Year: 2015

Endoscope Reprocessing Survey

Andreas Voss (@AVIPNL) Cleaning, Disinfection, endoscopy

What-do-you-think

Recent reports of multidrug-resistant infections related to contaminated endoscopes, which have intricate mechanisms and channels that are especially difficult to clean, have raised awareness about the necessity for meticulous reprocessing of all types of endoscopes to prevent the transmission of pathogens to patients.

In response to concerns from various countries about inadequately reprocessed endoscopes and to prevent further transmittal of infections by endoscopes, the ISC Infection Prevention & Control Working Group prioritized this issue in a meeting earlier this year and created a survey on current Endoscope Reprocessing Practices that could be used to compare such practices of institutions around the globe.

We would ask you to share the link to the on-line survey and encourage as many of your colleagues from various health care facilities to complete this. To complete this survey you need to be involved in Endoscope reprocessing activities or know the guidelines and structure of your institutions with regard to Endoscope reprocessing.

Thank you for your participation and for sharing the link!

Link to survey: https://www.surveymonkey.com/r/6ZSGF5L

This checklist was created by the following members of ISC IPC working group. Andreas Voss, Alex Friedrich, Peter Collignon, Moi Lin Ling, Brenda Ang, Wing Hong Seto, Paul Tambyah, Eli Perencevich, Marin Schweizer, Leanne Frazer, Achilleas Gikas, Tom Gottlieb, Joost Hopman, Nikki Kenters, Inge Huijskens, Kalisvar Marimuthu, Rehab El-Sokkary, Yogandree Ramsamy, Margaret Vos, Ermira Tartari, Debkishore Gupta.

We need to work together to reduce CRE and other pathogens

Jon Otter (@jonotter) CRE , , , ,

Some fascinating modelling from the CDC Vital Signs programme suggests that a co-ordinated, multi-facilitiy approach will be much more effective than each hospital doing its own prevention interventions.

The team first estimated the burden of key infections in the US: CRE, multi-resistant  P. aeruginosa, invasive MRSA and CDI combined were responsible for 310,000 infections in 2011, which would increase 10% to 340,000 over 5 years. However, with an ‘aggressive’ national intervention, this could be reduced to below 200,000 by 2019. It would be a huge undertaking to implement and co-ordinate a national campaign in the US, where there is so much heterogeneity in the way that hospitals are structured and funded. But if anybody can do it, the CDC can!

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It’s transmission doc, but not as we know it

Jon Otter (@jonotter) Whole genome sequencing , ,

A groundbreaking study just published in PLOS Genetics provides new insight into the transmission dynamics of bacteria in the ICU setting using WGS. The ambitious authors performed WGS on virtually all bacterial isolates from ICUs in a US hospital for a year. The first surprise was that 12% of the bacteria considered clinically relevant were previously undescribed.

The next – and perhaps biggest – surprise was that whilst transmission of the usual suspect pathogens (MRSA, VRE etc) was rare, 9% of the other bacteria were shared by multiple patients, often with overlapping admissions (see the figure below). This suggests that there is a fair bit of transmission going on under the radar in the ICU setting.

Figure: Clonal lineages extending across multiple patients.

WGS ICU timeline

This study reminds me of one published in CID a few years ago showing that outbreaks of resistance probably occur regularly and usually undetected across multiple species.

So, is it time to start using WGS for all bacteria identified in the clinical laboratory? Not quite yet I don’t think: the analytical methods have not yet caught up with the sequencing technology. But this study is a glimpse of the future, no doubt about it.

Should we throw out the chlorhexidine with the bathwater?

Jon Otter (@jonotter) Decolonisation , , ,

Noto chg

Following hot on the heels of a series of studies showing that daily bathing using chlorhexidine reduces the risk of HCAI, a recent study suggests that chlorhexidine daily bathing does not reduce HCAI. The headline finding is that chlorhexidine bathing did not reduce HCAI. Before throwing out the chlorhexidine with the bathwater, it’s worth considering the limitations of the study.

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Is CRE lurking in nursing homes?

Jon Otter (@jonotter) CRE , , , , ,

Nursing home CRE

They say that things come in threes, so following hot on the heels of blogs about MRSA and other MDROs in nursing homes, I was struck by a recent outbreak report of CRE associated with nursing homes the Netherlands.

Following the admission of a patient from a Greek ICU, a nosocomial transmission of CRE (ST258 KPC K. pneumoniae) occurred. By the way, this occurred despite the hospital recognising the risk of CRE at the time of admission from the Greek ICU, perform an admission screening and implementing pre-emptive contact precautions. Then the index patient was transferred to a nursing home, where subsequent transmission occurred to four other patients.

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How much chlorhexidine actually makes it to a patient’s skin?

Jon Otter (@jonotter) Decolonisation , ,

CHG

There has been much impressive research of late around the use of chlorhexidine daily bathing to reduce the burden of skin contamination and protect patients from infection. This is quickly becoming en vogue, especially for ICU settings in the USA. But what is compliance like with this intervention, and how do you measure compliance? The studies that have measured compliance previous have said “Yes, this patient was given a chlorhexidine wash today”, but have rarely gone so far as to measure the actual concentration of chlorhexidine on the patient’s skin.

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Up-date on M. chimaera

Andreas Voss (@AVIPNL) environmental contamination , , ,

Schermafbeelding 2015-07-23 om 15.52.36

More and more reports and guidance (Ref) appear with regard to Mycobacterial infections associated with heater cooler units used during thoracic surgery. As mentioned in this blog before, the infections are attributed to aerosol generated by the contaminated heater cooler units that are located in or adjacent to the operating room (Ref).

Just now, researchers published 10 patients with disseminated Mycobacterium chimaera infections subsequent to open-heart surgery at three (CH, GER, NL) European Hospitals (Eur Heart J. 2015 Jul 17).

What makes this infections special, is the fact that the time to infection may takes months to years and that the micro-organism in question is easily missed by routine bacterial diagnostics.

The word is out, that other, difficult to diagnose micro-organisms e.g. Legionella are possibly causing post-operative infections, too. Thus, I believe that we can expect more cases with different pathogens in the near future.

Schermafbeelding 2015-07-23 om 14.52.51

You wait for ages, and then two come at once..

Martin Kiernan (@emrsa15) Epidemiology, General, Infection Prevention and Control , , ,

NH

Sometimes waiting for research highlighting an issue that you know is a problem is like waiting for a bus..  Following on from my colleague @jonotter who last week posted about MRSA spread in nursing home settings, I was interested to read this new paper from the USA, published in the Journal of the American Geriatric Society. The study notes the high prevalence of Multi-Drug Resistant Organism (MDRO) carriage in nursing homes that was in excess of that in hospital settings and sought to determine any associations. The findings are interesting, if not surprising.

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How can we stop nursing homes nurturing MRSA?

Jon Otter (@jonotter) MRSA , , , , , ,

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There is an emerging feeling that we need to start spreading the focus of infection prevention and control beyond acute hospitals. There has always been a sense that standards of infection control outside of acute settings are, shall we say, “different” to acute hospitals (aka non-existent) so it’s great to see a study of an infection control intervention in nursing homes.

The study was a cluster randomised controlled trial of MRSA screening, decolonisation and enhanced environmental disinfection vs. standard precautions in 104 of 157 nursing homes in a Swiss region. The authors chose a rather unusual, pragmatic endpoint of the prevalence of MRSA colonisation after 12 months.

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We’ve got a policy, so that’s alright then..

Martin Kiernan (@emrsa15) Uncategorized

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I’m always interested in why people don’t do what they know that they should or why things don’t happen as we think they will. Interventions that are demonstrably effective, evidenced in the literature and incorporated into guidelines are not implemented even though ‘it’s in the policy’. We have to remember that implementation often has many sides. We can spend a lot of time designing an effective intervention based on the most robust evidence and then it just doesn’t happen on the shop floor. Sometimes this is failure to engage the staff that will actually implement the measure, but what about the involvement of those to whom the deed is done? A simple two-letter word can stop healthcare provision in it’s tracks. That word is ‘No’.

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