A new Lancet ID study suggests that restriction of fluoroquinolone usage has been the main driver of the national reduction in C. difficile infection in England. This paper is challenging in terms of some of the accepted approaches to controlling the transmission of C. difficile: if it’s all about reducing fluoroquinolones (and antimicrobials in general) and nothing to do with these measures, then why invest so much time and energy in isolation of symptomatic cases, cleaning and disinfection etc?
Year: 2017
Time to go shopping for a UVC system?
It is great to see the long-awaited ‘Benefits of Terminal Room Disinfection’ (BETR-D) randomised controlled trial of a UVC automated room decon (ARD) system published, in the Lancet, no less! This study firms up the importance of environmental contamination in transmission, and demonstrates additional benefit of UVC over and above enhanced conventional methods for VRE, maybe for MRSA, but not for C. difficile.
Attacking the fecal veneer*
What an excellent start of 2017. A great study from the USA today in Lancet: In a pragmatic cluster-randomized crossover study they tested 4 patient room cleaning strategies on the effectiveness to reduce acquisition with relevant bacteria for the incoming patients. The conclusion states that “enhanced terminal room disinfection decreases the risk of pathogen acquisition.” Yet, this paper is so “data-dense” that you must read the methods (and supplements) to get the picture. In one shot: Not for C. diff, may be for MRSA and yes for VRE. Continue reading
The end of antibiotics
A case of pan-drug resistant NDM-producing K. pneumoniae CPE that resulted in a fatal infection in a US woman has prompted a lot of coverage and discussion on both sides of the Atlantic. Although this report is concerning, not least because the patient succumbed to the infection, this is hardly a new scenario. There are parts of the world where pan-drug resistant CPE are commonplace and have been for years (for example parts of India, the likely country of origin of the organism in this case). Before getting to the case report in detail, let’s take a moment to review this case series from India, published in 2014. 13 patients with pan-drug resistant Gram-negative bacteria (7 of whom were infected with K. pneumoniae, 4 of these 7 died) were reported in a specialist cancer treatment centre over 18 months over 2012/13. This evidence, from half a decade ago, shows that pan-drug resistant CPE is by no means a new phenomenon! Continue reading
The silent Mycobacterium chimaera epidemic
There has been much discussion about the risk of Mycobacterium chimaera infections associated with contaminated heater-cooler units (HCUs) used in cardiothoracic surgery. A study published recently in CID explores the risk in the UK, and provides further evidence to link these tricky-to-treat infections to contaminated HCUs.
WHO is setting your IPC agenda
The World Health Organisation has updated its 2009 Guidelines on Core Components of Infection Prevention and Control Programmes. The report highlights eight ‘core components’ for IPC:
SSI – It’s not what you do, but the way that you do it?
Another of my favourite guitarists succumbed to sepsis following surgery just before Xmas, with the sad passing of Rick Parfitt following shoulder surgery, spookily the day after his band Status quo performed their final electric gig (which I was at). The other was Rory Gallagher, who died a few years ago now of MRSA. Surgical procedures are normally carried out under what should be the most controllable of conditions, yet there are variations in practice, a paucity of quality studies on even the most basic of interventions (such as pre-op bathing) and even when there is good evidence, it is ignored. However I do also wonder if we have been missing something. A paper that suggests no difference between Chlorhexidine (CHG) and Povidone Iodine (PI) for pre-surgical skin prep (both aqueous) recently piqued my interest. It was an RCT (non-blinded) undertaken in clean-contaminated upper gastrointestinal or hepatobiliary–pancreatic open surgery, however that wasn’t the aspect that I became interested in. Continue reading
Reflections on Infection Prevention and Control 