Sporination is a really great strategy (except when you're a human and don't want C Diff). A highly resistant way to disseminate DNA, even, if necessary, over extremely long timescales (hundreds of ky at least, probably my).
I worked on a drug program against a pathogen that was transmitted as spores. Basically the treatment was given when there was a flare up, because the organism was only vulnerable in that mode. We tried killing the spores themselves but evan at toxic-to-human doses the spores didn't give a shit. So people would get better, then have further outbreaks.
Note that from a drug company's perspective, this is actually pretty great. You don't treat them for long enough that it's considered a "chronic condition" from a regulatory perspective (which would mean much more complex trial protocols) yet you know if you treat anyone you'll have a repeat customer, probably for the rest of their lives. But despite public opinion of pharma companies, I never heard anyone say "thank you spores!" In fact we did continue to try to attack the spores.
I am getting into canning, and half the people have absolutely no fear of Clostridium botulinum and half of them are terrified. It has a similar sporulation strategy and even boiling doesn't necessarily kill it. Most recipes that have been scientifically proven to be safe with possible botulism vector foods use pH and sugar content to ensure that the little fuckers can't divide. Some pressure cook to raise the max temperature, and pH still matters in many of those.
It's the same strategy bees use (modulo the heat). Honey can contain botulinum spores, but the pH is so low and the sugar crushingly high so it can't divide - until you try to make mead and fuck up the recipe. Or feed it to an infant.
I don't think I've ever had non-acidic honey. I wonder if that's particular bees, particular flowers, or counterfeit honey. I'm suspecting the latter. We are just beginning to come to grips with how much of it there has been.
> Basically the treatment was given when there was a flare up, because the organism was only vulnerable in that mode
Committing the sin of a double reply, different subject.
There are treatments for HSV, some experimental but I thought I heard one had just about cleared the FDA, that are a cocktail of drugs that kill serum herpes simplex but as a chaser to a drug that tricks HSV into coming out of dormancy. So while it would always be good for big pharma to spend more research on prevention and less on treatment, it's not like no progress is being made.
Whether they're sandbagging I really couldn't say.
> But despite public opinion of pharma companies, I never heard anyone say "thank you spores!" In fact we did continue to try to attack the spores.
I think this is a good example of the public imposing a sinister explanation on top of what is really an unfortunate reality: Pharma companies aren’t choosing to ignore the spore problem, they’re just focusing on treatments that can actually be made to work under our current technologies.
As long as there is more than one pharma company, there's an incentive to cure chronic conditions because you'll take all of your competitor's business away and can charge a price equal to the lifetime costs of the chronic treatment.
An efficient market is characterized by a perfect, complete, costless, and instant transmission of information...
You have conflated your incentive (a cure) with people who make and sell treatments (maximize profits).
As long as there are Pharma companies, there is incentive to make slightly better treatments. That is same effect lower production cost, or same cost and better effect.
It kind of sad that treatements have gone from prescription to subscription.
Just wanted to add as an additional wrinkle in the simple ecomnomic explanations : a lot of the "discovering drugs" part -still necessary before you can actually sell drugs, afaik-, hinges very much on having really good researchers work for you. And these researchers do care about curing diseases: I do not have one colleague that does not dream of being a new Salk. The market needs thus to correct for it: it tends to be more efficient / worth it to be ethical, because it is a prerequisite for top talent hiring in this space.
This is of course complicated further by the sheer pigheadedness of CEOs with a career half life of 3 years who come in, _revolutionize_ something by destroying it and antagonizing the workers, bloat HR a bit more and drive sales through something illegal; and finally move on, tallying that one a success.
Two vaccine candidates use the same adjuvant. One demonstrates high efficacy at curing a disease killing over a million people per year in poorer countries, one demonstrates high efficacy in preventing shingles. Guess which one was prioritized for the adjuvant.
I can believe everything about that article except the explanation that the adjuvant itself was somehow the bottleneck. GSK simply didn’t see a way to make money from the TB case; the adjuvant seems tangential despite the way it was presented in the article. It reads as if the author just learned the word and didn’t understand its actual significance. The adjuvant function is useful in other contexts but vaccines!
Also shingles can be a serious disease. Doesn’t change the calculus of prevalence, but no need to be quite so dismissive.
It could be. It depends on the source and cost per dose of the adjuvant. Adjuvants from natural products can be supply limited and also costly to produce.
Regardless, it makes you wonder why they went forward with that particular adjuvant for the TB trial in the first case.
I'm not dismissing shingles, just triaging it relative to the seriousness of TB.
> Regardless, it makes you wonder why they went forward with that particular adjuvant for the TB trial in the first case.
Well sometimes you select an excipient or adjuvant because some other one you might have chosen has some interaction with your API (active pharmaceutical ingredient -- the thing you're actually trying to deliver). More often though they are pretty arbitrary: the program lead or someone on the team had used that compund before and knew how to handle it or already had all the literature needed for a regulatory submission (had an older submission) or perhaps the division you're submitting to is already quite familiar with that one so you use it.
And of course once you're approved for and done an initial trial (phase 1) with one formulation you don't want to go back and redo all the safety studies, especially for something that isn't the API itself, if you don't have to.
Note, I have not worked in vaccines, only in anti-infectives, so their can always be cultural and technical differences that I'm not aware of! Consider this the equivalent of "experienced Lisp, C++ and assembly programmer reads article written by a layperson about a problem with a Java program, and is dubious about the layperson's diagnosis".
:) I'm a synthetic biologist, but don't work with eukaryotes outside of knowing some basics about expression cassettes, so sure.
I don't know to what extent the ProPublica writer was informed by their sources, but they're typically pretty good journalists. Still, I get your point.
Everything is going the way of subscriptions. Ill probably be in subscription housing the rest of my life unless there is a crash in the property market.
But only as long as the patent lasts. You usually can't sell a better cure if the original already cures. A treatment on the other hand leaves room for "improvement".
Of course you can make a better cure. Faster, less side effects, simpler route of administration, higher success rate,...
The patent is actually an argument for the cure. Because if you have a lifetime treatment, as the patent expires, anyone will be able to copy your treatment. It is called generic drugs and it is done all the time.
If you have a cure, during the time you have the patent, you will be able to treat everyone, both existing and new cases, and make tons of money while your competitors will have nothing. After the patent expires and your competitors will be able to copy your cure, only new cases will remain. Still valuable, but far less than when you had the patent and there were plenty of people to cure.
Goldman Sachs Analyst thinks otherwise. The company behind the Hepatitis C cure seems to also not doing well with monetizing their cure. There are also countries like Brazil that just suspended the patent.
> biocide-exposed spores were spiked onto surgical scrubs and patient gowns and recovery was determined by a plate transfer assay
The article says nothing about washing scrubs and gowns. They put bleach-treated spores onto fabric, did not treat the fabric, and then collected samples from the fabric.
I.e. this is less of a "spores on gowns surviving disinfection" case, and more of a "you bleached this surface, you thought it's enough, but your gown touched it too early and the fabric 'rescued' the spores" one, am I right?
Yes, the relevance is providers don’t change scrubs between patients (although do wear typically disposable gowns and gloves when entering a patient room with c. diff).
Also relevant for things that travel between rooms and are disinfected in between, like ultrasound machines.
Other studies have reported that spores can survive washing processes in use.
You don't just sterilize fabric with bleach. (How would that even work? Hang the gown, spray the bleach on it, and let it drip off?) You sterilize fabrics with bleach + water + detergent + heat + agitation — with the goal not being to lyse the spores/other germs, but rather to detach all the contaminants from the fabric and suspend them in the water — which then gets flushed away.
In theory, bleach could help decrease the adhesion of the spore to a surface. A possible mechanism would be if it oxidized — and so weakened/destroyed — some spiky organic hooks that the spores were using to adhere to the fabric.
Of course, agents other than bleach — things not normally considered biocides, in fact — would likely be a lot more effective at removing spores during fabric washing, since the goal is detachment, not lysing the spore.
The obvious things (detergents themselves, and other soaps) would work, of course, to varying degrees.
But also, less-obvious things could provide benefits here. For example, if spores tended to stay adhered to fabrics because they possessed a rough proteinous exosporium that acted sort of like nano-scale velcro, then conditioners (yes, like the kind you use in hair) might get that protein coat to relax and lay flatter, in a way that disrupts the velcro-like effect.
Lubricants might also work, by "filling up" the rough valleys of the spore's surface. (Of course, you'd then need an extra wash cycle to remove the lubricants.)
There are some really amazing detergents out there. My go-to for cleaning anything I don't have specific information about is Tergajet. It's gentle, extremely powerful, low-foaming (so machine compatible), oxidizing, bleach compatible, and contains a protein degradation enzyme potent enough to disrupt prions: https://technotes.alconox.com/detergents/tergazyme/do-enzyme...
The downside to this magic stuff is that it's fairly expensive ($45 for 4 pounds). So, not for wanton use. But well worth it to solve tough problems or when time is more important than money.
oxidizing and bleach compatible is an unusual pairing is it not? There are a bunch of chemicals you can't mix with bleach because you create chemical weapon precursors if you do. Even the precursors can send you to the ER.
Additionally, if the spore didn't get detached in the washing process, it's veeeery unlikely to get detached when you're just walking around being a nurse.
It might activate within the fabric if the conditions are right, but that's not very fast and you shouldn't be wearing scrubs contaminated by a nutritional substance for too long anyway.
Perhaps. But why not test that then? Why the special non-real life case? Because it got a result worth sensationalizing? For me, it makes me wonder what other study "gymnastics" they used.
I hear ya. But to mitigate any doubt they should have covered all their bases, or at least the base most inline witb real life.
This article explores surface disinfection (commonly bleach in the hospital). Although provider gowns are removed after entering contaminated rooms, disinfected surfaces commonly come into contact with provider scrubs which are not laundered in between same day patient encounters as well as other patients (such as the table of a CT or MRI).
I don’t see the gymnastics you’re referring to, other studies have looked at laundering processes which is not the focus of this study.
I’m surprised there’s so little discussion of the form of chlorine. Chlorine dissolved in water can be dissolved Cl2, HOCl, OCl-, and chlorinated cyanurates. These are all in a pH-dependent equilibrium, and the latter is most of what you get when you mix “NaDCC” with water.
HOCl is generally considered the best disinfectant, and OCl- is weaker. Chlorinated cyanurates are very weak (and fairly UV-stable and non-irritating) and can replenish HOCl and OCl- as they are consumed.
Yet somehow the food-and-beverage-service standard for disinfection seems to be “100 ppm as Cl2” without regard to the balance of chlorine species.
On the other hand, this paper tested concentrations up to 10000ppm, which is really quite high.
Posting from a throw away.
C-Diff is huge problem now and has been for a while.
If the immune system is weakened and the system develops this specific infection that person will experience a life changing event.
Medical professionals can tell that infection by the smell of the room.
I don't know what to do about it -
C-Diff is a bad one
> Outbreaks of Clostridium difficile were initially associated with trehalose. This finding was disputed in 2019.
I don't find "was disputed" conclusive there. The trehalose stuff got into ice cream, then C. Diff. became a widespread problem. They took it out of most of them, and C. Diff died back down.
The worst thing I saw in residency was a case of a 32 year old father of three who came presented with spontaneous pneumothorax. Chest tube was placed and he was admitted, usually no big deal. Next morning the incision was slightly inflamed and he had some pain and mild fever. Later in the day he had follow up with pulmonary and he had black spots on the skin, pus, tachycardia, confusion. He was immediately taken to surgery and necrotizing fasciitis had already spread to his upper arm and a large portion of his chest. Arm and pectoral gone and he was placed into a hyperbaric chamber. 8 hours later no improvement, wheeled back to surgery, chest wall resection, lat removed, infection nearing hip. Back into hyperbaric. 8 hours later no improvement, hip and both legs gone, lobectomy and large section of neck had to be resected. 8 hours later and he was dead. Guy went from healthy, athletic actually, to a head connected to half a torso then dead in a day.
At no time did the doctors say "we can keeping cutting it away, but who wants to wake up like that?" After the second surgery, was there even a remote chance he'd survive?
In hindsight the decision is easy, at the time less so. The patient was making informed decisions alongside family but the speed and nature of necrotizing fasciitis make it very difficult. The skin can look largely fine until you begin surgery and find that the infection has spread 12 full inches along the fascia. So you cut that all out, plus some margin and hope for the best. There certainly was a chance he could have lived after the second surgery with a very altered life. And I get that, now that I have children I’d probably chose to live a very rough life just for a chance to watch them grow up.
I truly can’t imagine what that man and his family went through in that short period of time. Decision making I slow decline with weeks or months is hard enough.
It is not up to physicians to decide whether the resulting quality of life reduction and morbidity from heroic interventions is worth it for a patient.
If the intervention is unequivocally futile for preserving life it is permitted to not offer care, there are processes in place.
While unlikely, it is possible to survive necrotizing fasciitis and multiple debridements. Although it will come with many months of reconstructions, rehabilitation and pain.
We are legally and ethically obligated to offer heroic life saving measures if there is a chance of surviving. Quality of life is not a factor in our decision making process.
I do not know the exact discussion was had with this patient and their decision maker when incapacitated but it would be extremely unusual for a previously healthy 32 year old to decline heroic interventions, this is also a very rapidly evolving infection where you don’t have much time to think.
With that said I’ve also met 80+ year olds who want major surgeries that will leave them significantly impaired and almost certainly fail despite having time to think. At the end of the day patient autonomy supersedes our thoughts and opinions.
> If the intervention is unequivocally futile for preserving life it is permitted to not offer care, there are processes in place.
I want it to be clear that patients are not abandoned in these cases. Even in cases of serious incurable illnesses where death is imminent and cannot be prevented, there's plenty of things that can be done to provide comfort, manage symptoms and improve quality of life. Orthothanasia.
I had a surgery last January, broken labrum on both hips, left was "ok" and the right was really damaged, still it was an arthroscopic surgery and I could go on with my life 2 weeks after, but... 3 weeks after the surgery my right hip was getting worse, way worse, the pain was like nothing I have ever felt, I couldn't sleep, I couldn't walk, I couldn't even touch my fucking leg that I felt a nuclear bomb going off inside of it. No fever, puncture was ok, nothing that could deemed it as an infection. I was in literal agony, not even the strongest analgesics worked. I did a blood test and the PCR was off the charts, "yup, that's an infection, it's 10 AM, don't eat anything, today at 17hs you go in surgery".
I had a toilette done, infection was cleaned off but still I couldn't even move my leg, I lost all the muscle. Fast forward today, I had the worst 7 months of my life, antibiotics for 6 months but wait, there's more... Both infection and the initial cartilage problem evolved into a septic arthritis, last week I went into surgery again to have my hip replaced by a temporary spacer while the biopsy is performed and I will go in again in a month or so to get my definitive prosthesis.
For those who want to know, the bacteria was a Pseudomona.
I am so sorry you are experiencing all this. I sincerely hope things turn a corner and things improve for you. I’ve had my share of horrific trauma related to my health, and it often felt this would never end. Luckily my issues did end, but it does really change your perspective on how fragile and valuable life is, but in some ways it also made me more accepting of death having fully accepted a number a times death was preferable to my situation. I had people that depended on me though so it was more a recognition of the fact.
I did find places like HN and other outlets really helpful, little bit sized opportunities to nerd out and connect, that were just small enough that I could keep focus during the worst of things.
So what you’re trying to say is the fear is justified. That going in for surgery or a stay at the hospital is as much (or more) risky due to after procedure infections.
I’ve broken my olecranon (the pointy bit of your elbow) and declined surgery. I set it myself. Glad I did. It hurt. It wasn’t pleasant. But to me the risk of infection from being opened up for something so minor was too much of a risk. If I had internal bleeding or something I would have gone for it but a simple broken bone (even a joint) isn’t enough for me.
I wouldn’t jump to the conclusion that the fear is justified, not every broken bone is “simple” and while most fractures are nonoperative some do require surgical fixation.
Pain reduction isn’t the main reason to operate or the metric of interest, there are many ways to alleviate acute pain including casting.
Functional impairment (immediate and delayed) and reducing the risks of posttraumatic arthritis are far more important.
Joint infections (and pseudomonas in general) are an absolute nightmare as the joint space is not vascular.
Bone infections/osteomyelitis are much rarer and for the most part less catastrophic (although they certainly still can be).
As always patient autonomy is paramount and we all value risks differently. For myself as a young healthy adult (not an orthopaedic surgeon) I would rather accept the minimal risks of surgical reduction and fixation for a fracture needing one than risk needing complex reconstruction or joint replacement in 10-20 years which has much higher complication rates and longer recovery.
I broke my elbow tip as well on a skateboard but figured it would sort itself out like i do with all injuries.
A decade later I can’t do an elbow plank without some pain usually and I can’t put a lot of weight on that part of my elbow. My favorite laptop position is on my belly on the floor so it sometimes hurts too much to do that.
I don’t know if surgery would have helped but it’s annoying sometimes.
if it doesn't work and you didn't set it while it was broken (you let the pieces heal on their own) you probably do need surgery. They'll have to re-break it and set it properly. I did this to myself while it was broken and my arm wasn't useful. A few shots of whiskey, a friend giving me a firm handshake, and a really really strong pull. The broken bone bit slid back into the elbow socket and I could straighten my arm. I couldn't hold it there on my own, but it was straight. A couple of months with an arm sling and it healed ok. There's still a little gap in the bone but it no longer hurts when I hit it against door frames.
IANAD but I know my own body, I know when something is wrong, when something isn't working right, and sometimes kicking your body's a$@ is what it needs. Like doing a purge. Or fasting to shock the system.
> So what you’re trying to say is the fear is justified. That going in for surgery or a stay at the hospital is as much (or more) risky due to after procedure infections.
Short answer: What? No, no way.
Long answer: It depends, If you can avoid being opened sure, avoid it like the plague, I've learned that the hard way that no matter how much sterilization is done, bacteria is there, and if your body is cut there's a chance bacteria could get in, but there are cases when you have no other road, like my case. Last December I couldn't walk a single complete street, the labrum was damaged to the point that the only solution was an arthroscopy, there was no option for me to say no. My surgeon told me "patients get infected, shit happens", but on top of that I got extremely unlucky, I got the worst fucking bacteria in the universe, I had no fever and the needle that was inserted in my hip to test for bacterial growth yielded negative results.
It's like any medical procedure or drug. There are always risks and possible side-effects. The idea is that the risks of not treating the problem are worse than the risks of the cure.
Yes some people get infections after surgery. Most do not.
The COVID vaccine killed some people. Most were fine.
Don't make your medical decisions based on anecdotes.
Wife had appendicitis, or what looks like it. She had given birth a few months before and it didn't really go well. She had to have emergency surgery, and was pretty close to snuffing it.
Anyway, that healed, but she had some persistent pain, but that could just be scar tissue being a dick.
fast forward a few months, she has text book appendicitis symptoms. Now, as she's a doctor, she knows what it is, I know what it is, but she refuses to actually go into hospital. I drag her arse to the GP, who looks at me and says: "why haven't you taken her to A&E" I told the GP, that the patient knows too fucking much and won't listen to a muggle.
The GP turns to my wife and says: "you and I both know you need to go to hospital"
She goes in for assessment. Cant see much on the ultrasound. Go for a slice and dice to section the appendix.
Puss drained, appendix Yeeted, lots of IV antibiotics. Looks like a rampant infection rather than a swollen appendix.
Important note: men, topology wise, you are a doughnut. There is a tube from face to arse, and everything is mostly sealed(lungs are excluded for simplicity).
Women, are not doughnuts, There is a gap between the ovaries and the fallopian tubes, which from what I recall is only really sealed with "mucus".
This means that bacteria can get in from the outside. The hypothesis is that either when my wife was being professionally fisted by the midwives, or when she was being crash sewn up to stop her bleeding to death after the baby was born, is when Pseudomonas got in.
The hip joint is pretty isolated from the rest of the body I assume, I had the same question for my surgeon and he told me there was no way for that to happen.
Aren’t there any antibacterial sprays or devices they can leave behind? What if antibodies were extracted from the patient’s blood before surgery then sprayed on at the end of the operation?
About two years ago I had this unusual appendicitis. There was just nothing that suggested my appendix had burst. By the time I had a CT scan, the appendix no longer existed.
My cousin, an experienced surgeon, told me it'd be a quick operation and I'd probably be home in a few days. I spent over 40 days in the hospital due to a severe infection that ate through my abdominal wall and almost reached my skin. One week I was taking seven intravenous antibiotics at once. There was a moment where I became convinced I was going to die.
My grandmother on her homestead survived that without antibiotics, apparently because it did breach the skin and was able to drain. Crazy to think that not all that long ago, that was considered lucky for such an infection.
Yeah. If the abscess had drained, I would have recovered much quicker. It was hidden pretty deep and didn't quite make it to the surface though. They had to bring in a interventional radiologist to perform an ultrasound guided procedure with a ridiculously long probe meant for liver biopsies just to get at the thing.
Yep. It can go very bad. My father just had a simple (mostly non-invasive) biopsy done and ended up nearly dying and with brain damage due to antibacterial resistant bacterial infection from the minor surgery.
Getting MRSA seems to be as likely as a coin flip for any bone related operation these days. Being stuck for weeks in an unsanitary recovery ward while there's a metal rod screwed through your skin is a really hilariously bad recipe for disaster with superbugs around.
Other than urine, blood and CSF fluid, a sample from pretty much any part of the body will have visible bacteria. A Gram stain is performed on many cultures to start to eliminate groups of bacteria.
Even a minor infection is scary. I just had my wisdom teeth out and I'm being hyper cautious about masking and sticking to WFH while my mouth is full of swollen wounds, because I know catching a cold would be absolute agony. My co-worker went through catching a bug recovering from same and was out for a few weeks.
Oh Lordy, yes. I've not yet lost a friend or family in that specific way...but there have been a number of too-close calls. Seemingly thanks to "top-rated" hospitals - where doctors' fat egos and shiny stuff are far more important than the dreary dull old routines of preventing post-surgical infections.
I got infected in a hospital while already suffering from an autoimmune flare. I was isolated for a week, hazmat suits, the works. Lost 15lbs in the hospital and had to take antibiotics for 3 months to make sure any resistant spores were killed. I’ve heard that fecal transplants have a very high success rate in curing Cdiff but didn’t have that option at the time.
These infections are a huge problem. My neighbor missed 2 _years_ of college recovering from a C. diff infection. And you are correct: fecal transplant is the way, for now.
Per the article, these bleach (sodium hypochlorite) resistant spores are a HUGE problem. At my office, we clean surfaces with quaternary ammonium compounds, and those are supposed to be superior against spores. But still, if the required contact times to disinfect surfaces keep increasing in healthcare settings, we are going to have a major issue where only the most resistant spore-forming bacterial strains survive (basically, we'll be selecting for the strongest... you know, evolution).
> basically, we'll be selecting for the strongest... you know, evolution
Fortunately TANSTAAFL[0] applies to evolution as well, right? Specific adaptations come with increased metabolic cost, so e.g. strongly bleach-resistant bacteria should eventually start losing resistance to other antimicrobials/antiseptics. Right?
Transplants are typically reserved for those with recurrent CDI (although that is likely different in the US where I think you can pay for one privately). In Canada it is a covered procedure.
Not sure about Canada anymore, Queens was doing this in select cases when I was there, but FMT is also increasingly used for initial episode fulminant CDI in the US as well (varies by institution).
I was unlucky enough to get CDI in medical school when flagyl was first line and had to pay OOP for PO vanco, I assume that’s changed now.
What’s first line in Canada these days, is fidaxomycin covered?
Couldn’t tell you about inpatient hospital use. Outside of hospital, it’s covered by the public drug plan in Ontario if you’ve failed (or have allergies to) vancomycin treatment.
Metronidazole is still first line under that program for “mild” cases, otherwise it’s vanco. But nobody is really checking, so it comes down to how your doctor wants to document it.
Glad to hear approval for vanco is relaxed, this was 2015 when I think vanco first line was still new. I was also on the university drug plan which required documented treatment failure at that time.
I remember we used to give patients vanco IV bags to drink on discharge for outpatient therapy because the PO formulation was too expensive for some (iirc I paid $300 for a 10 day course).
The standup set that put Tig Notaro on the cultural radar centered around getting pneumonia, catching c diff, and then her mother dies from a freak head injury and she gets diagnosed with breast cancer. She was never what anyone would call 'sturdy' to begin with. I can only imagine she looked like Skeletor by the end.
I want to see studies to measure the impact of disease transmission in a hospital.
Pick a random (perhaps new) hospital, and make every patient live in their own sealed plastic bubble. No air goes in or out - instead it is recirculated per-patient like a space station. Make staff wear hazmat suits.
Then, after a few weeks, compare patient outcomes.
Hospitals in the USA are not super concerned about patient outcomes at the administrative level. Everyone just wants to be middle of the road “good enough” to not get sued for negligence. There isn’t really any incentive for doing better than that and it costs a lot to be better
Hospitals in the US are actually pretty concerned with hospital acquired infections. For the sole reason that medicare/medicaid and insurance typically don't cover costs associated with them. So the hospital itself is on the hook for diagnosis, treatment, and any associated costs.
Not really because moral hazard occurs when you’re protected from consequences. Missing an early nosocomial infection means you’re now on the hook for very long admissions with expensive treatments and interventions.
Personal experience in US academia also suggests not, far more concern for early diagnosis of infection and IPAC than I saw practicing in Canada.
The goal wouldn't even be to be better - it would be to measure how much benefit could be had with perfect biological isolation, so that we could decide where on the cost/effort/benefit scale to put our hospitals.
I worked at a hospital years ago and during the orientation session we had a speaker tell the audience that 1/8 pepe who go into the hospital will acquire an infection from the hospital.
My n=1 experience is that every time I walk into a hospital (even just to visit nana for an hour), a few days later I find myself sick...
I suspect that the true figure for hospital acquired infections is far higher than 1 in 8, but that they are only recorded if the infection is serious enough to cause immediate medical treatment to be necessary.
Perhaps you should consider wearing an N95 while visiting the hospital. You can a pack on Amazon for $15 (even in stylish black), and they really aren't that bad wearing. In my opinion, the practice of wearing N95s in medical settings is the one response to Covid that should be permanent. Unfortunately even in peak Covid medical advisors were too scared to advise proper masking and settled for cloth and surgical masks, while KN95/N95 offers far more protection for yourself. Looking back, we could have done away with social distancing, quarantining, shutdowns, and all the other extreme procedures if we had just ramped up N95 production and told everyone to wear them in public while we were waiting on the vaccines.
I wouldn't be surprised if your proposal, naively implemented would lead to worse patient outcomes.
Just simply the staff having to change hazmat suits between patients, porting in and out between plastic bubbles, would add a lot of overhead and less time to offer actual care.
Not talking about all the risks involved with that "space station" like air recirculation. "Sorry about your grandma. She did not pick up an infection, but she died when the overworked technician forgot to replace her bubble's CO2 scrubber."
Not saying that the current situation is peak optimum and the best possible. Just that infection control is not the only goal to optimise for in a hospital.
Surgical scrubs are disposable. Patient gowns are usually made of tough materials like cotton and polyester that can tolerate a fair amount of heat. If bleach in lukewarm water doesn't work, how about a boil wash?
Boil washing is usually done at 90-95C, but I suppose you could achieve higher temperatures with a bit of extra pressure in a purpose-built machine. No living pathogen is known to survive an autoclave at 120C.
Steam might be similarly effective on fixed hard surfaces like stainless steel and linoleum. Any non-disposable material that cannot withstand bleach, alcohol, or 120C for a few seconds a day probably doesn't belong in a hospital anyway.
This is bad news. But it doesn't tell us that washing with detergent is unable to remove the pathogen from scrubs. Nor does it tell us that that washing at high temperatures no longer kills it.
Hot wash (boiling water) with detergent, followed by hot air tumble drying also, will pretty much sterilize clothing. Of course that doesn't prevent contamination at some point later.
I had not thought of that! Good call out, definitely an opportunity for gamma radiation treatment as part of the cleaning cycle after mechanical washing.
Wouldn’t get inside the clothing (gowns, scrubs, etc). The benefit of gamma is you can throw it all in the target area and ensure somewhat uniform exposure (similar to food/ag irradiation).
Regardless, the outcome is going to be shorter lifetime of these medical resources due to decay rate from the more aggressive treatment cycle.
weird coincidence - I just had C diff. I was healthy before it, had not taken antibiotics in years, so I suspect what caused my c diff was years and years of taking pepcid. Long term antacid use are one suspected cause of c diff. Doctors like to act like antacids are pretty safe and you can just use (abuse?) them for years without consequence.
I went on a bender reading about c diff when I had it. The antibiotics for it have like 70% or less success rate [1]. The gold standard is a drug called dificid. With insurance my dificid was $1300, $4000 without insurance. There is a manufacturer coupon that makes the drug $50 with insurance - just a heads up if you ever find yourself in the same situation. The other antibiotics are not that great (vancomycin and metronidazole) and have more side effects, from my reading.
Fecal matter transplant (FMT) [2] seems to have the highest success rate [3]. There was recently a FDA approved drug for FMT called vowst, but its expensive as well. The whole science and process of FMT and FMT donors is super interesting and it will be exciting to see the developments in this field in the coming years to see what other things FMT can help out with (IBS, etc...). Its frustrating that FMT, with its high success rate, is considered a last resort method to cure c diff recurrence - it seems much safer than the general population using novel antiobitics with not-great success rates in preventing recurrence.
If you have GERD or similar you should be on a PPI, not over-the-counter antacids. I can't imagine a doctor recommending that except for mild, occasional complaints.
PPIs have their downsides, but they're the best available treatment to avoid acid damage.
PPIs do the same thing - suppress acid. That suppression of acid makes you vulnerable to bacteria like c diff. Long term use of PPIs is also linked to dementia.
Studies into the risks of using PPIs long term show all kinds of potential problems. Higher incidence of all kinds of mineral deficiencies, sometimes even life threatening. Increased risk of cancers. Increased risk of developing SIBO. Increased risk of respiratory and urinary tract infections. The list goes on.
Perhaps banking FMT might be considered pursuing? If one is hale and hearty, save that for later. It should alleviate some of the squeamishness for "dealing with other people's shit".
I always suspected that taking antacids might negatively affect bacterial infections. It was just a conjecture, and I hadn't researched it, so thank you for the information.
> However, prions, such as those associated with Creutzfeldt–Jakob disease, and some toxins released by certain bacteria, such as Cereulide, may not be destroyed by autoclaving at the typical 134 °C for three minutes or 121 °C for 15 minutes and instead should be immersed in sodium hydroxide (1M NaOH) and heated in a gravity displacement autoclave at 121 °C for 30 min, cleaned, rinsed in water and subjected to routine sterilization.
Seems like we should just burn them like the parent suggested. Prions are no joke.
I thought prions were immune to fire as well, as in Creutzfeldt–Jakob infected cows must not be burned, as the particulates can infect the feed on adjacent and nearby farms.
Prions are just naked proteins. They're scary because that makes them resistant against normal sterilizers like alcohol (nothing to dehydrate), heat (simple enough to not denature easily I guess), radiation (no DNA to damage), etc., but since they're just naked organic molecules, just stick stuff in a strong oxidizer (bleach) for a few minutes if you have a reason to be worried about them.
But also, you probably shouldn't have prions just floating around your environment in the first place.
Mercifully prions are a big deal, not an everyday thing. Autoclavation is an acceptable solution for bacteria but if there's even a hint that prions are involved it's time to bring in the all consuming fire to wipe it off the surface of the planet.
I wonder if this changes the prospects for finding life in Mars somehow. IIRC, one thing making life in Mars difficult is the presence of oxidizing chlorates or peroxides in the surface. If we have a example of microorganisms developing extreme resistance to oxidation here on Earth, I think it improves the odds of some microorganisms still being able to thrive in Mars today.
Spores are highly resistant to oxidisation, but for a spore to produce more spores, it has to develop into a bacterium, and bacteria are not resistant to oxidation. This is not happenstance - spores can be resistant because they don't do anything, they are just simple storage containers for DNA and the minimal machinery to use it, whereas a complete bacterium has to do much, much more. So, this is not a model for life which can exist in a permanently oxidising environment.
I mean hospitals already have a tremendous amount of radioactive equipment so the ship has already sailed about having the skillset to safely manage ionizing radiation and hyper-hazardous materials, so why not set up an industrial food irradiator in the laundry system to sterilize things?
I'm not a biologist but how can certain bacteria and viruses be resistant to alcohol?
I barely recall an internet discussion where people were concerned about "super bugs" coming about from using alcohol to disinfect -- "will this not create a resistance in them by using the one tool we know works to kill bacteria" they inquired.
I recall a researcher saying it would be like humans becoming resistant to nuclear explosions. It just simply won't happen and yet here we are.
Nothing will ever grow in pure alcohol, but there exist some spores which can last varying lengths of time in alcohol before being destroyed.
To continue the same analogy, humans will never become resistant to nuclear explosions, but we can build bunkers that allow us to last for varying lengths of time after one happens. The better the bunker, the longer we last.
If the alcohol isn't applied long enough then the longest lasting spores can make it through.
I used to think that isopropyl alcohol was the last word in cheap-and-convenient surface sterilization, such as hands.
For better or for worse, watching a handful of YT videos from doctors saying "just wash the wound with soap and water" or even "all you need is to wash your hands with soap and water" has made me dial back the "douse it with alcohol" thinking.
I still use alcohol from time to time. Or hydrogen peroxide, depending. But at least now I'll get a fresh wound (cat bite or whatever) under a thorough rubbing with soap + water as the immediate first step. A thorough wash, at that.
Exactly what I was thinking. Hospitals already use a lot of hyper-hazardous materials and ionizing radiation, this is within their skill and logistical abilities. A hospital could leverage something similar to a big industrial food irradiator within its laundry system to sterilize everything.
I dunno about that. I remember reading about an incident where a radiation source was transported in a lorry for miles without the cap on. Would have been a quite damaging if it hadn't happened to be pointed downwards
at the main hospital here they have a large UV/ozone machine that makes a popping sound like a large flashbulb twice a second or so. I don't think it's a robot.
As an aside, where can i reliably get any real UV-C + Ozone bulb these days? I had 3, i gave one away and two broke during the pandemic, and all i have been able to find in the past year and a half is UV-C that doesn't produce ozone, but instead that weird "too much sunlight" smell - anti-septic smelling but it doesn't murder pathogens like ozone does.
1. We really should try harder to use the internet to reduce hospital visits. This was a missed opportunity during the pandemic when hospitals were a source of spread and hospitals are also an ongoing source of antibiotic resistant infections.
2. I wonder what copper would do in this case. Copper is sometimes used in hospitals for railings, etc. because microbes typically die within an hour, thereby reducing transmission of disease.
Rarely have I encountered a latin name as accurate as Clostridioides difficile. For those without a Romance Language background, 'difficile/difficilis' is Latin for 'difficult' and difficile is preserved verbatim in French, <looks it up> and Italian, and is phonetically the same word in Portuguese and Spanish (minus the e and add some accents).
when my dad had cancer he took chemo that needed him to in the hospital for a week at a time. one of those stays he got a c diff infection. the c diff almost killed him. it was really bad, he didn’t leave the hospital for a month. and from what we heard, this wasn’t that rare. especially for chemo patients with low immunity
When my wife was on chemo my hands suffered so much, due to all of the washing i did between interacting with her; to prevent this sort of thing. As another anecdote about how little of a joke chemo is, half of my hair fell out, just from being near her.
This is talking about "Clostridioides difficile" bacteria, so despite the title it is not about how difficult it is to get rid of those bits of legacy C code nobody understand any more.
I'm in that overlapping part of the Venn diagram where I read "C diff" and both programming and infectious bacteria come to mind. But I see it written that way in the context of medicine far more than some incidental reference to diff in the C programming world.
I worked on a drug program against a pathogen that was transmitted as spores. Basically the treatment was given when there was a flare up, because the organism was only vulnerable in that mode. We tried killing the spores themselves but evan at toxic-to-human doses the spores didn't give a shit. So people would get better, then have further outbreaks.
Note that from a drug company's perspective, this is actually pretty great. You don't treat them for long enough that it's considered a "chronic condition" from a regulatory perspective (which would mean much more complex trial protocols) yet you know if you treat anyone you'll have a repeat customer, probably for the rest of their lives. But despite public opinion of pharma companies, I never heard anyone say "thank you spores!" In fact we did continue to try to attack the spores.