Nursing home infection rates climbing: Study

Nursing home infections can be reduced,
researchers say.

Nursing home infection rates are on the rise, a study from Columbia University School of Nursing found, suggesting that more must be done to protect residents of these facilities from preventable complications.

The study, which examined infections in U.S. nursing homes over a five-year period, found increased infection rates for pneumonia, urinary tract infections (UTIs), viral hepatitis, septicemia, wound infections, and multiple drug-resistant organisms (MDROs).

"Infections are a leading cause of deaths and complications for nursing home residents, and with the exception of tuberculosis we found a significant increase in infection rates across the board," said lead study author Carolyn Herzig, MS, project director of the Prevention of Nosocomial Infections & Cost Effectiveness in Nursing Homes (PNICE-NH) study at Columbia Nursing.

"Unless we can improve infection prevention and control in nursing homes, this problem is only going to get worse as the baby boomers age and people are able to live longer with increasingly complex, chronic diseases."

Herzig and a team of researchers from Columbia Nursing and RAND Corporation analyzed infection prevalence from 2006 to 2010, using data that nursing homes submitted to the U.S. Centers for Medicare and Medicaid Services.

While UTIs and pneumonia were the most common, infection prevalence increased the most – 48 percent – for viral hepatitis. Herzig presented findings from the study at IDWeek 2014 in Philadelphia.

More research is needed to determine the exact causes behind the increases in infection prevalence, Herzig said.

But there are several relatively simple interventions that have been proven to help reduce the risk of infection – and that families should look for when selecting a nursing home for a loved one.

UTIs, far and away the most common infection in nursing homes, increased in prevalence by 1 percent, the study found. UTIs can be prevented by reducing the use of urinary catheters and increasing the frequency of assisted trips to the toilet or diaper changes for residents who are unable to use the bathroom.

Families evaluating which nursing home to choose for a loved one should ask what protocols are in place to decrease catheter use, and they should also ask how the staff cares for residents with diapers, Herzig said.

"Nobody wants to think about diapers, but even if your loved one enters the nursing home able to use the bathroom independently, they may need assistance down the line. Seeing how well toileting needs are met is one way to assess infection risk."

Pneumonia climbed in prevalence by 11 percent, the study found. For pneumonia, and other infections that can spread through the air or contact with contaminated surfaces, proper hand hygiene is essential for prevention.

Residents, visitors, and staff should all have easy access to sanitizer or soap and water to clean their hands and be encouraged to do this frequently.

"When you walk into a nursing home for the first time, you should easily spot hand sanitizer dispensers or hand-washing stations," Herzig said. "If you don't see this, it's an indication that infection control and prevention may be lacking at the facility."

MDRO infection prevalence increased 18 percent, the study found. Screening for MDROs is an important tool for reducing the risk of MDROs, Herzig said. Families should ask whether residents are routinely screened for bacteria like C. difficile and methicillin-resistant Staphylococcus aureus (MRSA).

While some nursing homes may only screen residents who are symptomatic or at high risk for infection, routine screening of all residents upon admission is likely to be more effective, Herzig said.

In addition, it's worth asking whether a nursing home has private rooms to allow for isolation if necessary and whether families are consulted when their loved one shares a room with a resident who has an infection.

"Isolation is a common way to contain MRSA and other infections in hospitals, but in nursing homes this isn't as common because these facilities are tailored to residential needs. If the nursing home does have rooms for isolation, it suggests a more robust approach to infection prevention and control."

Source: Columbia University

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OSHA seeks input on chemical exposures at work

National dialogue on chemical exposures and permissible exposure limits in the workplace launched

Only a fraction of thousands of chemicals
used today has been tested - and that
info is often outdated, experts say.

The U.S. Department of Labor's Occupational Safety and Health Administration announced it is launching a national dialogue with stakeholders on ways to prevent work-related illness caused by exposure to hazardous substances.

The first stage of this dialogue is a request for information on the management of hazardous chemical exposures in the workplace and strategies for updating permissible exposure limits.

OSHA's PELs, which are regulatory limits on the amount or concentration of a substance in the air, are intended to protect workers against the adverse health effects of exposure to hazardous substances.

Ninety-five percent of OSHA's current PELs, which cover fewer than 500 chemicals, have not been updated since their adoption in 1971.

The agency's current PELs cover only a small fraction of the tens of thousands of chemicals used in commerce, many of which are suspected of being harmful.

Substantial resources are required to issue new exposure limits or update existing workplace exposure limits, as courts have required complex analyses for each proposed PEL.

"Many of our chemical exposure standards are dangerously out of date and do not adequately protect workers," said Assistant Secretary of Labor for Occupational Safety and Health Dr. David Michaels.

"While we will continue to work on updating our workplace exposure limits, we are asking public health experts, chemical manufacturers, employers, unions and others committed to preventing workplace illnesses to help us identify new approaches to address chemical hazards."

OSHA is seeking public comment regarding current practices and future methods for updating PELs, as well as new strategies for better protecting workers from hazardous chemical exposures. Specifically, the agency requests suggestions on:

• Possible streamlined approaches for risk assessment and feasibility analyses and
• Alternative approaches for managing chemical exposures, including control banding, task-based approaches and informed substitution.

The goal of this public dialogue is to give stakeholders a forum to develop innovative, effective approaches to improve the health of workers in the United States.

In the coming months, OSHA will announce additional ways for members of the public to participate in the conversation.

The comment period for the RFI lasts for 180 days. Instructions for submitting comments are available in the Federal Register, Docket No. OSHA-2012-0023.

Source: OSHA

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Companies start disclosing fracking chemicals

As hydraulic fracturing operations spread,
so have fears of potential chemical hazards.

SAN ANTONIO — Baker Hughes Inc. this month will start disclosing all the chemicals it uses in hydraulic fracturing — the first of the major oil field service companies to adopt a policy of transparency.

The Houston-based company said it will not make any trade secret claims in the information it posts on the industry website FracFocus.org, starting with wells fractured on or after Oct. 1.

The process pumps water and chemicals at high pressure to break shale. Then sand is added to the mixture to prop open the fissures and let oil and gas flow up the well.

Along with horizontal drilling, the use of hydraulic fracturing, known more commonly as fracking, has opened up new shale fields across the United States.

Among the many chemicals used for fracking are hydrochloric acid, petroleum distillates and ethanol, according to FracFocus.

“The policy we are implementing today is consistent with our belief that we are partners in solving industry challenges, and that we have a responsibility to provide the public with the information they want and deserve,” Derek Mathieson, Baker Hughes chief strategy officer, said in a news release.

Baker Hughes will not detail specific product formulations but will disclose a single list of all the chemical constituents and their maximum concentrations.

As shale drilling boomed across the country — and in response to grass-roots concerns about potential environmental or health effects — the oil and gas industry launched FracFocus.org in spring 2011 as a national registry for companies to voluntarily report the composition of hydraulic fracturing fluids.

The Ground Water Protection Council and the Interstate Oil and Gas Compact Commission maintain the FracFocus website, which has information on more than 77,000 wells.

Texas has required operators to disclose the composition of fluids used in hydraulic fracturing on FracFocus since Feb. 1, 2012, but the law allows them to withhold the identity and amount of the chemicals as a trade secret.

The use of the trade secret exemption is widespread.

Of 12,410 instances of hydraulic fracturing in Texas between April 2011 and early December 2012, companies used terms such as “proprietary,” “secret” or “confidential” 10,120 times while reporting data on the FracFocus.org website, according to data collected by Pivot Upstream Group and analyzed by the San Antonio Express-News.

In the Eagle Ford Shale in South Texas, the trade secret exemption was used 2,297 times in 3,100 fracturing events.

In Texas, the only people who can challenge a trade secret claim are the landowner and someone who lives adjacent to him or her. State regulators also can challenge the use of the exemption.

In 2013, the Harvard Environmental Law Program's Policy Initiative criticized FracFocus, citing a lack of transparency.

This year, an Energy Department advisory board said companies were shielding too much information from public view in the FracFocus registry.

Source: MySA

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Exposure to BPA while pregnant linked to children's lung problems

Pregnant women are urged to minimize BPA exposure.

Children of women exposed to the chemical bisphenol A (BPA) during pregnancy may be at an increased risk of lung problems, according to a new study.

In the study of 398 mother-infant pairs, researchers looked at the mothers' exposure to BPA during pregnancy by examining the concentration of the chemical in their urine.

They also assessed how healthy the children's lungs were and whether they developed wheezing by age 5. To measure their lung health, the investigators measured the amount of air they exhaled during the first second of an exhalation.

The researchers found that every tenfold increase in the average BPA concentration in a mother's urine corresponded to a 14.2 percent decrease in the child's lung functionat age 4, but not at age 5.

In other words, BPA may affect lung function during a child's early years, but the effect may disappear over time, the researchers said.

They also found that a tenfold increase in the average concentration of BPA in maternal urine was related to a fourfold-plus increase in a child's odds of experiencing persistent wheezing during the first five years of life, according to the study, published today in the journal JAMA Pediatrics.

"Our results support the conclusion that BPA exposure during pregnancy is associated with persistent wheezing in children and may have a negative health [effect] on lung function," said study author Dr. Adam J. Spanier, of the University of Maryland School of Medicine in Baltimore.

"I would recommend that women of childbearing age and pregnant women try to minimize their exposure to BPA," Spanier said.

BPA is a chemical used to make polycarbonate — a hard, clear plastic that is used in many consumer products, including the lining of metal food containers.

To measure the mothers' BPA levels during pregnancy, the researchers collected urine samples twice, once when the women were 16 weeks pregnant and again at 26 weeks.

The investigators also examined the children's exposure to BPA after birth, by taking their urine samples annually during their first five years, but they did not find a relationship between their exposure during early childhood and their lung health or wheezing risk.

The study did not look at what mechanism might link the prenatal exposure to BPA and children's lung health, Spanier said. However, "[at] least one animal study suggests that BPA might affect the development of the cells in the lung responsible for airway secretions," he said.

Still, it is not clear what the exact mechanism is, he said.

"BPA is also known for its potential estrogen-disrupting effects," Spanier said. "There are many other human health studies which demonstrate associations with other health outcomes,” such as neurodevelopmental and endocrine effects, he said.

"While I think it is important to avoid BPA during pregnancy, it is a difficult task for a consumer," because it is in so many products, he said. Consumers would benefit from a safer chemical management system at the national level, he added.

"But more specifically, given the mounting evidence, I do not see a reason for BPA to be in any consumer products," he told Live Science.

The U.S. Food and Drug Administration said on its website that the current presence of BPA in consumer products poses no risk to the public's health.

"FDA's current perspective is that BPA is safe at the current levels occurring in foods," the website reads. "Based on FDA’s ongoing safety review of scientific evidence, the available information continues to support the safety of BPA for the currently approved uses in food containers and packaging."

Source:  Live Science

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