CDC funds Emory research on antibiotic resistance transmission and medication safety

Woodruff Health Sciences Center | Oct. 7, 2016

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Janet Christenbury
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jmchris@emory.edu

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One Emory project will focus on environmental sampling and optimizing hospital room cleaning, in an effort to combat the transmission of certain pathogens within the hospital.

A second study looks at which forms of pill/medication containers are most commonly associated with unintentional pill exposure in children five-years-old and younger.

Emory University has been awarded more than $360,000 from the Centers for Disease Control and Prevention (CDC) to fund two research projects – one on combating antibiotic resistance transmission and another on medication safety.

The awards, going to 25 universities and other organizations totaling $14 million in funding, were made through the CDC's Broad Agency Announcement (BAA), which supports activities related to the organization's Antibiotic Resistance Solutions Initiative. The BAA also funds research in the areas of advanced molecular detection, medication safety and infection prevention in health care.

One Emory project will focus on environmental sampling and optimizing hospital room cleaning, in an effort to combat the transmission of certain pathogens within the hospital. Pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) can survive in the environment for days, and may potentially be transferred to other patients if rooms are not effectively cleaned. Other pathogens, like Clostridium difficile ("C. diff"), can persist in the environment for months and be resistant to usual cleaning agents.

Emory researchers will use adenosine triphosphate (ATP) bioluminescence assay, an existing current method for evaluating a room's cleanliness and what's left behind on its surfaces, to test 118 patient rooms at Emory University Hospital Midtown. Developed by the food service industry, ATP measures the amount of the basic unit of energy in living organisms, and is expressed in relative light units (RLU). Finding ATP on surfaces suggests that they are not clean and that the dirt or germs on a surface have the potential to support microbial growth.

Using the ATP system, researchers will test hospital room surfaces cleaned by a single, trained individual using hospital environmental cleaning protocols ("controlled cleaning"), which will be considered the gold standard. Results will be compared to rooms cleaned by environmental services ("usual cleaning"). The study will establish targeted RLU benchmarks that indicate optimal room cleaning per hospital protocol and assess the time that this level of cleaning requires.

The researchers will obtain RLU levels from various room surfaces (bedrails, TV remotes/call bells, telephones, bathroom rail handles, etc.) for analysis. Samples and RLU levels will be collected after a patient discharge. In half the rooms, levels will be measured after controlled cleaning, and in the other half, after usual cleaning.

"We hope this one-year environmental sampling study will tell us what the ATP targets for cleaning in the hospital should be, and how we can do this most efficiently, to reduce the transmission of pathogens, especially multidrug resistant bacteria," says Jesse T. Jacob, MD, associate professor of medicine in the Division of Infectious Diseases at Emory, hospital epidemiologist at Emory University Hospital Midtown, and a member of the Emory Antibiotic Resistance Center.

A second study looks at which forms of pill/medication containers are most commonly associated with unintentional pill exposure in children five-years-old and younger. Every year, more than 60,000 children, ages five-years-old or younger, are evaluated in an emergency department for ingesting medications not intended for them. Nearly 10,000 of those children will need to be hospitalized.

The Georgia Poison Center, which received more than 80,000 calls in 2014, will lead the study. Five other poison control centers, serving Florida and Arizona, will also participate.

The poison control centers will use a telephone questionnaire with four questions to determine the types of storage containers used and why, as well as the types of medications ingested. Callers will be enrolled as study participants and questions will be asked upon completion of their call, or within a few days after their call. Answers will be collected in a shared electronic medical record system among the poison control centers.

"Our goal is to assist stakeholders in pediatric poisoning prevention to develop interventions targeted to specific container types and behaviors that are associated with oral solid dose medication exposures," says Adam Pomerleau, MD, assistant professor in the Department of Emergency Medicine at Emory and assistant medical director of the Georgia Poison Center. Pomerleau is the principal investigator of this study.

Robert Geller, MD, professor in the Department of Pediatrics at Emory and medical director of the Georgia Poison Center, will serve as senior advisor on the study.  Maneesha Agarwal, MD, assistant professor in the Department of Pediatrics, Division of Pediatric Emergency Medicine at Emory, will serve as co-principal investigator.

For more information on the BAA and the full list of funded projects, visit the Antibiotic Resistance Solutions Initiative webpage.