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Hospital workers who see many patients may play a disproportionate role in spreading dangerous hospital-acquired infections, a new study finds.

These so-called peripatetic workers, such as radiologists or physical therapists, visit many patients in the course of a day, said Laura Temime, a researcher at the Conservatoire National des Arts et Metiers in Paris, and lead author of a study published online Oct. 19 in the Proceedings of the National Academy of Sciences.

“Although to my knowledge, an increased super-spreading potential of ‘peripatetic’ health-care workers has never really been formalized as a major hypothesis, there have been several reports of nosocomial outbreaks that have been traced back to such ‘peripatetic’ health-care workers,” Temime said.

Her study adds to the evidence, she said. The study used a mathematical model of a hypothetical intensive care unit that was presumed free of the pathogen to see how easily hospital-based infections, such as methicillin-resistant Staphylococcus aureus (MRSA) spread.

Containing these outbreaks is of grave importance, public health officials agreed.

For the study, Temime divided workers into three groups — a nurse-like group, which made frequent visits to a small number of patients assigned to them; a physician-like group, which made infrequent visits to a larger number of patients, and the peripatetic group, which visits all patients daily, such as physical therapists.

Next, using a complex mathematical model, the researchers assumed how long the patients would stay — an average of 10 days — and how much exposure they would have to each of the three categories of workers, plus how compliant the workers were with hand washing.

Then they computed the impact. They found infection rates increased by up to three times more when a peripatetic worker failed to wash his hands, compared to workers in the other groups.

The conclusions sound very logical, said Dr. Zachary Rubin, an epidemiologist at Santa Monica-UCLA Medical Center and Orthopaedic Hospital in Santa Monica. However, he added, “this is a mathematical model, and you have to do studies with human beings to see if the data is still true or not.”

Temime said she and her colleagues are doing just that. They are involved in a European project called Mastering Hospital Antimicrobial Resistance (MOSAR), in which data on exposures and bacterial colonization will be collected on patients and health-care workers. “We are planning to use this data to validate our model,” Temime said.

For now, many hospitals are stepping up efforts to promote hand washing among employees. Because the peripatetic workers have “major superspreading potential,” the study authors recommend individual surveillance of these health-care workers.

Rubin said that hospitalized patients shouldn’t be shy about asking the health-care workers who come in contact with them to follow infection control guidelines. Some hospitals have posted signs in patient rooms asking “Did your health-care worker wash his hands?” to make patients more aware of the importance of hand washing, he said.

“If a patient is concerned [about lack of hygiene from a health-care worker], he can always talk to the head nurse or charge nurse,” Rubin said, as well as the hospital’s patient advocate or his own physician

New research suggests a link between women’s exposure to household insecticides — including roach and mosquito killers — and the autoimmune disorders rheumatoid arthritis and lupus.

The scientist did not find a direct cause-and-effect relationship between insecticide exposure and the illnesses, and it’s possible that the women have something else in common that accounts for their higher risk. But epidemiologist Christine Parks, lead investigator of the study, said the findings do raise a red flag.

“It’s hard to envision what other factors might explain this association,” said Parks, an epidemiologist with the National Institute of Environmental Health Sciences who was to present the study over the weekend at the American College of Rheumatology annual meeting in Philadelphia.

Previous research has linked agricultural pesticides to higher risk of rheumatoid arthritis and lupus, two diseases in which the immune system goes haywire and begins to attack the body. Farmers, among others, appear to be vulnerable.

Parks and her colleagues wanted to find out whether smaller doses of insecticides, such as those people might encounter at home from either personal or commercial residential use, might have a similar effect.

The researchers examined data from a previous study of almost 77,000 postmenopausal women aged 50 to 79. Their findings were to be released Monday at the American College of Rheumatology’s annual scientific meeting in Philadelphia.

Women who reported applying insecticides or mixing them — about half — had a higher risk of developing the two autoimmune disorders than women who reported no insecticide use. This was the case whether or not they had lived on a farm. Those who used or mixed the insecticides the most — judged by frequency or duration — had double the risk.

Even so, the risk of developing the diseases remained very low. Overall, Parks said, about 2 percent of older adults develop the conditions.

Parks said the insecticides that the women used included insect killers, such as those designed to eradicate ants, wasps, termites, mosquitoes and roaches. They didn’t include insect repellents.

There are some caveats to the research. For one, it’s not clear exactly what products the women used or when. “Over time, there have been major changes in what products were available for home use,” Parks said.

And while researchers tried to take into account the influence of factors like age that may boost a woman’s risk of getting autoimmune diseases, it’s possible they missed something that boosted the risk of illness.

Could gardening, which often entails insecticide use, be a contributing factor? That’s possible. But Parks said a lot of insecticide use takes place inside the home, not outside in the garden.

For now, she said, the findings indicate the need for “more research on environmental risk factors and better understanding of what factors might explain these findings, what chemicals might be associated with these risks.”

She declined to speculate on how insecticides might cause problems in the body.

“I would recommend that people read the labels and take precautions to minimize their personal exposure” to insecticides, she said. “This is the case regardless of whether these results are implicating a chemical that’s on the market now or was before.”

Despite a long-standing federal ban on the sale of small turtles, the reptiles continue to be sold in the U.S. and to make owners, usually young children, sick with Salmonella — sometimes very sick, health officials warn in a report released Monday.

“Most people are unaware of the dangers of turtles as pets,” Dr. Julie Harris, a medical epidemiologist with the Centers for Disease Control and Prevention in Atlanta, told Reuters Health.

Turtles and other reptiles are well-known reservoirs for Salmonella, and while the sale and distribution of small turtles — measuring less than 4 inches — was officially outlawed in the United States in 1975, cases of turtle-associated Salmonella infection continue to occur.

Salmonella, Harris said, is a “serious infection,” which can lead to hospitalization and, in some cases, death. “Children are more susceptible than adults, and often have more complications from infection,” she added.

In the journal Pediatrics, Harris and colleagues detail a large outbreak of turtle-associated Salmonella, occurring between May 2007 and January 2008 and involving 34 states and 107 people.

“In this outbreak, 59 percent of patients were 10 years of age or younger, and 33 percent of all patients interviewed were hospitalized,” Harris said.

“We observed a strong association between turtle exposure and Salmonella infections in this outbreak,” the investigators report.

Forty-seven of 78 patients interviewed — a full 60 percent — reported contact with turtles during the week prior to their becoming sick.

Small turtles remain available to the public illegally from various sources, including pet shops, flea markets, street vendors, and the internet.

And don’t be fooled by sellers: “No one has succeeded in making a Salmonella-free turtle,” Harris said. “Antibiotic treatment of eggs often results in turtles with drug-resistant Salmonella infections.”

“Even if a turtle is born without Salmonella, because Salmonella exists in many places in the environment, it is difficult if not impossible to keep a turtle free of Salmonella,” Harris added.

Care

If you think that you or your child might have an RSV infection that requires medical care, schedule an appointment with a healthcare provider. Such visits are common for young children. The healthcare provider will evaluate the severity of the illness and decide how best to treat it. RSV symptoms in most infants, children, and adults clear up on their own in a week or two.
Transmission

RSV spreads when an infected person coughs or sneezes, sending respiratory droplets into the air. These droplets contain RSV and can end up in other people’s mouths or noses, where they can cause infection. The droplets can also land on objects that people touch, such as toys or countertops. People can be exposed to and possibly infected by RSV by touching these objects and then touching their mouths or noses. Children often pass the virus to one another at their school or daycare center.

Prevention

To help prevent the spread of RSV, people who have cold-like symptoms should
Cover their mouth and nose when coughing or sneezing,
Wash their hands often with soap and water for 15–20 seconds,
Avoid sharing cups and eating utensils with others, and
Refrain from kissing others.

There is not yet a vaccine to protect against RSV. However, for children at high risk for serious disease, such as certain premature infants and infants with certain lung and heart conditions, monthly shots with a drug called palivizumab can help prevent serious illness during RSV season. Ask your healthcare provider if your child would be a good candidate for the drug.
Symptoms

RSV symptoms are like those of many other respiratory illnesses. Infants and young children may experience a fever, reduced appetite, runny nose, cough, and wheezing. Older children and adults may have a runny nose, sore throat, headache, cough, and a feeling of general sickness. RSV also can lead to more serious illnesses, such as pneumonia and bronchiolitis, in both children and adults.

Respiratory syncytial virus (RSV) is a contagious viral disease that can lead to serious health problems—especially for young children and older adults. There is no vaccine to prevent RSV. However, there are simple ways you can protect your child or yourself from getting sick during RSV season.

Some quick facts about respiratory syncytial virus, or RSV:
It is a contagious viral disease that may infect a person’s lungs and breathing passages.
Almost everyone gets RSV by age 2.
People can get the disease more than once.
Most people recover from the disease in a week or two, but RSV can be severe, most commonly for children 6 months of age and younger and for older adults. Premature infants or those with lung or heart problems are especially at risk for serious disease.
The number of RSV cases typically rise in the fall, peak in the winter, and decline in early spring, but the exact timing of RSV season varies by location.