To what lengths will hospitals go to make sure their employees are washing their hands? The answer for North Shore University Hospital on Long Island, N.Y., is thousands of miles to India where far-flung employees check their monitors, trained on the hospital floors, to find workers who skip the sinks on their way to the hospital’s intensive care units. According to a recent article in the New York Times, that is just one of many ways hospitals are working to increase hand washing and stop the spread of germs that can kill hospitalized patients. Other methods include free pizza and coffee incentives for frequent hand-washers and embedded chips on hospital employees that emit an alarm when a doctor bypasses a sink outside a patient room.  

A March report from the Centers for Disease Control and Prevention (CDC) easily explains the increasing emphasis on hospital hand washing. According to the report, a family of bacteria called Carbapenem-Resistant Enterobacteriaceae, which includes e.coli, have become increasingly resistant to last-resort antibiotics during the past decade, and more hospitalized patients are developing incurable infections. CDC researchers found that during the first half of 2012, 4 percent of hospitals and 18 percent of long-term care facilities treated a patient with this type of infection. 

Some hospitals have incentive ideas that employers and families can adopt including buttons that say, “Ask me if I’ve washed my hands?”

>>Read the article.

>>Bonus Links:

• Read about a new CDC study that found that using germ-killing soap and ointment on all ICU patients can reduce blood stream infections by up to 44 percent.
• Read tips from the CDC on how to wash hands thoroughly including a song to hum timed precisely to the time it takes to wash hands thoroughly.

WHO Reports First Patient-to-Nurse Transmission of SARS-like Virus
The World Health Organization (WHO) is reporting that two health care workers in Saudi Arabia have become infected with a potentially fatal new SARS-like virus after catching it from patients, which represents the first case of the virus spreading this way within a hospital. Novel coronavirus, or nCoV, is thought to be spread through close contact, but, "scientists are on the alert for any sign that nCoV is mutating to become easily transmissible to multiple recipients, like SARS -- a scenario that could trigger a pandemic," according to Reuters. Read more on infectious disease.

Repeated Head Injuries Raise Soldiers' Suicide Risk
Soldiers who sustain multiple traumatic brain injuries, even if they are mild, are at greater risk for suicide, according to a study published in the journal JAMA Psychiatry. Researchers found that the risk for suicidal thoughts or behaviors increased for soldiers with such injuries over the course of a lifetime -- not just in the short term after the injuries occur. Suicide is the second-leading cause of death among U.S. military personnel, and researchers say this study provides further guidance on assessing risks and supporting wounded soldiers. Read more on military health.

HHS Announces $1 Billion to Fuel Health Care Innovation
The U.S. Department of Health and Human Services (HHS) launched a nearly $1 billion initiative -- the Health Care Innovation Awards -- that will fund work to transform the health care system by demonstrating better care and lower costs. This is the second round of the award. In the first round, the Centers for Medicare & Medicaid Services awarded 107 Awards out of nearly 3,000 applications. Round one awardees included a medical home for people with disabilities that showed a 71 percent reduction in hospitalization rates. Read more on access to health care.

The most recent update on flu activity in the U.S. from the Centers for Disease Control and Prevention finds 47 states showing widespread activity, down from 48 states the week before. “Widespread” means that more than half of the counties in a state are reporting flu activity. While the Western part of the country will likely see more cases, flu seems to be slowing some in the South, Southeast, New England and the Midwest—though still packing a punch in terms of illness, deaths, emergency room visits and hospital admissions.

NewPublicHealth spoke with Paul Etkind, MPH, DrPH, MPH, DrPH, Senior Director of Infectious Diseases at the National Association of County and City Health Officials about the role local health departments play in educating communities about flu prevention and helping to facilitate treatment.

NewPublicHealth: What, if anything, is different about the flu this year?

Paul Etkind: The flu severity that’s being experienced, which we haven’t seen for several years now, has gotten the public’s attention and they’re really heeding the public health urgings, communication and education that’s been going on all along saying hey, get your flu shots, protect yourself. So now, within a relatively short period of time, there’s a very large demand for flu shots.

During the H1N1 outbreak of a few years ago, there was much greater funding for what the health departments were doing. I saw some magic happening then. They had the funds to hold clinics in very unusual places, such as local baseball stadiums and airports. They went to places where people are most comfortable.

The proportion of flu-related doctor visits has reached a nine-year high for this time of year, according to the Centers for Disease Control and Prevention, as reported by USA TODAY. Correct anyone who tells you it’s too late to get a flu shot, though. The Centers for Disease Control and Prevention intentionally schedules National Influenza Vaccination Week in December as a reminder to get the shot for the many millions of Americans who still haven’t.

 “Flu season typically peaks in February and can last as late as May,” says Dr. Anne Schuchat, Assistant Surgeon General of the U.S. Public Health Service and Director of CDC’s National Center for Immunization and Respiratory Diseases. “We are encouraging people who have not yet been vaccinated to get vaccinated now.”

December holiday gatherings are optimal opportunities to spread the flu, and since it takes up to two weeks for full immunity to take effect, this week is a good time to roll up your sleeve if you’re still shot-less.

Flu shots come in several varieties. Children who never had a flu shot need two doses the first year they get the vaccine. There’s a nasal spray for adults 18-49 and a higher dose version for people 65 and older. Learn more from the CDC about different versions of the flu shot and what might be best for you and your family.  

Some people will exercise their right to protect themselves against the flu when they vote today. Throughout the country, “Vote & Vax” clinics have been set up at or near polling places to help improve the chance that people who still haven’t had their 2012/2013 flu shot get that shot in the arm. Vote & Vax, which had start up support from the Robert Wood Johnson Foundation, works with local public health providers including health departments to help set up the flu shot clinics. Project partners include the American Public Health Association, the Association of State and Territorial Health Officers and the National Association of County and City Health Officials.

In the last presidential election almost half of flu shot recipients who were vaccinated through Vote & Vax had not received a flu shot in the previous year or were not planning to get a flu shot that year.

Click here to see if there is a Vote & Vax clinic near, or at,  your polling place.

If not, search the American Lung Association's Flu Clinic Locator Site, to find the nearest site. 

Crowds of public health officials thronged Mary Selecky, Secretary of the Washington State Department of Health since 1999 and a former ASTHO president, at the ASTHO annual meeting, likely for her wisdom as a long time health director grappling with some of the most critical problems facing public health.

NewPublicHealth caught up with Mary Selecky at the recent ASTHO meeting.

NewPublicHealth: What is the rest of the country learning from the recent pertussis (whooping cough) outbreak in Washington State?  

Mary Selecky: We have more than 4,000 cases confirmed. Sixty percent of cases are in school age kids, 20 percent in adults and 20 percent in kids under age five. The most worrisome statistics are the numbers of babies hospitalized. [Editor’s Note: Babies get whooping cough vaccines at ages two, four and six months and don’t have full immunity until after the last vaccine.] Most adults get a mild case—they don’t know they have it, they have a dry hacky cough and they’re spreading pertussis germs. One of our very fundamental pieces of information is to make sure your kids are vaccinated and up to date, and that teens and adults have gotten a booster shot. We know we’re reaching the public because our insurance companies are telling us that double the  amount of people have gotten the booster from last year. We know we’re getting some penetration there, but clearly not enough.  

It has not really gone away. We’re still seeing about 100 new cases every week. We are slowing down—it’s a little bit less every week. Nevertheless, 100 cases per week is still ten times more than it was a year ago. We reached out to the CDC to have their epidemiology investigators to come in and look at our data and see what is happening. They were able to show us that our 13- and 14-year-olds are getting hit hardest and many were vaccinated, so we are evaluating when the booster shot was given and how soon after they got pertussis and what we can learn.

We’re seeing more whooping cough in the U.S. than we have seen in multiple decades. Our own numbers are more than we’ve seen since 1941. It’s a bug, easily passed person to person. We do have an effective vaccine but what the CDC is able to glean may indicate that we need to give a booster more often.

NPH: While the CDC investigates, what’s your recommendation as a state health director? 

The Centers for Disease Control and Prevention is reminding schools and parents that while many interacting with a “class pet” at school can present important opportunities to help children learn responsibility and nurturing, having animals in the classroom can pose a risk of illness and injury if not handled properly. The CDC has a list of over thirty diseases animals can spread, and a fact sheet onanimals in school and daycare settings. Little kids are at increased risk because their immune systems are still developing, also because they are more likely than older kids and grownups to put their fingers in their mouths after touching an animal.

In the United States, human illness from animals include salmonella, E. coli and rabies, and germs that spread the infection can be found in droppings, cages or wherever animals walk around.

The CDC advises that everyone wash their hands right after handling animals, their food and their habitats such as cages, water bowls and toys. Soap and water are best, and if hand sanitizer alone is used, wash hands with soap and water as soon as it is available.

CDC Says Plane Scare Unlikely to Have Been Monkey Pox

Investigators from The Centers for Disease Control and Prevention boarded a plane to examine—and then release—a woman with a rash who arrived back in the US from Uganda late last week. The immediate concern had been monkey pox, a sometimes fatal infectious disease that is similar to smallpox, but CDC investigators say her symptoms were not consistent with the illness. News sources say her rash was likely the result of bed bug bites

Read an interview with the screen writer and an advisor to the film “Contagion”

Low Literacy in Math and Reading Can Lead to Medication Dosing Errors by Parents

Parents with math skills at the third grade level or below were five times more likely to measure the wrong dose of medication for their child than those with skills at the sixth grade level or higher, according to a study presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Researchers say dosing liquid medications correctly can be especially confusing because parents have to read and understand dosing for different ages and weights and understand the measurement markings on dosing cups, droppers and syringes.

Read more on health literacy.

Text Messaging May Help Increase Immunization Rates

A new study by researchers at the Columbia University Mailman School of Public Health found that text message reminders to parents about flu vaccinations may help boost the number of children vaccinated. The study was published in the Journal of the American Medical Association and followed 9,213 children and adolescents ages six months to 18 years—primarily from minority households. Parents of children assigned to the text-message intervention received up to five weekly texts providing educational information and instructions on where the vaccinations were administered. Everyone in the study received an automated telephone reminder, and access to informational flyers posted at the study sites.

At the end of the study, a higher proportion of children and adolescents in the intervention group (43.6 percent) than in the control group (39.9 percent) had been vaccinated against the flu.

Read about text messaging interventions in public health.

This week is National Infant Immunization Week, an annual observance to promote vaccinations in kids two and younger.

Last September the Centers for Disease Control and Prevention announced that childhood immunization rates for vaccines routinely recommended for children are at near-record or record highs. But CDC experts say that without ongoing efforts to maintain immunization programs in the US – and to strengthen them worldwide -- vaccine-preventable diseases remain a threat to children. In 2010, for example, an outbreak of pertussis (whooping cough) killed ten infants in California.

CDC and the CDC Foundation are recognizing innovative child immunization efforts this year with the CDC Childhood Immunization Champion Awards, a new annual award to recognize individuals who make significant contributions toward improving public health through their work in childhood immunization.

Innovations recognized this year include:

• A contest to help increase the number of people vaccinated against season flu.
• A link between a hospital’s electronic medical records and the state immunization registry which lets pediatrics practices upload vaccine information directly into the registry and gives providers easy access to registry data about their patients.
• Vaccine mobiles, providing free vaccines regardless of insurance coverage, parked at public spaces and linked to a state registry system.

Read about the champions in all fifty states.

Weigh In: What innovative approaches have increased infant immunization rates in your community?

US Confirms Single Case of “Mad Cow”

The Department of Agriculture's Animal and Plant Health Inspection Service has confirmed the detection of bovine spongiform encephalopathy (BSE) in a dairy cow from central California. The USDA says the animal will be destroyed and had not been for slaughtered for human consumption, so at no time presented a risk to the food supply or human health. Additionally, according to USDA, milk does not transmit BSE.

Read more about the USDA.

Lung Association: US Air Quality Improving, Still Poses Health Risks

The American Lung Association’s State of the Air 2012 report, released today, finds that in America’s most polluted cities, air quality was at its cleanest since the organization began releasing the report thirteen years ago as efforts continue to make environmental hazards.

However, the report shows that more than 40 percent of people in the U.S. live in areas where air pollution continues to threaten their health--127 million people are living in counties with dangerous levels of either ozone or particle pollution that can cause serious health problems such as wheezing and coughing, asthma attacks, heart attacks, and premature death.

Read more on pollution.

Implanted Heart Devices May Pose Infection Risk

Implantable pacemakers or defibrillators may pose a risk for developing deadly infections, according to a new study in the Journal of the American Medical Association.

The study shows that more than 4.2 million people in the US had a permanent pacemaker or defibrillator implanted between 1993 and 2008, and that infections related to heart devices infections increased 210 percent during that time, according to the study.

The study authors say a contributing factor may be that some patients may have other medical conditions and be particularly vulnerable to developing infections.

Read more on heart disease.

See more public health news roundups.