A common antiseptic used to clean hospital patients' skin can linger on surfaces for hours, creating breeding grounds for bacteria to become tolerant, or even gain resistance, to chemicals that usually kill them.

Once they develop "tolerance," bacteria can survive certain concentrations of chemicals more easily than their peers do, but they can still be killed by the doses of antiseptics typically used for cleaning. Antiseptics include chemicals, such as alcohol, iodine or hydrogen peroxide, that are used to disinfect surfaces or the skin. "Resistance" is a greater concern because it enables bacteria to grow even when exposed to concentrations of an antiseptic that would typically kill them.

According to a study published April 2 in the journal Environmental Science & Technology, as they learn to tolerate faint traces of antiseptics, bacteria might be swapping bits of DNA with each other. That same DNA might also help them dodge drugs designed to treat bacterial infections — namely antibiotics.

The study adds to a growing body of research mapping the hidden environmental stressors that can encourage bacteria to evolve these tolerance and resistance genes.

"Antimicrobial resistance comes from a lot of different places," said lead author Erica Hartmann, a professor of civil and environmental engineering at Northwestern's McCormick School of Engineering. "To really tackle the problem, we need antimicrobial stewardship, responsible use in agriculture, and we need to think about responsible use of chemicals in other environments, as well," she told Live Science.

Practicing stewardship means using antimicrobial agents like antibiotics and antiseptics sparingly in order to prevent bacteria from evolving tolerance or resistance.

Tolerant bacteria travel by air

In the study, Hartmann and her colleagues tracked bacteria with tolerance to chlorhexidine, a commonly used chemical applied to patients' skins before surgery or catheter insertion. They searched for these bacteria in an intensive care unit in an Illinois medical center.

Researchers swabbed 219 samples from bedrails, nurse call buttons, door sills, keyboards, light switches, and sink drains in six locations around the ICU in 2018. The rooms were quite clean, they found, but they were able to isolate about 1,400 bacteria and they found that 36% showed some tolerance to chlorhexidine.

In the lab, the researchers applied chlorhexidine to common materials — plastic, metal and laminate — and then tracked how long the antiseptic lingered on the surfaces, including after they cleaned the materials with water and other chemical cleaners. They found that, even after cleaning, traces of the antiseptic persisted on surfaces for at least 24 hours.

These lingering traces weren't strong enough to kill bacteria. But these types of microenvironments, in which bacteria are exposed to non-lethal doses of a chemical that usually kills them, always raise alarm bells.

In these settings, the bacteria that thrive are those that carry genes that help them survive the chemical's effects. These tolerant bacteria outcompete those that lack tolerance genes and thus grow more abundant. The worst case scenario would be that bacteria become so used to fighting off a chemical — and so good at it — that they become resistant to its effects.

The team found chlorhexidine-tolerant bacteria throughout the hospital rooms, even though the antiseptic was applied only to patients' skin. The sink emerged as a hotspot for these bacteria.

Hospital sinks have become a focus for those studying antimicrobial resistance in recent decades. Bacteria love the humid, warm U-bends found in sinks, and they will do what they can to stay there, even if they are exposed to watered-down chemicals that get washed down the drain. This creates a perfect environment for tolerance and resistance to emerge.

Sinks can also spread bacteria by generating aerosols, or tiny particles that can float through the air; as water leaves the tap, hits standing water, or splashes against the drain, these particles can fly through the air. The researchers' swabs showed that tolerant strains could be found on door sills, suggesting they traveled through the air and settled up there.

Antiseptics still work really well

Some of the antiseptic-resistant bacteria carried a plasmid — a small DNA loop that can be transferred between bacteria — that not only helped them tolerate chlorhexidine but could also help them resist antibiotics, such as carbapenems. This type of gene transfer is a well known way that bacteria gain resistance to antimicrobials, and it can take place between bacteria of totally different species.

That is "really quite important," said Danna Gifford, a lecturer in antimicrobial resistance at the University of Manchester in the U.K., who wasn't involved in the study. This finding suggests that antibiotic resistance could be accelerated "without the use of antibiotics," she said, driven by antiseptic exposure alone.

But let's be clear: chlorhexidine is still highly effective at killing germs. The bacteria observed in the study could only survive very low concentrations of the chemical, far below the amounts used to clean patients' skin.

"I don't think that this supports a really conservative approach" to using chlorhexidine, said Gifford, adding that limiting the antiseptic's use in high-risk settings like ICUs, without proper clinical evidence, could put vulnerable patients at risk of infections. But this work, alongside other recent research, still raises the question of whether we need to be more cautious about our use of antiseptics, Hartmann and Gifford agreed.

Further studies should look into whether these effects can be seen in other settings — for instance, in the home or in veterinary clinics — to better understand how these antiseptic residues affect bacteria, the study authors wrote.

Whether we should be reserving antiseptics for "high-risk situations" is "probably worth more investigation," said Gifford. Often for household cleaning, "plain soap and water are more than sufficient for our cleaning and hygiene," Hartmann noted, so that might be a setting where antiseptic use can be reduced.

In the meantime, "we are running out of antibiotics that work effectively," she said. "We are not quite fully there yet, but if we don't intervene in the things that we do now, we're going to end up in a situation in the future where we can't do simple things like treat dental infections or do surgery because we can't then give patients antibiotics after treatment."

This article is for informational purposes only and is not meant to offer medical advice.

The fungus Candida auris, which causes a highly infectious and potentially deadly infection, is spreading faster in U.S. health care facilities and likely becoming more resistant to treatments, a new study shows. 

C. auris is a fungal species of yeast that can infect humans and spread in the blood to major organs. The infection occurs most often in healthcare settings and long-term care facilities and is rare in healthy individuals. But for people who are immune compromised or receive regular invasive treatments for other illnesses, it can often be fatal.

The first C. auris infection was documented in Japan in 2009 and the fungus has since been found in many other countries, including the U.S., which had its first confirmed case in 2016. The disease made headlines back in 2019 when the number of cases began to sharply climb worldwide, and it still "presents a serious global health threat" today, according to the Centers for Disease Control and and Prevention (CDC). 

In the new study, published March 21 in the journal Annals of Internal Medicine, researchers conducted a new assessment of C. auris cases recorded in the U.S. between 2019 and 2021. In total, 10,683 cases were recorded during this period: 3,270 of the cases were clinical infections, meaning the patient showed symptoms before being tested, and 7,413 cases were screening colonizations, meaning that people carried the fungus but showed no symptoms before being tested during routine screening. People carrying the fungus can still spread the pathogen, and they may develop symptoms of illness later on.

Related: Cause of mysterious brain-invading-fungus outbreak finally discovered 

The number of clinical infections increased year on year during the study period. In 2019 there was a 44% increase compared with 2018; in 2020 there was a 59% spike compared with 2019; and in 2021 there was a 95% surge compared with 2020. (The study did not include data on the number of fatalities among clinical infections.)

This shows that the rate of transmission is likely increasing, study lead author Dr. Meghan Lyman, a medical officer at the CDC, told Live Science in an email. "The number of cases has continued to increase since 2021," she added.

The number of screening colonizations also increased significantly during the study period. But this is partially due to an increase in the number of screening tests. In 2019, there were 19,756 tests conducted nationwide, but in 2021, there were more than 40,000 tests. This suggests that the number of colonizations could be underreported due to a lack of screening tests, which could be helping the disease to spread, Lyman said.

The number of states that have recorded C. auris cases has also increased, from 10 states in 2018 before the study began to 27 states in 2021.

Another key finding of the new study is that C. auris is becoming increasingly resistant to treatments. 

"There are only three main classes of antifungal medications used to treat Candida infections: azoles, polyenes and echinocandins," Lyman said. A majority of C. auris cases are resistant to azoles and a high percentage are also resistant to polyenes. But the number of cases of echinocandin-resistant C. auris has remained very low and, as a result, echinocandins have become the preferred treatment option for C. auris, Lyman said. 

However, the number of echinocandin-resistant cases has increased in recent years. Six cases were reported between 2016 and 2019, another six cases were reported in 2020, and 19 were reported in 2021, which suggests the fungus is slowly becoming more resistant to this treatment. But new antifungals are in the early stages of being developed to help treat future infections, Lyman said.

Since C. auris is mainly transmitted in hospitals and other healthcare settings, researchers suspect that the effects of the COVID-19 pandemic may have played a role in the fungus' spread.

"Gaps in case detection and infection control existed before the COVID-19 pandemic, but pandemic-related strain on the health care and public health systems likely contributed to [increased] transmission," Lyman said. 

However, for healthy people who are not regularly exposed to a healthcare setting, the risk of being infected or colonized by C. auris remains "low," Lyman said. But increased screening and better transmission control in healthcare settings are needed to keep the fungus under control, she added. 

Death is not a linear process. 

New research finds that it's fairly common for the heart to restart — usually just for a beat or two — after a person initially flatlines. No one in the study, which took place in intensive care units (ICUs) in three countries, survived or even regained consciousness. The longest gap between someone's heart stopping and restarting again was 4 minutes and 20 seconds. 

That's an important number, according to study leader Dr. Sonny Dhanani,  chief of the pediatric intensive care unit at the Children's Hospital of Eastern Ontario in Canada. Most organ transplant programs require doctors to wait 5 minutes before beginning to remove organs from a deceased donor, though protocols differ from country to country, province to province and state to state. There are cases where programs wait only 2 minutes, or stretch the waiting period up to 10 minutes. 

Related: Spooky! The top 10 unexplained phenomena

"We're very confident when we look at the findings of this study that, actually, we've got the scientific evidence to reaffirm our current standards in organ donation, to wait 5 minutes," Dhanani said during a press conference. 

Defining death 

Dhanani and his team focused on circulatory death, or death that occurs when the heart stops, they said in their research published Jan. 28 in The New England Journal of Medicine. The other type of death relevant to organ donation, brain death, occurs when the brain is irrevocably injured and the person has no reflexes or ability to breathe independently. In brain death, life support machines can keep the heart pumping even after a person is declared legally dead. 

Declaring brain death requires its own set of criteria to test reflexes and ability of the patient to breathe. Circulatory death is simpler: It occurs once a person's heart stops. But there are occasional anecdotes of people's hearts restarting after cardiopulmonary resuscitation ends, a phenomenon known as "autoresuscitation" or "Lazarus syndrome." This sometimes leads families considering organ donation to worry whether their relative is truly beyond saving, Dhanani said. 

What's more, protocols around organ donation can differ. In 2008, doctors in Colorado waited only 75 seconds after the death of a newborn to begin removing that baby's heart for donation, raising ethical questions about how soon is too soon, Reuters reported at the time. On the other end of the spectrum, waiting 10 minutes can lead to tissue damage that results in a useless organ for transplantation, Dhanani said. 

Dhanani and colleagues at 20 adult ICUs in Canada, the Czech Republic and the Netherlands approached 631 families of patients who were about to have life-saving supports removed after doctors confirmed that they had no hope of survival. They asked the families if they could use monitors to track the dying patients' blood pressure, heart rhythms and oxygen saturation levels for 15 minutes prior to removing life support and 30 minutes after death. 

Because of the horrors of what families were experiencing, the research team consulted with families who had been through the experience themselves when designing the study. One Ontario mother, Heather Talbot, lost her 22-year-old son to a car crash in 2008 and became involved in the research due to her subsequent advocacy around organ donation. Talbot said that monitoring in the ICU actually gave her peace of mind after her son died. 

"To watch the monitors at the end, it was really relieving for me to see, 'okay, he never took another breath, it was just the machines keeping him alive,'" she said in the press conference. 

The process of death 

 Of 695 families approached for the study, only 48 declined participation. Another 16 were found not to meet criteria for the study, leaving 631 patients as participants. 

At the bedside, clinicians reported that in seven cases, a patient's heart restarted after periods of stillness ranging from 64 seconds to 3 minutes. Dhanani and his team were able to confirm five of those reports with data from the monitors. They then did an analysis of a subset of 480 patients with complete monitoring records and found that, in fact, 67 patients had experienced at least one resumption of heartbeat. Seven had heartbeats that stopped and started more than once. 

Most of these resurgences in heart activity occurred between 1 or 2 minutes after the heart had stopped. They were usually only  a single heartbeat long, or less than 5 seconds in duration. 

The study suggests that protocols around organ donation should stick to the 5-minute convention, given that no one's heart restarted again after a gap longer than 4 minutes and 20 seconds, Dhanani said. Transplant teams should be prepared for the possibility that they might have to adjust their timing if a patient's heart does restart. Ultimately, he said, the research should help standardize organ donation processes internationally.

"I think our work will inform national and international guidelines," he said.

Originally published on Live Science.

Editor's note: This story was updated on July 27 to include news about the establishment of ethics committees to decide which COVID-19 patients receive ICU care. The original article was published July 23.

COVID-19 outbreaks are often followed by headlines saying that intensive care units (ICUs) have hit capacity. But what does it really mean for an ICU to be full?

In normal times, ICUs typically run at roughly 70% to 80% capacity, a sweet spot where a unit can maintain enough resources to run, without being overstaffed, and still allow wiggle room for additional patients, experts told Live Science. Hospitals can increase their ICU capacity to accommodate for surges, such as those caused by COVID-19, but there does come a point when resources and staff start to stretch uncomfortably thin.

"If we exceed that [capacity], we start doing things we don't want to do," such as asking medical workers to care for more patients than they normally would at a single time, or placing several beds in the same room, said Dr. James McDeavitt, senior vice president and dean of Clinical Affairs at the Baylor College of Medicine in Houston, Texas. COVID-19 also places a particular strain on hospitals' supply of personal protective equipment (PPE), as well as the mental health of both patients and medical staff, especially given that COVID-19 patients cannot receive visitors, he added.

Related: 20 of the worst epidemics and pandemics in history

But even if ICUs are at capacity, "if you need medical care, please come to the hospital," said Dr. Craig Coopersmith, director of the Emory Critical Care Center and a professor of surgery at the Emory University School of Medicine in Atlanta. Unlike in a grocery store, where people with COVID-19 might unwittingly mingle with uninfected people, hospitals identify probable and confirmed coronavirus infections and isolate those patients from others, he said. 

If you require care in an ICU, such as for a heart attack or stroke, "you are significantly safer coming to the hospital and getting the care you need than staying at home," Coopersmith told Live Science.

Stretching ICU capacity 

In May, the Society of Critical Care Medicine, an organization of intensive care professionals, issued guidelines for how hospitals can expand their ICU capacity to contend with the COVID-19 pandemic. Rather than the number of ICU beds, "the biggest challenge is actually staffing," said Coopersmith, who served as president of the organization from 2015 to 2016.

"A bed's a bed," McDeavitt told Live Science. Provided that a bed can be equipped with the appropriate monitors and equipment, such as ventilators, any bed can be turned into an ICU bed, he said. "The most important thing is that qualified staff take care of the patient."

To bolster ICU staffing, medical workers normally assigned to other departments can be redeployed to help care for critical care patients; these workers must have "complementary skill sets" that suit their new positions in the ICU, Coopersmith noted. 

For example, early surges of COVID-19 prompted hospitals to postpone many elective surgeries, leaving anesthesiologists available to manage ventilators, breathing tubes and blood pressure medication drips in the ICU, as these are tasks they might normally manage during surgeries. Nurse practitioners, physicians assistants in surgery, surgeons, cardiologists and trainees in pulmonary care also have skills that can ease the burden on ICU physicians tasked with caring for COVID-19 patients, Coopersmith said. 

Related: Why COVID-19 kills some people and spares others. Here's what scientists are finding.

Nurses at South Bay Hospital in Sun City Center, Florida, received similar cross-training to equip them for so-called team nursing in the ICU, where one ICU-trained nurse is supplemented by others who handle tasks like monitoring patient vitals and clearing bed pans, said Marcy Frisina, Chief Nursing Officer at South Bay Hospital. In addition, hospital staff members such as radiology technicians, physical therapists, medical record keepers and administrative assistants can be called on to deliver PPE, run samples to the lab and fetch water, among other tasks, when the ICU gets busy, she said. Only select staff actually enter the ICU rooms to care for COVID-19 patients, so although ancillary staff help with certain tasks outside, the hospital conserves PPE for those who need it most, she added.

Baylor College of Medicine, along with other member institutions of the Texas Medical Center, similarly prepared for COVID-19 surges by assessing the skills of their physicians and conducting extra training to better equip them for the ICU, should they be redeployed, McDeavitt said. In addition, the hospitals hired traveling nurses from outside the local community to further increase staffing. 

Baylor's preparation allowed it to handle the current surge of COVID-19 in Harris County, "because we had more warning than New York did," McDeavitt noted. 

If there does ever come a point when an ICU does not have enough trained staff to take in a new patient, the hospital can transfer that patient to another medical center, Frisina told Live Science. But in general, an ICU can technically be "'at capacity,' but have enough staff to do more," she said. In other words, patients don't necessarily get turned away when an ICU hits 100% capacity; the hospital typically makes more room, she said. 

That said, Starr County Memorial Hospital in Texas recently announced that, due to mounting strain on its ICU, the hospital will establish an ethics committee to decide which COVID-19 patients will be admitted and which will be sent home, according to CBS News.

Cases started surging in Starr in early July, after Texas began to reopen, and the local hospital must now transfer patients to medical centers elsewhere to conserve its limited resources, Dr. Jose Vasquez of the Starr County Health Authority told KGBT-TV. At least two to three patients are transferred out of the area each day, and as many as six to seven on some days; but as ICUs also fill in neighboring counties, the hospital will now have to decide which patients have the best chance of pulling through, Vasquez said.  

"The reality is that science and statistics are against those people with multiple medical conditions," Vasquez said during a press briefing, CBS reported. "For all of those patients who most certainly do not have any hope of improving, we believe that they are going to be better taken care of within their own family in the love of their own home, rather than thousands of miles away dying alone in a hospital room."

Unique challenges of COVID-19 

While COVID-19 patients aren't "inherently sicker" than other patients in the ICU, they do present unique challenges that other patients may not, Coopersmith said. For example, medical staff must be equipped with adequate PPE to ensure that they don't catch the highly transmissible virus while tending infected patients.

In a packed ICU, time is a precious commodity; time spent donning and discarding PPE must be factored into all protocols concerning COVID-19 patients, McDeavitt noted. But primarily, the need for layer upon layer of protection can place an emotional toll on medical staff, he added. "You typically don't go into work concerned that you're going to come away with an illness," he said.

The lack of visitors to the ICU only adds to the stress, Coopersmith said. "The 'no families [rule]' puts a massive emotional burden on the care teams … and the patient, if they're conscious," he said. Families and other visitors to the ICU can help calm patients and facilitate communication between those patients and health care workers attending them, he said. Without any visitors, both the staff and the patients themselves must shoulder that emotional burden alone.

For health care workers, "the stress of just exposing one's family members … has been a recurring theme," Frisina noted. South Bay Hospital has showers for staff to use and clean scrubs for them to travel home in, but also provides hotel rooms where staff can stay if they prefer not to risk going home once exposed.    

Related: 11 (sometimes) deadly diseases that hopped across species

In addition to protecting their physical health, those who take care of patients must be given adequate mental health support to cope with the prolonged stress, McDeavitt said. To this end, Baylor College of Medicine provides self-assessment tools to help staff gauge their stress levels and offers telehealth sessions with licensed psychologists and psychiatrists, as well as group therapy sessions with other staff members. Given that "this is an ongoing slog that's going to continue for months," the hospital also encourages staff to take time off when needed, McDeavitt said. 

In face of all these challenges, hospitals have improved the care of COVID-19 patients throughout the pandemic by adopting new care strategies in the ICU. "I don't want to call it routine ... but in some senses, this is the new normal," Coopersmith said. For example, since the early days of the pandemic, new evidence showed that many COVID-19 patients in critical condition may not benefit from ventilation, despite low blood-oxygen levels. Back in April, when they were mostly guided by these blood-oxygen levels, Baylor physicians placed roughly 44% of critical COVID-19 patients on ventilators; that percentage is now closer to 15%, McDeavitt estimated.  

While being more selective about who to place on a ventilator, hospitals are now quicker to prescribe blood thinners to COVID-19 patients in order to prevent dangerous blood clotting associated with the infection, Coopersmith added. Of course, while learning to better care for COVID-19 patients, and adjusting protocols based on brand-new research, hospitals must also plan for another impending surge of infection, Frisina said — the one caused by seasonal influenza.

Come winter, influenza season might compound the strain COVID-19 has already placed on ICUs, depending on how well communities contain the virus in the coming months, she said. And given that influenza and COVID-19 share some symptoms, extra pressure would be placed on diagnostic testing services to differentiate flu cases from coronavirus cases, McDeavitt added. Any delays in testing trickle down to the hospitals and could place extra strain on the ICU; that said, hospitals like Baylor avoid testing delays associated with commercial labs by conducting tests internally, he noted.

But whatever the coming months have in store, Frisina noted that people should not put off visiting the hospital for medical care, coronavirus-related or otherwise. "We're going to keep you safe; that is our number one priority," she said. And "the longer you wait, the harder it is to fix."

Editor's note: This article was updated on July 23 to correct the location of Baylor College of Medicine to Houston, Texas.

Originally published on Live Science.

Editor's note: This article was updated on July 17 to include news that the CDC is now displaying COVID-19 data on its website again — albeit old data from July 14. The original article was published on July 15.

The U.S. Department of Health and Human Services (HHS) issued new orders for hospitals to send COVID-19 data straight to the agency, rather than to the Centers for Disease Control and Prevention (CDC), which typically compiles the information. 

The orders, posted to the HHS website, direct hospitals to send daily reports about their total number of COVID-19 patients, admissions and related deaths from the previous day, along with data on their ICU bed occupancy, ventilators in use, staffing shortages and supply of personal protective equipment (PPE), among other information. Previously, the CDC collected and shared such data on publicly accessible databases. 

"The new, faster and complete data system is what our nation needs to defeat the coronavirus," Michael R. Caputo, an HHS spokesman, told The New York Times. "The CDC, an operating division of HHS, will certainly participate in this streamlined all-of-government response. They will simply no longer control it." The order went into effect Wednesday (July 15).

But some health experts have raised concerns that the change will limit the amount of data available to the public, including to scientists and health officials, at a time when COVID-19 cases continue to surge in many states.

Related: 20 of the worst epidemics and pandemics in history 

And in fact, the immediate effects of the order became apparent when the CDC pulled data on U.S. hospital capacities from its website, ProPublica reported. The swift change, implemented July 15, motivated U.S. Congress members and former CDC director Dr. Tom Frieden to call for the data to be restored, and transparency to be maintained into the future. 

"Covid is exploding in Arizona, Texas, South Carolina, Florida and other states. And the administration has chosen to sideline the CDC. Where did this data go?" Frieden wrote in a tweet on the morning of July 16. By noon, the CDC had restored the old data to its website, with a note that the numbers had not been updated since July 14, ProPublica reported. Notably, the CDC explained that the posted numbers do "not include data submitted to other entities contracted by or within the federal government" — meaning that the current stats don't include any information sent to the HHS, as now directed by the federal government.

Time will tell whether and how the HHS will make its database available to the public, but in the meantime, some experts have expressed grave concerns about the shift.

"Only the CDC has the expertise to collect data," Rep. Donna E. Shalala of Florida, who served as health secretary under former President Bill Clinton, told the Times. "I think any move to take responsibility away from the people who have the expertise is politicizing."

The Infectious Diseases Society of America (IDSA), a national organization of physicians, scientists and public health experts, echoed similar sentiments in a statement written by the organization's president, Dr. Thomas File, Jr.  

"Placing medical data collection outside of the leadership of public health experts could severely weaken the quality and availability of data, add an additional burden to already overwhelmed hospitals and add a new challenge to the U.S. pandemic response," File wrote.

Dr. Janis Orlowski, chief health care officer of the Association of American Medical Colleges, participated in meetings leading up to the new HHS order. During the meetings, held between hospital administrators and White House coronavirus response coordinator Dr. Deborah Birx, there had been "a verbal discussion" about making the data accessible to the public, or at least to hospitals through the HHS, Orlowski told the Times. She called the order "a sincere effort to streamline and improve data collection."

The new database, managed by a health data firm called TeleTracking, will rely on hospital administrators to manually enter data — similar to the CDC's National Healthcare Safety Network, which collected COVID-19 information until the new order went into effect on Wednesday. This method of manual entry is burdensome, experts said.

"The whole thing needs to be scrapped and started anew, " Dr. Dan Hanfling, an expert in medical and disaster preparedness and a vice president at In-Q-Tel, a nonprofit strategic investment firm focused on national security, told The New York Times. The HHS could establish an electronic system to automatically gather data from hospitals; it plans to eventually move away "from a manual entry process and toward an automated one to ultimately reduce the burden on data collection," according to the agency's statement. 

"It is laughable that this administration can't find the wherewithal to bring 21st-century technologies in data management to the fight," Hanfling said. 

Rather than switch to the new HHS database, "the administration should provide funding to support data collection and should strengthen the role of CDC to collect and report COVID-19 data by race and ethnicity, hospital and ICU capacity, total number of tests and percent positive, hospitalizations and deaths," File wrote in the IDSA statement. 

Representatives of hospitals agree that, so far, the process of sending data to the CDC has been cumbersome and could use improvement. Rush University Medical Center in Chicago needed four full-time employees on hand to send COVID-19 data to four different agencies, Dr. Bala N. Hota, the hospital's chief analytics officer, told The New York Times. The reports included more than 100 different data points that helped determine what resources the hospital would receive from the federal government. 

What's more, the CDC's reporting requirements have been in flux throughout the pandemic.

"It has been an administrative hassle and confusing to constantly be shifting gears on reporting while hospitals are on the front lines during a pandemic," Carrie Williams, a spokesperson for the Texas Hospital Association, told the Times.

But despite the clear flaws in data collection, "the CDC is the right agency to be at the forefront of collecting the data," Hota told the Times. The CDC's methods of sharing public data have also been flawed at times; for example, in May, the agency admitted to lumping positive diagnostic test and antibody test results together, a decision that clouded the nation's true testing rates, as well as skewing the rate of new infections, Live Science previously reported.

"Trust and accountability and transparency — all three go together," Will Humble, the executive director of the Arizona Public Health Association, told the Times. As the federal government begins curating the new HHS database, "they'd better keep it transparent, or else people are going to think that it was an ulterior motive," he said.

Originally published on Live Science. 

Very little is known about how to properly reuse medical masks to fight infectious diseases. No method is confirmed to work. Still, in a report to doctors, which has yet to be peer reviewed, some researchers are beginning to point to the best options for decontaminating used masks.

Medical professionals are reusing single-use medical masks across the country right now, according to the news organization The Intercept and numerous other reports, as the COVID-19 pandemic is stressing the usual supply chains for the masks. Medical masks, including N95 masks, are intended to be single use and must be worn properly to be effective. According to a new article released by researchers at Stanford University's School of Medicine's COVID-19 Evidence Service today (March 24), however, there are some methods that doctors can use that do seem to be better than others. (Their communications particularly targeted anesthesiologists.) 

"We do not advocate or advise specific treatments or approaches," the researchers began. "The COVID-19 Evidence Service aims to share the best available evidence to address questions for clinical anesthesiologists and the anesthesiology community. We recommend that hospital policy and procedures be respected and adhered to."

Related: 13 coronavirus myths busted by science

Referring to a paper published in the journal Annals of Occupational Hygiene in 2009, among others, the researchers compared and contrasted these different methods for sterilizing N95 masks, many of which were ineffective:

• Heat in an oven for 30 minutes at 158 degrees Fahrenheit (70 degrees Celsius)
• Use ultraviolet light for 30 minutes
• Soak the mask in 75% ethyl alcohol, then let it dry
• Clean the mask with liquid or vapor hydrogen peroxide
• Clean the mask with bleach
• Steam the mask with hot vapor from boiling water
• Microwave the mask
• Use extreme heat in an oven or autoclave
• Soak in soap and water

"To be useful, a decontamination method must eliminate the viral threat, be harmless to end-users and retain respirator integrity," they wrote.

All of the methods used were believed effective for destroying coronaviruses, they wrote, but not all of them were good ideas.

"DO NOT use alcohol and chlorine [bleach]-based disinfection methods," they wrote. "These will remove the static charge in the microfibers in N95 facial masks, reducing filtration efficiency. In addition, chlorine also retains gas after de-contamination, and these fumes may be harmful."

Microwaves tended to melt the masks and render them useless.

Hydrogen peroxide and ultraviolet radiation appeared to be at least somewhat more effective, they wrote, "but it is not known if they would retain filtration, material strength and airflow integrity with repeated use."

Autoclaves, 320 F [160 C] ovens, and soap and water soaking, all appeared ineffective, they wrote.

However, they wrote, "70 C / 158 F heating in a kitchen-type of oven for 30 min, or hot water vapor from boiling water for 10 min, are additional effective decontamination methods."

The CDC still does not recommend reusing masks, and the researchers encouraged doctors to follow guidelines in their clinics. If you are not a medical professional, the best way to avoid getting sick isn't using a mask (new or reused), but staying at home. If you must go out, homemade cloth masks are an imperfect but better-than-nothing option, as Live Science has reported. However, a mask is much more likely to help you avoid spreading the illness if you are sick than it is to protect you from the illness, as Live Science has also reported.

Again, if you can, stay at home.

Coronavirus science and news

• Coronavirus in the US: Map & cases 
• What are the symptoms? 
• How deadly is the new coronavirus?
• How long does virus last on surfaces? 
• Is there a cure for COVID-19? 
• How does it compare with seasonal flu? 
• How does the coronavirus spread? 
• Can people spread the coronavirus after they recover?

Originally published on Live Science. 

•  The 9 Deadliest Viruses on Earth 
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• 20 of the worst epidemics and pandemics in history

Homemade cloth masks aren't ideal, but given the present shortages of medical-grade protective gear in the midst of a pandemic, they may be the best option for some people.

The new coronavirus, named SARS-CoV-2, is a dangerous, airborne illness. It has already spread to 169 countries, including in the United States. Its rapid spread and a lack of preparation by government officials has left doctors, nurses and other frontline workers without access to the protective equipment necessary to defend themselves from the pathogen as they treat patients. It's also left the public without the option of masking up en masse to slow the spread of the disease.

In the past, infectious disease experts questioned the value of homemade cloth masks as a defense against viruses like the flu. But now those same experts are urging medical professionals who only have access to limited protective equipment to use homemade cloth masks if they have absolutely no other option. The Centers for Disease Control and Prevention (CDC) now recommends that health care providers with absolutely no other option use a bandana or scarf when treating patients with COVID-19, the disease caused by the new coronavirus. However,this should ideally be paired with a face shield, and even then, the impact on disease reduction is unknown. 

Related: 13 coronavirus myths busted by science

"It is a tragedy that so many countries have not done enough to stop this epidemic, and simultaneously failed to stockpile adequate PPE [personal protective equipment] supplies for health workers," said Raina MacIntyre, head of the Biosecurity Research Program at the University of New South Wales in Australia. "Other than the loss of lives in the community, we are losing doctors and nurses, who are cannon fodder, being forced to treat patients without PPE at all or in inadequate PPE."

MacIntyre led a study in Vietnam, published in the journal BMJ in 2015, which found that for  medical professionals treating the flu in Hanoi hospitals, cloth masks appeared to lead to more infections than medical masks. The cloth holds on to moisture, is often reused, and filters poorly compared to medical masks.

Still, MacIntyre told Live Science, if cloth masks are the only option available doctors should use them.

"When doctors are facing not having PPE, I think they should use whatever they can, and if it is homemade, it’s better than nothing," she said. "This is a life or death matter for them, and any barrier protection like a homemade mask will probably help, but, sadly, the outlook looks grim for the U.S. If the epidemic is spiraling out of control, hospital beds full, and health workers sick (and unable to work) or dead, this is a perfect storm. It is devastating."

Another study, published in 2013 in the journal Disaster Medicine and Public Health Preparedness, found that commercial surgical masks were three times as effective as homemade masks at preventing the spread of the flu. (Commercial surgical masks, the looser fitting fabric masks, are not as effective as specialized, tightly fitting N95 respirators at filtering out tiny virus particles, Live Science previously reported.)  It concluded that "a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection."

Anna Davies, lead author of that study and a researcher at the University of Cambridge in the United Kingdom, published instructions this March on how to make a homemade cloth mask.

"It is important to stress, however, that the wearing of face masks will only offer limited protection," she wrote, "and should not be considered sufficient protection. Additional preventative measures need to be adopted. These are detailed below:

"1) Avoid close contact with people who appear unwell and who have fever and cough.

"2) Cover your nose and mouth when coughing or sneezing, using a tissue when possible and disposing of it promptly.

"3) It is also important to wash your hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people and cleaning hard surfaces like door handles frequently using a normal cleaning product.

"4) If caring for someone with a flu-like illness, a mask may be worn to cover the nose and mouth to reduce the risk of transmission. The UK is looking at increasing its stockpile of masks for health care workers for this reason."

The full instructions for making homemade masks are available here, with the template referenced in the instructions available here. Davies stressed the users must read all instructions before beginning.

She concluded, "IMPORTANT: Remember to always wear your face mask in the same orientation, i.e., you should always have the same side facing outward (the contaminated side). Different colors used should help with this. Face masks should be machine-washed frequently to eliminate any residual flu particles, which may be contaminating the outside of the mask. Remove your mask by taking the straps from the back of your head and pull forward — do not touch the material part of the mask. If you do, please remember to wash your hands with soap and water before and after you touch your mask."

For individuals not in the medical field, as Live Science has previously reported, the number-one value of a mask is that it has the potential to help prevent you from spreading the virus to others. It is less likely to keep you safe. The best way to protect yourself, if you have the option, is to stay at home. Nonetheless, if you must go out, if you have access to a cloth mask, it may be worth using, according to the instructions above.

Coronavirus science and news

• Coronavirus in the US: Map & cases 
• What are the symptoms? 
• How deadly is the new coronavirus?
• How long does virus last on surfaces? 
• Is there a cure for COVID-19? 
• How does it compare with seasonal flu? 
• How does the coronavirus spread? 
• Can people spread the coronavirus after they recover?

Originally published on Live Science. 

•  The 9 Deadliest Viruses on Earth 
•  28 Devastating Infectious Diseases 
• 20 of the worst epidemics and pandemics in history

A small European study has found that the average man's beard is more replete with human-pathogenic bacteria than the dirtiest part of a dog's fur.

For the study, published in the February 2019 issue of the journal European Radiology, researchers analyzed skin and saliva samples from 18 bearded men (whose ages ranged from 18 to 76), and fur and saliva samples from 30 dogs (whose breeds ranged from schnauzer to German shepherd), at several European hospitals.

The researchers were looking for colonies of human-pathogenic bacteria in both man and dog — not in an attempt to beard-shame the hirsute masses, but rather to test whether it was safe for humans to use the same MRI scanners that dogs had previously used. [6 Superbugs to Watch Out For]

In fact, it was the humans who were the dirtier patients. Not only did the men's beards contain significantly more potentially-infectious microbes than the dogs' fur, but the men also left the scanners more contaminated than the animals.

"As the MRI scanner used for both dogs and humans was routinely cleaned after animal scanning, there was substantially lower bacterial load compared with scanners used exclusively for humans," the researchers wrote in the study.

To scan a dog

In their new paper, the researchers analyzed dogs that were scheduled for "routine" MRI scanner appointments to look for brain and spine disorders, the authors wrote. Because MRI scanners are too expensive for most veterinary clinics to own and operate, these tests were conducted at the radiology department of a European hospital that performs about 8,000 MRI scans of human patients every year.

The researchers swabbed each dog's mouth for bacteria samples, then took a simple fur sample by rubbing a special bacteria-collecting plate between each dog's shoulder blades (a "particularly unhygienic" spot where skin infections are regularly encountered, the researchers wrote). After the pooches completed their MRI scans, the researchers took samples from three spots in the scanner, too.

Meanwhile, the team also collected bacterial samples from the beards of hospital patients who were due for MRI scans of their own. The beardos were in relatively good health, and had not been hospitalized any time in the previous year.

My beard contains multitudes

The tests showed that all 18 men showed "high microbial counts" on their skin and in their saliva, whereas only 23 of the 30 dogs did, the researchers wrote.

Seven of the men and four of the dogs tested positive for human-pathogenic microbes — the kind of bacteria that can make a person ill if they colonize the wrong part of the host's body. These microbes included Enterococcus faecalis, a common gut bacteria that is known to cause infections (especially urinary tract infections) in humans, and several cases of Staphylococcus aureus, a common skin/mucous-colonizing bacteria that may live on up to 50% of all human adults, but can cause serious infections if it enters the blood stream.

Despite the comparatively higher microbial counts in this small sample of bearded men, the takeaway from this study isn't, "reach for that electric razor NOW, Rasputin!"; as the authors wrote, "there is no reason to believe that women may harbor less bacteriological load than bearded men."

Instead, it's that humans leave way more potentially-infectious bacteria behind in hospitals than you'd like to imagine — and simply sanitizing a surface is apparently not enough to solve the problem.

"The estimated number of healthcare associated infections (HAIs) in US hospitals was calculated to be approximately 1.7 million patients per year," the authors wrote. Around 100,000 people died as a result of those infections every year, the authors wrote.

"The central question should perhaps not be whether we should allow dogs to undergo imaging in our hospitals," the team concluded, "but rather we should focus on the knowledge and perception of hygiene and understand what poses real danger and risk to our patients."

• 11 Surprising Facts About the Immune System
• 10 Easy Paths to Self-Destruction
• Body Bugs: 5 Surprising Facts About Your Microbiome

Originally published on Live Science.

The next time you're at a hospital, you might want to think twice before touching the privacy curtains that hang around patient beds, a small new study finds.

That's because these curtains can become ridden with bacteria, including the nasty superbug methicillin-resistant Staphylococcus aureus (MRSA), in as little as 14 days, the study showed.

The finding highlights the need to launder or change privacy curtains in hospitals every two weeks, at the very least, the researchers in the new study said. [Tiny & Nasty: Images of Things That Make Us Sick]

"Maintaining a schedule of regular cleaning offers another potential way to protect patients from harm while they are in our care," Janet Haas, a nurse at Lenox Hill Hospital in New York City and the president of the Association for Professionals in Infection Control and Epidemiology, who wasn't involved in the study, said in a statement about the study.

Even though health care workers, patients and visitors frequently touch privacy curtains, these materials are rarely cleaned or changed, according to the study. Moreover, people are less likely to wash their hands after touching certain objects, such as hospital curtains, than they are after touching patients, the researchers wrote in the study, published in the September issue of American Journal of Infection Control.

However, no studies have looked at microbial growth on hospital curtains over time. So, the researchers in the recent study investigated by monitoring 10 freshly laundered hospital curtains: eight curtains in patient areas and two control curtains in nonpatient zones. The researchers tested two spots on each curtain for bacteria every few days for three weeks. (The spots tested were near the curtains' edges, where people tended to touch the curtains while entering and exiting the room.)

None of the rooms were occupied by patients with MRSA, the researchers noted. All of the testing happened in the Regional Burns/Plastics Unit at the Health Sciences Center, in Winnipeg, Canada.

The results, the researchers found, were concerning. By day three, the curtains showed increased microbial contamination. By day 14, five of the eight curtains tested positive for the MRSA superbug, which can be deadly, especially in people with weakened immune systems.

By the end of the three weeks, all eight of the curtains in patient areas exceeded contamination levels that are allowed for food-processing equipment in kitchens in countries such as the United Kingdom, the researchers said. In contrast, the control curtains, which were placed far away from patients, remained clean for the entire three weeks.

"We know that privacy curtains pose a high risk for cross contamination, because they are frequently touched but infrequently changed," study co-lead researcher Kevin Shek, a resident physician training at the University of Manitoba in Canada, said in the statement. "The high rate of contamination that we saw by the 14th day may represent an opportune time to intervene, either by cleaning or replacing the curtains."

Hospital curtains aren't the only seemingly innocuous items on the hook for contamination. Other research has shown that MRSA and other dangerous bacteria can also hitch a ride on the scrubs of health care workers, Live Science previously reported. 

Originally published on Live Science.

At hospitals around the world, staff dutifully slather on hand sanitizer to prevent the spread of infections. But now, at least one type of bacteria in hospitals appears to be growing more tolerant to alcohol-based hand sanitizers, a new study from Australia suggests.

The study focused on a bacterium called Enterococcus faecium, which is already resistant to some antibiotics and is a leading cause of hospital-acquired infections, such as urinary tract infections and sepsis. In fact, infections with drug-resistant E. faecium have been increasing in recent years, despite the growing use of hand sanitizers in hospitals, the researchers said.

The study found that over a nearly 20-year period, strains of E. faecium became better able to withstand alcohol-based hand sanitizer, meaning the sanitizer didn't kill the bacteria as well as it had before. [6 Superbugs to Watch Out For]

Still, the findings don't mean that hospitals should ditch the hand sanitizer.

"Alcohol-[based] hand-hygiene programs have been highly successful, particularly at controlling MRSA [methicillin-resistant Staphylococcus aureus], but also other types of hospital infections, and I would strongly advocate that we continue" using hand sanitizer, study co-author Dr. Paul Johnson, an infectious diseases professor at Austin Health in Victoria, Australia, said in a video about the study findings.

But to control certain pathogens, such as drug-resistant E. faecium, hospitals may need to add new measures, such as the use of other disinfectants, perhaps chlorine-based ones, the researchers said.

Withstanding alcohol

For the study, the researchers analyzed 139 samples of E. faecium bacteria collected between 1997 and 2015 from two hospitals in Melbourne.

Samples collected after 2010 were 10-fold more tolerant of alcohol-based sanitizers, compared with older samples, the researchers wrote in their paper, published Wednesday (Aug. 1) in the journal Science Translational Medicine.

The researchers analyzed DNA from the bacterial samples and found that the samples with more tolerance to hand sanitizers had several mutations in genes involved in metabolism. This resulted in increased resistance to alcohol.

The findings might explain the recent rise in drug-resistant E. faecium infections in hospitals, the researchers said.

Still, the researchers noted that because the study was conducted in only two Australian hospitals, more studies are needed to see if the same phenomenon is happening in other parts of the world.

"We are very keen to see whether the same patterns of alcohol tolerance are in [drug-resistant E. faecium] populations in other hospitals worldwide," study co-author Tim Stinear, a professor in the University of Melbourne's Department of Microbiology and Immunology, said in the video.

In addition, the researchers can't say for sure what's causing the bacteria's increased tolerance to alcohol. Although the findings suggest that the use of alcohol-based sanitizers in hospitals may play a role, it's possible that other factors, such as adaptations to better survive in people's guts, coincidentally led to increased alcohol resistance, Stinear said.

The researchers are now examining exactly how the genetic mutations found in this study cause increased tolerance to alcohol.

Original article on Live Science.

A hospital in Washington state is warning 2,600 patients that they may have been exposed to hepatitis C after being treated by a nurse who had the virus, according to news reports.

The nurse worked at MultiCare Good Samaritan Hospital in Puyallup, Washington, according to The News Tribune. Two patients, who were not at risk for the virus, later tested positive for it, after being treated by the nurse.

The hospital is offering free tests for hepatitis C and other contagious diseases to patients who received injections in the emergency room between Aug. 4, 2017, and March 23, 2018, and thus may have had contact with the nurse who had hepatitis C.

Hepatitis refers to inflammation of the liver that can be caused by a virus (hepatitis A, B and C are three of the viruses that can cause the disease), according to the Centers for Disease Control and Prevention (CDC). Hepatitis can also be caused by other factors, such as heavy alcohol use.

Hepatitis C is contagious and is spread primarily through contact with the blood of an infected individual, the CDC says. Most people become infected after sharing needles with a person who has the disease; less commonly, people can contract it from using items, such as other people's razors or toothbrushes, that may have traces of infected blood, according to the CDC.

A hepatitis C infection can be "acute," meaning it lasts several weeks to several months. However, 75 to 85 percent of people with the infection develop chronic hepatitis C, which can cause long-term health problems, including liver cancer, the CDC says. Some possible symptoms include fatigue, nausea and jaundice (a yellowing of the whites of the eyes or the skin). But most people don't have any symptoms, so they don't even know they have the disease.

According to the CDC, 15 to 25 percent of people with hepatitis C recover with no treatment during the acute phase of the infection. Anti-viral drugs are available to treat hepatitis C, but these drugs can be expensive, Live Science previously reported.

Unlike for the hepatitis A and B viruses, there is no vaccine to prevent infection with the hepatitis C virus, according to the CDC.

Originally published on Live Science.

Some patients at a Colorado hospital may be at risk for HIV or hepatitis infection after the hospital discovered an issue with the way it cleaned certain surgical instruments. But what, exactly, went wrong?

On Wednesday (April 4), the Colorado Department of Public Health and Environment (CDPHE) announced that it was investigating a sterilization "breach" at Porter Adventist Hospital in Denver. The breach may have affected patients who had orthopedic or spine surgery at the hospital between July 21, 2016, and Feb. 20, 2018, according to a statement from CDPHE.

"The process for cleaning surgical instruments following orthopedic and spine surgeries was found to be inadequate," and this may put patients at risk for infections of their surgical site, or for HIV, hepatitis B or hepatitis C infections, the statement said. Still, this risk is of contracting HIV or hepatitis is "very low," CDPHE said.

Specifically, Porter Adventist Hospital said the issue involved the "precleaning" process, which occurs before the instruments go through heat sterilization and other cleaning steps.

The precleaning process is the first step in cleaning after the instruments have been used. The process essentially involves manually cleaning off debris from the instruments after surgery, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, who is not involved with Porter Adventist Hospital or the investigation. [27 Devastating Infectious Diseases]

This step needs to take place so that there is nowhere for pathogens to "hide" during the sterilization process that follows. "If you’ve got debris in there, it might shield the viruses from being deactivated" by the sterilization process, Adalja told Live Science.

Adalja likened the precleaning process to rinsing off a plate before you put it in the dishwasher — if you've got food stuck to the plate when you put it in the dishwasher, it's not going to be fully cleaned when it comes out.

"You want to get the debris off so the cleaning process is more effective," Adalja said.

Even with this lapse, Porter Adventist Hospital said that the chance of getting an infection from a blood-borne pathogen, such as HIV or hepatitis, is "extremely low." But the hospital said it was notifying patients for transparency's sake, and to "ensure the safety and confidence" of their patients.

Patients who may have been affected by the breach are being given the option to get tested for blood-borne pathogens. So far, no infections related to the breach have been found, CDPHE said.

Original article on Live Science.

When you have the flu, one choice looms large in front of your feverish eyes: Should you drag your aching body out in the cold to go to the doctor or hospital, or should you just wrap yourself in blankets, drink fluids and stay put?

For sick people, there's no downside to going to the hospital or seeking care from a professional, said Dr. Amesh Adalja, an infectious-disease specialist and a senior scholar at the Johns Hopkins Center for Health Security. The antiviral drugs that can help people with the flu work better if they are prescribed early on, he said.

In deciding whether to head to the doctor's office or hospital, the main symptom that people should watch for is shortness of breath, Adalja told Live Science. [Flu Shot Facts & Side Effects (Updated for 2017-2018)]

"When someone is unable to breathe normally, that's a sign the flu may be progressing to pneumonia," and the person should definitely seek care, he said. Having difficulty breathing means that the infection has moved downward. Usually, the influenza virus infects the upper part of the respiratory tract, for example, the bronchi (the tubes that lead into the lungs), he said. If the infection moves down into the lungs and causes pneumonia, a patient can get worse very quickly.

Another sign of a particularly severe case of the flu that needs treatment is an unrelenting fever, Adalja said. If a person has a temperature of 101 degrees Fahrenheit (38.3 degrees Celsius) or higher, and the fever does not get better after taking acetaminophen or another over-the-counter medicine, then that person should see a doctor.

Fevers raise the heart rate, which takes a toll on the body, he said. Fevers can also make people feel especially miserable, so seek care if you feel that you cannot cope with your fever, he said.

A third reason to go to the doctor is a feeling of complete fatigue, to the point of being unable to do anything, and being completely confined to bed, he said.

Some groups of people are at higher risk of developing pneumonia or other complications from the flu, Adalja said. For example, pregnant women, people who have had organ transplants and cancer patients who are undergoing chemotherapy should strongly consider seeking care at the earliest signs of illness. In addition, people caring for young children or older adults should take them for treatment if they suspect the flu. Children under 6 months old, frail older adults and people with respiratory conditions such as severe asthma are at especially high risk of developing pneumonia during a flu infection, he said.

Doctors worry about pneumonia developing in flu patients because pneumonia impairs the lungs' ability to function, and the body may not be able to get enough oxygen. In severe cases, flu patients may develop a severe breathing problem called respiratory distress and need to be hospitalized and put on a mechanical ventilator, he said. [6 Flu Vaccine Myths]

People with the flu who choose to stay home should keep track of their symptoms. "Make sure you are getting better," Adalja said. If you're not — if it's getting harder to breathe, if the fever isn't going away or if it's getting more and more difficult to do daily activities — then get to a medical professional, he said.

It may be helpful even to simply call your doctor if you're feeling sick, he noted. During flu season, doctors know that most people with certain symptoms have the flu, so they are often willing to call in a prescription for antiviral medicine to a pharmacy without requiring a patient to first come to the office.

So far this year, the U.S. is experiencing a relatively harsh flu season.

In recent years, the number of influenza-related deaths in the U.S. has ranged from 12,000 (during the 2011-2012 season), to 56,000 (during the 2012-2013 season), according to the Centers for Disease Control and Prevention.

Original article on Live Science.

A visit from a golden retriever can brighten a person's day when in the hospital or in a senior-care facility. But the policies for pet therapy programs in health care facilities may fall short in protecting the people and pets involved, a new study suggests.

Researchers found that hospitals typically had stricter health and safety policies for animal-visitation programs than eldercare facilities did. Those facilities tended to have fewer requirements to confirm that visiting pets were healthy and had up-to-date immunizations, for example. The findings were published online (June 19) in the American Journal of Infection Control.

The facilities surveyed didn't always have strong policies in place to ensure that their animal therapy programs were safe and effective for both the participants and the visiting animals, said veterinarian Deborah Linder, the lead author of the study and associate director of the Tufts Institute for Human-Animal Interaction at Tufts University in North Grafton, Massachusetts. [10 Things You Didn't Know About Dogs]

People at health care facilities often assume that therapy-animal organizations have liability insurance, strong training programs for the animals, and testing standards for both the animals and their handlers, as well as rigorous health and grooming requirements for the animals, Linder told Live Science. But the new findings show that this is not always the case, she said.

Previous studies have shown that animal therapy programs can have several health benefits: They may reduce participants' blood pressure, improve mood and calm people with dementia. 

Even though these positive effects usually exceed any potential dangers posed by the animals, pet therapy programs can carry some risks, the researchers said. Not everyone likes animals, some people are allergic to them, and some pets may bite or transmit disease to individuals with weakened immune systems, according to the study authors.

Another drawback is that although animal visitation programs have become increasingly popular in the United States, there are no national requirements for therapy-animal organizations that provide the services or the facilities that host the animals.

To find out more about these policies and procedures, the researchers conducted two surveys: one of hospitals and senior care facilities and a second of the therapy-animal organizations that arrange the visits. Using phone or email, the researchers contacted 45 hospitals, 45 eldercare facilities (independent-living communities, assisted-living centers and nursing care facilities) and 27 therapy-animal organizations from nine states in different regions of the country.

Benefits and risks

The researchers found that 16 percent of hospitals and 40 percent of eldercare facilities required written confirmation that the therapy animal was healthy, while 4 percent of hospitals and 22 percent of eldercare facilities accepted a verbal confirmation of the pet's health. In addition, 4 percent of hospitals and 22 percent of eldercare facilities surveyed had no requirements for documentation of the animals' health, the study found. 

Only 7 percent of a facilities required that an animal and its handler meet with a facility administrator before interacting with any patients so the administrator can assess the appropriateness of the animal's behavior. [6 Secrets to Unlocking Your Cat's Personality

Pet therapy programs may allow participants to walk or play with the animals or let the pets sit on their laps. But the study found that 26 percent of the programs did not require that the animals have a veterinary exam, and 7 percent did not even require visiting pets to have rabies vaccinations. 

This study is not meant to discourage facilities from developing and holding animal visitation programs, Linder said. But she encouraged the facilities to ask questions and create policies that safeguard themselves, their residents and the participating animals.

Health care facilities and animal therapy organizations can put animals and people at risk by failing to follow strict health and safety policies, Linder said. She said she doesn't believe lax policies are intentional, but instead may result from an enthusiasm for pet therapy programs and limited awareness of the potential risks.

It's not just that obvious problems can occur, such as animal bites and allergies, Linder said. Risks can also arise from a visiting animal spreading infections due to diet or inadequate grooming, she said. Problems may even arise because unwanted stress placed on the animals from participating in the program leads to behavioral issues, she explained.

For example, a new trend among pet owners is feeding animals a "raw meat diet." But raw meat may be contaminated with bacteria such as Salmonella, and if pet therapy animals have consumed this meat, they could pose a risk to people in health care facilities who have weakened immune systems, Linder said. [America's Favorite Pets]

Checking on health and safety policies can cover everything from asking about rabies vaccinations and ensuring the visiting animal's temperament is suitable for a pet visitation program to confirming annual veterinary screenings and the training received by the therapy animal and the volunteer handler. Linder also recommended asking the animal therapy organization about its liability insurance coverage as well as how often it tests and evaluates the therapy animal and volunteer handler.

Some animal therapy organizations have rigorous standards for their programs, but this study shows that not all of them have the same standards, Linder noted.

If facilities and organizations want to develop an animal visitation program, Tufts Paws for People, the veterinary school's therapy animal program, has created a free manual that offers step-by-step instructions for creating one, including appropriate questions to ask before hosting the activity, Linder said.

Originally published on Live Science.

In the first study of its kind, researchers have conducted a yearlong survey of the bacteria in a newly constructed hospital, starting two months before the facility opened and continuing over the next 10 months.

Initial results of the Hospital Microbiome Project, published today (May 24) in the journal Science Translational Medicine, provide an unprecedented map of the microbial communities that inhabit a hospital — on the patients, the staff and the surfaces. The study also gives researchers foundational information that could improve the understanding of hospital-acquired infections, the researchers said.

"We are mapping a new world in the hospital so that we can understand the trade routes, if you will, of microbes moving in that space," said study senior author Jack Gilbert, director of the Microbiome Center at the University of Chicago. [Body Bugs: 5 Surprising Facts About Your Microbiome]

The map of the hospital, the Center for Care and Discovery at the University of Chicago Medicine, is not a typical two-dimensional projection of a physical space, Gilbert said. Rather it is a "multidimensional, mathematical hypervolume of interactive space."

The map shows not only where the microbes are, but also how they tend to move around. "It helps me to see the pathway by which things move, so I can use that information to understand the dynamics of interacting organisms much more readily."

Those dynamic interactions occur because in general not a day goes by when a person is not picking up organisms from one place and dumping them in another, Gilbert said. In the microscopic world of microbial communities, some organisms gain a foothold in one place and die in another, and they can even evolve into antibiotic-resistant organisms, such as Staphylococcus aureus andStaphylococcus epidermidis, he said.

Over the course of the year at the hospital, Gilbert and his team focused on 10 noncritical carerooms on two different floors and two nurse stations, one that provided care to surgical patients and another that provided care to cancer patients. In the rooms, the researchers collected samples from multiple surfaces, including the floor, bed rail, door handles and phones.

Patients who gave consent were also swabbed, with samples taken from hands, nostrils and armpits. Finally, the nursing staff allowed samples to be taken from their hands, gloves and shoes, as well as from countertops, pagers, shirts, chairs, computers, landlines and cellphones.

In all, the researchers collected 6,523 microbial samples from 252 patients.

From the very beginning, the team saw interesting trends, the researchers said. Before the hospital opened on Feb. 23, 2013, most of the bacterial organisms in the building were those commonly found in the soil and water, such as Acinetobacter and Pseudomonas.

But after the hospital opened, the soil and water microbes were quickly replaced by those typically found on human skin, such as Corynebacterium, Staphylococcus and Streptococcus.

The staff disinfected rooms daily with an ammonium cleaning solution, and after a patient wasdischarged, the room was cleaned with bleach. Despite this, some microbes survived. [5 Ways Gut Bacteria Affect Your Health]

"You've got this horribly alien environment. It's basically raining humans and animals and plants down onto a volcanic island," Gilbert said. "It's a horrible environment, and only a few [microbes] are ever going to survive."

Those that lived tended to move from a room's surfaces onto a new patient on that person's first day in the hospital, the study found. By the second day, though, the patient's own microbes began colonizing the room's surfaces, replacing the bacteria from the previous person. 

Gilbert and his team said they encountered a couple of surprises: During the heat and humidity of summer, staff members shared more bacteria with one another.

The scientists also found that different surfaces contained different kinds of microbes. The organisms on telephones were different from those on door handles and computer mice. This shows that although bacterial organisms come from common sources, each of the microenvironments somehow selects for distinct microbes, Gilbert said.

"That helps us consider the different surface materials and what their impact could be on the ecosystems," he said.

This information could provide a foundation for future studies that look specifically at infections that patients acquire after being admitted to a hospital, Gilbert added. 

For 92 patients in the study who were in the hospital for months, some potentially harmful bacteria, including Staphylococcus aureusand Staphylococcus epidermidis, acquired genes associated with antibiotic resistance, the study said. Although the patients did not acquire infections, microbes with antibiotic resistance genes were present in the room in numbers that were greater on surfaces than on skin. [6 Superbugs to Watch Out For]

Most of the microbes that Gilbert and his team found were benign, though, and unlikely to cause any problems. 

"If anything, this study is an education to all of the germaphobes out there," Gilbert said. "You're swimming in bacteria and most of them are dead, but there's a lot of them that are alive and there's not much you can do about it."

Originally published on Live Science.

Where the bodies are buried

Built in 1855, the Mississippi State Insane Hospital housed an estimated 35,000 patients over a span of 80 years, until it was shuttered in 1935. Experts suspect that as many as 7,000 of the asylum's former patients are buried in unmarked graves under what is now the University of Mississippi Medical Center (UMMC).

Exhuming coffins

In 2012, construction workers unearthed 66 coffins while preparing to build a new road on the UMMC campus.

Respectful removal

Anthropologists from Mississippi State University respectfully and ethically removed and documented skeletal remains found in 2012, following guidelines established by the Mississippi Department of Archives and History in Jackson.

Highly compressed

The pine coffins that held the human remains found in 2012 measured about 6 feet (1.8 meters) in length, but were unusually narrow, probably because they were compressed over decades by the soil's weight.

Valuable insights

“Human remains represent archives and sources of information about human health and disease, and life experiences in the past that cannot be gotten from any other source of information,” Molly Zuckerman, an assistant professor in Mississippi State University’s Department of Anthropology and Middle Eastern Cultures, said in a statement.

Bird's eye view

An aerial view of UMMC's 20-acre campus, where radar scans of the grounds detected as many as 7,000 buried bodies that were buried during the 18th and 19th centuries.

Asylum grounds

A map shows the layout of the buildings that were part of the Mississippi State Insane Hospital, which closed in 1935. According to hospital records, approximately 9,000 of the asylum's residents died during its 80-year history.

High mortality

Between 1855 and 1877 alone, 1,376 patients were admitted to the Mississippi State Insane Hospital. One in five of those people died, from ailments including "softening of the brain," "nervous exhaustion" and "chronic diarrhea," according to hospital records.

Anonymous remains

Patients that died while under the care of the Mississippi State Insane Hospital were buried in unmarked graves, making it next to impossible for archaeologists to identify them today.

Hidden graveyard

Radar scans revealed the location of thousands of bodies buried in wooden coffins under UMMC's campus.

Original cemetery

The Mississippi State Insane Hospital's buildings, marked here in blue, were located hundreds of yards from the area where patients' bodies were buried, shown here in red.

An estimated 7,000 bodies are thought to be buried under The University of Mississippi Medical Center (UMMC), according to radar scans of the campus grounds.

Construction workers first discovered some of the unidentified human remains under the university in November 2012 while preparing to build a new road on the campus. University officials described the discovery of the 66 corpses in a statement published online in April 2013, noting that the workers had uncovered wooden coffins containing human remains dating to the 19th and 20th centuries. The remains were thought to be those of former patients at the Mississippi State Insane Hospital, an asylum for people with mental illnesses, which operated on that site from 1855 to 1935, according to the statement.

Then, in 2014, radar scans of land to the west of the UMMC School of Dentistry yielded another grim surprise: 2,000 more bodies, The Clarion-Ledger reported in March of that year. And more recent scans now place the current estimate of human bodies under UMMC at around 7,000 people, distributed across 20 acres of grounds, UMMC officials announced yesterday (May 9) in a statement. [See Photos of the Excavations that Uncovered 'Insane Hospital' Bodies]

Exhuming and reburying 7,000 bodies could be very expensive — about $3,000 per corpse, or a total of about $21 million — and UMMC is currently investigating options that could relocate the bodies and create both a memorial center and a dedicated lab for analyzing the remains, UMMC representatives added. 

Records indicate that the State Insane Hospital housed as many as 35,000 patients between 1855 and 1935, and up to 9,000 of its residents died on the site during its 80-year history. Between 1855 and 1877 alone, 1,376 patients were admitted. One in five died, from ailments including "softening of the brain," "nervous exhaustion" and "chronic diarrhea," according to The Clarion-Ledger.

Studying the remains of people who lived and died long ago can provide pathologists with unique insights into human health and disease, Molly Zuckerman, assistant professor of anthropology and Middle Eastern culture at Mississippi State University, said in a statement.

In addition to analyzing the skeletons themselves, archaeologists will investigate the age and composition of the wood coffins, which could also hold clues about the bodies that were buried in them, UMMC officials said in the statement.

The coffins, all of which are pine boxes of the same design, are extremely narrow — likely because they were compressed over decades by the weight of the soil, according to UMMC representatives.

Archaeologists working with the 66 bodies recovered between 2012 and 2013 emphasized the importance of handling and analyzing these anonymous skeletons with dignity and care — courtesies that their owners might not have received in life, Zuckerman said in a statement published in April 2013.

"Asylums in [the] late 19th century or early 20th century probably weren't salubrious places to live, so it matters to us to be able to exhume these people in a very respectful and ethical manner," Zuckerman said.

The names and stories of these thousands of people, interred in unmarked graves, may never be revealed. But experts are already working to ensure that the patients will not be forgotten.

Faculty from UMMC and other institutions recently formed the Asylum Hill Research Consortium (AHRC) to help guide the respectful relocation of the bodies and the creation of a memorial that would be open to the public, according to an AHRC overview that Ralph Didlake, director of the Center for Bioethics and Medical Humanities at UMMC and a member of the consortium, shared with Live Science.

"If we exhume the remains and rebury them off site, what we would have at the end of that process is a cemetery," Didlake said in a statement. "But with the project we're proposing, we will have not only a respectful memorial for these individuals, but we will have an education platform and a research resource."

The AHRC also hopes to assist in assembling resources for analyzing the recovered bodies, and to provide educational resources that could help bring the long-buried history of the state asylum and its patients to light, according to the overview.

Original article on Live Science.

Marathons are exciting for runners and spectators alike, but for people in the community who simply need to get to the hospital on a race day, the events may be hazardous, according to a new study.

The study found that when cities host marathons, residents who have a heart attack on the day of a marathon take nearly 5 minutes longer to get to the hospital and are more likely to die in the following weeks than people who have a heart attack on other days.

The findings suggest that road closures and other disruptions to city infrastructure during marathons may delay hospital care for patients and result in a higher risk of death for people who experience acute heart problems on those days, the researchers said.

"Large public events may disrupt access to timely medical care for both participants and nonparticipants of these events," the researchers wrote in today's (April 13) issue of the New England Journal of Medicine. "Our study suggests that a citywide strategy for emergency medical preparedness should consider the risks not only to event participants but also to others whose care may be delayed." [5 Most Amazing Marathon Feats]

For the study, the researchers analyzed information from Medicare recipients ages 65 and older who were hospitalized with a heart attack or cardiac arrest in 11 U.S. cities that hosted marathons from 2002 to 2012. (The cities were Boston; Chicago; Honolulu; Houston; Los Angeles; Minneapolis; New York City; Orlando, Florida; Philadelphia; Seattle; and Washington, D.C.) The researchers also analyzed information on hospitalizations that occurred on the same day of the week as the marathon, but five weeks before or five weeks after the marathon event. In total, their analysis included 121 marathon dates (in 11 cities over 11 years) and 1,210 non-marathon dates.

The researchers found that, among the people who were hospitalized with a heart attack or cardiac arrest on the day of a marathon, about 28 percent died within the following month, compared to 25 percent who were hospitalized on the non-marathon days.

When the researchers looked at hospitals outside of the areas where the marathons were held that were not affected by the marathon traffic or closures, they found there was no difference in the percentage of deaths among those hospitalized on marathon days versus non-marathon days.

Finally, when the researchers looked at how long it took for ambulances to take patients to the hospital, they found that on the morning of a marathon, ambulances took 4.4 minutes longer on average to get to the hospital than on non-marathon dates.

"Taken together, our findings suggest that road closures, diversion of ambulance resources and ensuing delays in hospital care may explain the higher mortality that we observed among patients" on marathon days versus non-marathon days, the researchers said. [Why Are Marathons 26.2 Miles Long?]

The researchers noted that although they found a link between marathons and higher mortality rates among patients, their study cannot definitively prove that the delays in care resulting from marathon were the cause of this higher death rate.

The researchers also don't know for certain if some people were hospitalized as a result of running the marathon, but they took several steps to account for this. They focused on an older population of Medicare patients who typically had multiple chronic conditions and so would be unlikely to participate in a marathon. They also looked at local newspapers for any cases of deaths among marathon runners and found no evidence that the rate of death among runners was different before or after the marathon.

Original article on Live Science.

Drug-resistant bacteria can lurk in the pipes of hospital sinks, and a new study shows that these dangerous bacteria can also make their way out of sinks and continue on to reach patients.

A number of recent reports have found that drug-resistant bacteria grow in the drainpipes of hospital sinks, according to the study, published today (Feb. 24) in the journal Applied and Environmental Microbiology. "The wet, humid and relatively protected environment" of the drainpipes makes for an ideal breeding ground for bacteria, the researchers wrote.

In addition, many reports have also found a genetic link between the pathogens in hospital drainpipes and the pathogens in patients, they wrote. In other words, the same bacteria found in the drainpipes have been found in infected patients. [6 Superbugs to Watch Out For]

But it was unclear how these pipe-dwelling bacteria ended up infecting patients, considering patients don't come into direct contact with the insides of drainpipes.

To trace the path from pipe to patient, the researchers built a lab with five identical hospital sinks that were all connected via plumbing. It was "the only sink lab we are aware of in the U.S.," senior study author Dr. Amy Mathers, an associate professor of medicine and pathology at the University of Virginia School of Medicine, said in a statement.

The researchers began by colonizing the elbow of the drainpipe — also called the P-trap — in one of the sinks with Escherichia coli bacteria. For the first two weeks of the experiment, the researchers occasionally ran water from the faucet, and they did not observe much bacterial growth. But after two weeks, they stopped turning on the faucet, and instead added nutrients to the drainpipe, based on what they predicted would be found in a hospital, such as intravenous fluid, feeding supplements and leftover beverages.

The nutrients jolted the E. coli into action: The researchers observed that the nutrient-fed bacteria colony grew at an average rate of 1 inch (2.5 centimeters) a day, reaching the sink strainer after just one week.

And the bacteria didn't only grow upward, toward the sink; they also grew along the pipes that connected the five sinks. (The sinks in the researchers' lab were all in a row.) Seven days after the E. coli in a sink at the end of the rowwas given nutrients, the researchers found bacteria in the pipes of the next three sinks in the row. Only the sink on the opposite end of the row didn't have bacteria in the pipe. Moreover, one week after that, the bacteria had grown up to the sink strainer in two more sinks, they found.

But the question of how the bacteria could reach a patient still remained. [Tiny & Nasty: Images of Things That Make Us Sick]

To see how the bacteria spread further, the researchers placed a number of petri dishes in areas around the sink — including the countertop, the sink bowl, the faucet and the faucet handles — and ran the water. They found that running the faucet when there was E. coli in the sink strainer caused the bacteria to be dispersed to petri dishes up to 30 inches (76 cm) away. In other words, the bacteria are splattered around the sink, and can be picked up by hospital workers or patients.

In the dispersion experiment, the researchers noted that the highest concentrations of bacteria were found closer to the faucet, which may be due to the specific design of the sink bowl and the faucet used in the study. This is important, as many hospital sinks have similar designs, the researchers wrote.

An understanding of how the bacteria are spread is important, Mathers said, as it gives researchers the opportunity to "develop and test potential intervention strategies that can be used to prevent further spread."

Originally published on Live Science.

Older patients who are treated by female doctors after being admitted to a hospital may be slightly less likely to die within a month of their admission than those who are treated by male doctors, according to a new study.

Researchers found that patients who were treated by female doctors had a 4 percent lower risk of dying within a month of being admitted to a hospital than those who were treated by male doctors. Moreover, these patients were 5 percent less likely to be readmitted to a hospital within a month, the researchers found.

More research is needed to understand why exactly patients treated by female doctors have lower mortality rate, study co-author Dr. Ashish Jha, a professor of health policy at Harvard T.H. Chan School of Public Health, said in a statement. [The Odds of Dying from Shark Attacks, Tsunamis & Dozens of Other Causes]

But previous research has suggested that there are differences between how male and female physicians practice medicine, Jha said. For example, studies have shown that female doctors may be more likely to adhere to clinical guidelines, provide preventive care and communicate with their patients more effectively than male ones, according to the study, published today (Dec. 19) in the journal JAMA Internal Medicine.

The new findings add to that research because Jha and his colleagues looked at actual patient outcomes. The results "suggest that those differences matter and are important to patient health," Jha said.

In the study, the researchers examined data on 1.5 million hospitalizations of more than 620,000 men and 960,000 women who were on Medicare and were admitted to U.S. hospitals for various conditions between 2011 and 2014. All of the patients were at least 65 years old, and their average age was 80, according to the study. During these hospitalizations, the patients in the study were treated by a total of about 60,000 doctors, including about 20,000 female doctors and about 40,000 male doctors.

The researchers looked at the relationship between the gender of the doctors who treated the patients and these patients' risk of death and needing to be hospitalized again within 30 days of their original admission.

The findings that the patients treated by female doctors were less likely to die or be hospitalized again are especially important in light of previous research that showed disparities between salary and promotion prospects of female and male doctors in academic medicine, said Dr. Anna Parks, a resident physician at the University of California, San Francisco, who co-authored an editorial accompanying the new study and published in the same journal. [Busted! 6 Gender Myths in the Bedroom & Beyond]

For example, one study showed that female physicians at academic centers earn an average of 8 percent less than male physicians at those centers, according to the editorial.

Some people have speculated that female academic physicians may be burdened by additional home responsibilities than their male colleagues, which supposedly may lead women to provide inferior care, Parks said.

"I think that this study is one piece of the puzzle to combat that claim," Parks told Live Science.

Originally published on Live Science.

For patients facing serious illnesses, dying isn't necessarily the thing they dread the most — according to a new survey, a majority of patients consider bowel and urinary incontinence and having to rely on a breathing machine to be fates worse than death.

In the survey, researchers asked 180 patients with serious illnesses if they considered 10 different health states, ranging from being unable to get out of bed to being in a wheelchair, to be better or worse than dying. The results were published today (Aug. 1) in a research letter in the journal JAMA Internal Medicine.

Avoiding death is often the main goal for doctors and patients, the researchers, led by Dr. Emily Rubin, a fellow in pulmonary and critical-care medicine at the University of Pennsylvania, wrote in the letter. But "despite this general preference," studies have shown that a large minority, and in some cases a majority, of healthy patients consider states such as severe dementia to be "worse than death," the researchers wrote. [The 10 Deadliest Cancers and Why There's No Cure]

For each of the health states in the survey, the researchers asked the patients to rank the condition on a five-point scale, as either worse than death, neither better nor worse than death, a little better than death, somewhat better than death, or much better than death.

All of the patients in the survey were ages 60 older and had serious illnesses, including advanced forms of cancer and heart failure, according to the researchers.

They found that more than half of the patients considered bowel and bladder incontinence and relying on a breathing machine to live to be health states worse than death. In addition, more than half of the patients considered being unable to get out of bed, being confused all the time, having to rely on a feeding tube to live, and needing care all the time to be either worse than, or the same as, death.

The state that the majority of the patients ranked as "much better than death" was being in a wheelchair, the researchers found. Less than 5 percent of the patients ranked being in a wheelchair as a condition worse than death, according to the study.

More than three-quarters of the patients ranked being at home all day and being in moderate pain all the time as either much better than death, somewhat better than death, and a little better than death.

And more than 50 percent of the patients considered living in a nursing home to be better than death, while the remaining patients thought it was the same or worse than death, the researchers found.

When patients in the hospital are facing serious illnesses, they are often at a high risk for ending up in many of the health states that the researchers included in the survey.

But many hospitals assume "implicitly or explicitly that death is an outcome to be avoided no matter what the alternatives are," the researchers wrote.

There are many reasons why patients in hospitals receive care to prolong life even when they are living in states that they have deemed to be the same or worse than death, according to the researchers. For example, patients may change their preferences as death nears, or they may believe that their health will be restored, the researchers wrote. In addition, doctors may not offer options that are consistent with what the patient wants, they added.

But patients may also underestimate their abilities to adapt to certain health states, the researchers wrote. It's possible that these "once-feared states" may become more tolerable once they have been experienced, they said.

The researchers noted that while there are some limitations to the study (for example, it was carried out in just one health-care system), the findings suggest that more research is needed to improve patient outcomes. 

The patients completed the survey between July 1, 2015, and March 7, 2016.

Originally published on Live Science.

Breast-feeding mothers are now getting more support from hospitals, according to a new report from the Centers for Disease Control and Prevention (CDC).

In 2013, over half of the hospitals in the United States were meeting at least five of 10 common recommendations for hospitals to support breast-feeding, up from 29 percent of hospitals that met that many recommendations in 2007.

Breast-feeding is the most effective way for babies to get the best nutrition, and hospitals play a major role in supporting moms who want to breast-feed, Dr. Tom Frieden, director of the CDC, said at a news conference today (Oct. 6).

However, of the nearly 4 million newborns in the United States each year, only 14 percent are born in hospitals that have won the designation of "Baby-Friendly," for meeting all 10 of the recommendations, Frieden said. Although that number has tripled in recent years, there is still much progress to be made, he said. [7 Baby Myths Debunked]

The 10 recommendations — which were written by the World Health Organization and UNICEF and also promoted by the CDC — include educating pregnant women on the benefits and management of breast-feeding and helping new mothers initiate breast-feeding within 1 hour of giving birth.

The percentage of U.S. hospitals that offer prenatal breast-feeding education increased from 91 percent in 2007 to 93 percent in 2013, according to the report. And the percentage that offer to teach breast-feeding techniques to new moms increased from 88 percent to 92 percent over the same period, according to the new report.

In addition, the percentage of hospitals that help moms quickly initiate breast-feeding following birth increased to nearly 65 percent in 2013, up from 44 percent in 2007.

Frieden highlighted the importance of beginning breast-feeding early.

The first few days of life create a pattern for breast-feeding, he said. Breast-feeding a newborn can also help the baby's immunity, because breast milk is rich in antibodies, Frieden added.

Cria Perrine, an epidemiologist in the CDC's Division of Nutrition, Physical Activity and Obesity, gave another reason for starting breast-feeding early: It operates like supply and demand. Mothers need to start breast-feeding right away to establish their supply of milk, she said. If the baby doesn't breast-feed, there's no demand, so the supply goes away, she said.

The report also revealed areas in which hospitals still need to improve.

For example, just 26 percent of hospitals ensured that only breast milk was given to healthy infants (those who did not need formula for a medical reason) in 2013, Frieden said. Giving infants even a little formula, instead of breast milk, may undermine the benefits of breast-feeding, he said.

"Sometimes we see an overzealousness in providing formula," perhaps due to excessive concern from hospital staff, he said. For example, a caretaker may fear that an infant will become dehydrated if he or she doesn't drink formula, he said.

The report also found that only 32 percent of hospitals in 2013 provided enough support for breast-feeding moms after they left the hospital, including follow-up visits and phone calls, Frieden said.

Both Frieden and Perrine stressed the importance of continued support for breast-feeding mothers after they leave the hospital.

In a survey of mothers throughout the year after they gave birth, 60 percent reported that they stopped breast-feeding earlier than they had wanted to, Perrine said.

The reasons the mothers gave for stopping breast-feeding were often related to problems that developed early on, such as pain, difficulties with getting the baby to latch on and thinking they weren't producing enough milk, she said. The early period in the hospital and after leaving the hospital are critical times to address these issues, she said.

The benefits of breast-feeding

The American Academy of Pediatrics recommends that babies be exclusively breast-fed for the first six months of life. However, most mothers do not follow this recommendation, including some who want to follow it, but find they cannot.

There remains a stigma around breast-feeding. For example, a 2011 study found that despite the health benefits associated with breast-feeding, women who chose to breast-feed were viewed as "less competent" than women who did not breast-feed. The health benefits linked to breast-feeding include reduced risk of infections, asthma and obesity for the baby, and a reduced risk of breast and ovarian cancer for the mom.

Follow Sara G. Miller on Twitter @SaraGMiller. Follow Live Science @livescience, Facebook & Google+. Originally published on Live Science.

A visit from a furry companion can give comfort to patients in the hospital, but new guidelines recommend that only dogs — and not cats — be allowed in hospitals for pet therapy programs.

The guidelines, from the Society for Healthcare Epidemiology of America (SHEA), are aimed at reducing the potential risks from having animals in hospital facilities.

In recent years, it has become more common for hospitals to allow the presence of animals, such as service animals, trained therapy animals, personal pets and research animals. However, little is known about the risks that animals in hospitals may pose in terms of transmitting diseases to people, and hospital policies on animal visits vary widely among institutions, SHEA says.

"While there may be benefits to patient care, the role of animals in the spread of bacteria is not well understood. We have developed standard infection prevention and control guidance to help protect patients and health care providers," Dr. David Weber, a lead author of the recommendations, said in a statement.

To devise the new guidelines, a committee of experts reviewed information from studies on animals in health care settings, as well as existing hospital policies and a survey of more than 300 SHEA members.

For pet therapy, the guidelines recommend that only dogs that are at least 1 year old be used. "Cats should be excluded," the guidelines continue, "because they cannot be trained to reliably provide safe interactions with patients in the health care setting." What's more, people are more likely to be allergic to cats than to dogs, and cats may pose an increased risk for bites and scratches compared to trained dogs, the recommendations say.

The guidelines also say that the dogs used in pet therapy programs should undergo formal training and evaluation for their behavior in a health care setting, before they are allowed to visit; the dogs' handlers should also undergo formal training. Hospitals should consider using animals that have been certified by pet therapy training organizations, the guidelines said.

Pet therapy animals should also be evaluated by a veterinarian once per year, and should be vaccinated against rabies. They should be combed before entering the hospital to remove as much loose hair and dander as possible, and should avoid contact with invasive devices (such as catheters), bandages or parts of the body with damaged skin, the guidelines say. In addition, patients should not eat or drink while they play with the animals, and any people who touch the animals should wash their hands before and afterward. [7 Surprising Health Benefits of Dog Ownership]

In general, hospitals should prohibit their patients' personal pets from visiting the facility, the guidelines say. Personal pets don't usually have the same formal training as therapy animals, and it may be hard to prevent patients other than the owner from encountering a visiting pet.

But there can be exceptions if doctors determine that a pet visit would benefit the patient, and that it can happen with limited risk to the owner and other patients, the guidelines say. Doctors might consider allowing a pet visit in cases of a terminally ill patient, a patient who has been hospitalized for a long time or patients who have close bonds with their pets.

As with therapy animals, pet visits should be restricted to dogs, the guidelines say. Pets generally should not be allowed to visit patients in isolation, patients in the intensive care unit (IUC) or those who have recently undergone organ transplants.

There have been very few studies on whether animals in hospitals can transmit diseases. But a 2006 study of 100 dogs in hospitals in Ontario found that about 80 percent of those animals carried potentially harmful bacteria, including Clostridium difficile and Salmonella. However, the study did not look at whether the animals could transmit the diseases to patients, and in the United States, the Centers for Disease Control and Prevention has never received a report of an infection related to pet therapy, according to the Mayo Clinic.

Because of the lack of information about risks from pets in hospitals, the new guidelines should be viewed as "suggested actions to consider in the absence of a recognized standard or regulation," the authors said.

"Adoption and implementation of these recommendations (including allowing the use of cats) should occur at the discretion of individual institutions based on a risk assessment for their patients," Dr. Rekha Murthy, a co-lead author of the guidelines, told Live Science in an email.

The new guidelines are intended only for acute care hospitals and ambulatory care facilities, and not for assisted living facilities or nursing homes.

The guidelines were published Monday (March 2) in the journal Infection Control & Hospital Epidemiology.

Follow Rachael Rettner @RachaelRettner. Follow Live Science @livescience, Facebook & Google+. Original article on Live Science.

"Superbug" bacteria that are resistant to antibiotics have the potential to create a nightmare scenario for modern medicine, but experts are hopeful that doctors will be able to slow the spread of these scary infections, by both traditional means and new innovations.

Recently, a Los Angeles hospital announced that more than 100 patients treated there had potentially been exposed to CRE, or carbapenem-resistant enterobacteriaceae, bacteria that are resistant to many antibiotics. The bacteria appear to have contaminated a piece of medical equipment used at the facility called an endoscope, which is a flexible tube that doctors use to view the digestive tract. Seven patients at the hospital were infected with CRE after they underwent an endoscopy with the device.

Endoscopies are generally considered to be low-risk procedures, but two of the patients died from their infections, the hospital said.

As antibiotic-resistant bacteria like CRE become more common, they threaten the safety of modern medicine, because they can make routine procedures more risky, experts told Live Science.

"Lots of procedures that go on in hospitals ... are made safer because we use antibiotics," said Dr. Amesh Adalja, an infectious disease specialist and a senior associate at the University of Pittsburgh Medical Center's Center for Health Security. "If antibiotic resistance continues to increase, all of the stuff that’s part of modern medicine and done routinely will become more dangerous," Adalja said.

CRE have been dubbed "nightmare" bacteria, because they are resistant to nearly all antibiotics, and they can be highly lethal, killing up to 50 percent of infected patients, according to the Centers for Disease Control and Prevention.

CRE infections first appeared in the United States only in 2001, and have increased in recent years. A CDC study found that in 2012, nearly 5 percent of U.S. hospitals, and 18 percent of long-term care facilities reported having at least one patient with CRE. [6 Superbugs to Watch Out For]

To reduce the spread of CRE and other superbugs, it's important for doctors to change how they use antibiotics, and for researchers to come up with new alternatives to fight these infections, experts said.

'Nightmare' bacteria

CRE are essentially "normal" bacteria that have acquired the ability to produce enzymes that work against most antibiotics. These CRE enzymes can even counter antibiotics that doctors generally use as a "last resort" to treat bacterial infections. "Our toolbox against CRE is very small," Adalja said.

Bacteria naturally produce such enzymes as a defense against other bacteria. Scientists have found genes that confer resistance to antibiotics even in environments were there have never been any humans, said Dr. Jesse Goodman, director of Georgetown University's Center on Medical Product Access, Safety and Stewardship. When doctors use antibiotics frequently, it spurs bacteria to activate these defenses, and develop resistance.

"These genes are out there in nature, but it's our use of antibiotics that makes them become more selected for, and much more widespread," Goodman said.

Right now, CRE infections typically occur in people who need long-term care, require treatment with medical equipment such as ventilators or catheters, or are put on long courses of antibiotics. Doctors don't know all the ways that CRE is spread, but the bacteria appears to be transmitted by health care workers — for example, if they have contaminated hands or clothing — and by medical devices.

CRE infections are still relatively uncommon in the United States; a study published last year in the journal Infection Control and Hospital Epidemiology found that, among 25 hospitals in the Southeast, there were about 300 cases of CRE infections over a five-year period.

But the concern is that infections will increase. The recent outbreak in Los Angeles "illustrates what can happen when CRE becomes more common in the health care environment," Goodman said.

Doctors may also run out of antibiotics that they can give patients prophylactically, meaning as a protective measure before surgery or other invasive medical procedures that come with a risk of infection, Adalja said.

"The risk-benefit calculation [of many medical procedures] could be altered if the rise in antibiotic resistance continues," Adalja said.

Preventing infections

One important step to reducing CRE infections is to limit the use of powerful antibiotics to when they're really needed, Goodman said. Studies have found that all too often, patients are given antibiotics when they don't need them (such as when they have a cold or other infection caused by a virus), or are kept on antibiotics for too long.

For bacteria, it is costly to carry around genes for resistance against certain antibiotics unless this defense is really needed, Goodman said. So "if you can reduce people's exposures [to antibiotics], where they're unnecessary, you can at least slow this down," Goodman said.

Adalja agreed, and said that alternatives to antibiotics are also needed, because in an "arms race with bacteria, there's no question that we will lose."

One important area of research that could help prevent antibiotic-resistant infections is the study of the microbiome, or the diverse community of microorganisms that naturally live on and in people's bodies and promote health, Goodman said. Studies have shown that when a person's normal gut bacteria community is disturbed, it puts that individual at risk for becoming sick with "bad" bacteria, including CRE. Research that looks into how to prevent the normal microbiome from being disturbed, or how to restore the normal microbiome after illness or antibiotics, could help treat or prevent infections, Goodman said.

New vaccines against bacterial diseases could also help protect people against certain infections that often develop in health care settings, Goodman said.

And traditional practices to prevent infections — such as consistent hand washing, and the proper use of personal protective equipment — are essential. Studies have found that hospitals can dramatically reduce CRE infections when they implement proper use of these practices, Goodman said

"I definitely think that it's achievable to slow the spread of these infections," Goodman said. Increasing antibiotic resistance "is a nightmare scenario, but there's a lot we can do."

Follow Rachael Rettner @RachaelRettner. Follow Live Science @livescience, Facebook & Google+. Original article on Live Science.

Dr. Bruce Koeppen is founding dean of the Frank H. Netter MD School of Medicine at Quinnipiac University. Koeppen contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

If health care's goal is to keep patients out of the hospital, why are primary care physicians training in hospitals?

There are several compelling reasons to train primary care physicians outside hospital settings. With the rising cost of medical education, even the most dedicated resident planning a career in a primary care discipline often reconsiders that plan. During a three-year hospital residency, that future physician is surrounded by specialists whose work is often perceived as more prestigious, and certainly more lucrative.

As the Affordable Care Act brings millions of previously uninsured Americans into the health care system, the flaws in our current system of hospital-based residencies and reimbursement practices have reached critical mass. The system is in desperate need of an overhaul, and there is not a minute to spare.

Here is another problem: By 2017, the number of American medical school graduates (M.D. and D.O.) will exceed the number of existing residencies. And, without a residency, physicians — who dedicated years to the pursuit of a medical education and incurred significant debt doing so — will not be able to practice medicine. [Doctor Shortage Looms in Health Care Reform (Op-Ed)]

This is tragic, and quite a turn of events in a profession where medical school graduates have historically been guaranteed a job at a time when physicians are needed more than ever before.

The reasons behind this situation are complex and go back many years. It began during the administration of President Bill Clinton, when the Balanced Budget Act of 1997 capped the number of first-year residency slots funded by Medicare (which covers the majority of the cost of training medical residents) to help balance the budget.

As new medical schools opened to try to stem the physician shortage — including ours, the Frank H. Netter School of Medicine at Quinnipiac — the number of U.S. medical school graduates began to rise, increasing competition for the fixed number of residency slots — unchanged since 1997.

Last year, more than 400 medical school graduates across the United States did not receive a residency match. With more students graduating from medical school in the coming years, this number will only increase.

It is possible for hospitals to expand the number of residency slots, but to do so, they must fund those positions. While trends in patient care emphasize wellness and prevention, the current reimbursement system is based on the number of procedures performed. As a result, there is an incentive for hospitals to fund additional residences in specialties that produce revenue, such as cardiology, gastroenterology and orthopedic surgery — another blow to that primary care shortage problem.

Earlier this year, Reps. Allyson Schwartz (D-PA) and Aaron Schock (R-IL) introduced the bipartisan Training Tomorrow's Doctors Today Act, which would increase the number of Graduate Medical Education (GME) slots by 15,000 over the next five years. However, its passage in the current Congress is unlikely.

Currently, there is another approach to train primary care physicians that totally bypasses hospital-based residencies. The Affordable Care Act's $230 million Teaching Health Center Graduate Medical Education Program has funded 11 Teaching Health Centers to train primary care physicians outside hospital settings, many of which serve underserved communities. The residency programs do not rely on Medicare funding, but must be self-supporting by 2017.

Teaching Health Centers not only provide slots for medical students interested in practicing primary care, they create the right kind of residency programs to nurture aspiring primary care physicians.

Primary care is delivered outside hospitals, and residency training for primary care disciplines must also take place, predominately, outside hospitals. We need to learn from these Teaching Health Centers, expand them, and provide new training sites with stable funding beyond the term of these initial grants.

No one said changing the American health care system would be easy, and balancing the physician patient equation will require some creative accounting. But, we must solve these problems if we want to do right by patients and the medical students who have invested so much to care for them.

Follow all of the Expert Voices issues and debates — and become part of the discussion — on Facebook, Twitter and Google+. The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.

This article was originally published on The Conversation. The publication contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

Hospitals and pharmacies around the country are facing severe shortages of essential drugs. These shortages can limit access to critical medications and compromise patient safety, resulting in serious illness and even death. In a 2011 survey, the American Hospital Association reported that 82% of hospitals had to delay therapy due to a drug shortage. And the consequences of drugs shortages go beyond delays. A 2010 report by the Institute for Safe Medication Practices implicated drug shortages in medication errors, adverse drug reactions and several deaths.

I’ve seen this happen while working in a hospital in the Washington, DC area. We were forced to use alternative drugs to sedate and paralyze a patient for placement of a breathing tube because we were out of the standard drugs. And those alternative were being rationed, so we had to change to yet another set of drugs to keep the patient sedated.

Shortages often impact generic injectable drugs, like sodium bicarbonate, the anesthetic propofol and the painkiller fentanyl, but any medication can be affected. For example, during last year’s influenza epidemic, there were shortages of both the influenza vaccine and antiviral medications, contributing to more cases of influenza and complications from the disease.

Cancer drugs are commonly affected by shortages, often resulting in delayed chemotherapy. Patients may also receive less effective or more toxic alternative chemotherapy regimens. This has been associated with decreased cancer survival and cure rates.

Replacement and risk

Providers often memorize details about medications they commonly prescribe or administer. So when alternatives must be used, providers may not as be as familiar with the proper dosing, administration procedures, and contraindications to these medications. All of this can lead to errors.

Pharmacy purchasers may need to obtain medications in different concentrations during a drug shortage. This can lead to dosing errors when providers are administering medications in concentrations they are not used to.

In one reported case, in a hospital’s gastroenterology suite, there was a shortage of the anesthetic ketamine in the concentration the hospital usually stocked. The pharmacy was stocking a much higher concentration of the same drug because that was the only dosage concentration that they could obtain. The provider did not properly dilute the medication and a patient was overdosed, experiencing confusion and delirium.

Shortages also mean that some pharmacies are compounding products from raw materials. This can introduce calculation and measurement errors during preparation and the risk of microbial contamination. Although unrelated to drug shortages, the outbreak of fungal meningitis associated with injections made at the New England Compounding Center in 2012 highlights the potential risk improper compounding poses to patient safety.

Medication vials that are meant for single use are re-used multiple times, which can lead to microbial contamination and even infectious disease transmission between patients.

And shortages often drive drug prices up several-fold, which can make it harder for patients to afford their medications, sometimes forcing them to go without treatment.

Health-care spending also increases as hospitals, pharmacies and providers devote additional resources to managing medication shortages. More manpower is devoted to managing medication shortages rather than treating patients. It is estimated that managing drug shortages costs hundreds of millions of dollars annually.

Prescription for change

So, why do these drug shortages occur and why are they so widespread? There are several reasons. To cut production costs manufacturing facilities have been consolidated, which means there isn’t much slack in the system when a shortage happens. On top of that there are raw material shortages, manufacturing problems, product discontinuation, and unanticipated demand for medication.

Market factors also play in a role. Making injectable drugs is costly and generic companies do not get as much return on their investment and Medicare pays fixed prices for some generic drugs.

And even though there are significant public health consequences, the US Food and Drug Administration (FDA) has limited authority to address drug shortages. The problem is complex enough, that there isn’t a single solution.

In 2012 some progress was made when Congress passed the Food and Drug Administration Safety and Innovation Act (FDASIA). This act, which builds upon previous legislation, requires all drug manufacturers to report anticipated drug discontinuations and shortages. Although it’s a step in the right direction, the act won’t solve the problem. The FDA does not have authority to require pharmaceutical companies to manufacturer a particular drug and there are no penalties for manufacturers who do not comply with current reporting requirements.

The FDA has a Drug Shortages Program, which it has expanded to play a more active role in managing shortages, and prevent them from happening. On a policy level, incentives should be provided to manufacturers to encourage compliance with good manufacturing practices and early reporting of potential shortages. More stringent reporting requirements for pharmaceutical companies are needed and the FDA should be given enforcement authority.

This article was originally published on The Conversation. Read the original article. Follow all of the Expert Voices issues and debates — and become part of the discussion — on Facebook, Twitter and Google +. The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.

Dr. Gary Smith, director of the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital, contributed this column to Live Science's Expert Voices: Op Ed & Insights.

If there are children on your holiday shopping list, any toys you purchase for them are intended to fill them with joy. Kids benefit from playing with toys, but unfortunately, toys can present hazards as well. In fact, our recent study found the rate of toy injuries increased nearly 40 percent from 1990 to 2011.

A child's job is to play, and toys are important tools. Parents want children to explore, challenge themselves, and develop while using those tools safely. That's why my colleagues and I conducted a study about toy-related injuries. We obtained data from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. NEISS collects data from a network of about 100 hospitals, and coders record information about injury events — including patient age, gender, injury diagnosis, affected body region, products involved and location where the injury occurred, among other details. [Kids Gift Ideas: Best Educational Toys and Games of 2014]

Our team in the Center for Injury Research and Policy at Nationwide Children's Hospital found that an estimated 3,278,073 children were treated in U.S. hospital emergency rooms from 1990 through 2011 for toy-related injuries. In 2011, a child was treated every 3 minutes for such an injury. Slightly more than half the injuries from that period occurred among children younger than 5 years of age. The study is published in Clinical Pediatrics.

The rate of injury rose almost 40 percent during the 22-year period that we studied. Most of that increase was associated with foot-powered scooters.

Children of different ages face different hazards from toys. For instance, children younger than 3 years of age are at particular risk of choking on small toys and small parts of toys. During the years we studied, there were more than 109,000 cases of children younger than 5 swallowing or inhaling toy objects, equivalent to almost 14 cases per day.

As children get older, injuries involving riding toys increase. Those toys — which include foot-powered scooters, wagons and tricycles — were associated with 42 percent of injuries to children 5 to 17 years of age and 28 percent of injuries to children younger than 5 years of age. Injuries associated with ride-on toys were three times more likely to involve a broken bone or a dislocation than other toys. Falls (46 percent) and collisions (22 percent) were the most common ways that children of all ages were injured in association with toys of all categories.

Foot-powered scooters are popular and will no doubt be on many holiday wish lists. They are also of special concern when it comes to potential for injuries. From 2000, after a new kind of scooter first became popular, through 2011, there were an estimated 580,037 injuries to children associated with scooters. That's about one injury every 11 minutes.

Even in light of our findings, foot-powered scooters can be used safely. The first three tips I give for preventing injuries on scooters or any riding toys are: 1. Wear a helmet. 2. Wear a helmet. 3. Wear a helmet. That's how important I think helmets are. It's also important to use scooters and other riding toys only on flat, dry surfaces away from traffic.

Foot-powered scooters should also only be used by children who have good balance. Young children don't always have it. The American Academy of Pediatrics recommends that any child younger than 8 years of age should be closely supervised by an adult when riding a scooter.

The frequency and increasing rate of injuries to children associated with toys, especially those associated with foot-powered scooters, is concerning and underscores the need for increased efforts to prevent these injuries to children. We want children to be adventuresome and playful, but it's crucial to consider safety too. Important opportunities exist for improvements in toy safety standards, product design, recall effectiveness and consumer education.

You can help children stay safe with toys by following these tips: Follow age restrictions and other manufacturer guidelines for all toys. Examine toys for small parts that could be choking hazards for young children. Children should use riding toys on dry, flat surfaces away from vehicle traffic. Closely supervise any child who is younger than 8 years of age on a riding toy. Children should wear helmets, knee pads and elbow pads on scooters and other riding toys with wheels. Check Recalls.gov to see if toys that you own or may buy have been recalled.

This is also a season when parents clear out clutter and give away extra toys. Families need to be careful with hand-me-down toys or second-hand toys. While some are great finds, make sure these items have not been recalled or modified from their original design.

We hope these study findings and tips help kids to enjoy their playtime and avoid injury. We wish families a happy, healthy and playful holiday season.

Follow all of the Expert Voices issues and debates — and become part of the discussion — on Facebook, Twitter and Google+. The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.

Dr. Christopher Hanks, medical director for The Center for Autism Services and Transition at The Ohio State University Wexner Medical Center, contributed this article to Live Science's Expert Voices: Op-Ed & Insights

Over the last several decades, the number of children diagnosed with autism spectrum disorder (ASD) has skyrocketed. Today, the United States spends $11.5 billion a year on children with ASD, a complex, lifelong developmental disability that affects an individual's ability to communicate and interact with others.

But what happens when these kids become adults? Relatively few physicians specialize in treating adults on the spectrum, and as a result, these patients often don't receive the type of support and attention they need. 

In addition, research has indicated that a majority of physicians aren't comfortable caring for adults with ASD. Due to these roadblocks, adults with autism have been called "the forgotten patients." We in medicine really need to reverse our thinking on adult autism because the number of patients is on the rise .

Currently, there is a significant need for providers who care for adults with ASD. It's estimated that one out of 68 babies born in the U.S. are on the autism spectrum. The shortage of coordinated care is likely to get worse as pediatric patients with ASD transition to adulthood, and this patient population is expected to soar nearly 700 percent by 2030.  

Once patients move away from their pediatricians, they struggle. These patients often miss out on important check-ups, immunizations and cancer screenings. It's also important to note that without specialized care, these individuals can have a hard time transitioning into an intimidating world. 

Many teens with ASD struggle to obtain meaningful vocational or educational opportunities after they've finished high school, which provides a structured environment and allows for social interactions and continual development. Unless these young adults are employed or enrolled in an educational program, most spend too much time alone or isolated, with little or no social interaction. When this happens, they often regress and lose some of the skills they previously developed.

These patients deserve physicians who understand their needs and will work with them to overcome the challenges associated with becoming an adult who has an illness that will impact their entire life. 

That's what we're striving to do at The Ohio State University Wexner Medical Center, where we recently opened one of the only clinics in the country to care for adults with ASD. Here at the Center for Autism Services and Transition (CAST), we provide care coordination, along with primary and specialty care services for patients. We offer access to diagnostic testing, counseling services, therapy, dental care, nutrition and other resources. Our goal is to give new hope to these patients, and to connect them with medical experts who truly understand their needs so they can continue to grow and succeed. 

We're inspired by patients like Braden Gertz, a 24-year-old early childhood education specialist at the Nisonger Center at Ohio State's Wexner Medical Center. He creates his own lesson plans, provides tutoring and teaches children diagnosed with ASD and other developmental and intellectual disabilities how to speak and interact with others. He has his own apartment, does his own laundry and grocery shopping, and is an instructor at a local recreational facility on campus. Braden has autism, but that hasn't stopped him from becoming incredibly independent. He serves as a model for what we hope to achieve with our other patients in the future.  

Beyond offering medical care, we want to provide options for continuing education courses and job opportunities to help patients transition into their new lifestyle. We try to focus on helping people not only develop the skills they need to survive in a medical setting, but the skills they need to thrive in the broader community. 

Medical care for adults with ASD is a big issue, one that cannot be fixed easily. We still have a long way to go, but we're on our way to providing new hope for families and patients. It's time to stop forgetting these patients, and remember that all children will someday grow up. 

Follow all of the Expert Voices issues and debates — and become part of the discussion — on Facebook, Twitter and Google+. The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.

Rediscovered Paintings

Late-1800s wall murals portraying Crusader knights and symbols of medieval military orders have been rediscovered in a Jerusalem hospital thanks to a burst water pipe and a storeroom reorganization. The paintings were rediscovered in a storeroom in Saint-Louis Hospice, a Jerusalem hospital built by a prominent Christian. [Read full story on the Crusader murals]

Heraldry on the Walls

Medieval heradlry on the walls of Saint-Louis Hospice in Jerusalem. The designs were painted in about 1896 by a Christian count from France. [Read full story on the Crusader murals]

Crusade Walls

French Count Marie Paul Amedee de Piellat painted these designs to commemorate the Crusades. They were painted over by Turks who controlled the buliding during World War I. [Read full story on the Crusader murals]

Hospital Chapel

The paintings of Comte de Piellat adorn the walls of the Saint-Louis Hospice chapel. [Read full story on the Crusader murals]

Hospital Altar

A view of the Saint-Louis Hospice chapel in Jerusalem, built between 1879 and 1896, and named after St. Louis IX, a king of France and leader of the Seventh Crusade between A.D. 1248 and 1254. [Read full story on the Crusader murals]

Working Hospital

There are no plans to turn the paintings into a tourist attraction, however, as the Saint-Louis Hospice is still in use for chronic and terminally ill patients. Sisters of the order of St. Joseph of the Apparition run the facility. [Read full story on the Crusader murals]

Water Damage

Water damage from a burst pipe revealed forgotten paintings on the Saint-Louis Hospice walls. [Read full story on the Crusader murals]

The government's 2015 budget includes an additional $30 million to detect and prevent antibiotic resistance, according to the department of Health and Human Services.

This budget more than doubles the Center for Disease Control and Prevention's funding for fighting antibiotic resistance, HHS said.

The announcement comes just after the CDC released a report describing how misuse of antibiotics in hospitals can increase a patient's risk complications, such as development of the deadly bacterial infection Clostridium difficile. The CDC estimates that implementing programs that prevent antibiotic misuse could reduce the rate of C. difficile infection by half over a five-year period.

The Infectious Disease Society of America applauded the budget request.

"On behalf of the millions of patients who suffer from resistant infections, IDSA has long called for increased federal leadership to address this public health crisis," the IDSA said in a statement. "This budget request is an important step forward, and we urge Congress to fully fund it."

The organization also called on the government to pass legislation that would provide tax credits to spur the development of new antibiotics.

More than half of hospitalized patients receive antibiotics, but these prescriptions may often be inappropriate — for example, giving patients the wrong medicine or leaving them on a drug for too long, according to a new report from the Centers for Disease Control and Prevention.

These prescriptions can put patients at risk for serious complications, including developing the deadly bacterial infection Clostridium difficile, according to the report.

In 2010, nearly 56 percent of hospitalized patients were prescribed antibiotics at some point during their stay, according to the report, which reviewed information from more than 300 U.S. hospitals.

But for about one-third of prescriptions for urinary tract infection (UTI), the researchers found evidence of prescribing errors: antibiotics were given without proper testing or evaluation for a UTI, or given for too long, the report found. (UTI is one of the most common conditions for which antibiotics are prescribed.) [6 Superbugs to Watch Out For]

In addition, an analysis of medical-surgical wards at selected hospitals showed that antibiotic use at some of these hospitals was three times higher than at other hospitals, a finding that suggests hospital prescribing practices can be improved, the CDC said.

The report found that patients who received powerful antibiotics (so-called board spectrum antibiotics) were three times more likely to get the notoriously difficult to treat diarrheal disease Clostridium difficile compared to patients who did not receive antibiotics.

The CDC estimates that reducing use of broad-spectrum antibiotics by 30 percent would lead to a 26 percent decrease in C. difficile infections. There are about 250,000 C. diff infections in hospitalized patients each year, and about 14,000 people in the U.S. die yearly from C. diff infections, CDC statistics show.

Inappropriate prescribing of antibiotics also contributes to other antibiotic-resistant infections, a growing problem in U.S. hospitals, the CDC said.

"Antibiotics are often lifesaving; we have to protect them before our medicine chests run empty," Dr. Tom Frieden, director of the CDC, told reporters today (March 4). "The drugs we have today are endangered, and any new drugs we get could be lost just as quickly if we don't improve the way we prescribe and use them," Frieden said.

The CDC recommends that every hospital implement a program to help improve antibiotic prescribing.

Such programs would include a way to monitor prescribing practices and antibiotic-resistant infections. The CDC also recommends that physicians who prescribe antibiotics reassess their patients after 48 hours to see whether the dose, duration or type of drug should be changed, Frieden said.

The CDC estimates that implementing these programs could reduce the rate of C. difficile infection by half over a five-year period, Frieden said.

The report will be published on Friday (March 7) in the CDC's Morbidity and Mortality Weekly Report.

Follow Rachael Rettner @RachaelRettner. FollowLive Science @livescience, Facebook & Google+. Original article on Live Science.

Stethoscopes tend to be more contaminated than the palms of physicians' hands, new research shows.

In a recent Swiss study, researchers discovered that more bacteria cover a stethoscope's diaphragm (the part that's held against a patient's body) than all regions of a physician's hands, except the fingertips.

The study also found a close correlation between the degree of the contamination of the diaphragm and that of the physician's fingertips. There are no official guidelines that tell doctors how often they should clean their stethoscopes, the researchers said.

"The more you have bacteria on the fingertips, the more you find bacteria on the membrane of the stethoscope," said study author Dr. Didier Pittet, director of infection control at the University of Geneva Hospitals. [10 Weird and Terrifying Medical Instruments from the Past]

In the study, 71 patients were examined by one of three physicians who used sterile gloves, and a sterile stethoscope. After the examination, the researchers checked the degree of bacterial contamination on two parts of the stethoscope — the tube and membrane ­­— and four regions of the physician's hands — back, fingertips, the region near the base of the thumb and the region near the little finger.

Researchers found more contamination in the diaphragm than in all regions of the physician's hand, except the fingertips. The tube of the stethoscope also showed more contamination than the back of the physician's hand.

"What was relatively surprising is the degree of colonization, which is pretty high," Pittet said.

The findings may have implications for patient safety regulations.

"It means that the stethoscope needs to be cleaned, some people say 'decontaminated' or 'disinfected,' after each single clinical use," which is not routinely done, Pittet said.

There are currently no recognized guidelines for cleaning stethoscopes anywhere in the world, he said.

However, doctors do use a separate stethoscope for patients infected with bacteria that are resistant to drugs, Pittet said. The new research could lead to additional precautions, he said.

"So this paper would certainly push people to think about it and to evolve the guidelines," Pittet said.

Follow Agata Blaszczak-Boxe on Twitter . Follow Live Science @livescience, Facebook & Google+. Original article on Live Science.

In an emergency, few facilities are as critical as hospitals. But as Hurricane Sandy made painfully clear one year ago, hospitals and other health care facilities are just as vulnerable to the ravages of a storm as any building.

During Hurricane Sandy, major medical institutions in New York City — such as Bellevue Hospital Center, New York University's Langone Medical Center and Coney Island Hospital — had to be evacuated after multiple electrical and mechanical systems failed.

One year later, these institutions have had a chance to assess their performance before, during and after the storm struck. "We fared better than most," said Loyola Princivil-Barnett, administrator of the Shorefront Center for Rehabilitation and Nursing Care in Brooklyn. "We made sure we were stocked up to the wazoo." [On the Ground: Hurricane Sandy in Images]

Built for resilience

The Shorefront Center has received recognition from a number of experts for its success in weathering the storm punch that Sandy delivered  — a remarkable fact, given that the 360-bed facility is located just a few yards from the Atlantic Ocean on Coney Island.

But Shorefront's resilience wasn't a matter of luck: Because of its seaside location, the facility was built in 1994 "to meet and exceed the 500-year floodplain by 3 feet [1 meter]," Princivil-Barnett told LiveScience. Although the parking garage is located at ground level, the lobby is elevated above it. "Our building is built on stilts," she added. "It's 30 feet [9 m] from our garage to the first-floor lobby."

Shorefront was so well prepared that it was able to assist other health care facilities by taking in their patients. "People came to us for everything under the sun," Princivil-Barnett said. Even the local police and other emergency responders came to the facility for coffee and other support.

'Out of commission'

About 2 miles (3 kilometers) away from Shorefront stands Coney Island Hospital, a comprehensive 371-bed medical center with a large emergency department (ED), psychiatric-care facility and nuclear-medicine center.

Even though the hospital is farther inland than Shorefront, Coney Island Hospital fell victim to the devastation wrought by Hurricane Sandy's floodwaters. More than 220 patients had to be evacuated, partly because the hospital's ground-level emergency generators had to be shut off for several hours to prevent permanent damage from the flooding that inundated the whole hospital campus — including the ED — under several inches of water. 

Nonetheless, the hospital was able to serve as an emergency shelter for about 60 displaced area residents — including four people and two dogs delivered by a police boat — according to a New York City report nicknamed "SIRR" (Special Initiative for Rebuilding and Resiliency), which was commissioned by the city in the aftermath of Hurricane Sandy.

One year later, most of Coney Island Hospital is fully operational, though there's still much work to be done. "If you were to go there today, you would still see parts under construction," Ian Michaels, public affairs director for the New York City Health and Hospitals Corp. (HHC), told LiveScience.

The psychiatric ED room at Coney Island Hospital "is out of commission," Michaels said, adding that those services are currently being addressed at the hospital's main ED space. Pediatric inpatient services, detox facilities and inpatient rehabilitation also remain unavailable at the hospital. "Otherwise, Coney Island [Hospital] is back, and has been back for a substantial period of time," Michaels said.

Preparing for the next storm

"There's been a flurry of activity over the last 12 months not only to repair, restore, rebuild and replace areas that were damaged, but also to be better prepared for the next storm," Alan D. Aviles, president of HHC, said in a statement. "We have worked within the guidelines of Mayor [Michael] Bloomberg's Special Initiative for Rebuilding and Resiliency to create an effective plan."

It takes much more than solid buildings to stand up to a major hurricane, experts agree, and Shorefront started planning for the storm days in advance. Communication, Princivil-Barnett said, is a critical concern. "That's been a big part of our planning," she said. "We have a good communication structure."

Princivil-Barnett and other team leaders were prepared to use satellite telephones to communicate during the emergency, since ordinary cellphones may be ineffective in a blackout. But beyond technology, there are commonsense initiatives that help make communication networks run smoothly.

Executive team support

Phone lists need to be updated more often, to ensure that contact information is "not from the Stone Age," Princivil-Barnett said, and communication has to occur proactively with people inside and outside the institution.

Princivil-Barnett stressed that because all health care facilities rely on outside vendors for things like fuel, paper and pharmaceuticals, she needed to communicate with vendors to make sure they were solid. "It helps them, and it allows them to help you," she said.

And in any planning endeavor — but especially for disasters like Hurricane Sandy — it helps to have support from the leaders of any organization. "Our executive team have been taking, and are taking, emergencies very seriously," Princivil-Barnett said. "It's a matter of life and death."

Follow Marc Lallanilla on Twitter and Google+. Follow us @livescience, Facebook & Google+. Original article on LiveScience.

This Behind the Scenes article was provided to LiveScience in partnership with the National Science Foundation.

When you peer through the smear on the screen of your smartphone, thousands of tiny microbes are staring back at you, waiting to hitch a ride on your fingertips.

Harmful microbes lurk everywhere — doorknobs and faucets, locker rooms and hospitals. It's enough to make a germophobe afraid to touch anything.

A new antimicrobial coating on the verge of being commercialized by a research team at the University of Florida, however, could change the landscape for surface-to-skin microbe transmission.

Healthcare facilities, including hospitals and assisted living facilities in particular, could benefit. Patients and visitors pick up 2 million infections each year in healthcare settings, and 90,000 patients die, according to the Centers for Disease Control. Treating healthcare-acquired infections costs $4.5 billion a year, the CDC says.

The new antimicrobial coating, called "PhotoProtect^TM," was developed at the University of Florida's Particle Engineering Research Center. It is designed to act as a barrier between microbes on surfaces and humans. The material, developed by researchers Vijay Krishna, Ben Koopman and Brij Moudgil, can be sprayed on any surface to form an invisible coating that is activated by indoor light and kills all microbes that come in contact with it. The coating uses ingredients such as titanium dioxide and polyhydroxy fullerenes, which are found in food and cosmetics, respectively, and last up to a year.

"Other [photocatalytic] coatings in use require such a thick coating that everything turns white," said Moudgil, distinguished professor of materials science and engineering and director of PERC. "PhotoProtect coating is so thin you won't even notice the coating is there."

A UF start-up company, NanoHygienix LLC, has taken an option to commercialize the technology.

The coating is designed to have advantages over other common antimicrobial products, which either do not kill all types of microbes or leave dead microbes on the surface, decreasing the lifetime of the coating. Furthermore, microbes can develop resistance, eventually rendering the coating useless.

PhotoProtect^TM, on the other hand, mineralizes microbes, turning them into carbon dioxide and water, making it impossible for microbes to develop resistance or leave a residue. The new product degrades even the hardiest microbes on earth — bacterial and fungal spores — the developers say.

Moudgil and Koopman credit a comment from a colleague in the UF School of Building Construction for piquing their interest in the research project, now nearly a decade in the making. The colleague mentioned that asthma in children in subsidized housing was increasing at a faster rate than asthma in children in other housing and asked them if an economical antimicrobial agent could be developed to keep the children from becoming infected with microbes that triggered asthma.

Moudgil's research group was one of a handful chosen to develop new technologies by the National Science Foundation's Accelerating Innovation Research program, and showcased at the NSF grantees meeting in May. The national showcase is designed to highlight research that is ready for commercialization.

The technology is one of several particle-based technologies that have been commercialized through discoveries at PERC, which was launched in 1994 and funded by NSF from 1994 through 2005.

Healthcare-acquired infections are an escalating problem. MRSA, methicillin-resistant Staphylococcus aureus, is a highly contagious staph bacterium that can be fatal. Moudgil said a recent study showed that up to 90 percent of MRSA remains on surfaces after a hospital room has been cleaned.

Other applications include fighting mold and mildew and boosting indoor air quality by killing bacteria, fungal spores and degrading volatile organic compounds, potentially reducing the $60 billion a year spent to alleviate sick building syndrome.

UF engineering students collaborated with UF business students in developing the new product.

Editor's Note: The researchers depicted in Behind the Scenes articles have been supported by the National Science Foundation, the federal agency charged with funding basic research and education across all fields of science and engineering. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation. See the Behind the Scenes Archive.

A gigantic bounce house, video games at every turn, cartoons on flatscreen TVs, a playground that dwarfs anything down at the local schoolyard … The best children's hospitals certainly come across as fun places to visit.

Wouldn't it be great if adult hospitals were like this, too? Well, seriously, why aren't they? One medical student asks that question in an editorial published today (Aug. 20) in the Journal of the American Medical Association (JAMA).

Say what you will about Dr. Patch Adams and his humor-based approach to medicine, but children's hospitals are designed the way they are for two reasons: Kids don't want to be in a hospital, and higher spirits while in a hospital translate to better health outcomes. [9 Weird Ways Kids Can Get Hurt]

Mark Attiah, a fourth-year medical student at Penn Medicine, part of the University of Pennsylvania in Philadelphia, asks: How are adults any different from children?

Attiah was inspired to write the JAMA editorial after visiting one such pleasant children's hospital during his pediatric medical rounds. The concept later crystallized, he said, when he met a patient who became an adult overnight, by turning from age 17 to 18. That patient was out of the children's ward, with all its comforts, and into the adult ward — a change, the patient said, that was like day to night, or heaven to hell.

Gone were the activities to fill the day, such as art and games and even a hospital prom. Gone were the privileges common to children's hospitals, such as having family members around at any time, even overnight. All this newly minted adult patient could do was lie around, dwelling on her illness, Attiah said.

While it may seem like common sense that all hospitals could stand to be a little more inviting, "sometimes in medicine, common sense is overlooked for decidedly loftier goals, like waiting for peer-reviewed evidence and doing something a certain way because that's how it's always been done," Attiah told LiveScience.

Although Attiah currently has zero years of experience as a medical doctor, his idea resonates with many in the medical establishment. Attiah's own hospital has newly erected buildings with patient-friendly features, such as direct sunlight, pleasant distractions, more social-support, less noise, and single bedrooms, said Patrick Brennan, the chief medical officer of the University of Pennsylvania Health System.

The best hospitals in the nation are following suit. And although this is a positive trend, this isn't specifically what Attiah is after.

"While hospitals might remodel their exterior, they should remember that some of the most important and perhaps the hardest changes to be made aren't with bricks and mortar," Attiah said. "You could be eating at a five-star restaurant and still get terrible service. I think the more substantive changes ... are the care patterns and the attitudes of the healthcare workers themselves."

These changes — in addition to brighter hallways and more art and plants — could include extended visiting hours, more family involvement during patient procedures and discussions, a medical staff that seems truly happy to be there serving, and lots and lots of activities, all of which have been standard practices in children's hospitals for decades.

A large study published in March 2013 in the New England Journal of Medicine found that having family members present during scary procedures such as cardiopulmonary resuscitation (CPR) had a positive effect on health outcomes, did not interfere with medical efforts, did not increase stress in the health care team and did not result in legal conflicts — overturning several long-standing assumptions.

Perhaps adults find comfort in suffering, along the lines of "no pain no gain." Consider no-tears children's shampoo. Adults apparently don't mind their eyes stinging when washing their hair. The heart of Attiah's idea is to strive for no-tears hospitals, for children and adults.

Christopher Wanjek is the author of a new novel, "Hey, Einstein!", a comical nature-versus-nurture tale about raising clones of Albert Einstein in less-than-ideal settings. His column, Bad Medicine, appears regularly on LiveScience.

This is the fifth in a six-part MyHealthNewsDaily series examining the problems and solutions related to six "winnable battles" in public health, as recently announced by the U.S. Centers for Disease Control and Prevention.

Nobody wants to get sicker in a hospital than they were at home, but that's the reality for 1.7 million Americans every year, who develop health-care-associated infections (HAIs). With those numbers shrinking and brand-new federal mandates in place, however, health experts think this preventable danger may be finally coming under control.

Other highly visible public health crises including obesity and swine flu have allowed this problem to fly under the radar for five years, officials say. But HAIs are among the top ten leading causes of death in the United States, killing 99,000 annually, according to the Centers for Disease Control and Prevention (CDC).

CDC director Thomas Frieden recently plucked HAIs from the background by naming it one of six "winnable battles," along with AIDS, smoking, teen pregnancy , auto injuries and obesity. The CDC hopes additional attention, resources and collaboration will have an even more measurable impact in these areas.

"I think there are a lot of very promising indicators now that we're on track for," said Russell Olmsted, president-elect of the Association for Professionals in Infection Control and Epidemiology (APIC). "Certainly, consumers are concerned about these complications."

Is this battle winnable?

HAIs also occur in health settings other than hospitals, including same-day surgery centers, outpatient clinics, dialysis centers and rehabilitation facilities. According to the CDC, 32 percent of all HAIs are urinary tract infections, which are typically associated with catheter use; 22 percent are surgical site infections; 15 percent are pneumonia; and 14 percent are bloodstream infections. [Related: Q&A: The Bladder Infection Superbug, Explained by the Doctor Who Discovered Its Spread ]

This year, federal health officials set a goal to reduce bloodstream infections which are the easiest to prevent by 50 percent in the next five years. The mandate is the first measurable goal for quality and safety that the nation has set, said Dr. Peter Pronovost, a professor at Johns Hopkins University School of Medicine.

Hospitals in more than 40 states have agreed to institute the multi-step approach Pronovost created to reduce blood infections, which dropped 18 percent in 2009 alone.

"There are not many outcomes that have a scorecard," Pronovost told MyHealthNewsDaily, adding that social, economic and regulatory pressure on hospitals will nudge them to honestly report their infection rates.

"Prior efforts have been more competitive than cooperative," Pronovost added. "Now I think we're really poised to do this."

What will it take to win?

The steps Pronovost suggested to reduce HAIs include thoroughly washing hands, swabbing areas with certain disinfectants before inserting catheters and ensuring catheters where bacteria easily grow are correctly inserted.

Pronovost is also pushing for more aggressive reporting standards and hospital culture changes to improve how employees handle infections.

"Patients are probably our best surveillance tool," said the APIC's Olmsted, who is also an epidemiologist in infection prevention and control services at the St. Joseph Mercy Health System in Ann Arbor, Mich.

As they are being treated in various health care settings, patients and consumers can be on the lookout for infections, Olmsted said.

"By and large," he said, "for most sites of infection, we have the scientific evidence and information that says we can prevent a high proportion of these."

• Part 4: Obesity: A 'Winnable' Public Health Battle?
• Bacteria Surprisingly Crafty at Sharing Antibiotic Resistance
• Is It Better to Wash With Antibacterial Soap?

When a hospital patient's heart stops beating, exactly how long doctors should spend trying to revive him is not known. Now, a new study suggests that increasing resuscitation times may benefit patients.

In the study, patients whose hearts stopped were less likely to die if they were at a hospital that tended to spend a long time resuscitating patients, compared with a hospital that spent shorter times resuscitating patients.

In addition, longer resuscitation times did not appear to increase neurological problems among patients who survived.

While doctors should always use their best judgment in deciding whether to continue resuscitation attempts, the findings suggest increasing resuscitation times on a hospitalwide basis could improve patient survival, the researchers said.

Extending resuscitation times by 10 to 15 minutes "is a very small expense to be added, for potentially a large gain," said study researcher Dr. Zachary Goldberger, of the University of Washington School of Medicine in Seattle.

The researchers noted the study found only an association — not a direct cause-effect link — and was not designed to determine the optimal duration for resuscitation efforts.

Still, the findings suggest that setting a minimum time for resuscitation duration could improve patient outcomes, Goldberger said.

When a heart stops beating

Out of every 1,000 patients who stay in a hospital, between one and five experience cardiac arrest, a condition in which the heart stops beating. However, doctors have little evidence to guide them on how long they should spend trying to get a heart to beat again, and previous research has suggested that long-lasting resuscitation attempts are often futile, the researchers said.

In the new study, Goldberger and colleagues analyzed information from more than 64,000 patients, at 435 U.S. hospitals, who underwent resuscitation for a cardiac arrest between 2000 and 2008. The researchers determined how long each hospital typically spent trying to resuscitate by looking at the amount of time its staff spent resuscitating patients who did not survive. (Patients who survive often are revived after a short resuscitation time.)

About 48 percent of the patients in the study survived their cardiac arrest, but many died later during their hospital stay; only 15 percent of those in the study survived to be released from the hospital.

Patients at hospitals with the longest resuscitation times (typically 25 minutes) were 12 percent more likely to be revived and eventually discharged from hospital than those at hospitals with the shortest attempts (around 16 minutes), the researchers said.

The researchers were not able to take into account some factors — such as how well the chest compressions were done — and its possible longer resuscitation times were simply a marker of better care in general, the researchers said.

Each case is different

It's very difficult to make broad recommendations on how long resuscitation should continue because each case is different, said Dr. Roger White, an anesthesiologist at Mayo Clinic specializing in resuscitation care, who was not involved in the study. Doctors need to quickly decide whether a patient stands a good chance of being revived, based on such factors as the number of health conditions they have, White said.

Long resuscitation attempts can be justified, White said, especially if doctors have objective measurements to guide them on how well the resuscitation is going. Such measurements include changes in heart rhythm, and the amount of blood that reaches vital organs, White said.

The new study will be published tomorrow (Sept. 5) in the journal the Lancet.

Pass it on: For those who have a cardiac arrest in the hospital, increasing resuscitation times may improve patients' survival.

Follow Rachael Rettner on Twitter @RachaelRettner, or MyHealthNewsDaily @MyHealth_MHND. We're also on Facebook & Google+.

Scrubs used to be white — the color of cleanliness. Then in the early 20th century, one influential doctor switched to green because he thought it would be easier on a surgeon’s eyes, according to an article in a 1998 issue of Today’s Surgical Nurse. Although it is hard to confirm whether green scrubs became popular for this reason, green may be especially well-suited to help doctors see better in the operating room because it is the opposite of red on the color wheel.

Green could help physicians see better for two reasons. First, looking at blue or green can refresh a doctor’s vision of red things, including the bloody innards of a patient during surgery. The brain interprets colors relative to each other. If a surgeon stares at something that’s red and pink, he becomes desensitized to it. The red signal in the brain actually fades, which could make it harder to see the nuances of the human body. Looking at something green from time to time can keep someone’s eyes more sensitive to variations in red, according to John Werner, a psychologist who studies vision at the University of California, Davis.

Second, such deep focus on red, red, red can lead to distracting green illusions on white surfaces. These funky green ghosts could appear if a doctor shifts his gaze from reddish body tissue to something white, like a surgical drape or an anesthesiologist’s alabaster outfit. A green illusion of the patient’s red insides may appear on the white background. (You can try out this “after effect” illusion yourself.) The distracting image would follow the surgeon’s gaze wherever he looks, similar to the floating spots we see after a camera flash.

The phenomenon occurs because white light contains all the colors of the rainbow, including both red and green. But the red pathway is still tired out, so the red versus green pathway in the brain signals “green.”

However, if a doctor looks at green or blue scrubs instead of white ones, these disturbing ghosts will blend right in and not become a distraction, according to Paola Bressan, who researches visual illusions at the University of Padova in Italy.

So, although doctors trot down the street these days in a rainbow of patterned and colored scrubs, green may be a doctor’s best bet.

This answer is provided by Scienceline, a project of New York University's Science, Health and Environmental Reporting Program.

Originally published on Live Science.

Some doctors say they care for more hospitalized patients than they can handle, which may compromise patient safety, a new study finds.

The study surveyed about 500 hospitalists, physicians who manage patients' care in hospitals. Forty percent of respondents said that, at least once a month, they took on more patients than they could safely handle. And, often, this occurred more frequently.

About a quarter of doctors said their high workload prevented them from fully discussing treatment options with patients, and 22 percent said they sometimes ordered unnecessary tests because they didn't have enough time to examine the patients' cases.

"If a hospitalist is short on time and a patient is having chest pains, for example, the doctor may be more likely to order additional tests, prescribe aspirin and call a cardiologist, all because there isn't adequate time to immediately and fully evaluate the patient," said study researcher Dr. Henry Michtalik, an assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore.

A smaller portion of doctors (5 to 10 percent) said some of their patients likely suffered adverse events — such as requiring transfer to an intensive care unit, or even death — because of the physician's workload.

Monetary concerns may help explain the workloads, Michtalik said. Efforts to reduce health care costs may lead to a decrease in physician reimbursement, which in turn prompts doctors to take on more patients, he said.

The findings suggest that hospitals need to evaluate doctors' workloads and create standards for safety, the researchers said. While there are limits on how many hours residents, or doctors-in-training, can work, there are no such guidelines for higher-level doctors known as attending physicians, Michtalik said.

Future research may shed light on the best ways to keep workloads safe, as well as methods to better manage patients when doctors are overloaded, Michtalik said.

An upcoming study by Michtalik and colleagues will examine factors associated with safe physician workloads. For example, the area of the hospital in which physicians and their teams work may make a difference. Allocating one particular area of the hospital to one provider may allow doctors to safely take on more patients by reducing the time they spend traveling around the hospital, Michtalik said.

The new study is published online today (Jan. 28) in the journal JAMA Internal Medicine.

Pass it on: Forty percent of hospital physicians say they take on more patients than they can safety handle at least once per month.

Follow Rachael Rettner on Twitter @RachaelRettner, or MyHealthNewsDaily @MyHealth_MHND. We're also on Facebook & Google+.

 Hospitals are releasing patients faster and faster these days, but little is known about whether people are being sent home too soon. Now, a new study has found that earlier discharges do not necessarily result in expensive and stressful readmissions.

  Researchers reported that the length of the typical hospital stay decreased by nearly one-third (27 percent) between 1997 and 2010, from five and a half days to four days.  During that same period, the rate of readmissions within 30 days of leaving the hospital dropped by 16 percent, with hospitals eliminating nearly three out of every 100 readmissions.

The researchers analyzed more than 4 million patient records across the Veterans Affairs hospital system and examined five of the most common diagnoses for admission to the hospital, excluding patients hospitalized for psychiatric conditions or surgery.

The investigators were concerned that the decrease in readmissions was associated with discharged patients dying at home. However, the data also showed that despite shorter hospital stays, the likelihood of dying within 90 days of being admitted to the hospital also dropped by 3 percent annually.

"To see all three of these factors improve over a 14-year period is incredibly reassuring that our health care system is becoming more efficient and safer," said study author Dr. Peter Kaboli, of the Iowa City VA Health Care System.

The VA system data aren't relevant to most U.S. hospitals. That's because the VA system controls all aspects of a veteran's health care. By contrast, health care in the U.S. is primarily a hodgepodge of independently operated clinics, hospitals, pharmacies and nursing homes.

 "Medical care in this country is not a system; it's a bunch of individual forces or players each of whom takes a small part of the system," said Dr. James Goodwin, director of the Sealy Center on Aging at The University of Texas Medical Branch in Galveston, who was not involved in the current study.

"You really can increase efficiency and increase quality simultaneously when you have an integrated system. To be able to reduce hospital length of stay to that degree, those are huge changes," Goodwin said. "While there's a lot of resistance, we're moving towards integrated systems."

   Readmissions aren't the only measure of hospital care quality. Others include hospital-associated infections, safety issues like falls in older people and medication safety, Goodwin said. About 25 percent of readmissions are linked to preventable causes, Kaboli added.

Though patients and family members can't change the health care system, researchers said the study has a takeaway message: From the minute a person enters a hospital, she should ask the doctor when she can expect to be discharged. Patients and families should discuss the proposed length of the hospital stay and make sure a patient doesn't leave if she doesn't feel ready.

"Communication is key from the beginning of a hospital stay," Kaboli said. "It's for your benefit not to stay longer than you need to."

"There is no absolute rule. There's no computer governing your movement in and out of the hospital," Goodwin added. "You can influence that process and clearly stating your desires has an impact.

The study appears online today (Dec. 17) in the journal the Annals of Internal Medicine.

Pass it on: Early hospital discharge doesn't always mean readmission.

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When hospitals lose power — as was the case for two New York hospitals due to Hurricane Sandy — the lives of critically ill patients are at risk. But such emergency situations can be difficult to prevent in the face of stretched budgets, space limitations and the wrath of Mother Nature, experts say.

Over the last decade, hospitals have become better prepared for disasters such as hurricanes and flooding, said Dr. James Augustine, an emergency physician at Mercy Hospital Anderson in Cincinnati.

In 2001, Tropical Storm Allison caused major flooding in hospitals in Houston, and many lost power when their generators — located in the basement — were damaged, Augustine said. That experience led to newer hospitals in flood-prone areas placing their generators on higher levels, or on the roof.

But most hospitals built before 2001 still have generators in the basement, said Paul Richter, the emergency management coordinator at South Carolina Hospital Association. This was the case for the New York University Langone Medical Center, which lost power in Hurricane Sandy, as well as hospitals in New Orleans during Hurricane Katrina. The NYU hospital had just one generator in the basement and seven on upper levels, with tanks of fuel located underground as required by buildling codes, according to a university spokesperson. However, some of the circuitry governing the flow of electricity to portions of the hospital was located in the basement.

Retrofitting older hospitals to add a generator on the roof costs millions of dollars, Richter said. "A lot of them just don’t have the funds to do that," Richter said.

In addition, while a roof generator in theory sounds like a good idea, it's not certain whether generators tacked on in this way can withstand hurricane-force winds, Richter said. Even more, if the device that pumps fuel to the generator is located in the basement, as it was for New York City's Bellevue Hospital, which lost power due to Sandy, the generator can be rendered useless in a storm.

"It's hard to test something when it's installed unless there's an actual hurricane," Richter said. "You can only test it in a lab somewhere," he said. Richter said that to his knowledge, such testing of roof generators has not been done.

The size and weight of a generator large enough to power an entire hospital can also be an issue in terms of putting it on the roof, Richter said. As a compromise, one hospital in South Carolina is considering putting a smaller generator on the roof that will power a subset of rooms that house very critical patients who rely on electric-powered medical equipment for survival, Richter said.

The space needed to store fuel for the generators, as well as the logistics required to get the fuel to the generators is also a problem for hospitals, Richter said

Sometimes, the strength of a natural disaster can overcome even good planning. In Joplin, Mo., a hospital put its generators on ground level in an adjacent building, anchored to a concrete pad. During a tornado last year, the generators were sucked out of their location, Richter said. "Mother Nature just is too strong in some circumstances," he said.

Augustine agreed, saying, "There's no completely safe place for hospitals to put their generators."

It's also the case that different parts of the country are better prepared for certain types of disasters than others. Unexpected events for a particular region can mean the systems in place to deal with those types of disasters become outdated, said Dr. Joseph Nates, deputy chair of the Department of Critical Care at the University of Texas MD Anderson Cancer Center in Houston.

"Unfortunately, when you are expecting a flood and then you have an earthquake, you can be thrown off your game," Nates said. "You can be surprised, unfortunately," Nates said.

Pass it on: Even with backup generators, power outages in hospitals during natural disasters can be difficult to prevent.

Editor's note: This article was updated on Nov. 8 to include new information about the location of the generators at NYU hospital.

Follow Rachael Rettner on Twitter @RachaelRettner, or MyHealthNewsDaily @MyHealth_MHND.We're also on Facebook & Google+.

Doctors tend not to read the results of medical tests ordered on a patient's last day at the hospital, and this could cause doctors to miss worrisome findings, a new study from Australia suggests.

In the study, 21.3 percent of tests ordered on a patient's last day at the hospital were not reviewed by  health care personnel, whereas just 1.8 percent of tests ordered on other days went unread.

Additionally, the researchers found that of all hospital tests that went checked, close to 50 percent were ordered on a patient's last day.

Some tests are ordered automatically, because not everyone involved in a patient's care may be aware that the patient is going home that day, said study researcher Enrico Coiera, director of the Centre for Health Informatics at the University of New South Wales in Sydney. "These tests are probably unnecessary, and represent an opportunity for savings," Coiera said.

However, an unreviewed test may also mean a doctor will miss an abnormal result. This problem was highlighted in the recently publicized case of a 12-year-old boy who died of sepsis at a New York hospital. Although several test results might have been warning signs about the boy's condition, those tests allegedly went unchecked.

"People are going home, with clinically abnormal values, and not being followed up," Coiera said. If a test result indicates the presence of a life-threatening condition, such as cancer, the impact of missing that result, and delaying patient treatment, is high, Coiera said.

In the study, tests ordered on the last day were just as likely to have abnormal results as tests ordered on other days, Coiera said.

Unchecked tests

Coiera and colleagues analyzed information from 6,736 patients who stayed at a metropolitan hospital in Australia between February and June 2011.

The researchers examined computer records of the patients' tests. Test results that had been viewed by a doctor received a time stamp, while unreviewed tests did not receive a time stamp.

During the study period, 662,858 tests were ordered for patients. Of these, 3.1 percent were not reviewed.

Tests ordered on patients' last days made up just 6.8 percent of all tests ordered and performed, but accounted for 46.8 percent of unreviewed tests, the researchers said.

Among the unreveiwed tests ordered on a patients' last day, 14 percent had abnormal results that were not seen by doctors. After two months, 10.8 percent had still not been checked, the researchers found.

What can be done

The findings are concerning, and describe a problem that has been known about for quite some time, said Dr. Christopher Roy, of Brigham and Women's Hospital in Boston.

In 2005, Roy and colleagues conducted a study in which they asked doctors whether they were aware of abnormal results that came back from tests ordered on a patient's last day at the hospital. Sixty-two percent of doctors surveyed said they were not aware of the results, Roy said.

If the results of tests suggest something is wrong, such as signs of an infection, an unreviewed test "could potentially result in patient harm," Roy said.

Roy said his hospital has implemented a system in which results of pending test results are sent by email to the person that discharged the patient once they are available — a system that many are satisfied with.

Better communication between health care professionals about when a particular patient is leaving the hospital may also help reduce unnecessary tests, Coiera said.

The study was published online Aug. 13in the journal Archives of Internal Medicine.

Pass it on: Tests that are ordered on a patient's last day, but not reviewed, may result in patient harm.

This story was provided by MyHealthNewsDaily, a sister site to LiveScience. Follow Rachael Rettner on Twitter @RachaelRettner, or MyHealthNewsDaily @MyHealth_MHND. We're also on Facebook & Google+.

The desire of hospitals to make a buck is driving some surgery patients home before they’re ready, a new study finds. The study finds a link between readmission rates — someone who has to check back in after being sent home — and how full the hospital was when the surgery patent was discharged. That suggests patients went home before they were healthy enough, the researchers say.

"Discharge decisions are made with bed-capacity constraints in mind," said University of Maryland Professor Bruce Golden, who conducted the research with Ph.D. student David Anderson and other colleagues. "Patient traffic jams present hospitals and medical teams with major, practical concerns, but they can find better answers than sending the patient home at the earliest possible moment," Golden adds.

The findings are detailed in the journal Health Care Management Science.

The research examined patient movement at a large, academic U.S. medical center. They found that patients discharged when the hospital was busiest were 50 percent more likely to return for treatment within three days.

Surgeons and hospitals are incentive-driven to perform as many surgical procedures as feasible, Golden points out.

"The hospital has to maintain revenue levels to meet its financial obligations. Surgeons are working to save lives and earn a livelihood. It's what they do," he explains. "If the hospital says 'sorry there are no beds available,' there's a lot of tension and pressure from both sides to keep things moving."

These problems are much more likely at large hospitals, which tend to provide more advanced, specialized surgeries not accessible at smaller, community institutions, the researchers say. Patients often have to travel a great distance for the procedures, so hospital delays become expensive for both them and the care providers.

The study findings cover surgical discharge data from fiscal year 2007 covering more than 7,800 surgery patients who collectively spent 35,500 nights at the facility.

"This gives us a good snapshot of the pressures at work in a busy non-profit hospital," Golden adds. "Other institutions may handle the challenges somewhat differently, but the pressures are widespread and these results call for some introspection."

When one thinks of the worst polluting industries — industrial farming, coal mining, toxic sludge manufacturing and the like — hospitals usually don't come to mind. Hospitals are supposed to help heal, not harm.

Yet hospitals are among the greediest consumers of natural resources, burning a sixth of the nation's energy; and they are the most prodigious producers of waste — not just those obscene paper gowns that reveal your tush and need to be trashed, but also mercury-containing solvents and phthalate-laced IV tubing and bags.

Hospitals generate on average more than 26 pounds of waste per patient bed per day, according to the health-care sector's own statistics, and most of this ultimately is burned or buried. This doesn't include the hundreds of thousands of electronic devices disposed of annually, many with dangerous compounds such as lead and cadmium.

Now the industry wants to green itself. Announced at a press conference on April 3 in Washington, D.C., 11 large U.S. health systems have formed the Healthier Hospitals Initiative (HHI) to dramatically reduce their energy consumption and waste production, as well as to serve more-nutritious food to patients and employees.

"If a hospital's fundamental commitment is to health, then we have a unique obligation to be leaders in making positive environmental change," said John Messervy, chair of the HHI and director of facilities for the Boston-based Partners HealthCare, the parent company of Massachusetts General Hospital and the Brigham and Women's Hospital. "It means that the Hippocratic oath of 'Do no harm' extends beyond the operating room [and] the exam rooms, out to the communities that we are a part of and that we serve." [Infographic: Renewable Energy Consumption in US]

Do no harm

The connection between environment and health is well established. Many birth defects and chronic diseases — cancers, circulatory disease, diabetes, obesity and asthma, together accounting for more than 75 percent of health-care costs — are linked to poor diets and polluted air and water.

The irony of contributing to the very ailments they try to treat and cure has not been lost on hospitals. Each of the health-care systems participating in the initiative has been on its own road to better practices.

Partners HealthCare, for example, has overhauled airflow handlers and implemented programs to buy more energy-efficient products with a goal of reducing energy consumption 25 percent by 2014. Kaiser Permanente has a program to purchase environmentally preferable products, such as IV bags and computers with fewer harmful chemicals. Inova Health System has revamped its cafeterias to serve healthier food to its workers. Dignity Health has increased the number of reusable products it purchases. And so on.

What's new about the Healthier Hospitals Initiative is that, for the first time, these major health-care players are teaming up to share best practices, not only among themselves but freely with any hospital that wants the information. The HHI also is gathering data over the next three years to measure the impact of the program. [American's Best Hospitals, 2012]

Save some money, too

While going green is nice to tout, a major driver of the HHI is to reduce energy and waste-disposal costs.

Knox Singleton, CEO of the Virginia-based Inova Health System, spoke at the April 3 press briefing of a hospital's bottom line of saving money while maintaining quality. Purchasing reusable products, for example, has reduced waste by 4 million pounds and saves millions of dollars annually at Inova. Similarly, Kaiser Permanente's environmentally friendly purchasing program saves $26 million annually, the company representative said.

By combining forces, the members of the HHI — comprising more than 500 hospitals — hope to use their purchasing power to drive market forces and to reduce the costs of healthier and environmentally friendlier products, making it more affordable for any hospital to go green.

For all its potential strength, the HHI represents only about 10 percent of the nearly 5,800 U.S.-based hospitals and doesn't include the very largest systems, such as the Veterans Affairs hospitals. As such, HHI hopes to enlist more hospitals across the United States and Canada.

Christopher Wanjek is the author of the books "Bad Medicine" and "Food At Work." His column, Bad Medicine, appears regularly on LiveScience.

Babies born at home are at increased risk for health problems immediately after birth compared with babies born in hospitals, according to a new study.

However, a certified midwife may make a difference in the health of babies born at home, the study found.

In the study, babies born at home were more likely to have a neonatal seizure and low Apgar scores at five minutes after birth. Apgar scores assess the health of newborns based on the baby's breathing, heart rate, muscle tone, reflexes and skin color, with low scores indicating the baby needs medical attention.

But when a certified midwife was present, it seems babies born at home may fare as well as those born in hospitals, said study researcher Dr. Yvonne Cheng, an obstetrician and gynecologist at the University of California, San Francisco.

"It's not just about where you deliver, but perhaps who you deliver with," Cheng said.

Home births are known to be associated with fewer obstetric interventions — that is, women in labor at home receive fewer epidurals and less pain medication.

Women must weigh the benefits of home births against the risks to make an informed decision about where to give birth, Cheng said.

"It's a trade-off," Cheng said. "I think that women should be aware that there may be some risks associated with home birth," Cheng told MyHealthNewsDaily.

The findings are based on an analysis of more than 2 million births in the United States in 2008. Of these, 12,433 (or 0.54 percent) were home births.

Babies born at home may be at increased risk for health problems because monitoring may not be as rigorous, compared with at a hospital, and any problems the baby has may not receive medical attention as quickly, Cheng said.

Women planning to give birth at home should know what kind of training and experience the person who is going to deliver the baby has, and should have a back-up plan — a way to quickly get to the hospital if they need to, Cheng said.

The findings were presented today (Feb. 10) at the Society for Maternal-Fetal Medicine's annual meeting in Dallas, Texas.

Pass it on: Home births are associated with an increased risk of neonatal seizures and lower scores on tests of health immediately after birth.

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