Nosocomial Infections
by Brian Fraser
Copyright 2008
June 21, 2008 a

The Problem and Its Scope

"Each year, approximately two million patients (about 10% of those hospitalized) in U.S. hospitals develop a nosocomial (healthcare-associated) infection. These infections result in an estimated 90,000 deaths, immeasurable suffering and disability and are associated with billions of dollars in increased healthcare costs."  (Central Service Technical Manual, Jack D. Ninemeier, Ph.D, editor, 6th ed., 2003)

To help you understand that better, let's suppose you were in a bad auto accident You had internal injuries and broke several  bones.  The surgeons at the hospital put you back together with various pins, screws, plates and lots of stitches, both internally and externally. This is an "invasive procedure" but it saves your life. Your immune system, however, goes into a state of hibernation for few days under these circumstances, and despite being loaded with antibiotics, you develop an infection. This infection is not something you had before you went to the hospital, and it was not due to the auto accident either. You are now in that unfortunate 10% of patients who develop nosocomial infections.

My Method of Inquiry

My approach was simple. I decided to circulate a few published articles that seemed relevant and appropriate for reducing nosocomial infections and see what the culture at the hospital did with them. Here are some samples of the articles:

__________

"Keys to Safer Hospitals",  Donald M. Berwick, M.D., Newsweek Dec 12, 2005, http://www.newsweek.com/id/51386

Dr. Berwick gives the six key measures of the 100,000 Lives Campaign as:

1. Prevent respirator pneumonia
2. Prevent IV catheter infections
3. Stop surgical site infections
4. Respond rapidly to early-warning signals.
5. Make heart-attack care absolutely reliable
6. Stop medication errors

Thousands of hospitals were enrolled in the 100,000 Lives Campaign. The article gives more details. I'll use this list to provide somewhat of a frame work for the presentation that follows.

_____

"Pilot Study: Orally-Administered Yeast b1,3-glucan Prophylactically Protects Against Anthrax Infection and Cancer in Mice", Vaclav Vetvicka, PhD, Kiyomi Terayama, MD, Rosemonde Mandeville, MD, PhD, Pauline Brousseau, PhD, Bill Kournikakis, PhD, Gary Ostroff, PhD, The Journal of the American Nutraceutical Association, Vol. 5, No. 2, Spring 2002 ( www.biotherapharma.com/pdf/glucan-reprint5-2.pdf   )

This article is relevant to items 1,2, and 3 in the list above.

I came across this article when trying to estimate how difficult growing and weaponizing anthrax spores would be for terrorists. The anthrax found at the Senate Hart building was of very  high quality. It probably had a density of 500 billion spores per gram. This is "over weaponized" by a factor of ten. It would have been extremely dusty—almost like smoke. If a test tube with a little of the fresh spores were shaken, the dust would not settle out for several minutes. The chemicals apparently required to make it are widely used in industry, and the equipment could be made by a clever and determined experimentalist.   A terrorist would need only a few grams (not tons) of the spores. Production of quantities this small would have a small manufacturing footprint, probably no bigger than a storage shed or a large closet. Keep that in mind when you read the article cited above.(See also "Bioterroism", Lara Simmons, Managing Infection Control, April 2007, p.59-66, http://www.manageinfection.com/database/dms/mic0407w58.pdf )

Although the article is about anthrax and mice, the point I want to make is that  b 1,3-glucan can be used to stimulate a human patient's immune system:

"b1,3-glucan also stimulates phagocytosis of neutrophils. In one study, the killing efficiency of neutrophils was increased 20- to 50-fold. . . . b1,3-glucan has been shown to increase lymphocyte production, NK cell activation, and activation of macrophages. "

This illustrates a point that seems to have been overlooked in the nosocomial infection senario. Hospital infection control programs focus on hospital systems (as noted above) and on medical interventions (like the use of antibiotics). Those are all necessary. But administrators should also focus on improving the patient's own immune system.  If you knew you were going to be a patient having an invasive surgery, wouldn't you want to know how to produce a several-fold increase in your immune system efficiency?

Quality b 1,3-glucan is available commercially and is used as a dietary supplement. I have had good results with Beta-1,3D Glucan by Beta Force. I think patients facing an invasive surgery should use it too.

_____

"D-Ribose: Energize Your Heart, Save Your Life. Rejuvenate Cardiac Cellular Energy Production", By Julius G. Goepp, MD, LE Magazine May 2008,  http://search.lef.org/LEFCMS/aspx/PrintVersionMagic.aspx?CmsID=115650   (See also patent 20030045482 )

"A natural ingredient for building new ATP, D-ribose is an important component of a “cardiac rejuvenation” regimen. Animal studies show that it dramatically increases ATP levels in the critical reperfusion period after a heart attack (the time when blood flow is restored and cells use energy at extremely high levels to repair the damage). This provides much-needed energy levels to block further injury and start the healing process. . . . These studies show that D-ribose not only enhances cardiologists’ ability to accurately gauge the degree of heart damage, but also suggest strongly that this supplement might hasten the recovery of healthy heart function following a heart attack. "

This article is relevant to item 5 in the list above.

Infusing ribose directly into the heart during surgery produced "dramatic results". These studies were done several years ago. I don't know if they are still considered to be experimental. But ribose can always be administered as an oral dietary supplement.

_____

"Early enteral nutrition in critically ill patients with a high-protein diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet. The effect on nosocomial infections and outcome", JPEN: Journal of Parenteral and Enteral Nutrition,  Nov/Dec 2001  by Caparros, Tomas,   Lopez, Jorge,  Grau, Teodoro, http://www.findarticles.com/p/articles/mi_qa3762/is_200111/ai_n8954706

"Results: The patients in the control and study groups had similar baseline characteristics. The study group had a lower incidence of catheter-related sepsis (0.4 episodes/1000 ICU days) than the control group (5.5 episodes/1000 ICU days) . . ."

"Increased energy expenditure, elevated protein catabolism, and the loss of lean body mass are the metabolic landmarks in critical illness that can lead to a decreased immune function. Moreover, prolonged fasting and the use of total parenteral nutrition (TPN) impair gut barrier function and could increase intestinal permeability and facilitate bacterial translocation. Both fasting and TPN can be related to the development of nosocomial infections, the appearance of multiple-organ failure, and death.

Early enteral nutrition has been advocated as the preferred method of nutrition in critically ill patients, not only because it can mitigate protein catabolism and support immune function, but also because it can preserve intestinal function. Despite some conflicting results, early enteral nutrition has been shown to reduce postoperative septic complications in surgical, trauma, and critically ill patients"

This article is relevant to item 2 in the list above.

 

Healthcare Mythologies

"Disinfecting Wipes May Spread, Not Kill, Germs", Allyson T. Collins, ABC News Medical Unit, June 3, 2008, http://abcnews.go.com/print?id=4989093

_____

"The truth shall make you free, but first it shall make you angry."

"As scarce as truth is, the supply has always been in excess of the demand."

("Truth", Heritage Foundation Leadership for America Lecture Series, No. 7, p.4)

_____