The aim of the study, which began in early 2018, is to develop a “recipe” that will allow the materials to be blended to create new viable products. It follows on a study several years ago conducted by HPRC in collaboration with Penn State, where Plastics Engineering students tested and analyzed the physical

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PUBLICATION STAFF Publisher / Editor Rick Downing Contributing Editors / Writers P.J. Heller Sandy Woodthorpe Production & Layout Barb Fontanelle Christine Mantush 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 Healthcare Environmental Solutions news, 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. Copyright 2018 by Downing & Associates Printed on Post-Consumer Recycled Paper

Study Into Recycling Medical Plastics Could Provide Cure for Hospitals

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properties associated with various blends of recycled plastics and virgin resin. That study concluded that “healthcare plastics have great potential as an untapped source for materials for recyclers . . .” The current study is expected to look into combining the flexible plastics with commercially available compatibilizers, which are additives that allow two polymer resins to bond and stabilize, resulting in an improved final product. That part of the study will b e c o n d u c t e d by researchers in the plastics engineering department at the University of MassachusettsLowell. “Through this project, we hope to shed some light on the physical properties these materials will have when processed with different types of compatibilizers applied in varying concentrations,” said Chris Rogers, project manager for HPRC, in a news release announcing the program. “By better understanding these properties, recyclers can better determine potential opportunities to compound these materials with other products for resale markets and therefore better understand their value.” “The volume of discarded healthcare plastics is huge and the ability to recycle this material would reduce the landfill burden while preserving the value of these highly engineered products,” said Margaret J. Sobkowicz, associate professor at U Mass Lowell, in the same release. “The students participating in this research will not only learn hands-on processing skills, but they will also gain appreciation for the importance of sustainability in the plastics industry.” Chu estimates that 1 million tons of healthcare plastics come out of hospitals annually, a majority of which goes to landfills or is incinerated. Of that, 35 percent is blue wrap and 25 percent is other mixed flexible packaging; the remaining 40 percent is rigid plastics, such as bottles and trays. Flexible plastic materials, consisting of sterilization wrap and film packaging, were gathered at Cleveland Clinic and Lehigh Health Network and shipped to Dartmouth-Hitchcock, which collected only non-rigid plastics. Some 2,000 pounds of materials were collected between April and June, Conaway reports. The material is scheduled to be sent to EREMA, a manufacturer of plastic recycling fall 2018

equipment, where it will undergo initial processing at the company’s Ipswich, MA facility. From there, it will go the U Mass Lowell. Preliminary results are expected in November. A report on the findings is expected to be published early next year. “We’re really trying to get to a point where we are able to combine this material into a viable product after it’s recycled,” explains Conaway. “The big question right now is, if we melt all of this down and turn it into resin can that resin be made into something from a rigid plastic standpoint that will hold its structure and mold together properly.” “We are hoping to identify targets and end markets for which this would be suitable,” adds Chu, noting that the automotive and construction industries are among those who could be likely opportunities. She says recyclers as well as other users of flexible plastics, such as those in the food and beverage industry, are interested in seeing the results of the study. “What we’re really trying to do it get the interest of recyclers,” Chu says. “If recyclers understand what these materials are and the characteristics of these materials, then they can go and find markets for it. Once they find those markets, that will create the demand for pulling these plastics from the hospitals. It’s really being able to create that end-market demand. Hospitals know they want to recycle this material. The problem is recyclers don’t know what the material is and therefore they can’t go and find a market for it. We want to help them understand what this material is, help them find suitable markets for it and then that’s going to create the pull to get these materials out of the hospitals and into the marketplace.” The study is funded by HPRC members Baxter, BD, DuPont, Eastman, Johnson & Johnson, Medtronic, Nelipak Healthcare Packaging and the Flexible Packaging Association. HPRC, headquartered in St. Paul, MN, describes itself as “a private, technical consortium of industry peers across healthcare, recycling and waste management industries seeking to improve the recyclability of plastic products and packaging within healthcare.” It was founded in 2010. Photos courtesy of Minnesota Waste Wise.

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Healthcare Sector Making Progress, Yet Still Lagging in Sustainability Initiatives

MedAssure Services Investigated for Improper Hazardous Waste Disposal

review of sustainability efforts at 49 healthcare organizations shows the sector has much room for improvement, according to a study published in JAMA Network Open. Only about 12 percent of all health-related companies including private and charitable organizations, had sustainability initiatives in place, Yale University researchers found. In 2016, 78 percent of non-healthcare Fortune 500 companies reported sustainability efforts, compared to 50 percent of healthcare companies. Among non-healthcare S&P 500 companies, 82 percent reported sustainability efforts, compared to 33 percent of healthcare organizations. Currently, corporate social responsibility reporting is voluntary in the United States but published by a majority of the largest publicly traded companies as well as many private and nonprofit companies. The study authors note that the 49 healthcare organizations they analyzed represent a small fraction of the more than 5500 hospitals in the United States and further review is needed to make a broader assessment. Pointing to the more than 1200 US hospitals enrolled in the Practice Greenhealth Healthier Hospitals Initiative, the sector appears to be adopting programming in engaged leadership, healthier food, leaner energy, less waste, safer chemicals, and environmentally preferable purchasing. While only some metrics were publicly reported by the Healthier Hospitals Initiative, this represents a much broader interest in sustainability than the authors were able to measure. Similarly, the American Hospital Association has several health care challenges and provides an option for benchmarking direct energy consumption through the American Society for Healthcare Engineering Energy to Care (Energy Star) program.

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ammond, IN — A box oozing blood that was discovered in a semitrailer has led to city violations and further wider investigation into a medical waste company’s operations, according to NWITimes.

com. The MedAssure facility is a transport station, where medical waste is transferred from truck to truck and taken away for treatment. The company has been operating there since 2014 without proper zoning approval or a business permit from City Hall, the city attorney told reporters. The property is zoned I-2 (industrial), which allows for trucking and can include transfer of materials from truck to truck. MedAssure has been paying $500 in monthly rent to the property owner, HRP II LLC, under a lease agreement that expired in June 2016. Businesses that handle waste must obtain conditional zoning approval through the city’s Board of Zoning Appeals if the material is explosive, flammable or potentially dangerous. The landlord told reporters that the city of Hammond has been aware of MedAssure’s tenancy for well over a year when he filed in court for bankruptcy on the property, but city officials said they were not aware of the bioharzard waste being handled there. The city notified the Indiana Department of Environmental Management’s emergency response team of the incident. The agency will be conducting an investigation. City officials said that MedAssure potentially faces up to two years of city violations. Under city ordinance, the fine is $2,500 for the first two violations and $7,500 for the remainder.

VA Study Focuses on MRSA Colonization, Infection Rates

RSA colonization significantly increases the risk for subsequent MRSA infection during and after hospitalization, according to study findings published in the journal, Clinical Infectious

Diseases. The team compared rates of pre- and post-discharge MRSA infections for more than 985,000 patients hospitalized in acute care facilities of the Department of Veterans Affairs (VA) health care system from January 2008 through December 2015. A substantial proportion of MRSA infections occur after discharge, they found. The infection rate data was collected and estimated for two main categories of patients: those who were colonized on admission, identified as importers; and those who acquired MRSA during their hospital stay. Patients were examined for MRSA infection before discharge and at 30, 90, 180 and 365 days after discharge. The highest percentage of patients (91.6 percent) were determined not be colonized with MRSA during hospitalization. The rate for importers was 7.3 percent, while a far lower number (1 percent) acquired MRSA during their hospital stay. Predischarge and 180-day postdischarge rates were higher for patients admitted directly to the ICU. MRSA pre- and postdischarge infection rates within 180 days after discharge were 63.9 percent for importers and 61.2 percent for acquirers. The median time to acquisition of infection was 14 days. Patients who did not have predischarge MRSA infections spent 4.5 days in hospital if they were found to be colonized, while importers spent 6.0 days, and acquirers,18 days. “Several recent studies have linked colonizing and infecting organisms across wide ranges of time between the colonization and infection events. It has been shown, for instance, that colonizing S. aureus strains may be concordant with those causing bacteremia up to 14 months later, indicating that even our 365-day time period may be too short to capture some infections associated with an acquisition event,” the researchers wrote.

News Briefs

Leeds Scientists Call For Hospitals To Remove ‘Germ Spreading’ Hand Dryers

eeds, UK — Groundbreaking research by Leeds University has revealed ‘jet air’ hand dryers are responsible for spreading germs, prompting hospital officials to call for their removal, reports Leedslive.co.uk. Leeds researchers tested restroom microbial levels at Leeds General Infirmary along with other hospitals in France and Italy, finding that levels were five times higher where jet air hand dryers were installed than restrooms with paper towels. In Leeds, Staphylococcus aureus (including MRSA) was found three times more often and in higher amounts on the surface of the jet-air dryers compared with the paper towel dispensers. Also, significantly more enterococci and multidrug resistant bacteria were recovered from either floors, sinks or floating dust and other surfaces in restrooms equipped with jet-air dryers and no paper towels. The research team concluded that when people don’t wash their hands properly, microbes from bacteria or viruses are literally blown across the room by the jet air dryer. Alternately, paper towels absorb the water and microbes left on the hands and if disposed of properly, paper towels have less potential for cross-contamination. Introduced in 2006, jet air dryers were thought to prevent spread of bacteria and be a “green” alternative to paper towels. While the original models blew hot air, the new models use unheated air blown at about 400mph to scrape the water off people’s hands rather than evaporation.

Leapfrog Group Report Shows Hospitals HAI Efforts Could Be Better

Alcohol Based Rub Improves Surgical Hygiene Compliance

hen compared to the traditional surgical scrub, alcohol-based surgical hand preparation is at least equally effective for the prevention of surgical site infections, according to study findings published in Antimicrobial Resistance & Infection Control. A team of University of Sao Paulo researchers in Brazil examined the effect of alcohol-based surgical hand rub on the quality and duration of the procedure as well as on surgical site infection prevention. There are two well-recognized methods for performing surgical hand preparation. The most traditional one is scrubbing hands and forearms with antimicrobial soap, usually 2 percent chlorhexidine or 10 percent povidone-iodine (PVPI). In recent years, alcohol-based surgical hand preparation has been proposed as an alternative to surgical scrub. Among potential advantages of the alcohol-based procedure are: less skin irritation, less time-consuming, economy of tap water, and more potent antimicrobial effect. Between April 1, 2017 and November 1, 2017, the researchers studied 56 cardiac and orthopedic surgical teams and 231 patients who underwent surgical procedures at a tertiary-care university hospital in Florida. Alcohol based hand rubs were made available in the operating theatre; effort was made to convince and train surgical teams in using them; direct observation of surgical hand preparation was promoted; and aggregated feedback on the quality of the preparation was provided. Researchers studied 534 surgical hand preparation events. For the 33 participants with full data available, they observed full compliance with all the steps predicted in the WHO technique in 0.03 per cent of the events in the pre-intervention period and in 36.36 percent of the events in the intervention period. The individual risk of a patient developing a surgical site infection did not significantly change between the pre-intervention and the intervention phase.

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new report published by The Leapfrog Group and analyzed by Castlight Health shows that the percent of hospitals achieving zero infections has declined dramatically since 2015, according to a Leapfrog news release. The report, “Healthcare-Associated Infections,” found that the percentage of hospitals reporting to the Leapfrog Hospital Survey and achieving zero infections has declined dramatically since 2015. Rates have gone upwards for all five of the infections examined on the Survey, including Central Line Associated Blood Stream Infections (CLABSI), Catheter Associated Urinary Tract Infections (CAUTI), Surgical Site Infection after Colon Surgery (SSI: Colon), Methicillinresistant Staphylococcus aureus (MRSA), and Clostridium difficile (C. diff). Each day, one out of 25 hospital patients in the U.S. contracts a healthcare-associated infection (HAI), resulting in billions of wasted dollars and an alarming 90,000 deaths annually, the release states. At the same time, Centers for Medicare & Medicaid Services (CMS) is proposing to decrease public reporting and transparency around infection rates and other measures of problems in hospitals. Leapfrog President and CEO, Leah Binder, said, “Leapfrog and its purchaser members remain committed to getting this data voluntarily from those hospitals willing to be transparent with their data should CMS choose to move forward with their proposal.” CMS often consolidates the data from multiple facilities under a single Medicare Provider Number (MPN). The report also found hospitals that report as part of the same health system under the same MPN sometimes perform significantly differently on preventing infections. Notably, using the Centers for Disease Control and Prevention’s (CDC) Standardized Infection Ration (SIR) methodology, the Leapfrog report’s findings showed the majority of hospitals reporting had fewer infections than would be expected.

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Multiresistant Superbug Appears in Australia

ictoria, Australia – The first reported case of the fungus Candida auris (C. auris), a multiresistant superbug has appeared in Australia, according to a HospitalHealth.com and TheGuardian. com/Australia articles. Patients in two Victorian hospitals were screened this summer after the rare fungal superbug was diagnosed in a man in his 70s while he was being treated in a Melbourne hospital for a pre-existing condition. The patient had been colonized by the fungus but not infected, according to the state’s deputy chief health officer, who explained that C. auris had not entered the man’s bloodstream and he was not showing symptoms. This is the first time the bug has been detected outside Western Australia. Although the patient was cared for in a single room, and while transmission of the fungus is person-to-person contact or via environmental contact with contaminated surfaces or medical equipment such as thermometers, the hospital screened all the patients on the hospital ward. Like antibiotic-resistant bacteria and viruses, drug-resistant fungal infections can be particularly dangerous once they enter the bloodstream, because they can then infect and permanently damage organs. Blood infection can occur in hospitals during surgery or when intravenous lines are inserted, because the bugs are pushed from the skin into the bloodstream of patients, who often already have compromised immune systems. C. auris can live on surfaces for several weeks. For example a hospital study found C. auris persisted on dry mattresses and linen for up to seven days and remained viable on plastic for up to 14 days. The fungus was first reported in Japan and South Korea in 2009. In 2011 in South Korea, reports from 1996–2009 revealed a high case mortality with the deaths of two of three patients with nosocomial candidemia. By 2016, C. auris strains had caused outbreaks in five continents prompting alerts to be issued by the Center for Disease Control and Prevention (CDC), European Centre for Disease Control (ECDC) and Public Health England (PHE). In 2017, cases were reported in the Middle

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East and Canada. In these and other international settings C. auris has spread quickly in healthcare settings, including hospitals and aged-care institutions, particularly in the intensive care populations. Healthy people do not generally come into contact with the fungus. In immunity compromised patients, C. auris can lead to sepsis. The fungus colonizes the skin, urine, sputum, enteral feeding tubes, drainage or intravascular clinical devices and can be asymptomatic. Infection with C. auris results in sepsis or clinical syndromes such as otitis media, pericarditis, peritonitis, osteomyelitis, meningitis, wound and urinary catheter-associated infections as well as intravascular line-associated fungaemia which spread to the blood stream. Complications of the infection can result in a mortality rate of 30 percent to 60 percent. Patients most at risk for becoming colonized or infected with C. auris tend to have other health conditions, such as immunosuppression, diabetes mellitus, recent surgery (especially abdominal) or age (prematurity). Guidelines from Public Health England recommend isolation of colonized or infected patients during all admissions. Also, broad containment and prevention measures in terminal cleaning of patient rooms, clearing colonization of body sites using chlorhexidine washes, decontamination of the environment using disinfectants and hand hygiene.

Weaponizing Oxygen to Kill Infections and Disease

ccording to an American Chemical Society journal article published in August, scientists have been able to wipe out bacteria by activating oxygen with light. They say that the method could be used to treat other microbial infections, and possibly even cancer. The team of University of Cincinnati researchers presented study results at the 256th National Meeting & Exposition of the American Chemical Society (ACS) in Boston. Principal investigator, Peng Zhang, Ph.D., explained that photosensitizers (mostly dye molecules) become excited when illuminated with light. The photosensitizers then convert oxygen into reactive oxygen species that attack the bacteria. Although other study teams have experimented with using these types of photocatalysts to kill bacteria, they did not destroy enough microorganisms to effectively shake off infections. Photosensitizers in a molecular form tend to not be corralled enough to do significant damage. In addition, many of them are hydrophobic. This makes it difficult to disperse them in aqueous media where microorganisms typically exist. To overcome these challenges, Zhang’s group collaborated with Neil Ayres, Ph.D., and his team at University of Cincinnati. The two groups set out to design a new, water-dispersible, hybrid photosensitizer -- one that includes noble metal nanoparticles decorated with amphiphilic polymers to entrap the molecular photosensitizers. The metal nanoparticles provide two benefits. First is a plasmonic enhancement effect that promotes the generation of more reactive oxygen species, while also concentrating the photosensitizers in one place for a more localized hit to the bacterial cells. Second is the delivery method. Zhang has patented a spray which medical professionals could put it on any surface and then illuminate it with blue or red light to clean away the bacteria, including MRSA,that may be present. Zhang also says that the method shows promise in direct wound applications to eliminate infection and assist in healing without harming tissue. The nanoparticles, however, worked for destroying skin cancer cells, Zhang says. The nanoparticles perform effectively with the illumination of red light, which has a long wavelength that penetrates deep below the skin -- something that’s important for a skin cancer treatment. Finally, the nanoparticles have been shown to eliminate nail bed fungus.

News Briefs

Green Recycling Service Launches in US and Canada for Biopharma

British company has introduced a new, eco-friendly way for healthcare facilities to dispose of their pharmaceutical packaging waste, reports EpmMagazine.com. Softbox, a provider of temperature control packaging for the life science and logistics industries, has launched a Green Recycling Service across the US and Canada. The service ensures a sustainable alternative for ‘end of life’ temperature control packaging waste. For an all-inclusive fee, the company’s logistics division collects and recycles all Softbox temperature control packaging waste. Softbox has developed other sustainability programs to keep the packaging out of the waste stream. According to its website, “the company has focused much of its’ recent R&D on the use of recyclable materials and the delivery of reusable packaging systems. The new and ground-breaking AEON shipper can be used and reused repeatedly.” The temperature control packaging market growth in biopharma has been spurred by demand for shipping and handling convenience, as well as evidence that a product’s temperature (and the associated fluctuations) can have profound impacts on a product’s stability and its therapeutic effectiveness, according to a PharmaTech.com article.

North Carolina Strikes Back at Legionnaire’s Disease

harlotte, NC — Legionnaires’ disease cases are up by more than 300 percent alone in North Carolina over the last decade prompting a Veterans Administration hospital to take major steps toward prevention, reports WCNC.com. Public records show more than 200 North Carolina cases of this often fatal type of pneumonia reported in 2017, an alarming increase from just 49 in 2007. South Carolina averages roughly 55 cases a year, according to public records. Following a VA directive, Salisbury Veterans Administration now has patient room faucets turn on automatically every hour and run for three minutes at a time to prevent water from stagnating in pipes. The facility also has stepped up monitoring for proper chlorination, air temperature controls and has drained an atrium pond inside. Adults 50 and older with weaker immune systems are most at risk for Legionaires’. The Legionella bacteria enters the lungs via small droplets of water that originate in warm water such as hot tubs, hot water tanks, large plumbing systems and air conditioning cooling towers. The Pittsburgh VA previously experienced an outbreak that killed six individuals several years ago. In Illinois, 13 others died at a veterans’ home. In August, more than a dozen people reportedly became sick at a New Hampshire beach resort resulting in one person dying. Other major area hospitals in North Carolina, such as Atrium Health and Novant Health are taking preventive measures, as well.

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High Bacterial Contamination on Frequently Touched Objects

iometric attendance devices, elevator buttons, door handles, staircase railings, telephone sets and water taps are teaming with bacteria, according to an article on AricJournal.biomedcentral.com. Over a period of five months, researchers at Manipal Teaching Hospital, Pokhara, Nepal, collected hundreds of bacterial samples from objects frequently touched by patients, visitors and healthcare workers. Of the total 232 samples collected, 219 bacterial isolates were recovered from 181 samples. Most commonly found was Staphylococcus aureus. The majority of S. aureus isolates were recovered from elevator buttons, biometric attendance devices and door handles. Among the S. aureus isolates, 36.3 percent were methicillin resistant Staphylococcus aureus (MRSA) while remaining were methicillin sensitive Staphylococcus aureus (MSSA). Out of 44 S. aureus isolates, 12 (29.5 percent) were multidrugresistant and 14 (31.8 percent) were biofilm producers. The majority of MRSA isolates were biofilm producers. Acinetobacter was the most common Gram-negative isolate followed by E. coli and Pseudomonas species. All the isolates of S. aureus were susceptible to amikacin. Colonization of such devices by potential pathogens such as MRSA and ESBL producing Gram negative bacteria indicates the possible spread of these pathogens among the hospital as well as in community population. Manipal Teaching hospital has more than six hundred healthcare workers who mark attendance twice a day with biometric devices yet rarely wash hands after use of the devices, findings revealed. The results demonstrate the need of improved hand hygiene among 2018 healthcare workers and regular cleaning/disinfection of sites of frequent Healthcare Environmental Solutions - MWMA public contact, study authors concluded.

Photosensitizer Technology Proposed as Weapon Against MRSA, Melanoma

ospitals have been battling MRSA (methicillin-resistant ) for years with various infection control schemes, but University of Cincinnati researchers are looking at a bright alternative – one that actually uses light, according to a Phys.org article. The technology employs photosensitizers (mostly dye molecules) that activate when illuminated with colored light. The photosensitizers convert oxygen into reactive oxygen species that attack the antibiotic resistant bacteria. The scientists say the method also could be used to treat other microbial infections, and possibly skin cancer. In a paper presented at the 256th National Meeting & Exposition of the American Chemical Society (ACS), study lead investigators Peng Zhang, Ph.D. and Neil Ayres, Ph.D., described a new, water dispersible hybrid photosensitizer that includes noble metal nanoparticles decorated with amphiphilic polymers to entrap the molecular photosensitizers. Zhang has a patent related to the design of hybrid photosensitizers, which can be formulated into a spray or gel. He says that once the spray is developed into a product, medical professionals could put it on any surface and then illuminate it with blue or red light to clean away the bacteria, including MRSA, that may be present. Zhang also says that the method shows promise in direct wound applications to eliminate infection and assist in healing. He has recently performed experiments on laboratory samples of human skin and found that the photosensitizer was not harmful to skin cells.

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uba, Republic of South Sudan — According to a Xinhuanet.com article, the United Nations and South Sudan are launching a defense against Ebola virus disease (EVD) in the wake of a Democratic Republic of Congo (DRC) outbreak where 6 out of 10 infected individuals have died. Although South Sudan has not confirmed any EVD case, the disease remains a national and regional threat, ministry of health officials say. The ministry, along with the World Health Organization (WHO), Center for Disease Control (CDC) and other partners began discussions of public health measures through visits to high-risk states of Yei River, Torit, Maridi, Gbudue, and Tambura in August and September. The visits were set up to engage policymakers and mobilize ample resources to support EVD preparedness and response. Measures such as establishing Ebola treatment centers with optimal infection prevention and control (IPC), dedicated ambulance services, and adequate personal protection equipment were discussed. The team also identified the need for specialized training in EVD case management, safe and dignified burials, and contact tracing. According to WHO, South Sudan is one of the four high-risk countries (Burundi, Rwanda, South Sudan, Uganda) prioritized by WHO to enhance preparedness and operational readiness based on the proximity to the outbreak area as well as the capacity to manage EVD outbreaks.

Australian Scientists Warn of Enterococcus Faecium Alcohol Tolerance

indings of a new study published in the August 2018 issue of Science Translational Medicine show that alcohol-based disinfectants and hand rubs are may not be as effective against multidrug-resistant bacterium Enterococcus faecium as previously thought. Enterococcus faecium has become increasingly tolerant to the alcohols in widely used hospital disinfectants such as hand rub solutions, Australian researchers say. The findings of their study may help explain the recent increase in this pathogen in hospital settings. Testing revealed a sharp increase in E. faecium isolates after 2010 were 10-fold more tolerant to killing by alcohol than were older isolates collected between1997 and 2015. Alcohol-tolerant E. faecium accumulated mutations in genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed the roles of these genes in the tolerance of E. faecium to 70 percent isopropanol, suggesting that bacterial adaptation is complicating infection control recommendations, necessitating additional procedures to prevent E. faecium from spreading in hospital settings. “A global response to E. faecium will need to include consideration of its adaptive responses not only to antibiotics but also to alcohols and the other active agents in disinfectant solutions that have become so critical for effective infection control,” the researchers warned. “Extension of active surveillance cultures outside high-risk areas of the hospital and return to strict contact precautions during outbreaks with new emergent strains of [vancomycin-resistant enterococci] may be required to prevent widespread cross-contamination,” senior author Timothy P. Stinear, PhD, professor of microbiology and immunology at the University of Melbourne in Australia, told Medscape Medical News. Findings of a previous study showed that bacteria can develop tolerance to biocides such as chlorhexidine, an active agent that is sometimes added to alcohol-based hand rub products. The new study is thus another reminder that bacteria evolve in response to infection control efforts, thereby complicating infection control recommendations.

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Med-Tainer™ Single Deposit Containers The Med-Tainer™ 10 and 17 Gallon Single Deposit Containers are versatile, “Point of Use”, reusable medical waste containers. These sharps containers offer high volume capacity for needles, lab waste, IV bags, and tubing keeping waste collection costs at a minimum. • FDA 510(k) clearance. • US DOT Marking for transportation of regulated medical waste. • OSHA Markings: Compliant with OSHA Exposure Control Plan (when supplied with decal).

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News Briefs

CMS Inpatient Quality Reporting Hi-Desert Medical Center Program stands Honored for Zero HAI

altimore, MD — The Centers for Medicare and Medicaid Services (CMS) will continue to publicly report the errors, injuries, and infections occurring at hospitals the government reimburses, reports USAToday.com. Hospitals receiving Medicare payments have been required to report on errors, injuries, and infections since 2005 when The Inpatient Quality Reporting Program was established. In an about-face, federal health officials have decided to continue public disclosure of hospital infection and safety problems. Previously, the agency had proposed removing the information from a public reporting program. Late last year, the American Hospital Association (AHA) had urged the Trump administration to remove certain reporting measures that hit hospitals with financial penalties for safety problems. The data that will remain on the federal Hospital Compare website includes infections such as Clostridium difficile (C. Diff.), Methicillinresistant Staphylococcus aureus (MRSA) and the rate of sepsis after surgery. The information is available in downloadable format and will include the dates and details. When hospital rating organization Leapfrog Group and safety advocacy group, Health Watch USA, publicized CMS’ earlier decision to halt public release of hospital safety data, citizens and healthcare professionals joined in to voice opposition. CMS also will collect safety data from the hospitals through two Obamacare payment programs. The agency also had ruled it would not post so-called “never events” – the safety problems such as leaving instruments inside patients that are so serious they should never occur in hospitals – on Hospital Compare. The Leapfrog Group does collect and analyze such data.

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

Turning Hospital Waste into an Income-Producing Product

esearchers from Charles Sturt University, James Cook University and The University of Queensland have been working on developing a new method for treating hospital plastic and textile waste. The team from the University’s Institute of Land Water and Society has been testing methods to break the hospital waste down into a safe, char-like material which could be used for agriculture or water treatment. Along with a chemist at James Cook University the team is investigating how to convert the waste into low-to-medium value products such as fertilizers or adsorbents with the end goal of turning the waste into an income stream. The project is funded by Charles Sturt University, Research Seed Grants, James Cook University, and the University of Queensland. The researchers hope to gain additional funding to pursue testing large-scale waste conversions.

New Device Monitors Handwashing in Hospitals

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ucca Valley, CA — Hi-Desert Medical Center has received the Collaborative Alliance for Nursing Outcomes award for infection measures that resulted in no hospital patient infection contracted while receiving care for another condition, HiDesertStar.com reports. The hospital, a Tenet Corporation facility, has a strict hand-washing policy. The Joshua Tree hospital, along with all others in California, is required by law to test for MRSA.The last time the hospital had a positive test for a MRSA infection associated with health care was in 2015. Hi-Desert Medical Center has been working with the California Department of Public Health’s infection control team, regional hospitals and nursing homes to combat hospital acquired infections. According to the state agency’s website, the Healthcare-Associated Infections (HAI) Program is one of two programs in the Center for Health Care Quality of the California Department of Public Health. The Program was created by mandate to oversee the prevention, surveillance, and reporting of HAI in California’s general acute care hospitals. Since 2010, the HAI Program has produced annual public reports of hospital HAI data to inform choices of healthcare consumers and prompt providers to take actions to prevent infections.

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t. Paul, MN — Ecolab, a St. Paul-based company has developed a device that assures doctors, nurses and other health care providers are washing their hands to prevent the spread of infections, reports KSTP.com. Deployed at North Memorial Hospital in Minnesota, about 100 caregivers in the oncology ward wear badges that are electronically linked to hand sanitizer dispensers and beacons in patient rooms. Badges remain green for five minutes after hand-washing and will beep and turn red if a caregiver doesn’t cleanse their hands. The monitoring system has improved hand hygiene practices. Staff have been washing their hands 95 percent of the time, a hospital infection control official told Minneapolis Public Radio. The system also tracks individual performances. The hand monitoring system is currently deployed in Minneapolis, Florida and Colorado hospitals and is being tested in Ohio, New Mexico, Michigan, Virginia and West Virginia. According to its website, Ecolab is a global leader in water, hygiene and energy technologies and services. The company also is exploring other potential markets for the handwashing monitor system, such as long-term care facilities and restaurants.

News Briefs

CA Needle Take-Back Program Proposal Heads to the Governor

acramento, CA — California state legislators have passed a measure to create the first statewide drug and needle take-back program funded by the pharmaceutical industry, according to a statement by sponsor, Senator Hannah-Beth Jackson (D-Santa Barbara). Senate Bill 212 passed unanimously and is expected to be signed into law by Governor Jerry Brown. T h e l e g i s l at i o n re q u i re s m a nu f a c t u re r s o f pharmaceutical drugs and medical sharps to establish, implement and fund take-back programs for safe and secure collection and disposal of their products. This is the first statewide proposal in the nation to include both prescription medications and medical sharps. Assembly member Phil Ting (D-San Francisco) said he drafted the bill because the current patchwork of take-back programs isn’t working. While California has some safe drug disposal sites, a mere 489 locations serve 39 million residents. The sites are financed by state and local tax revenues. The bill shifts the expense to the manufacturers. In 2012, Alameda County became the first local government agency in the country to pass an ordinance requiring drug manufacturers to develop, implement and pay for a drug take-back program. The program was challenged but prevailed in the courts when the Ninth Circuit Court of Appeals upheld it in 2014.

House Passes VA Cost Savings Enhancements Act to Cut Medical Waste Costs

ashington, D.C. — The US House of Representatives has passed H.R. 5974, a measure that outlines safer, cheaper removals of hazardous medical waste at U.S. Department of Veterans Affairs (VA) facilities. The new regulation, if enacted, directs the Secretary of the VA to develop “a uniform regulated medical waste cost analysis model to be used to determine the cost savings associated with the use of an on-site regulated medical waste treatment system at department facilities,” according to the draft text of the bill. The bill also calls upon the VA to identify facilities that would benefit from on-site regulated medical waste treatment systems within a 5-year timeframe. Purchases might include equipment that sterilizes, grinds and compacts the waste, aimed at reducing the handling and transport hazards and costs. “The management and disposal of regulated medical waste is required at virtually every clinical site operated by the Veterans Health Administration (VHA)--with approximately 80 percent of VHA facilities outsourcing to contractors who specialize in off-site disposal. While off-site disposal is a relatively safe and effective method, on-site disposal often provides a cheaper, safer, and more environmentally-friendly means of disposal. The on-site disposal of regulated medical waste is also beneficial in emergency and contingency scenarios, where off-site disposal services may be interrupted,” the bill reads. The bipartisan bill was sponsored by U.S. Rep. Jeff Denham (R-CA). Co-sponsors of the bill were U.S. Reps. Rodney Davis (R-IL), Mike Bost (R-IL), Charlie Crist (D-FL) and Ann Kuster (D-NH). Implementing the technology for such on-site machines also would align the VA with Centers for Disease Control best practices for infection control, according to a statement from Rep. Denham’s staff.

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