PROVIDENCE, R.I. – How often do you clean your hands? A study at Rhode Island Hospital observed staff on 161,526 occasions to monitor how often they cleaned their hands (ie, hand hygiene) between July 2008 to December 2012 and found that hand hygiene compliance improved from 60 percent to 89 percent. The study is published online in advance of print in the journal Infection Control and Hospital Epidemiology.

The investigators found there was greater hand hygiene compliance when health care workers were leaving patient rooms, when going in or out of the room of a patient that was known to be infected or colonized with antibiotic-resistant bacteria, and when caring for patients during the evening shift. In the publication, the investigators also outlined the infection control and prevention program utilized at Rhode Island Hospital that significantly improved hand hygiene compliance among doctors, nurses and support staff.

Hospital-associated infections have a significant impact on health care in the U.S. According to the Centers for Disease Control and Prevention (CDC), in 2002, such infections developed in 1.7 million patients and were associated with nearly 100,000 deaths. In 2009, the CDC estimated that the annual direct medical costs of such infections in U.S. hospitals was $36 billion to $45 billion.

"Hand hygiene is the most important intervention to reduce the risk of hospital-associated infections, but many hospitals have struggled to develop a culture of safety where high hand hygiene compliance becomes the norm rather than the exception," said principal investigator Leonard Mermel, D.O., medical director of the department of epidemiology and infection control at Rhode Island Hospital. "With use of a process improvement program that engaged hospital administration at the highest levels, as well as hospital staff from housekeepers, to facilities engineers, to nurses, doctors and others, we were able to dramatically improve our hand hygiene compliance in a sustainable fashion, thereby reducing the potential for harm in our patients".

There was no funding for this study. Mermel's principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island. He also has an academic appointment at The Warren Alpert Medical School of Brown University, department of epidemiology and infection control. Other researchers involved in the study are Julie Jefferson, RN, MPH; and Benjamin Kowitt, MD, both are affiliated with Rhode Island Hospital and/or Brown University.

About Rhode Island Hospital

Founded in 1863, Rhode Island Hospital in Providence, R.I., is a private, not-for-profit hospital and is the principal teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Last year, Rhode Island Hospital received more than $55 million in external research funding. It is also home to Hasbro Children's Hospital, the state's only facility dedicated to pediatric care. For more information on Rhode Island Hospital, visit https://www.rhodeislandhospital.org, follow us on Twitter @RIHospital or like us on Facebook.

CHICAGO — Dentists don’t want to put a damper on the Halloween fun; they just want to help patients avoid cavities. As the American Dental Association (ADA) prepares to kick off its 154^th Annual Session in New Orleans on Halloween, dentists want to offer some candy-eating tips that will help keep cavity-causing sugar monsters at bay.

“Avoid snacking on candy and drinking sugary beverages throughout the day,” advises Jonathan Shenkin, D.D.S., an ADA pediatric dentist spokesperson who practices in Augusta, Maine. “The plaque on your teeth contains bacteria that feeds on sugar and releases acid that attacks teeth. Continual sipping and snacking subjects your teeth to continuous acid attacks which could lead to the breakdown of tooth enamel that might eventually lead to cavities.”

Instead of snacking and sipping all day, Dr. Shenkin recommends eating candy and drinking sugary beverages with meals. Saliva production increases during a meal, rinsing food particles from the mouth and neutralizing plaque acid which helps prevent tooth decay.

Dr. Shenkin said it’s not only how often you eat, but it’s also what you eat that might spook your teeth.

 “Beware of candies like gummies and taffy, which stick to your teeth longer than something like chocolate, which easily washes away with saliva or by rinsing,” he says. “Also, remember that hard sugary candies remain in the mouth longer, giving bacteria more time to create acid that weakens tooth enamel.”

The ADA offers the following tips to help reduce tooth decay and still enjoy Halloween:

- Get those juices flowing: Consider chewing ADA Accepted sugarless gum after meals. Certain sugarless gums have earned the ADA Seal of Acceptance for scientifically proving that chewing the gum for 20 minutes after meals helped prevent tooth decay.

- Go with the flow: Drink optimally fluoridated water has been shown to reduce cavities from 20 to 40 percent.

- 3:  Floss once a day, brush for 2-minutes twice a day with a fluoridated toothpaste and eat three healthy meals a day.

- Check out those vitamins: Eating calcium-rich foods such as cheese, leafy greens and almonds are good for the teeth. Protein-rich foods such as meat, eggs and fish are good sources of phosphorus. Both of these minerals can help rebuild tooth enamel and bone.

- Take a trip: Visit your dentist regularly.

To keep the mouth-healthy message going throughout this frightfully fun Halloween, ask your little ghouls and goblins to check out the ADA’s spooky Halloween-themed retro video series Throwback Tooth Day (#TBT). These videos are classic public service announcements from the 1960s through the 1980s that are available on MouthHealthy.org, the ADA’s consumer website, the ADA’s YouTube channel as well as the ADA’s Facebook and Twitter pages.

About the American Dental Association

The not-for-profit ADA is the nation's largest dental association, representing 157,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit www.ada.org. For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA’s consumer website www.MouthHealthy.org.

CHICAGO — Patients at elevated risk for developing cavities benefit from applying prescription fluoride directly to their teeth at home or having their dentist apply it in the office, according to new clinical recommendations from a multi-disciplinary expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. Topical fluoride, used in conjunction with drinking optimally fluoridated water and using toothpaste with fluoride, is helpful to prevent tooth decay in these particular patients.

The summary of these updated clinical recommendations, "Topical Fluoride for Caries Prevention: Executive Summary of the Updated Clinical Recommendations and Supporting Systematic Review,” is published in the November issue of The Journal of the American Dental Association (JADA) and will be available to the public Nov. 1 on the ADA’s Center for Evidence-Based Dentistry (EBD) website and ADA members on the JADA website.

These clinical recommendations cover professionally applied and prescription-strength, home-use topical fluoride agents for cavity prevention. This marks the first time that these evidence-based recommendations were updated based on a systematic review of clinical studies. The authors reviewed clinical studies on fluoride mouth rinses, varnishes, gels, foams and pastes.

Evidence-based clinical recommendations are intended to provide dentists and other health professionals with a review of the latest scientific evidence on particular topics and are not considered a standard of care. Rather, health care professionals can consider clinical recommendations, patient preference and their own clinical judgment when diagnosing and treating patients.

The panel concluded that additional research is needed, but recommended the following for patients at elevated risk of developing cavities:

-professionally-applied 2.26% fluoride varnish or a 1.23% fluoride gel every 3-6 months

-home-use prescription-strength 0.5% fluoride gel or paste or 0.09% fluoride mouth rinse (for patients 6 years old or older)

-A 2.26% professionally-applied fluoride varnish every 3-6 months is recommended for children younger than 6 years old

In addition, the recommendations specify the fluoride concentrations that provide the best benefit and indicate that APF foam not be used in children younger than 6 years old due to the potential of swallowing the foam. Foam is also not recommended for children older than 6 years old and adults due to a lack of evidence for benefit. In addition, the panel recommended that clinicians determine a patient’s risk for developing cavities by conducting a caries risk assessment. 

The ADA recommends the following oral hygiene habits to fight tooth decay:  brushing twice a day with fluoride toothpaste, flossing daily, eating a balanced diet and visiting your dentist regularly for checkups.

The full report of the clinical recommendations, a chairside guide for dentists to use to talk to their patients and an audio podcast summary of the recommendations will be available Nov. 1 on the EBD website.

About the American Dental Association

The not-for-profit ADA is the nation's largest dental association, representing 157,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit www.ada.org. For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA’s consumer website www.MouthHealthy.org.

Washington, DC – Five years after implementing a national initiative to reduce methicillin-resistant Staphylococcus aureus (MRSA) rates in Veterans Affairs (VA) medical centers, MRSA cases have continued to decline, according to a study in the November issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

The MRSA Prevention Initiative, implemented in 2007, resulted in significant decreases in both the transmission (colonization with the organism) of MRSA (17% for intensive care units [ICUs] and 21 percent for non-ICUs) and healthcare-associated infection (HAI) rates within the hospitals (62% for ICUs, 45% for non-ICUs). In the two-year period following the first wave of the initiative (data previously published[i]), both MRSA transmissions and HAIs continued to decrease in non-ICU settings (declining an additional 13.7% and 44.8%, respectively), while holding steady in ICUs. 

The MRSA Prevention Initiative utilizes a bundled approach that includes screening every patient for MRSA, use of gowns and gloves when caring for patients colonized or infected with MRSA, hand hygiene, and an institutional culture change focusing on individual responsibility for infection control. It also created the new position of MRSA Prevention Coordinator at each medical center.

“The analysis…shows that over the ensuing 24 months, MRSA transmission and MRSA HAI rates continued to decrease nationwide,” state the authors. “Detailed analysis showed that there were statistically significant declines in MRSA transmissions and MRSA HAIs in non-ICUs but not in the ICUs. The absence of statistically significant trends in the ICUs may be because MRSA transmission and MRSA HAI rates were low.”

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that is resistant to many antibiotics and an important cause of illness and sometimes death. In medical facilities, MRSA causes life-threatening bloodstream infections, pneumonia and surgical site infections. In the community, most MRSA infections are skin infections.

ABOUT APIC

APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: https://twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou.

In September, the first patient-to-patient transmission of hepatitis C in a dental healthcare setting was documented and over 7,000 patients were at risk of possible infection because of unsafe practices in a single office. The OSAP Infection Control Boot Camp is an essential “CORE” training for infection control coordinators, risk managers and those who teach or consult on this critical topic. OSAP has selected national and international experts to present the fundamentals and recent advancements in infection prevention and safety.

-- 24 hours of continuing education credits* in just three days

-- Attendees receive comprehensive resource binder, checklists, and practice tools

-- Member rate: $300 - OSAP’s 30th anniversary rate for Members and Federal Employees

-- Non-member Rate: $450

*OSAP is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental

Association to assist dental professionals in identifying quality providers of continuing dental

education. ADA CERP does not approve or endorse individual courses or instructors, nor does it

imply acceptance of credit hours by boards of dentistry.

The following article is from the Centers of Disease Control and Prevention.

Make “green” holiday choices when you are shopping, traveling, sending cards, decorating, and choosing gifts. When you save energy and resources, you protect the environment and safeguard health both now and for the future.

The winter holidays are nearly here! Some of us are ready for the festivities, but many of us are still planning and shopping for decorations and gifts and organizing holiday gatherings. We want to enjoy the fun and spirit of the season, but we don’t want to spend too much money or use too many resources in the process. And most of all, we want to enjoy quality time with those we love.

The good news is that we can participate in all these holiday activities and still manage to conserve resources. In doing so, we also protect our environment. And protecting our environment can safeguard our health now and in the future.

Whether we are traveling, sending holiday cards, decorating our homes, or choosing gifts, all of us can have “green” celebrations. Even if you already reduce, reuse, and recycle, browse through the suggestions below for more ways to bring those practices into your holiday activities. If all of us make even a few eco-friendly choices, we will save energy and resources and send less trash to the landfill during this busy time of year.

Decorate with items that are energy-efficient and durable.

• Research the most energy efficient choice for your holiday tree. The choice will vary depending on your location. Below are some suggestions.

  • Use other types of decorations besides trees.

  • Buy an artificial tree that you can use for years to come.

  • Contact your state cooperative extension service to find out about trees grown in your area or trees grown in ways that keep forests healthy and safe.

  • Buy a living tree you can plant outside or keep as a houseplant after the holidays.

  • Buy a smaller tree so that you have less to recycle.

  • Dispose of your tree at a chipping facility or return to the environment in other eco-friendly ways.

• Use energy efficiently.

  • Consider using few or no lights in your holiday decorations.

  • Decorate with more energy efficient LED (light emitting diodes) strings.

  • Plug your decorative indoor and outdoor lights into a timer to save electricity.

• Decorate creatively and inexpensively with natural materials from your yard or with items you already own.

• Choose durable ornaments from wood, metal, or cloth rather than plastic or thin glass.

Use fewer resources when you shop, give presents, and wrap gifts.

• Take your own bags on shopping trips. Keep them in the car so they’re ready whenever you stop at a store.

• Shop online.

• Conserve energy when shopping. Use mass transit if possible. If you have to drive, combine several errands in one trip or carpool with family and friends.

• Give gifts that are durable, energy-efficient, recyclable, or made of natural products.

• Buy from local shops and craft shows or from companies that use fair-trade practices.

• Search antique and second-hand stores for unique gifts.

• Make your own gifts: knit, sew, bake, or create art from reused items.

• Make calendars using your own photographs or make a recipe book with your favorite recipes

• Give a membership or an experience—tuition for a class or a visit to museum.

• Give of your time—coupons for providing a meal, planting a garden, cleaning, or using another talent or skill.

• Plant a tree in someone’s yard.

• Use creative materials for gift wrap:

  • Scarves, fabric, handkerchiefs

  • Old maps, sheet music, advertisements

  • Reusable tins

  • Usable baking pans or other home or garden items

Give cards that are eco-friendly and save resources.

• Make your own cards.

• Buy cards made from recycled paper (look for "post-consumer" content) and printed in non-toxic inks.

• Buy cards and envelopes that can be recycled in your town. Choose cards printed on white stock without metallic or plastic coatings.

• Buy cards wrapped in the least bulky or most recyclable packaging.

• Substitute postcards for cards that require envelopes.

• Reuse the fronts of old holiday cards as gift tags.

Eat sustainable food and avoid disposable containers and extra packaging.

• Research sustainable food choices in your area and buy locally if possible.

• Buy snacks and beverages in bulk to avoid extra packaging.

• Serve food with washable utensils, plates, and glasses, rather than disposable items.

• Make homemade eggnog, hot chocolate or iced tea in large quantities, and prepare pitchers of ice water in advance to reduce waste from water and soda bottles or cans.

Choose a few of these ideas that will be easy for you to incorporate into your holiday celebration. Not only will you conserve energy and resources, but chances are you will also simplify your life. And you may get more of what we all need at this time of year—time to enjoy your family and friends and to focus on the joys of the season.

Faced with inevitable pain, most people would choose to get it out of the way as soon as possible, according to a new study.

Researchers from the Institute of Global Health Innovation (IGHI) at Imperial College London and the Wellcome Trust Centre for Neuroimaging at UCL asked 35 volunteers to choose between electric shocks of different intensity occurring at different times.

They found that most people chose to hasten the pain, and would even accept more severe pain to avoid having to wait for it. A smaller proportion preferred to put it off into the future.

They found similar results when they asked the volunteers to choose between imagined dental appointments involving different levels of pain.

The study, which was funded by the Wellcome Trust, is published in PLOS Computational Biology.

The anticipation of pain is a major source of misery. People who suffer from longstanding painful conditions report that the dread of their pain getting worse can be more disabling than the pain itself.

The research team sought to better understand the fundamental processes by which people anticipate pain, with the hope of providing new insight into these conditions.

In 71% of tests, the participants chose to have the pain earlier, even though in half of the tests that meant a more painful stimulus.

Dr Giles Story, from the IGHI at Imperial, said: “When people are offered a reward, they prefer to have it as soon as possible, which could be interpreted to mean that we rate future experiences as less important when we’re making decisions. This reasoning would suggest that you would put off unpleasant things to the future as well.

“We found that this isn’t the case for most people. If pain can’t be avoided, most people choose to get it out of the way sooner, even if that means the pain is worse.

“This might make sense if anticipating pain stops you from doing things well or enjoying yourself. We’re planning to investigate this in our next studies.”