Ebola, MRSA, HIV and rabies are just a few examples of these microbial infestations. Learn how to protect yourself from harm, and how our area hospitals keep patients healthy and well-informed.
What do you think of when you hear the term “infectious disease?”
An exotic killer virus like ebola, that spreads through bodily fluids? A bacterial infection like salmonella, acquired through tainted food? A parasite infection like malaria, that spreads through mosquito bites? A fungal infection like athlete’s foot, picked up from the gym’s shower floor?
Any of those answers would be correct, as would hundreds of others, ranging from the common cold to herpes, HIV/AIDS, hepatitis, rabies, MRSA, leprosy and measles.
By definition, an infectious disease is a microbial infestation of the body, whether by virus, bad bacteria, fungus or parasite.
Worldwide, the mosquito is known as “the most dangerous animal in the world” because its bites result in more than 1 million malaria deaths each year. In fact, the World Health Organization estimates that a child dies every 30 seconds from malaria, mostly in tropical or subtropical regions of Africa, Asia and the Americas.
While malaria is seldom a problem in our country, the U.S. Centers for Disease Control and Prevention (CDC) constantly tracks infectious disease outbreaks here, from sickness caused by E. coli bacteria consumed in ground beef to viral meningitis outbreaks in college dormitories.
The Local Picture
Some infectious pathogens are much worse than others, but it’s often the general health of an infected patient that determines the odds of survival and speed of recovery, says Dr. Kavitha Subramanian, of OSF Saint Anthony Medical Center, who is board-certified both in infectious disease and internal medicine.
“Symptoms of patients who present with infections can range from mild to moderate,” she explains. “Patients with suppressed immune systems are most vulnerable, such as those in chemotherapy, HIV patients, or people being treated with drugs for conditions like lupus, rheumatoid arthritis or certain skin conditions. They tend to get more sick more quickly.” Elderly patients and the very young are more vulnerable, too.
While Rockford hospitals don’t see infectious diseases like malaria or cholera, they do see diseases caused by soil-borne molds, fungi and the nocardia bacteria, because they serve patients from nearby rural communities, says Subramanian. “We also see our share of Lyme disease caused by deer tick bites, and of course pneumonia and bloodstream infections that can be life-threatening if left untreated. While we don’t see a lot of uncommon infectious diseases, we stay very aware of those which can be spread by travelers because of our proximity to O’Hare, which is a very large and international airport.”
Recently, local doctors were alerted when a man who traveled from Saudi Arabia to Chicago O’Hare International Airport was thought to have MERS-CoV (Middle East Respiratory Syndrome), a new, fast-spreading and often-lethal infectious disease. “We’re very watchful for those kinds of communicable diseases,” says Subramanian. “All infectious disease doctors in Rockford’s three hospitals stay connected and share information with one another about what we’re seeing. If we see a pattern, we alert each other.”
What to Do
The symptoms for many infectious diseases are similar to those of the common cold and flu, so people often delay medical help too long, says Subramanian.
“Often we find ourselves telling patients, ‘If only you could have come in a day earlier, before this infection had advanced so far.’ Once patients get really sick, it becomes much more difficult for them to fight off infection. Especially if there’s a rash, a high fever of more than 101.5 degrees, or if they feel they’re getting worse and not better, after a few days, they should get adequate urgent care.”
Babies under 12 months who have a fever of 100 degrees or more should be seen by a physician, she adds. Infections can overtake infants very quickly.
Even a relatively common infection of the bladder or gall bladder can become life-threatening if bacteria spills into the bloodstream and causes bacteremia or septicemia (blood infections).
“Most bacterial infections are treatable with antibiotics, but there’s a catch,” says Subramanian. “As we doctors get smarter, so do the pathogens. Multi-drug resistance is a real concern. As pathogens evolve to resist the drugs, our options for treatment become smaller and smaller. We have to use stronger antibiotics, but they have more negative side effects. A small number of new antibiotics are being developed, but they’re nowhere close to keeping up with the rate at which pathogens are becoming resistant. That’s why physicians are increasingly cautious about giving antibiotics to people, are cautious about overuse in general. It may be the same bacteria causing an illness, but when it evolves, it’s more resistant to treatment.”
The good news is that some infectious diseases once considered untreatable are now treatable, if not curable, including some caused by viruses. As examples, Subramanian cites three new drugs for hepatitis C patients, as well as new medicines for those with HIV and herpes simplex virus. Even better, vaccinations like flu shots prevent illness from gaining a foothold in the first place.
When outbreaks of diseases like measles, mumps or chicken pox occur, it’s likely among pockets of unvaccinated people, says Subramanian, who cites a recent outbreak of whooping cough in Indiana as an example.
In our daily routines, there are many things we can do to reduce our exposure to infectious diseases.
“My favorite advice is to wash your hands a lot – before eating, cooking, dining out,” says Subramanian. “Also, don’t push your doctor to prescribe antibiotics for every little ailment. Most of the time they’re improperly used. If your illness is caused by a virus, they won’t help anyway. Antibiotics treat bacterial infections, not viruses. And if you’re on antibiotics, always complete the full course as prescribed. Don’t stop just because you’re feeling better. When people stop early, that’s when the bad bacteria have a chance to evolve and become resistant to medicine, rather than being killed off completely.”
Finally, she says, follow CDC recommendations for vaccinations. “I know there is still some fear of vaccinations out there, but if the CDC or your doctor recommends it, it’s probably the right thing to do.”
Dr. William Renk, a board-certified pediatrician at SwedishAmerican Hospital, couldn’t agree more. Over the past decade, a fear that familiar inoculations might be the cause of other health conditions has lead to a trend against immunization.
“Most parents lived through the height of this, only to learn those fears didn’t pan out,” Renk says. “And those that did pan out, such as mercury occurring in the vaccine, were immediately addressed. At SwedishAmerican Hospital, 90 percent of our child patients are inoculated against measles, mumps and rubella (MMR), while the other 10 percent may not be inoculated because their parents forgot to get it done. It’s not simply a matter of refusing to have their children inoculated, some parents just forget. Still, we do see deliberate refusal, in some families.”
Sometimes a look back at world history is all it takes to motivate parents to have their children immunized. Infectious diseases have killed more people than all military actions combined and remain a leading cause of death in poorer nations. Less than a century ago, in 1918 & 1919, the Spanish flu spread to every continent, infecting a third of the world’s population and killing between 50 and 100 million people. Rockford’s Camp Grant reported 100 Spanish flu deaths in just one day.
Still, for more than a century, dedicated scientists and medical professionals have focused on developing inoculations to combat diseases that ravaged populations. From the black plague that swept through Europe more than once, killing millions, to seemingly simple childhood diseases like measles and mumps, vaccines have emerged and been refined to the point where, today, many bacteria-based killer diseases have nearly been eradicated.
The problem, Renk says, is that childhood diseases such as whooping cough are rebounding, even in the U.S., because of the 10 percent of unimmunized children. In many cases, parents who were not inoculated are giving diseases to their newborn children. Because children don’t receive MMR injections until 15 months of age, with a booster at age 5, they’re vulnerable to infected older siblings and other casual contacts who were not inoculated.
“Our school systems require immunization and have done an excellent job of encouraging families to keep inoculations up to date,” Renk says. “And parental fears about MMR causing autism, for example, have been proven unfounded. The overall data does not support this belief.”
Pediatricians are in the business of keeping children healthy, Renk points out.
“There is absolutely no conspiracy, and if we believed these inoculations did cause autism or any other severe adverse events, the shots would be stopped. About 20 years ago, we found that children inoculated with rotavirus were at risk of developing bowel obstructions. The practice was immediately suspended until it was reformulated and reintroduced. It now has been given for several years without issue.”
One of the reasons diseases such as polio have nearly disappeared is because of what Renk terms “herd immunity.” When non-immunized children are surrounded by immunized children, they’re unlikely to get the disease because people around them are disease-free, Renk explains.
“All the diseases we vaccinate against can either cause death or serious disease, in a spectrum that includes the unborn fetus to children under age 2,” Renk says. “These are the highest-risk groups and the ones least able to fight these diseases on their own. We vaccinate to boost children’s immune systems to better fight on their own.”
Keeping Hospitals Clean
Given how easy it is to pass along infectious diseases from one person to another, it’s no surprise that hospitals regard cleanliness and disease containment as an ongoing top priority. For Karen Draves, RN, the infection prevention and control coordinator at Beloit Health System, this involves multi-level awareness, training and a whole lot of hard work. Millions of plastic gloves and thousands of hand sanitizer dispensers are only the beginning.
“When people come into Beloit Memorial Hospital, they’re going to see sanitizer dispensers inside and outside patient room doors, in bathrooms, and in dozens of other strategic places,” Draves says. “Every single staff member and doctor who goes into a patient room douses his or her hands with sanitizer on the way in and again on the way out.”
Draves explains that the CDC is the primary source for the universal guidelines and mandates designed to protect people and save lives.
“Hand hygiene and plastic gloves are just one facet of our efforts at Beloit Hospital,” says Draves. “For example, the CDC and equipment manufacturers have stringent guidelines about sterilization and cleaning of all medical equipment used in the hospital. There are laws governing infectious disease control, while the CDC issues guidelines and recommendations.”
The hospital then reviews all directives and compares them to polices and practices already in effect, to be sure everything is up to date and being followed, says Draves. Annual training sessions keep staff updated on any changes to mandates and recommendations.
“If there’s a change on how our nurses are to start a new IV in a patient, we look at the new policies and each nurse is trained to follow those new guidelines,” Draves says.
The goal is to protect everyone. This means looking at things not only from the patient’s perspective, but also with a view toward public health in general, when it comes to acute or communicative diseases, Draves says.
“For example, if a patient comes in with measles, we automatically isolate him or her in a negative air room, preventing any possibility of airborne bacteria from escaping into the hospital,” she explains. “We not only have to be concerned about airborne germs that spread through coughing, but also droplet contamination from sneezing flu patients or contact contamination from casual touching like handshakes or hand holding. Visitors may unknowingly take bacteria out of the hospital with them and spread infections.”
The layers of sanitation and disinfection extend to every single part of the hospital, she says. Managing cleanliness is a major issue not only in patient rooms, but also in food service areas, surgical suites, administrative offices, public waiting rooms, receiving and storage areas, and bathrooms.
“We wash everything every day,” Draves says. “Our engineering department is responsible for cleaning and changing all filters in the building, keeping records of when each one was changed and how often they need to be changed.”
Airflow is an important matter for all hospitals. At Beloit Memorial Hospital, the heating/cooling system is checked regularly to maintain proper humidity and temperature levels, especially in surgical rooms.
“Our operating teams get very warm in those surgical gowns, but at the same time we must keep the patient warm because that helps them to tolerate procedures and operations,” Draves explains.
How You Can Help
Another serious matter concerns what you might call hospital etiquette, Draves says.
“Visitors should not come into the hospital if they don’t feel well that day,” she emphasizes. “If they’re coughing, have runny noses, are running a fever or just plain are not well, they should not visit patients that day.”
This courtesy, coupled with being conscientious about washing hands before coming into a patient’s room, helps to control the spread of infectious disease. Occasionally, the hospital has to institute stricter measures to prevent contagion.
“In 2009, Beloit Memorial Hospital asked the community not to visit patients for a two-week period because of the H1N1 virus,” Draves says. “It’s the only time in the 40 years I’ve worked here that we needed to do this.”
Preventing the spread of infectious disease and treating infected patients is an ongoing challenge for health care workers around the world.
“Infections still kill people in America, even though we’re a developed country,” cautions Subramanian of OSF. “A more informed public is a healthier public.”