The invisible menace! I’ve often thought it would be great if there was some visible sign that your hands had become contaminated during patient care. I guess that does happen to a degree when hands are visibly soiled – and we know that compliance with hand hygiene is almost universal when that happens. But what about when there’s no visible contamination but invisible and risky contamination with pathogens that can cause HCAI? A helpful systematic review and meta-analysis from 2019 suggests that around 5-10% of HCW working in acute care hospitals or care homes are contaminated with key hospital pathogens.
Continue readingAuthor: Jon Otter (@jonotter)
Respiratory protection for healthcare workers and SARS-CoV-2: evidence is equivocal but does that matter?
So, a double blog day today! I couldn’t resist reading the latest statement from a UKHSA expert group on “The role of respirators and surgical masks in mitigating the transmission of SARS-CoV-2 in healthcare settings: an overview of evidence (2022)”, published yesterday, as soon as it hit my desk. “Equivocal” is a word that I try to avoid. It’s one of those ‘jargony’ and overly technical words that is best worded-around in my view. But for this, it’s about right. The evidence from well controlled clinical trials that respirators (FFP2/3 or N95s) offer superior protection to healthcare workers than surgical masks is equivocal (“open to more than one interpretation”). But does that matter? If we look to the physics of SARS-CoV-2 transmission, there is a risk that the type of small, virus-laden particles emitted by patients infected with SARS-CoV-2 could circumvent the level of protection provided by surgical masks. And so, it now seems reasonable to recommend FFP2/3 or N95s for healthcare workers caring for patients with SARS-CoV-2 (and influenza for that matter). However, given the uncertainty of the evidence base, as highlighted by this review, I can understand why some have decided to continue with a policy of surgical masks when caring for patients with SARS-CoV-2 infection in most settings.
Continue readingPredicting colonisation with antibiotic-resistant bacteria at the time of hospital admission
A systematic review and meta-analysis identify 22 studies that used various methods to predict colonisation with antibiotic-resistant bacteria at the time of hospital admission. The models were chosen to focus on MRSA and CPO colonisation. The “performance” of these tools varied widely, with a sensitivity of 15–100% and specificity of 46–98.6% for MRSA, and sensitivity of 30–81.3% and specificity of 79.8–99.9% for CPO. I think my main take-away from this that simple risk tools for predicting colonisation with MRSA and CPO (which are often used to determine who to test) are pretty blunt instruments. However, the more advanced tools making use of big datasets and machine learning can take us forward in predicting the risk of MRSA and CPO colonisation at the time of admission.
Continue readingEstablishing the transmission rate of CPE in hospitalised patients
A helpful new study has combined shoe-leather epi and WGS to establish a transmission rate of CPE in hospitalised patients. Overall, 3 (2%) of 152 exposed patients ended up colonised with the same CPE from 47 index patient exposures. None of the 54 exposed staff ended up colonised with CPE. This transmission rate is a bit lower than I would have expected, but it’s also not zero!
Continue reading“Gonna take you right in to the sink splash zone” (duh duh duh)
A great new little study has just been published in Infection Prevention in Practice by Mark Garvey and colleagues up in Birmingham investigating the sink splash zone in the ICU. The study certainly does identify elements of danger in the sink splash zone, and provides evidence of tangible transmission risk for Pseudomonas and other water-borne pathogens in the ICU.
Continue readingWhat the Cochrane “masks don’t work” review does (and does not) tell us
You may have seen some commentary and debate on a recently updated Cochrane review on physical interventions to interrupt the spread of respiratory viruses. I’m stepping into the debate only to clarify a few small points – and to provide an overview of what the review does (and does not) tell us. However, my firm advice is to read the review for yourself and come to your own conclusions.
Continue readingHow often does colonization precede infection with MDR-GNB and VRE?
Ever found yourself wondering how often colonization precedes infection with MDR-GNB and VRE? A new systematic review and meta-regression in Lancet ID gives us a pretty solid answer: about 14% of MDR-GNB and 8% for VRE. This information is helpful for us to qualify the significance of acquiring these organisms in healthcare settings.
Continue readingHCAI and AMR point prevalence from Ukraine
JHI have just published an interesting point prevalence HCAI and AMR study from Ukraine. Headlines are that rates of both HCAI and AMR are higher than you’d hope to see, especially with rates of resistant to carbapenems in Gram-negative bacteria and meticillin in S. aureus.
Continue readingComparing SARS-CoV-2 air and surface contamination in the first vs. second waves
Way back during the first wave of COVID-19 (April 2020), we got our swabs out and sampled surfaces and air across a range of settings in the hospital. This cross-sectional study identified SARS-CoV-2 RNA on a rather startling 52% of surfaces and 45% of air samples collected from across the hospital and some public areas. During the second wave (January 2021), we undertook a similar exercise, and identified a vastly different level of contamination with SARS-CoV-2 RNA: 5% of surfaces and 4% of air samples. What had changed between April 2020 and January 2021 to explain this difference? A whole host of things, and we don’t know for sure – but I suspect that improved testing availability and the introduction of masks for staff and patients were the most important factors.
Continue readingOmicron and the diminishing spectre of long COVID
As we move on the journey to ‘Living with COVID’ and in doing so tolerate a greater risk of transmission of SARS-CoV-2 in society and in our hospitals, one of the issues is the threat of “long COVID”. A recent study suggests that long COVID is less common with Omicron than with previous variants, and that vaccination is effective in preventing long COVID.
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Reflections on Infection Prevention and Control 