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April 15th, 2010
11:55 AM ET

How dangerous is MRSA?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Kathleen

“If a person was found to have MRSA cluster in the nose while in the hospital but not given anything for it, how dangerous is it to be around this person and for how long? I was wondering why they didn't give her the antibiotic for it – everything I read on line seems to lean towards MRSA as a ‘forever’ thing. Please help us to know the facts – I worry about my two very young grandchildren catching it if I get it. Thank you so much!”

Answer:

It is tough to give a definitive answer to your question, Kathleen, without knowing more about why the culture was done and whether there were signs of an actual MRSA infection. To help answer your question, a little background about MRSA might help.

MRSA stands for methicillin-resistant staphylcoccus aureus.

"Staph aureus is ubiquitous, it is everywhere," said Dr. Gregory Moran, of the Division of Infectious Diseases at Olive View-UCLA Medical Center.

Staph bacteria are very common and do not pose a big threat to most healthy people. In fact, we are exposed to staph on a daily basis. About one-third of us are walking around right now with the bacteria in our nose, and it is not affecting our health, according to Moran.

Keep in mind that there are different strains of MRSA out there. Your concern may stem from the more aggressive strains of MRSA we hear about in community settings – the strains that have proven fatal for some in prisons or among athletes. Those MRSA strains are genetically more toxic than what is typically encountered in hospitals, in addition to being resistant to some of the antibiotics we have to fight them. They most often cause skin infections, but in rare cases the bacteria can penetrate to internal organs, causing an otherwise healthy person to become very ill, and in some cases die.

Hospital-acquired MRSA strains are less dangerous to healthy individuals, but testing for them is common to avoid spreading infection among hospitalized patients with weakened immune systems or during operations. The strain of MRSA that was most likely found in this hospitalized patient would not be expected to cause problems at home. A non-aggressive strain usually would not require an antibiotic, and usually is not dangerous to healthy people.

And that brings us back to the most critical part of your question, Kathleen. Will this MRSA strain detected at the hospital harm your grandchildren? The likelihood is extremely low, however, be on the alert for the telltale first sign of a MRSA infection: a painful skin lesion resembling a pimple or a spider bite. If it crops up for you or your grandchildren, go see your doctor.


February 23rd, 2010
06:36 PM ET

Hospital-acquired infections lead to substantial loss in life, and waste billions

By Miriam Falco
CNN Medical News Managing Editor

Researchers believe 48,000 deaths could have been prevented and $8.1 billion dollars could have been saved in the United States, if patients hadn't gotten infections after being admitted to a hospital. (Watch Video)

Previous research has shown an association between deaths and hospital infections, but according to a new study, it's difficult to figure out whether the patient actually got the infection in the hospital.

In the study, published this week in the Archives of Internal Medicine, the authors set out to find out how many patients died because they got infected in the hospital.

"Just the way we know that there are 15,000 people who die every year in this country because of HIV, we should know how many people die because of infections they got in the hospital,” says Ramanan Laxminarayan, a senior fellow at the social sciences think tank Resources for the Future. He and his colleagues wanted to find out how many people became sickened by pneumonia or sepsis (a life-threatening infection that has spread throughout the body) while they were hospitalized. They looked at 69 million hospital discharge records from 40 states between 1998 and 2006. In an effort to rule out patients that already had infections or were so sick they would not have survived even without a hospital-acquired infection, researchers considered only patients who went in for elective surgery, not because of an emergency.

"These were people that the surgeon would not have operated on if they showed any signs of infection and not being well," Laxminarayan explains. He says that judging by the number of patients who then got an infection as opposed to those who didn’t, there were an estimated 290,000 cases of hospital-acquired sepsis and 200,000 cases of hospital-acquired pneumonia in 2006. Further, he said, "48,000 sepsis and pneumonia deaths can be attributed to hospital-acquired infections every year."

In addition to the loss of life, these infections add to health care costs. The researchers estimate that the extra hospital days lead to $8.1 billion in added costs.

Laxminarayan says there are multiple reasons for patients getting an infection.

"You could have a surgery and the wound is not dressed properly or the operating room is not scrubbed properly or someone didn't wash their hands."

Laxminarayan says some hospitals are starting to standardize procedure to reduce the spread of unnecessary infections. Probably best-known in the medical community is Johns Hopkins physician Dr. Peter Pronovost, who developed a five-step checklist for doctors to follow when inserting a central line or catheter in a patient: wash your hands using soap or alcohol prior to placing the catheter in the patient; wear sterile gloves, mask, hat, gown and completely cover patient with sterile drapes; avoid placing the catheter in the groin if possible; clean insertion site of patient’s skin with chlorhexidine antiseptic solution; remove catheters when they are no longer needed

Pronovost’s checklist caught the eye of the hospitals in Michigan who asked him to help them reduce medical errors in their intensive care units. More recently, surgeon and author Atul Gawande developed a checklist for surgeons. But the majority of hospitals still don't use checklists yet. Which means mistakes can still happen.

Nancy Foster, the American Hospital Association's vice president for Quality and Patient Safety Policy, tells CNN that this new study confirms what they have known from previous studies but it doesn't show the progress hospitals have made since 2006, which is when the last data were collected for the study. "We at AHA are working with Peter [Pronovost] and others who are expert in infectious disease to help hospitals implement those strategies all over the country," says Foster.

She points out that many hospitals now have prominently placed hand gel dispensers everywhere. They are also encouraging patients to ask hospital personnel if they washed their hands. But more needs to be done to make systemwide changes. To help make that happen, two years ago, Foster says, the AHA received funding from the Agency for Healthcare Research and Quality for programs to prevent infections in hospitals in Michigan and 10 other states. "Just last year, we received additional funding from the stimulus package to roll out the project nationwide," she says.

Study author Laxminarayan believes hospitals need financial incentives to make changes. He points out that last year Medicare, the federally funded health insurance program for retirees, stopped paying hospitals in some cases, if preventable infections occurred. He thinks this should be done on a broader scale. Until that happens, Laxminarayan thinks there are at least three things hospitals could do now that don't cost them more money but could save lives: improve hand-washing; adopt checklists; and screen everybody who comes into the hospital for germs that could infect somebody else. He says they need to be tested if they are colonized with bacteria – not necessarily infected – because they could be inadvertently transmitting bugs that could infect others already in the hospital.


November 26th, 2009
11:40 AM ET

Does flying put my family at risk for getting sick?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Connie in California:

"My family will be flying for the holidays. Should we be concerned about being in an enclosed space for five hours?"

Answer:

Connie, more than 2 million people are expected to be flying over this holiday weekend and many have the same concern as you. The Centers for Disease Control and Prevention points out there are not many studies about the spread of flu on airplanes, but anytime people are in close quarters the chance for germs spreading is much higher.

If you are sitting next to someone who is coughing excessively or seems ill, that’s when you are most at risk. According to researchers at Purdue University, you’re most likely to get sick from the people sitting in your row or the row behind you. They actually developed an animation showing how germs move around an airplane. If you’re in this situation, there are things you can do to lessen your risk of getting sick. Point the air vent away from yourself and towards the sick person – that may help push the germs back at that person. Also, turn your body away from the person who seems ill and as we’ve been saying – don’t touch your face. Dr. Julie Gerberding, the former director of the Centers for Disease Control and Prevention, adds that you could ask a flight attendant whether a mask could be given to that person or if that person or you could be moved to another part of the plane. Gerberding also points out that the air on planes is circulated through a HEPA filter, so if you are several rows away from a sick person you’re unlikely to catch his or her germs.

Keep in mind, you can go a long way in protecting yourself by taking some simple steps. I know we talk about this all the time, but wash your hands frequently with soap and water. If soap and water aren't available, you can carry those alcohol-based hand sanitizers. Cover your nose and mouth with a tissue while sneezing and encourage people around you to do the same thing and avoid touching your eyes, nose and mouth. We touch our hands to our faces a lot. In addition, some people might consider carrying a disposable mask, especially if you're feeling sick yourself. Finally, the CDC recommends that you get vaccinated, if you can. That’s sometimes harder than it sounds. For more information, check out flu.gov and CNN’s special report on H1N1.  Have a safe trip, Connie


October 28th, 2009
05:04 PM ET

It’s not always H1N1

By Miriam Falco
CNN Medical Managing Editor

For all the (legitimate) talk about the new H1N1 influenza virus, it's worth a reminder that this new flu strain is not all we have to worry about as fall turns into winter (except for Colorado, which evidently has winter now).

There's also something called "RSV." As a medical reporter, I've come across this term a few times. As a new mom of a 6-month-old, I've paid a little more attention and did some research. RSV, or respiratory syncytial virus, can cause upper- and lower-respiratory infections.
The symptoms include runny nose, dry cough, low-grade fever, sore throat, mild headache and general discomfort. But in severe cases, it can cause bronchiolitis (infection of the tiny airways in the lungs) and pneumonia. According to the Mayo Clinic, severe symptoms include "high fever, severe cough, wheezing - a high-pitched noise that's usually heard on breathing out (exhaling), difficulty breathing, and bluish color of the skin due to lack of oxygen. "

RSV is so common that virtually every child will be infected before his or her second birthday. Fortunately, only a small percentage of infants develop severe illness. Luckily for my little guy, he's apparently no longer in the highest risk group, since most children hospitalized for RSV infection are younger than 6 months of age, according to the CDC. However, a study published in the New England Journal of Medicine in February suggests that among children 5 and younger, RSV infection is responsible for approximately 1of every 334 hospitalizations, 1 of every 38 visits to an emergency department, and 1 of every 13 visits to a primary care office each year in the United States.

Older people and adults with underlying illness can also be affected, but young children are at highest risk. One way to limit the risk to your child is to require folks to wash their hands before picking up your baby. Kissing can also spread RSV.

On August 30, the CDC stopped counting only H1N1 hospitalizations and deaths and started counting all hospitalizations for H1N1 and pneumonia; the new numbers will probably include cases of RSV too.

Consider this your reminder that in addition to H1N1 or swine flu, there are other viruses that lurk around. So if you or your children or parents get sick, it's not automatically always swine flu.

Have you had an experience with RSV that you can share with others?


October 8th, 2009
10:39 AM ET

Is it H1N1 or seasonal flu and how do we treat it?

As a new feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here are two questions for Dr. Gupta.

From Kat in College Park, Maryland:

“Is it possible to get swine flu (or regular flu, for that matter) twice in the same season?”

Answer:
Once you’ve had the flu, your chance of getting it again in the same season is low. Your body builds antibodies to protect against it. This basically means if you contract that same exact strain, your body fights it off naturally, typically before you’d notice any symptoms. There are a couple of concerns, though, and one that we've been talking about almost since the beginning, and that is that the virus can mutate. It can start to change. If it mutated, a couple of things could happen. A person who has already had H1N1, would no longer be protected. But also, the people who get the vaccine being shipped out now, which is designed specifically to protect against this strain of H1N1, also wouldn’t have protection if it mutates. 

From Vanessa in Gholson, Texas:

“My kids are sick with flu-like symptoms. I’m not sure if I should take them to the doctor but would like to confirm if my children have H1N1 or not. Should we go?”

Answer:
Great question and one I’ve been getting a lot from viewers. Should a person with flu-like symptoms go to the doctor? For the vast majority of people reading this right now, the answer is no. You will have a few miserable days but most likely not need any medical attention whatsoever.

There are some high-risk groups that would need medical attention, but, a good rule of thumb is if you think you are sick enough that you would have gone to the doctor a few years ago for flu-like symptoms, then you can go this year as well. But don't treat this differently simply because it has a different name of H1N1.

As far as getting tested, this is really interesting. When we first started reporting on this virus back in the spring, health officials were trying to figure out exactly what the virus was and confirm whether it was H1N1. They were doing a lot of testing then to help investigate what areas of the country it spread to. But now we know this virus is pretty much everywhere. And the CDC isn’t recommending health providers test for it in most cases because they don't need that information anymore.   Also, the patient probably wouldn’t be medically treated any differently from the treatment for seasonal flu.


September 11th, 2009
01:15 PM ET

Stop calling it swine flu!

By Miriam Falco
CNN Medical News Managing Editor

The U.S. Department of Agriculture symbolically slapped the news media on the hand Thursday for perpetuating the term "swine" flu in reports about the new H1N1 strain of influenza that's spreading across the world.

In a written statement and during two telebriefings, the USDA reminded reporters that since last Spring they have “consistently asked that the media stop calling this ‘novel’ pandemic virus ‘swine flu.’”

So what's the big deal? Health officials say the H1N1 virus more closely resembles the pandemic Spanish flu of 1918 than a swine flu. The USDA says struggling pork farmers are being hurt in a big way when the virus is called “swine flu.” USDA officials stress that “ you cannot get infected with 2009 pandemic virus from eating pork or pork products."

"Each time the media uses the phrase ‘swine flu’ a hog farmer, their workers and their families suffer,” says USDA Secretary Tom Vilsack in a statement posted on the USDA Web site. “It is simply not fair or correct to associate the 2009 pandemic H1N1 influenza with hogs, an animal that does not play a role in the ongoing transmission of the pandemic strain."

USDA officials point out that China is not importing U.S. pork because of the erroneous belief that eating pork is tied to the spread of this new type of flu.

I am a member of the news media and I have used both H1N1 and “swine flu” in my stories because some people know the virus only as “swine flu,” which is what it was originally labeled.

So how did the confusion start?

Back in the spring, when we first heard about "swine" flu, it was given that name because initial tests showed it resembled some known viruses that have circulated in pigs. However, the CDC explains on its Web site, "…further study has shown that this new virus is very different from what normally circulates in North American pigs." The agency explains that this new H1N1 virus has genetic material from viruses found in European and Asian pigs, as well as genes from birds and humans. Plus, USDA officials point out that this is a human virus because it was first detected in humans. They say there are no reports of H1N1 circulating in any swine herds here in the United States. They acknowledge that Canada, Australia and Argentina have found H1N1 in a few pigs. And Deputy Agriculture Secretary Dr. Kathleen Merrigan says she wouldn’t be surprised if the H1N1 virus does eventually surface in U.S. pig herds. But she stresses that pigs infected with the virus would not be sent to market.

Health officials keep reminding us that the best way to avoid getting sick with this new H1N1 flu virus is to take the following precautions:
– Wash your hands frequently.
– Cough into a tissue or your sleeve, not into your hand.
– Get a regular seasonal flu shot now, and the H1N1 flu vaccine when it becomes available, allowing the highest risk groups to get their shots first.

And please don't call it swine flu.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


September 2nd, 2009
03:10 PM ET

How to manage H1N1 flu at day care?

By Caleb Hellerman
CNN Medical Senior Producer

We're still waiting on federal guidelines for how day care centers and preschools should handle the H1N1 flu virus. They were promised last week, but the date has slipped amid behind-the-scenes debate over how far the guidance should go: Should they match the advice for K-12 schools, which say that students who are out sick can come back after just 24 hours without a fever? Or should the day care guidance be more restrictive, since young kids are more prone to complications – and tend to transmit more virus?

In the meantime, I’m watching the debate play out in miniature at the pre-school of my 3-year-old daughter and 15-month-old son. As it happens, my wife helps research flu guidance for the CDC, as do two other parents at the preschool. They helped write a preparedness plan for the school, which goes well beyond the CDC's guidance for K-12 schools – and is stronger than the basic advice the federal government is currently considering for daycares.

My wife and her colleagues recommended that students who are sick with respiratory symptoms stay away for at least seven days. One of them, a senior CDC flu scientist, told me that children with H1N1 typically shed virus – i.e., it's in their mucous and other secretions – for five to 10 days. She said that fits with published research on other flu strains, showing that young children often shed virus for seven days or even longer.

But the head of the school is pushing back. She’s OK with a seven-day restriction for toddlers, but wants it at five days for 3- to 6-year olds, and “24-hours fever-free” – the CDC’s K-12 guideline – for elementary-school-age students. More than that would be too hard on parents, she says. My wife and her friends want to include a warning that the rules are not meant to stop the spread of flu.

In the midst of all this, I talked with Dr. D.A. Henderson of the Center for Biosecurity, who oversaw the CDC's response to the global flu pandemic of 1957. He thinks the guidance to date has been too intrusive – that keeping sick students home longer than usual won't stop the spread of H1N1 and would lead to serious disruptions – including a shortage of health care workers staying home with their kids.

No easy answers, and a lot of disagreement, even among medical professionals. Just one more example: Yesterday, Dr. Sanjay Gupta visited a doctor at Children's Healthcare of Atlanta, who reminded us that for most people, even young children, H1N1 is not likely to cause more than passing symptoms. Dr. Jim Fortenberry said that parents should not bring their kids to the ER unless they seem dehydrated, are younger than 12 weeks, have fever for three days or have a fever that returns after being gone for 12-24 hours. That's all well and good, but he didn’t mention CDC guidance – which says that people in high-risk groups (including children younger than 5, as well as pregnant women and people with medical conditions such as asthma) – who have flu-like symptoms (fever higher than 100 PLUS a cough or sore throat) – should take antiviral medication right away, as a precaution. If you’ve got a child with those symptoms, you don’t have to go to the ER, but do call your doctor right away.

The head of my preschool wants to finalize and send out guidelines by tomorrow. As of now, she and the parents on the health committee have to make their decision without official CDC guidance.

Are you a parent? Have you received guidance from your child's day care on what to do if your child becomes ill?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


August 27th, 2009
01:32 PM ET

Do masks protect you from H1N1?

By Miriam Falco
CNN Medical Managing Editor

When H1N1, better known as swine flu, first appeared in April, I saw a lot of video of people wearing face masks. Video from Mexico showed people wearing surgical masks in their effort to protect themselves from this new type of flu. But I also remember when we covered SARS and the H5N1 bird flu, we made a point that those often loose-fitting surgical masks don't protect you from getting sick. (I'm talking about in a non-hospital setting) That's because people usually aren't wearing them properly.

I remember one particular bit of video showing a man crossing the street with the mask covering only his mouth, not his nose. The firmer, more industrial strength N-95 masks are much more effective. But they are hard to wear for a long time because they can make breathing difficult. So I was surprised to see the latest CDC guidelines do recommend face masks in certain settings.

I asked a few experts about this, including the CDC's main point person for the H1N1, Dr. Anne Schuchat, who is the director of the CDC's National Center for Immunization and Respiratory Diseases. She told me that in certain settings, particularly if it's difficult to separate sick people from those who are healthy, wearing a mask can help reduce the amount of virus being spread by blocking some of the virus-carrying droplets that can float through the air. As I look at the guidelines on the CDC Web site, I see some other plausible situations, where face masks are recommended. For instance, when you're sharing common spaces with another family member or when you're breastfeeding.

I also asked Dr. Manoj Jain, an infectious disease expert and adjunct professor at Emory University. I thought he had a pretty good explanation: "The masks are helpful because it makes us more conscious of where our hands are going and we are less likely to put our hands on our nose and mouth. Because that's how the virus gets into your system and can make you sick." He also says wearing a mask can make you more conscious about washing your hands and could ultimately lead to behavior change.

A small study this month in the Annals of Internal Medicine found that if people who had seasonal flu and their families wore surgical face masks and washed their hands in the first 36 hours of symptoms, healthy family members got less seasonal flu. Researchers think the principle would hold true for H1N1 too.

Of course, you don't have to wear a mask. Health officials remind us daily that there are simple ways to protect yourself from the flu and reduce spreading it if you have it already. Cough into a tissue or into your sleeve, not your hands. Wash your hands frequently – even if you cough into your sleeve - because the virus may have lurked on a surface you touched. Get a flu shot – both for the regular flu and for H1N1 when it becomes available. And if you do get sick, stay home, so you don't make other people sick. Other tips can be found at www.flu.gov.

Will you wear a mask? Are you taking special precautions to protect yourself from H1N1? Are you concerned?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


May 12th, 2009
03:57 PM ET

FDA issues face paint warning

By Jen Pifer-Bixler
CNN Medical Senior Producer

Where I live, festival season is in full swing. You know how I know? The little people are painted. Just the other day, I ran into a group of children with ladybugs, flowers and spiders drawn on their faces. This childhood tradition is usually harmless, but today a certain brand of face paint is causing concern.

The Food and Drug Administration is telling consumers to stop using "Face Paint" distributed by Fun Express, Inc., a subsidiary of Oriental Trading Company of Omaha, Nebraska.

So what's going on? Apparently a group of children developed skin problems after using the paints at an organized event. The FDA says the skin problems included rashes, itchiness, burning and swelling in places where the face paints were applied. Subsequent tests found “significant microbial contamination” in most of the products. As a result, the company issued a recall. The FDA says if you have any of these face paints, you should throw them away or return them to the company.

We contacted the company for a comment, but so far, they haven't returned any of our calls. If your child has suffered a rash after using face paint, the FDA wants to hear from you. You can contact the agency online at MedWatch or by calling 1-800-FDA-1088.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


May 7th, 2009
11:39 AM ET

Does hand sanitizer kill bacteria and viruses?

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

From CNN.com blogger, Dick:

"Hand sanitizer has been recommended but the bottles say, "Effective against bacteria," with no mention of viruses. What gives?"

Answer:

That is a good question. There are not a lot of data actually on how effective those sanitizers are against viruses. There have been some studies done over the years and the conclusion is washing your hands with soap and water is still probably the best idea. If you are having a busy day and it is hard to get to a sink, then carrying a bottle of hand sanitizer would be a good idea.

In essence, it makes your hands very inhospitable to viruses. You put it on your hands and viruses simply don't want to cling to it. So it does reduce the amount of a virus that can cling to your hand but it does not kill it. Alternatively, it also can’t harm you in any way. We get a lot of questions from concerned viewers asking if sanitizers could actually cause antibiotic resistance down the road. Many studies have looked into the issue and all evidence points to the answer being no.

At the end of the day, basic principles apply to avoid getting a virus. Avoid touching your mouth, eyes and nose as much as possible. If you cough or sneeze, cover your mouth and nose with a tissue or your sleeve. If you're sick, stay home and avoid close contact with others. Some viruses can live for hours on surfaces such as ATMs, doorknobs, even money.

So be methodical about good hygiene, all year long! Remember that the number of 2009 H1N1 cases will most likely decrease over the summer months because viruses just don't transmit that well in the heat. But in the fall and winter, we're all going to have to remember what the new H1N1 strain was like and be extra vigilant so this doesn't get out of control.


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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.

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