Clean hands save lives, wash your hands to combat germs!

PETALING JAYA: The role of hand hygiene in preventing the spread of drug-resistant germs is the focus of the World Health Organisation’s annual “SAVE LIVES: Clean Your Hands” campaign this year.

Launched yesterday, the campaign is in line with WHO’s recently-released report on Antimicrobial Resistance: Global Report on Surveillance.

How bacteria become resistant

Bacteria grow resistant to antibiotics through natural selection. When drugs are used, some organisms may have ways of surviving. As they reproduce or pass DNA to other bacteria, those traits become more common, weakening antibiotics’ power.

The report states that there are increasingly more types of bacteria which cannot be killed by antibiotics. The report also stated that no one in the world is safe from this menace.

However, WHO also reported that should compliance with hand hygiene in health facilities increase from under 60% to 90%, there could be up to a 24% reduction in the infection of methicillin-resistant Stap­hylococcus aureus (MRSA).

MRSA, most commonly contracted in hospitals, is rapidly becoming more difficult to treat with current drugs.

“Whether it is the hands of the patient, their visitors or the healthcare team, people must remember to practise good hand hygiene in a healthcare setting, especially in hospitals,” said Patient Safety Council of Malaysia member Dr Milton Lum.

Good hand hygiene means washing the hands thoroughly with soap and water before and after touching a patient.

“Everyone has germs on his or her body so despite our good intentions in visiting our sick relatives or friends, we may actually pass on a bug unintentionally,” said Dr Lum.

Patients for Patients Safety Malaysia chairman J. Manvir said he believed that patients should also wear masks to protect themselves from airborne infections.

“Children under 12 should not be visiting patients, especially in hospitals.

“You may not be able to teach them to practise good hand hygiene but you can keep them at home to prevent them from passing on an infection to the patient as well as preventing them from getting ill,” said Manvir.

Antibiotic resistance has been around since the 1940s when the first antibiotic, penicillin, allowed doctors to kill off the many bacteria that were the source of different infections.

However, subsequent misuse of penicillin accelerated the natural evolution of the bacteria, resulting in the microbes becoming resistant.

Contributed by Tan Shiow Chin The Star/Asia News Network

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WHO's Alarm Bells: Antibiotic Resistance Now a 'Major Threat to Public Health'

The world's leading health organization is sounding serious alarm bells about the problem of antibiotic resistance.

Related: Good hand hygiene can save lives - SDHB

WHO's Alarm Bells: Antibiotic Resistance Now a 'Major Threat to Public Health'

The world's leading health organization is sounding serious alarm bells about the problem of antibiotic resistance.

In its first report on the issue ever, the World Health Organization (WHO) is sounding alarms about the issue of antibiotic resistance and the global public health threats it poses to our increasingly interconnected world.

"The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century," the report states.

Antibiotic resistance occurs when bacteria no longer die when treated with antibiotics. As a result, doctors have to use stronger, more potent antibiotics, and the more those are used, the more resistance bacteria develop to those as well. The WHO is warning that we're reaching a point in which the strongest antibiotics doctors have in their arsenal, the "treatment of last resort" drugs as they're called, no longer work.

And in fact, it's no longer just bacteria that are becoming resistant. The WHO has stopped referring to the problem as "antibiotic resistance" and now calls it "antimicrobial resistance," to encompass other organisms, such as viruses and parasites, that no longer respond to the drugs of choice. Namely, treating the viruses tuberculosis and HIV, and malaria (a parasite), has become harder as these diseases become resistant to medications. Even H1N1, the so-called "swine flu" that reached pandemic levels in 2009, has begun developing resistance to potent antiviral drugs.

Resistance Is a Worldwide Problem

One of the major points of the report is that diseases that used to be restricted to certain locales are now spreading internationally:

Among their key findings:
• Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumonia—carbapenem antibiotics—has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections.

• Treatment failure to the last resort of treatment for gonorrhea—third generation cephalosporins—has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.

• People with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64 percent more likely to die than people with a non-resistant form of the infection. MRSA, which can cause septic bloodstream infections when exposed to broken skin, is one of the most common "community-acquired" resistant infections, meaning you're likely to pick it up anywhere other people are—your gym, place of worship, a nearby park or even at schools. In the Americas, as many as 90 percent of staph infections are reported to be MRSA.

• There hasn't been a new class of antibiotics developed since the late 1980s.

We Can't Track What We Don't Know

The WHO is calling on countries all over the world to step up their surveillance of these deadly infections, something that happens rarely, if at all. An investigative report, "Hunting the Nightmare Bacteria," that ran on the PBS program Frontline in October 2013 revealed that public health officials in the U.S. have little to no data on the extent of antimicrobial resistance in this country. Healthcare facilities aren't required to report outbreaks, the report found, and many don't because they don't want to scare people or have to deal with bad PR.

“It is frankly embarrassing that we as a country do not know where resistance is occurring, how bad the problem is for various organisms or who’s using what antibiotics when,” Brad Spellberg, MD, an infectious disease doctor at Harbor-UCLA Medical Center, said in the documentary.

The Centers for Disease Control and Prevention has estimated that antimicrobial resistant infections hit two million people a year and kill at least 23,000. But the WHO notes that in most countries around the world, including the U.S., often only the most severe infections are documented and minor community-acquired infections (which can get passed along repeatedly and wind up as a severe infection) go unreported.

Clean Up the Food Supply!

For quite possibly the first time, the WHO also called out the food industry for its contribution to antimicrobial resistance. " The use of antibiotics in animal husbandry—including in livestock, poultry and fish farming—are leading to increasing recognition that urgent action is needed to avoid inappropriate use, and to reduce antibiotic usage in animal husbandry and aquaculture, as well as in humans," the report states. In the U.S., 80 percent of antibiotics sold go into animal feed to prevent infections in healthy animals or to speed growth. And we're not alone. "In many countries, the total amount of antibiotics used in animals (both food-producing and companion animals), measured as gross weight, exceeds the quantity used in the treatment of disease in humans," the authors found.

The same classes of antibiotics used on these animals are the same as those given to humans. In particular, fluoroquinolones, antibiotics used widely in the poultry industry, are increasingly ineffective against urinary tract infections caused by drug-resistant E. coli bacteria, which have been detected on all forms of supermarket meat, and against MRSA soft-tissue and skin infections.

Numerous groups in the U.S. have sued the Food and Drug Administration to revoke its approvals in animals for antibiotics that are valuable for humans. The agency's only response has been to set voluntary guidelines for the industry.

What You Can Do

Despite the damage factory farming has done to antibiotic effectiveness, the WHO and other public health officials insist that the first line of defense in controlling the problem of antimicrobial resistance is the healthcare setting: Stopping doctors from giving patients antibiotics for conditions they aren't designed to treat, for instance, when you're given antibiotics for a cold that's caused by a virus, not bacteria.

• Don't automatically ask for antibiotics when you feel sick and visit a doctor.

• If your doctor prescribes an antibiotic, ask if there's an alternative before just accepting the advice. Some doctors feel compelled to offer the drugs to make people feel better, but asking for an alternative can open up a dialogue about other options.

• When you do need an antibiotic, take the full course, even if you're feeling better.

• Wash your hands frequently to protect yourself from community-acquired infections, and keep your hands away from your nose, eyes and mouth, where infections can enter.

Contributed by  By EMILY MAIN

 


Alarm bells over antibiotic resistance 

The World Health Organisation’s most comprehensive report to date sounds a warning that we are entering a world where antibiotics have little effect.

THE World Health Organisation (WHO) has sounded a warning that many types of disease-causing bacteria can no longer be treated with the usual antibiotics and the benefits of modern medicine are increasingly being eroded.

The comprehensive 232-page report on anti-microbial resistance with data from 114 countries shows how this threat is happening now in every region of the world and can affect anyone in any country.

Antibiotic resistance – when bacteria evolve so that antibiotics no longer work to treat infections – is described by the report as “a problem so serious that it threatens the achievements of modern medicine”.

“A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” said Dr Keiji Fukuda, WHO assistant director-general who coordinates its work on anti-microbial resistance.

“Without urgent, coordinated action, the world is headed for a post-antibiotic era in which common infections and minor injuries which have been treatable for decades can once again kill.

“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine.

“Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

The report, “Antimicrobial Resistance: Global Report on Surveillance”, shows that resistance is occurring in many bacteria causing different infections.

It focuses on antibiotic resistance in seven bacteria responsible for common, serious diseases, such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

What is especially alarming is that the bacteria’s resistance has also breached “last resort” antibiotics, which are the most powerful medicines that doctors resort to when the usual ones do not work.

When patients do not respond to the usual medicines (known as first-line or first-generation medicines), doctors prescribe newer (second line medicines) which also usually also cost more.

When these also don’t work, newer and often more powerful (but sometimes with also more side effects) antibiotics are used, and they are even more expensive.

If these third-line or “last resort” medicines are not available or too costly for the patient, or if they don’t work on a patient because of antibiotic resistance, the patient remains ill or dies if the infection is a serious one.

New antibiotics have been discovered in the past to treat infections when the old ones became useless due to resistance.

But these discoveries dried up in the past 25 years.

The last completely new classes of anti-bacterial drugs were discovered in the 1980s.

Pathogens that are becoming increasingly resistant including to the more powerful antibiotics include E. coli, K. pneumonia, S. aureus, S. pneumonia, salmonelia, shigella and n. gonorrhoeae.

Key findings from the report include:

> Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, K. pneumonia — carbapenem antibiotics — has spread worldwide.

K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients.

In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections;

> Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli – fluoroquinolones – is very widespread.

In the 1980s, when these drugs were first introduced, resistance was virtually zero.

In many countries today, this treatment is ineffective in more than half of patients;

> The sexually transmitted disease, gonorrhoea may soon be untreatable unless there are new drugs. Treatment failure to the last resort of treatment for gonorrhoea – third generation cephalosporins – has been confirmed in several countries; and

> Antibiotic resistance causes people to be sick for longer and increases the risk of death.

For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.

There are many cases of patients being infected by MRSA in hospitals.

The report also gives useful information on the worrisome building up of resistance in four serious diseases — tuberculosis, malaria, HIV and influenza.

A major factor accelerating resistance is in the animal husbandry sector, where there is a liberal use of antibiotics mainly to promote the growth of the animals used for food, for commercial purposes.

This builds up resistance in the bacteria present in the animals.

These resistant germs are passed on to humans who consume the meat.

The report has a small section on the animal-food chain, which has been identified as a major problem.

The European Union has banned the use of antibiotics as growth promoters in animals, but it is still allowed in other countries.

A WHO press release on the report calls for some actions. These include:

> Setting up basic systems in countries to track and monitor the problem;

> Preventing infections from happening in the first place to reduce the need for antibiotics;

> Only prescribing and dispensing antibiotics when they are truly needed, and prescribing and dispensing the right antibiotic(s) to treat the illness;

> Patients using antibiotics only when prescribed by a doctor and completing the full prescription; and

> Developing new diagnostics, antibiotics and other tools to stay ahead of emerging resistance.

Contributed by Global Trends by Martin Khor

Martin Khor is executive director of the South Centre, a research centre of 51 developing countries, based in Geneva. You can e-mail him at director@southcentre.org. The views expressed are entirely his own.

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• Do You need jabs, antibiotics?

•   Are antibiotics an end to modern medicine?

•  Superbug lurking! Drug resistance now a nightmare!

Obama Wants $1.5 Trillion In Tax Hikes, Mostly On Rich, Draws Election Battle Lines

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Janet Novack, Forbes Staff I write from D.C. about tax and retirement policy and planning.

Image via Wikipedia President Barack Obama will call today for an additional $3.2 trillion in deficit reduction over the next decade, including $1.5 trillion in tax hikes, mostly on the rich. His plan also includes $1.1 trillion in savings from winding down the wars in Iraq and Afghanistan and $580 billion in savings from “mandatory” programs, including $248 billion in Medicare cuts, but significantly, no increase in the age for Medicare eligibility and no Social Security trims.

Contrary to earlier press reports, however, the plan Obama is sending to Congress’ Joint Select Committee On Deficit Reduction—the so-called Super Committee– won’t include a special  new  millionaire’s tax. Instead, Administration officials said in a background briefing with reporters Sunday night, Obama will call for tax reform to be based on five principles and one of those will be the “Buffett rule”—in honor of Berkshire Hathaway CEO Warren Buffett who has complained for years that he pays taxes at a lower rate than his secretary.  An official put the rule this way: “People making more than $1 million should not pay a smaller share of their income in taxes than middle class people pay.”  The other four principles, he added, are that tax reform should lower rates; reduce the deficit (in other words raise taxes) by $1.5 trillion over 10 years; close “wasteful loopholes and tax breaks”; and “boost job creation and growth.”


Republicans, too, favor tax reform and lower rates, but have ruled out raising any new revenue. On Thursday House Speaker John Boehner (R-Ohio) declared tax increases “off the table”.  In an interview on NBC’s Meet The Press show Sunday, Senate Minority Leader Mitch McConnell (R-KY) dismissed any consideration of tax increases as “a bad thing to do in the middle of an economic downturn.”

The August political deal that raised the nation’s debt ceiling and averted a Treasury debt default created the Super Committee and charged it with coming up with a plan by Thanksgiving to trim at least $1.2 trillion from the deficit over 10 years. The Super Committee is  made up of six Democrats and six Republicans and if it deadlocks—or its final product is voted down by Congress or vetoed by Obama–automatic budget cuts would kick in. Republicans insist the $1.2 trillion should come solely from cuts to spending, including to entitlement programs like Medicare and Medicaid.

Significantly, the Administration official said Obama is making his embrace of Medicare cuts contingent on tax increases being included in the final deal.  “He’ll say he’ll veto any bill that takes one dime from the Medicare seniors rely on without asking the wealthy and the biggest corporations to pay their share,’’ the official said in a preview of Obama’s remarks. In another move that should similarly please his restive Democratic base, Obama is excluding from his proposal any change  to Social Security, including a reduction in inflation adjustments for Social Security recipients that was part of a bigger deal he tried to strike with Boehner in July. “It’s his vision,  not a legislative compromise,” an Administration official explained. “It’s inherently different form the grand bargain he was working on with the Speaker.”  A higher age for Medicare eligibility was also, reportedly, considered as part of the failed bargain with Boehner but won’t be in Obama’s proposal. (Currently, Americans become eligible at 65 even if they haven’t yet claimed their Social Security benefits.)



In the Sunday night preview, Administration officials cast Obama’s plan as a total of $4.4 trillion in net deficit reduction —including cuts that were made in discretionary spending as part of the August deal and prospective savings on interest costs. (While Republicans are sure to dismiss Obama’s counting of war savings, they have done the same thing in their deficit plans.)  Moreover, an Administration official noted, the $4.4 trillion is net of the cost of Obama $447 billion “jobs” proposal—a package of payroll tax cuts, infrastructure spending, and help for the unemployed designed to attack the nation’s stubbornly high 9.1% unemployment rate. Obama has proposed paying for that too with tax hikes Republicans have rejected, including a limit on mortgage, charitable and other deductions for the well off; elimination of the “carried interest” tax break enjoyed by the managers of hedge funds and other partnerships; and the repeal of various tax preferences enjoyed by oil and gas producers, including Exxon Mobil,  Chevron and BP.

Indeed, most of Obama’s tax proposals will apparently repeat those he has made before. For example, $800 billion would come from letting the Bush tax cuts for families earning more than $250,000 expire at the end of 2012, meaning the top rate on ordinary income such as salary would rise from 35% to 39.6%. Last month, in a New York Times op-ed, Buffett called for two higher tax rates—one on income over $1 million and the other on income over $10 million. Published reports over the weekend variously suggested Obama would endorse a new millionaire’s rate or release some sort of proposal for a minimum tax on millionaires—say to replace the current convoluted alternative minimum tax.  But Sunday night, the Administration official said the Buffett rule was simply a principle for tax reform.

Most people earning more than $1 million are already taxed at a higher effective rate than their secretaries. In 2008, for example, taxpayers with adjusted gross income between $1 million and $10 million paid an average of 24.5% of their adjusted gross in federal income tax, compared with an average of 12.6% for those earning $100,000 to $200,000, and 8.4%  for those earning $50,000 to $100,000. But the 400 highest income taxpayers do pay a lower effective rate  than mere millionaires—an average of just 18.1% in 2008. That’s because the top 400 get the bulk of their income from capital gains, which are taxed at a top rate of 15%, scheduled to rise to 20% when the Bush tax cuts expire at the end of 2012. If tax reform is to insure that billionaires pay a higher effective rate than the upper middle and middle class it would have to reduce or eliminate the break for capital gains—something that was done in Reagan’s 1986 tax reform but that doesn’t sit well with most Republicans today.

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Obama tax plan draws election battle lines

Stephen Collinson 

An impassioned US President Barack Obama has set up an acerbic and personal clash with Republicans, demanding $US1.5 trillion ($A1.47 trillion) in new taxes on the rich in a plan aimed at slashing the deficit.

"This is not class warfare, it is math," Obama declared, arguing that without tax increases on those who could afford it, the budget gap - which is casting a shadow over future generations of Americans - could never be closed.

"All I'm saying is that those who have done well, including me, should pay their fair share in taxes," Obama said in a speech that effectively staked out the ground on which the 2012 presidential election will likely be fought.

But Republicans immediately came out against the move, making it more likely that a fierce partisan row over taxes and spending will rumble on and define the terrain of the 2012 presidential election.

"Pitting one group of Americans against another is not leadership," said Republican House Speaker John Boehner.

A fiery, populist Obama laid out a plan few experts believe has any chance of passing Congress but which will make clear the battle lines between the White House and Republicans on the lumbering economy.

"We can't just cut our way out of this hole," Obama said in the White House Rose Garden, laying out his plans to cut $US3.0 trillion from the deficit with a mixture of spending cuts and tax hikes.

"It is only right we ask everyone to pay their fair share," Obama said, in a direct challenge to House of Representatives speaker John Boehner, who has categorically ruled out any tax increases to trim the budget gap.

"We can't afford these special lower rates for the wealthy. We can't afford them when we are running these big deficits," Obama said, fighting for the end of tax cuts for the rich passed by former president George W Bush.

"Middle class taxpayers shouldn't pay higher taxes than millionaires and billionaires. That's pretty straightforward. It's hard to argue against that," said Obama, who has seen his approval ratings hammered by the slowed economy.

In a sign of the antipathy between Obama and Republican leaders after months of political confrontations, the president took personal aim at Boehner's refusal to contemplate any tax revenue raises.

"The speaker says we can't have it 'my way or the highway' and then basically says 'my way or the highway'."

"That's not smart. It's not right."

Obama's plan amounted to suggestions to a congressional supercommittee charged with finding up to $US1.5 trillion in deficit cuts by November.

The president threatened to veto any bill produced by Congress that was based on cutting medical benefits for the elderly but did not include increased revenues drawn from higher taxes on the rich and corporations.

Obama's plan effectively forced Republicans to defend continued favourable tax treatment for the wealthiest Americans and corporations while unemployment is at 9.1 per cent and economic frustration stalks the United States.

But Republicans, who say tax hikes would penalise small business and lower growth, reacted with contempt to his speech.

"Veto threats, a massive tax hike, phantom savings, and punting on entitlement reform is not a recipe for economic or job growth-or even meaningful deficit reduction," said Mitch McConnell, the top Republican in the Senate.

Mitt Romney, a leading Republican contender to take on Obama in the 2012 election, also rejected his plans as the action of a president who he portrays as out of his depth on the economy.

"President Obama's plan to raise taxes will have a crushing impact on economic growth," Romney said.

"This is yet another indication that President Obama has no clue how to bring our economy back."

Obama's plan includes $US1.2 trillion in cuts in federal discretionary spending already agreed in August as part of a compromise which ended a standoff with Republicans over raising the federal debt ceiling.

It includes $US580 billion in spending cuts across all mandatory spending programs and $US1.1 trillion of savings realised from drawing down US troop numbers in Afghanistan and Iraq.

Tax reform would result in $US1.5 trillion in savings, and a further $US430 billion will be found in additional interest savings elsewhere.

Included in the spending cuts will be $US248 billion in savings from Medicare programs for the elderly and $US72 billion in cuts from the Medicaid service for the poor, officials said.

© 2011 AFP
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