http://www.yourlawyer.com/topics/overview/psedomonas_aeruginosa Sat, 21 Nov 2009 14:44:29 -0800 pixel-app en http://www.yourlawyer.com/articles/read/12391 Sat, 16 Dec 2006 00:00:00 -0800 http://www.yourlawyer.com/articles/read/12391
The Boyle Heights hospital shut its busy neonatal unit Dec. 4 after identifying an outbreak of Pseudomonas aeruginosa, which is believed to have infected five babies.

Then Friday, White Memorial closed its high-level pediatric unit after learning that two older children were infected with the bacterium. Dr. Rosalio Lopez, the hospital's chief medical officer, said he is unsure if the new cases are linked to the outbreak among babies.

Neither unit will be reopened until "we believe it is safe for the patients to be admitted," Lopez said, adding that other parts of the hospital are not affected.

White Memorial officials said they believe that the most likely cause of the outbreak is improper cleaning of a laryngoscope blade, a piece of equipment used to insert breathing tubes. They are working with local, state and federal health investigators to conclusively determine the source.

Lopez said the hospital has tightened its infection control practices, notified the families of patients in the affected units and given antibiotics to all babies remaining in the neonatal unit as a precaution.

"Our first priority is to continue to work with the families affected in this situation," Lopez said. "We're totally committed to providing our patients safe care."

Any critically ill babies born at the hospital now are being taken to a special isolation area to be stabilized before being transferred to other hospitals. High-risk pregnant women are also being advised to consult with their doctors to determine if they should go to White Memorial or another hospital.

About 90% of the hospital's patients are Latino.

'Being extremely cautious'

Los Angeles County public health officials say that their investigation is ongoing and that the number of infected patients may change as test results come in.

"They are being extremely cautious," Dr. Laurene Mascola, chief of the county's acute communicable disease control unit, said of the hospital.

P. aeruginosa is a common bacterium found in water and soil and can be spread through body contact, fluids and water. In most people, it is not deadly or even dangerous, because their immune systems can ward off infection.

But that is not the case in patients with weakened immune systems, such as premature babies, patients with cancer or AIDS and those on breathing machines.

In such situations, the bacterium can cause a variety of infections depending on where it enters the body. These include respiratory, urinary tract and blood infections.

It can spread rapidly and, in some cases, be unstoppable.

Babies in the neonatal unit are especially at risk for infections, because they are often connected to ventilators, tubes, monitors and other equipment that give bacteria an easy pathway to the body.

"It's a group of patients that are very vulnerable," said Dr. Arjun Srinivasan, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention. "They're very sick, so they are at risk of these infections. The care that's delivered for them is very complicated."

The bacterium is particularly deadly for extremely premature and underweight infants, said Dr. Leandro Cordero, director of the newborn intensive care unit at Ohio State University Medical Center. His hospital had an outbreak a decade ago that sickened about 10 infants, most of whom died.

Babies born before 27 weeks of gestation and weighing less than 2 pounds already have a 40% to 50% chance of dying from other causes, Cordero said. But that mortality rate can rise to 70% to 80% with a P. aeruginosa infection, he said.

Experts said doctors face a Catch-22 with these tiny patients. They can't live without medical interventions, but such steps can increase their risks of other problems.

"Those infants have no chance at survival without all the types of invasive devices that they have," said Dr. William Jarvis, an expert in hospital infections who previously worked at the CDC. "But those devices obviously place those patients at risk, because they are bypassing the normal body defense mechanisms."

The bacterium is hardy and like the more familiar Staphylococcus aureus, or staph can develop resistance to common antibiotics. Experts recommend that infected patients be isolated from others and that units known to harbor the bacterium receive deep cleanings.

Since Nov. 30, 33 patients have been treated in White Memorial's neonatal unit. Of the five babies who were infected, three died, Lopez said, but only one death appears to have been caused by the infection. Eighteen babies showed no signs of the bacterium. The remaining 10 had colonies of P. aeruginosa in their noses or rectums but no signs of infection.

Thirteen babies remain in the neonatal intensive care unit, Lopez said. The 28-bed unit is in a specialty care tower that opened in April.

Hospital officials said they are seeking outside reviews of all deaths in the neonatal unit since Nov. 30.

Other such outbreaks

Several outbreaks of P. aeruginosa have been identified previously in neonatal nurseries around the country.

From 1997 to 1998, 16 newborns died at Children's Hospital of Oklahoma. An investigation found that the bacterium had been found under the fingernails of two nurses, although researchers said they were unsure if that was the mode of infection.

In 1997, Children's Hospital Boston had to close its neonatal unit after four newborns died from P. aeruginosa infections.

After a 1999 P. aeruginosa outbreak in which five infants were sickened and one of them died, Prince George's Hospital Center in Maryland hired a full-time technician just to clean equipment in the neonatal unit. It has not seen an outbreak since, said Abdul Zafar, director of infection control for the system that runs the hospital.

Mascola of L.A. County said her agency did not release information on the outbreak at White Memorial before the hospital came forward Friday, because there was no risk of harm to the general public.

"We don't go public with any outbreak unless its something that the public needs to know about that's going to affect their health," she said.

According to the CDC, about 2 million patients suffer hospital-acquired infections annually, accounting for 90,000 deaths and $4.5 billion in healthcare costs.]]> http://www.yourlawyer.com/articles/read/12219 Sun, 29 Oct 2006 00:00:00 -0700 http://www.yourlawyer.com/articles/read/12219
At present, 22 patients most of them elderly are still sick with Clostridium difficile-associated disease at the Centre hospitalier Honore Mercier. The superbug is suspected to be lurking on five floors of the building, despite the fact housekeeping staff have twice washed down patient rooms with bleach.

The outbreak is baffling authorities because it comes as rates of C. difficile infections have been declining across Quebec, especially in the Montreal region.

Quebec's top public health officer, as well as a leading expert on C. difficile, dismissed claims yesterday by the hospital that an entirely new, hypervirulent strain has emerged in St. Hyacinthe, about 65 kilometres east of Montreal.

Rather, a lack of infection-control measures is probably to blame, suggested Mark Miller, head of a national surveillance group on C. difficile for the Public Health Agency of Canada. Miller said the hospital has probably been hit with a strain called NAP1/027 the same one that has circulated in Quebec since 2004.

That strain is 20 times more toxic than older strains of C. difficile and has directly or indirectly caused the deaths of 2,000 Quebecers.

"With the strain we have here in Quebec, there's no room for errors and no room for being lax," Miller said.

"You have to have excellent infection control all the time. You have to have great housekeeping all the time. If you become lax, the hospitals have shown that this strain causes outbreaks."

The infections started occurring in the 202-bed hospital on July 23 a couple of months after extensive renovations were undertaken to eliminate a fungus that was discovered in the walls.

Ghislaine Archambault, the hospital's communications director, said workers are in the process of disinfecting half the building. What's more, visits have been limited to one person per patient and children under 2 are not allowed in the hospital. Visitors are also advised to wash their hands before entering the hospital and after seeing patients.

"We want to ask the public to help us," Archambault said.

"We'll get through this."

Patients who are sick with C. difficile are being isolated. Certain pieces of equipment have been sterilized, curtains have been replaced and furniture is not being moved around.

Archambault said the hospital has faced two outbreaks the first in August and the second in recent weeks. Housekeeping staff scoured the hospital after the first outbreak.

Proper sanitation is good but is not enough, Miller said. Early diagnosis and treatment of C. difficile diarrhea must be made, and patients must be isolated without delay, he added. If those measures are not carried out immediately, an outbreak will occur, he said.

Across the province, the rate of C. difficile infections in large hospitals was eight per 1,000 admissions last month. That's down from a province-wide rate of 24 at the height of the epidemic in 2004.

At Montreal's Jewish General Hospital where Miller works as chief of infectious diseases the rate of infection dropped last month to its lowest level in 13 years.

For smaller hospitals, the average rate last month was four C. difficile cases per 1,000 admissions.

"It continues to improve every month," Miller said, the exception being St. Hyacinthe.

Horacio Arruda, provincial director of public health, said he doubts Honore Mercier has been beset by a new strain.

"It's clear that if you don't react fast to an outbreak, you'll get more cases," he said, adding he's satisfied with the hospital's measures.

"If you look at hospitals in Quebec, there are some that have seen increases and others that have seen decreases," said Jacques Bisson, of the Association to Defend Victims of Nosocomial Infections. "It all depends on how a hospital manages the problem of nosocomial infections and how they keep up with proper hygiene and prevention."

The provincial government is monitoring the situation at the hospital, said Isabelle Merizzi, an aide to Health Minister Philippe Couillard. "We have confidence in the rapid response by the hospital," Merizzi said.

It's doubtful the C. difficile bacterium was a direct cause of death in all nine patients at the hospital. Some of the patients were suffering from multiple illnesses, Archambault said, and C. difficile was a contributing factor in their deaths.

After initially playing down the C. difficile epidemic, the provincial government last year invested $25 million to fight hospital-acquired infections.

Similarly virulent strains of C. difficile have caused outbreaks in four U.S. states as well as in Britain and the Netherlands.]]> http://www.yourlawyer.com/topics/overview/psedomonas_aeruginosa Sun, 29 Oct 2006 00:00:00 -0700 http://www.yourlawyer.com/topics/overview/psedomonas_aeruginosa Psedomonas Aeruginosa Psedomonas aeruginosa is a lethal strain of bacteria that is responsible for hospital infections in patients with immune system diseases and cystic fibrosis. Psedomonas aeruginosa is accountable for 18% of hospital acquired pneumonia and is incredibly resistant to antibiotics. Additionally, Cancer and burn patients also commonly suffer serious infections by Psedomonas aeruginosa.

Psedomonas aeruginosa is the second most common cause of nosocomial pneumonia and the most common cause of intensive care unit (ICU) pneumonia. Health care workers, medical equipment, sinks, disinfectant solutions, and food can spread pseudomonas infections within hospitals.

Other Body Parts That Can Be Affected

• Heart
• Blood
• Bones
• Joints
• Ears
• Eyes
• Urinary tract
• Lungs
• Skin

Symptoms
Psedomonas aeruginosa symptoms include fever, tiredness, muscle pains, joint pains, swelling, redness, headaches, cough, weight loss, decreased appetite, tiredness, rapid breathing, rashes, bleeding, stomach pain, breast tenderness, earache, sore eyes, sore throat, and chills.

Treatment
Psedomonas aeruginosa is commonly resistant to antibiotics; infections are usually treated with two antibiotics at once. Psedomonas aeruginosa may be treated with blend of ceftazidime (Ceftaz, Fortraz, Tazicef), ciprofloxacin (Cipro), imipenem (Primaxin), gentamicin (Garamycin), tobramycin (Nebcin), ticarcillin-clavulanate (Timentin), or piperacillin-tazobactam (Zosyn). Most antibiotics are administered intravenously or orally for two to six weeks.

Free Lawsuit Case Consultation
If you or a loved one has suffered from a hospital-borne bacterial infection you may have valuable legal rights. Complete the case evaluation form at the right of this page for a free case evaluation by a qualified attorney. If you prefer contact Parker & Waichman, LLP, at 1-800-LAW-INFO (1-800-529-4636) 24 hours per day.]]>