Very Important Information Regarding Hospital Care!

The government recently released its annual report on the quality of health care Americans receive and while there have been some improvements, the news was not positive: hospitals still have work to do to put an end to the ongoing, but very solvable, problem of patients acquiring life-threatening infections in hospitals.

To help achieve that, Kimblery-Clark Healthcare has put together a website called "Not on My Watch" at www.haiwatch.com to educate patients and health care professionals. Their goal is to eliminate these preventable illnesses and their often tragic consequences.

I thought that you and the readers of Reaching Out Online would care about this issue and I was hoping you could post some information spread the word about protecting patients from preventable hospital infections. I've created a useful site that you're welcome to check out and grab resources from:

http://haiwatchnews.com

Barbara Dunn
barbara@haiwatchnews.com
www.haiwatch.com

Is Your Showerhead Harboring Hidden Dangers?

WASHINGTON (AP) - In what may be the scariest shower news since Alfred Hitchcock's "Psycho," a study says showerheads can harbor tiny bacteria that come spraying into your face when you wash.

People with normal immune systems have little to fear, but these microbes could be a concern for folks with cystic fibrosis or AIDS, people who are undergoing cancer treatment or those who have had a recent organ transplant.

Researchers at the University of Colorado tested 45 showers in five states as part of a larger study of the microbiology of air and water in homes, schools and public buildings. They report their shower findings in Tuesday's edition of Proceedings of the National Academy of Sciences.In general, is it dangerous to take showers? "Probably not, if your immune system is not compromised in some way," lead author Norman R. Pace says. "But it's like anything else — there is a risk associated with it."The researchers offer suggestions for the wary, such as getting all-metal showerheads, which microbes have a harder time clinging to.Still, showerheads are full of nooks and crannies, making them hard to clean, the researchers note, and the microbes come back even after treatment with bleach.People who have filtered showerheads could replace the filter weekly, added co-author Laura K. Baumgartner. And, she said, baths don't splash microbes into the air as much as showers, which blast them into easily inhaled aerosol form.It doesn't seem as frightening as the famous murder-in-the-shower scene in Hitchcock's classic 1960 movie. But it's something to be reckoned with all the same.

The bugs in question are Mycobacterium avium, which have been linked to lung disease in some people. Indeed, studies by the National Jewish Hospital in Denver suggest increases in pulmonary infections in the United States in recent decades from species like M. avium may be linked to people taking more showers and fewer baths, according to Pace.Symptoms of infection can include tiredness, a persistent, dry cough, shortness of breath, weakness and "generally feeling bad," he said.

Showerheads were sampled at houses, apartment buildings and public places in New York, Illinois, Colorado, Tennessee and North Dakota.The researchers sampled water flowing from the showerheads, then removed them, swabbed the interiors of the devices and separately sampled water flowing from the pipes without the showerheads.By studying the DNA of the samples they were able to determine which bacteria were present.They found that the bacteria tended to build up in the showerhead, where they were much more common than in the incoming feed water.Most of the water samples came from municipal water systems in cities such as New York and Denver, but the team also looked at showerheads in four rural homes supplied by private wells. No M. avium were found in those showerheads, though some other bacteria were.In previous work, the same research team has found M. avium in soap scum on vinyl shower curtains and above the water surface of warm therapy pools.And stay tuned. Other studies under way by Pace's team include analyses of air in New York subways, hospital waiting rooms, office buildings and homeless shelters.

The research was funded by the Alfred P. Sloan Foundation and the National Institute of Occupational Safety and Health.Virginia Tech microbiologist Joseph O. Falkinham welcomed the findings, saying M. avium can be a danger because in a shower "the organism is aerosolized where you can inhale it."In addition to people with weakened immune systems, Falkinham also cited studies showing increased M. avium infections in slender, elderly people who have a single gene for cystic fibrosis, but not the disease itself.Two copies of the gene are needed to get cystic fibrosis, but having just one copy may result in increased vulnerability to M. avium infection as people age, said Falkinham, who was not part of Pace's research team.___

Traveling With Cystic Fibrosis

In-Depth Education
Thomas J. Newton, RCP, RRT For someone with a chronic lung disease like cystic fibrosis (CF), traveling can be fun and exciting. Unfortunately, it might also include the wrong kind of excitement. Here are some examples of excitement that you could do without:
Running out of your medication
Not having a place to plug in your compressor
Getting short of breath at higher elevations or in an airplane
Not having any oxygen on the plane because you forgot to call the airlines ahead of time to arrange for it
Not knowing where to go if you have an emergency

Preparation Is the KeyWhether you travel by car, boat, train, or plane, being prepared is the key. Preparation is important not only for long trips lasting several days or weeks but also for shorter excursions lasting only one day.Before embarking on a trip, be sure to talk with your healthcare provider and cystic fibrosis healthcare team. They can help you plan your medical care during your trip.If you are planning to travel and are unsure of your lung function, check with your healthcare provider. This is especially important if you plan to fly or travel to higher elevations, such as the mountains. People with altered or impaired lung function may have more symptoms at higher elevations, especially if they already use oxygen or have poor exercise tolerance.Normal Lung Function and Normal Exercise ToleranceIf you have normal lung function and normal exercise tolerance:
Take more than enough medications to get you through your trip.
Ask your doctor if you can substitute metered-dose inhalers (MDIs) with spacers for some of the inhaled medications that you normally take using a nebulizer. Metered-dose inhalers may be more practical, since you may not always have access to an electrical outlet for your nebulizer while you are traveling. Common medicines that come in inhaler form are albuterol (Proventil or Ventolin), cromolyn (Intal), ipratropium (Atrovent), and inhaled steroids.
Ask your healthcare provider if you can be off Pulmozyme (rhDNase) and/or TOBI (tobramycin solution for inhalation) for the duration of your trip, or at least for parts of it.
Ask your healthcare provider about trying a PEP (positive expiratory pressure) mask or a Flutter or Acapella mucus clearance device to clear your airways. These devices are easy to learn and are very portable. They can also be used in a car, plane, train, or boat without the assistance of another person.
Make sure that battery-powered machines are right for you. Battery-powered machines work well but are a bit slower and are more expensive than standard electrical devices. Also, not all insurance policies pay for them. Important: If you are going to purchase a battery-powered model, check how long the battery lasts on a full charge. This will give you an idea of how many treatments you can get out of a charged battery. This is important if you are taking multiple medications, such as Pulmozyme and TOBI.
Impaired Lung Function and/or Poor Exercise ToleranceIf you have impaired (moderate to severe) lung function and/or poor exercise tolerance:
Follow the instructions noted above.
Let your healthcare provider know about your trip at least one month in advance.
Find out if you will need oxygen while traveling by airplane or when visiting higher elevations. Your healthcare provider may want to test your oxygen needs before you take the trip.
Check with your oxygen supplier to help coordinate oxygen delivery in connecting cities and at your final destination.
Bring extra medication with you. Trips can be delayed because of bad weather or missed connecting flights.
Your Medical History Checklist Keep a copy of your medical history with you in case of any unplanned trips to an emergency room or hospital. Your medical history should include:
Your diagnosis -- cystic fibrosis, as well as any other medical problems you may have, such as diabetes or asthma
All current medications, including TOBI (even if you are off cycle) and oxygen (liters/minute)
Last chest x-ray report
Information about your central intravenous line, portacath, or Broviac (if you have one)
Information about your G-tube or button (if you have one)
Last sputum culture
Last pulmonary function test
Information indicating whether you have ever coughed up blood and the last time you did
Information indicating whether you have ever had a pneumothorax
The names and phone numbers of all your healthcare providers
Ask your CF team to provide you with the addresses and telephone numbers of CF centers along the way or close to where you will be staying. This information may come in handy in the event you need to consult a CF specialist while you are on your trip.Bon Voyage! Letting your CF team know about your trip well in advance can make traveling easier. That will give them enough time to help you prepare for your trip. And it will give you more time to have fun while you are away.This article was written by Thomas J. Newton, RCP, RRT, a clinical specialist in pediatric respiratory care and a CF team member at a hospital for children. It was reviewed in 2007 by James W. Wallace, MD.ReferencesBreathin’ Easy: A Guide for Travelers With Pulmonary Disabilities. Available at: http://www.oxygen4travel.com. Accessed January 29, 2004. California Thoracic Society and the American Lung Association of California. Safe Flying For People With Lung Disease. 2002. Available at: http://www.thoracic.org/chapters/california_adobe/safeflying.pdf. Accessed January 29, 2004.
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