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December 1, 2015 Download print version

New resources: “Do’s and Don’ts” of procedure masks and N95 respirators

New target in sepsis: The host response

Recall: RotaWire Elite Guidewire and wireClip Torquer Guidewire by Boston Scientific

Alzheimer’s cure is possible thanks to synapse discovery

How controversial gene editing could lead to groundbreaking cures

Green Security announces agreement to provide institutional security to Yankee Alliance Members

Doctors' use of computers during appointments leaves patients less satisfied


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Self Study Series:
December 2015

Improving quality and patient safety through accreditation preparedness

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New resources: “Do’s and Don’ts” of procedure masks and N95 respirators

To help educate healthcare professionals on how to properly wear respiratory personal protective equipment (PPE), the Association for Professionals in Infection Control and Epidemiology (APIC) has created two new fliers that outline key points on use of N95 respirators and procedure masks in non-surgical settings.

The Do’s and Don’ts for wearing procedure masks in non-surgical healthcare settings and the Do’s and Don’ts for wearing N95 respirators in non-surgical healthcare settings are free, downloadable fact sheets that present quick tips for wearing and safely removing this PPE, helping healthcare professionals prevent the spread of infection by avoiding common mistakes.

The fliers were developed by APIC’s Communications Committee with input from the American Nurses Association (ANA), the Association of Occupational Health Professionals in Healthcare (AOHP), and the Association of PeriOperative Registered Nurses (AORN).

Healthcare professionals often care for patients with infectious diseases that are spread by droplets or particles in the air and therefore frequently require respiratory protection. Data from the Respiratory Evaluation for Acute Care Hospitals (REACH) studies conducted during the 2009 H1N1 pandemic revealed the need for continued education and training about respiratory PPE among healthcare professionals.

Download the new fliers on the “Do’s and Don’ts” for wearing N95 respirators and procedure masks as well as other education materials for healthcare professionals from APIC’s Infection Prevention and You website:

New target in sepsis: The host response

As antibiotic resistance rises worldwide, researchers have been exploring novel ways to treat severe sepsis, with one group having discovered host-protective molecules that potentially could be harnessed to eradicate bacteria quickly and in a nonbactericidal manner.

Researchers from Harvard University's Center for Experimental Therapeutics and Reperfusion Injury reported that bioactive lipid molecules referred to as 13-series resolvins (RvTs) hastened the resolution of inflammation and increased survival from Escherichia coli infections in a mouse model.

Twelve hours after the administration of four RvTs to infected mice, the treatment "afforded dose-dependent protection against hypothermia, limited further neutrophil recruitment to sites of inflammation, and increased bacterial phagocytosis by peritoneal leukocytes ... without exerting bactericidal or bacteriostatic actions," reported Charles N. Serhan, PhD, and colleagues in Nature Medicine.

Sepsis remains a prominent clinical challenge, with more than 750,000 cases occurring each year in the U.S. and up to 30% mortality, according to Craig R. Lee, PharmD, PhD, of the University of North Carolina at Chapel Hill, and Darryl C. Zeldin, MD, of the National Institute of Environmental Health in Research Triangle Park, NC. Thus far, efforts to identify new treatments that could block activation of the excessive inflammatory response in sepsis such as corticosteroids and nonsteroidal anti-inflammatory drugs have been unsuccessful.

Serhan and colleagues have been analyzing the factors that participate in the regulation of acute inflammation, and previously identified specialized pro-resolving mediators that appear between 4 and 12 hours after the initiation of infection. However, the mediators that control the very earliest phase of the inflammatory response and the subsequent crucial clearance of the phagocytosed bacteria had not previously been recognized.

Accordingly, they conducted a series of experiments looking for the earliest mediators that accomplish these tasks, focusing on neutrophils, which are the first responders to the vascular endothelium at the site of infection. These experiments revealed the presence of RvTs in the first 4 hours of infection in mice, and also in the peripheral blood of sepsis patients.

They then observed the effects of these molecules on human leukocytes, and found dose-dependent increases in E. coliphagocytosis in macrophages, as well as enhanced efferocytosis (from the Latin efferro, to take away, carry to the grave, bury) of neutrophils undergoing apoptosis, which is a crucial component of the resolution of inflammation.

They further reported that the synthesis of RvTs was a two-step neutrophil-endothelial interaction process, in which docosapentaenoic acid undergoes metabolism by COX-2 present in the endothelium, and the resulting compound 13-hydroxydocosapentaenoic acid is metabolized to RvTs.

They then noted that the administration of statins has been shown to be beneficial in sepsis and is protective in a murine model of bacterial infection. Pointing out that atorvastatin regulates endothelial COX-2, they questioned whether the statin might influence the synthesis of RvTs.

So they incubated cultures of the neutrophil-endothelium cellular mix with atorvastatin and injected this into mice before E. coli infection, and found an increase in RvT biosynthesis along with rapid infection resolution and greater survival.

Serhan's group also considered whether the use of RvTs plus atorvastatin might enhance recovery from infections, and found that mice given the combination had longer survival than those given the statin alone, suggesting that lower doses of atorvastatin might be sufficient during infection, thereby lessening the likelihood of the adverse events that can occur at high doses.

They concluded, "Given the extensive size of the vascular-endothelial system in humans and the abundance of neutrophils within the circulation, formation of RvTs during early stages of self-resolving acute inflammation and their regulation by atorvastatin could provide a molecular basis for the development of new treatment strategies for infectious inflammation."

Visit MedPage Today for the study.

Recall: RotaWire Elite Guidewire and wireClip Torquer Guidewire by Boston Scientific

Boston Scientific Corp is recalling RotaWire 'Elite' core wires because they may crack and separate from the rest of the Rotablator Rotational Atheroctomy System and cause serious injury such as tamponade (blood in the sac around the heart causing decreased heart function), myocardial infarction (heart attack), and migration of wire fragments elsewhere in the body.

The company has received three reports of this issue occurring, including one patient death following medical intervention to remove the broken wire. Other interventions have included purposefully blocking off (occluding) the affected artery, placing stents into the affected artery, and emergency heart surgery.

The use of affected product may cause serious adverse health consequences, including death.

The RotaWire Elite Guidewire and wireClip Torquer Guidewire are components of the Rotablator Rotational Atherectomy System. The device is used to open narrowed arteries and improve blood flow to the heart by cutting plaque from the artery wall (atherectomy).

Boston Scientific sent an Urgent Medical Device Recall Removal - Immediate Action Required letter to customers beginning October 9, 2015. The letter listed the following instructions: Stop distributing and using these devices immediately and return all affected products to Boston Scientific.

Read the FDA MedWatch safety alert.

Alzheimer’s cure is possible thanks to synapse discovery

According to scientists, a new discovery of a synapse protein may soon lead to Alzheimer’s disease being a thing of the past.

It has recently become common knowledge that the links between brain cells are obliterated during the onset of Alzheimer’s disease. UNSW Australia scientists lead the team of researchers who discovered this fact.

This has paved the way for a range of cures on a hypothetical level. The vanishing of synapses is the first stage of Alzheimer’s. These synapses connect various neurons in the human brain. They are a necessity for learning purposes and the formation of memory. In fact, all brain functions are dependent on these synapses. 

“One of the first signs of Alzheimer’s disease is the loss of synapses – the structures that connect neurons in the brain,” says study leader, Dr. Vladimir Sytnyk, of the UNSW School of Biotechnology and Biomolecular Sciences.

“Synapses are required for all brain functions, and particularly for learning and forming memories. In Alzheimer’s disease, this loss of synapses occurs very early on, when people still only have mild cognitive impairment, and long before the nerve cells themselves die.

“We have identified a new molecular mechanism which directly contributes to this synapse loss – a discovery we hope could eventually lead to earlier diagnosis of the disease and new treatments.”

In the earlier stages of Alzheimer’s, the victims only have a little bit of cognitive damage. It is a long and painful journey from this relatively benign stage to the devastating period when all nerve cells simply die off.

A novel molecular mechanism has been found whereby the synapses get wiped out in the first place. It is hoped that this discovery will help in finding a suitable cure for the dreaded malady. Care is better than cure and so an earlier diagnosis is of the essence. And suitable therapeutic steps may be instituted that will work on a regular basis. 

A protein termed neural cell adhesion molecule 2 (NCAM2) was thoroughly studied by the experts. This protein is said to help in the formation of synapses. It facilitates the various connections in the brain.

Thus it could prove very useful in the fight against Alzheimer’s. Post-mortem brain samples from people with Alzheimer’s proved that levels of NCAM2 were low in the hippocampus.

Furthermore, this protein is broken up by another protein which is called beta-amyloid. Beta-amyloid is a major part of the plaques that accumulate in the brains of Alzheimer’s patients.  

“Our research shows the loss of synapses is linked to the loss of NCAM2 as a result of the toxic effects of beta-amyloid,” says Dr Sytnyk. “It opens up a new avenue for research on possible treatments that can prevent the destruction of NCAM2 in the brain.”

The wearing away of synapses is due to the obliteration of NCAM2 and this in turn is due to the derangements wrought by the protein known as beta-amyloid. The avenues opened up for future research will explore the prevention of NCAM2 destruction.

This is the only direction that holds promise so far. And it just might be the sole means of ending the disease in the times which are yet to come. Alzheimer’s often begins in the ripe years of most senior citizens.

And it progresses steadily to reduce the afflicted person’s memory till all functions necessary for a responsible life are gone. The final stage leads to certain death. It is a degenerative disease of modern civilization and requires new solutions rather than the tried and tested therapeutic methods of yore.  

he study’s first author is Dr. Iryna Leshchyns’ka of the UNSW School of Biotechnology and Biomolecular Sciences and the team includes researchers from Neuroscience Research Australia and the Dementia Research Unit of the UNSW School of Medical Sciences.

Visit i4u News for the report.

How controversial gene editing could lead to groundbreaking cures

Thanks to the controversial new technology known as CRISPR, scientists are beginning to make headway in understanding and potentially curing some of the world's most intractable diseases.

Sickle-cell anemia, HIV, schizophrenia and autism -- essentially, anything involving bad DNA is now fair game. The latest example, from a study published earlier this month in the journal Molecular Therapy, focuses on Facioscapulohumeral muscular dystrophy, or FSHD, which is one of the most common forms of muscular dystrophy. The genetic disease causes the muscle fibers in the face, shoulders and upper arms to weaken over time -- and there is no known cure.

Enter CRISPR. This new gene-editing technique allows researchers to easily change, delete or replace genes in any plant or animal, including people. Picture the precision and ease of the find-and-replace function on a word document -- that’s how easy it now is to change the human genome. As an article in the MIT Technology Review put it last year, “This means they can rewrite the human genome at will.” Or, as one bioethicist told The Huffington Post last week, comparing what CRISPR can do to earlier attempts at genetic manipulation, “We used to have a butter knife, now we’ve got a scalpel.”

Biomedical researchers all over the world are now wondering how the technology might change their approach to all sorts of diseases. About a year ago, a team of FSHD researchers, led by Peter Jones at the University of Massachusetts Medical School, decided to give CRISPR a try. They already had a pretty good idea which of the thousands of genes in the human genome caused the disease, but until CRISPR came along therapeutic avenues were limited.

The acronym CRISPR, which stands for (take a deep breath) “clusters of regularly interspaced short palindromic repeats,” refers to both a technique and an actual thing, which is a macromolecular complex. The complex consists of a mix of two different types of biological material, protein and RNA. The RNA seeks out and binds to the targeted gene, like a hunting dog chasing down a fox, and the protein goes to work on it -- the hunter firing a shot.

The implications of this are pretty huge. The research could pave the way for other valuable studies, according to Charis Himeda, the lead author on the study. “I think progress for any disease is really progress for all diseases, because a lot of these therapies and technologies are going to turn out to be broadly applicable,” she said.

Himeda’s use of CRISPR may be less risky than some of the other potential therapies. Replacing bad genes, as other scientists have done, involves cutting away pieces of DNA. To simply stop them from making stuff, as the U. Mass team has done, is less likely to cause the genes any permanent damage. But that doesn’t mean the technique is risk-free. Himeda points out that while they achieved a 50 percent reduction in expression of the FSHD disease gene, we still don’t know what the effects are on all the other genes in a cell.

There’s a bigger ethical question at play here, too. Many people think it’s simply a bad idea to meddle with the human genome, no matter what technique you use or how good your intentions are. The fact that CRISPR is so easy to use makes it especially frightening. What happens if it ends up in the wrong hands?

Visit the Huffington Post for the story.

Green Security announces agreement to provide institutional security to Yankee Alliance Members

Green Security and Yankee Alliance have entered into an agreement designating Green Security as the preferred provider of vendor and contractor credentialing and background investigation services to Yankee Alliance’s 12,600 plus healthcare members across the country. This relationship will leverage Green Security’s advanced onsite technologies to help these members control, manage and monitor vendor and contractor access across their facility.

Craig Shoukimas, Vice President of Contracting at Yankee Alliance, commented, “We have been looking for an advanced security solution to fix the current, unacceptable screening practices. We found that Green Security is an organization that is uniquely familiar with credentialing and background investigation for healthcare organizations of all sizes. As such, Green Security is well positioned to ensure that the risk of outsider presence does not expose our members, and their patients, to dangerous situations. In our efforts to create the most protected and safe environment for healthcare services, this is a big win.”

Green Security President Shawn Fitzgibbons explains: “While staff at hospitals are carefully screened, the hospital remains is a high-risk environment where vendor, contractor and visitor access is less controlled, leaving the hospital vulnerable to security threats and ultimately liability and safety concerns. We have listened to the concerns at hospitals about this and developed a novel solution to help hospitals easily take back control of vendor and visitor presence in the hospital.”

For more information visit

Doctors' use of computers during appointments leaves patients less satisfied

Doctors who entered data into computerized health records during patients' appointments did less positive communicating, and patients rated their care excellent less often, in a recent study.

“Many clinicians worry that electronic health records keep them from connecting with their patients,” said Dr. Neda Ratanawongsa of the University of California, San Francisco, who co-authored the research letter.

But doctors who used the computer more also spent more time correcting or disagreeing with patients, she told Reuters Health by email.

The researchers used data from encounters between 47 patients and 39 doctors at a public hospital between 2011 and 2013. The patients had type 2 diabetes, rheumatoid arthritis or congestive heart failure, and sometimes more than one of those chronic conditions. All spoke English or Spanish. Researchers interviewed them by phone before their appointment, videotaped the appointment, and interviewed the patients again after their visit.

Using the tapes, the researchers rated how much each physician used the computer during the appointment on a scale from one to 12. The electronic health records could be used to review test results, track healthcare maintenance, prescribe medications and refer patients to specialists.

In the post-appointment interview the patients rated the quality of their care over the past six months.

About half of the 25 encounters with high computer use were rated as “excellent care” by the patients, compared to more than 80 percent of the 19 encounters with low computer use, as reported in JAMA Internal Medicine.

Doctors who spent more time using the computer spent less time making eye contact with patients and tended to engage in more “negative rapport building,” correcting patients about their medical history or drugs they’ve taken based on information in the electronic record.

“Just under half of my patients have limited health literacy and about half speak a language other than English,” Ratanawongsa said. “The computer helps me know about their health and their healthcare.”

“The hard part is figuring out how to help care teams access and add to this information AND still stay present with patients in the room,” she said.

Electronic health records “need to be more usable so clinicians with varying computer proficiency can use them without struggling and diverting focus from patients,” Ratanawongsa said.

Visit Reuters for the article.