Dogs are recognised to have the keenest of noses and have been used for detecting illicit drugs, early stage cancer and even C. difficile including an outbreak (possibly a cheaper option than PCR for screening – I should have used this in my debate with Jon). Now a new study finds that trained dogs can reliably detect significant bacteriuria.
A study protocol has caught my eye this week, a trial of oral probiotics vs placebo as prophylaxis for UTI in spinal cord patients, a very high risk group for these infections and associated complications. It will be a multi-site randomised double-blind double-dummy placebo-controlled factorial design study running over 24 weeks conducted in New South Wales, Australia. Probably about as robust as it gets scientifically. Continue reading
I am always interested in compliance. What makes staff implement an intervention reliably? What makes a patient follow the advice they’ve been given? A new retrospective cohort study purports to look at what factors influence compliance with preoperative regimes aimed at preventing surgical site infection (SSI). The authors were of the opinion that socio-economic group would be a major factor in whether individuals would be compliant with measures that are likely to reduce the risk of SSI, since this has been demonstrated to be the case in chronic health issues such as asthma. Disappointingly the authors stated that the method of determining at adherence is described elsewhere with the accompanying reference to an 4-minute abstract given at a paediatric orthopaedic conference in Toronto in 2013 which, if you weren’t there, you’ve missed it. However they do provide a small amount of detail and of the 2-5 protocol tasks they only mention bathing and decolonisation of those screened.
We often see those tasked with finding suitable isolation facilities counting down to when precaustions can be discontinued and the ’48 hours clear’ of symptoms of loose stools or vomiting has almost become one of the most welcome statements heard in healthcare settings. No more contact precautions, no more disinfectants sloshing around, normality beckons.. Or should it? Continue reading
To be honest I’m a bit fed up with quoting the £4000 per CDI case that was calculated by Mark Wilcox and colleagues back in 19 0 plonk (1996 to be exact) and so I was quite excited to stumble across a new estimate from Merseyside whilst browsing ‘Value in Health‘, one of my usual reads. Well, possibly not.. although perhaps it should be – and it does support open access.
Nakamura and colleagues presented an abstract at the 18th International Society for Pharmacoeconomics and Outcomes Research (ISPOR) meeting and have calculated the mean extra cost of a patient with CDI to be £10,956.82, although as the authors point out, how much of this is attributable to the extra cost of CDI rather than the multiple co-morbidities that likely contributed to the infection leading to the antibiotic treatment, which led to the CDI continues to elude us. The authors are continuing to work on this and I await their final findings with interest, however for now I’ll settle for £11,000 per case as opposed to the 1996 figure of £4000 (data collected in 1995) and is probably more realistic than just allowing for inflation that has averaged at 2.8% pa, which would have made it £6868. As we know (well all of us apart from the Treasury), health inflation is way ahead of normal financial indicators.
It’s the most Chunderful time of the year (or maybe not). The Norovirus ‘season’ will still be on us and a few points are well worth reflecting on. A recent systematic review of Norovirus risk in high and middle-income countries asserts that there may be as many as 12.5 million infections annually these countries alone, with possibly as many as 2.2 million outpatient visits related to the illness. Personally I have always liked having a bit of norovirus around. Keeps the staff on their toes and gives a good indicator of how IPC is really being performed rather than another set of 99% compliant hand hygiene audits.
A few papers on the use of urinary catheters have caught my eye recently. It’s a subject close to my heart and was the subject of my eponymous lecture at the Infection Prevention 2013 meeting in London, available online for insomniacs via the excellent Webber Training Teleclass recording The slides are here. Despite these devices being second to peripheral cannulation in the ‘most’ used devices’ awards annually (and a clear winner in the ‘most overused’ section), the evidence base is somewhat thin. Are they inserted well? Possibly (and indeed probably) not. Do they only get inserted appropriately and are they speedily removed? Um… maybe not. Continue reading
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.
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’.
Bells have a certain resonance for me. When they toll, people listen as they are normally of significance. I have just heard one. I have been waiting from this paper to come out since I heard the authors speak about progress at last year’s Infection Prevention Society meeting in Glasgow. Decision-making prior to passing a urinary catheter is something close to my heart, since we need to know why people do things if we are to modify practice. For me, telling people that a list of specific indications for an intervention exists merely makes the decision-maker pick which one on the list fits their desire or perceived need to catheterise most.