Author: Jon Otter (@jonotter)

Who’s looking for CPE in English hospitals?

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

A team of authors surveyed NHS acute hospitals in England to determine the approach to CPE detection, including laboratory methods. The findings provide an opportunity to compare the approach to CPE detection and prevalence nationally, identifying higher CPE prevalence in the North-West, North-East and the South-East (the region that includes London) of England. The findings also suggest that more screening for CPE would detect more carriers – and perhaps help to prevent a silent epidemic of CPE in some regions.

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Can we ever de-isolate CPE carriers?

Jon Otter (@jonotter) CRE , , , ,

One of the questions that we often ask ourselves is whether carriers of CPE (and other MDR-GNR) can de-isolated. Most of the guidelines are pretty non-committal on this point due to lack of evidence. Some new guidelines from ESCMID-EUCIC address this issue head on. But, unfortunately, the answer is that de-isolation of CPE carriers, particularly over the course of a single hospitalisation, isn’t going to work because there’s no effective decolonisation method.

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Rampant carbapenem-resistant Klebsiella BSIs: a window to a post-antibiotic apocalypse?

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

People have been talking in apocalyptic terms for years – probably decades – about the threat of AMR. But has this really materialised? MRSA BSIs are now rare in the UK, and C. difficile infections are rarer than they once were. But things are looking considerably gloomier in other parts of the world. For example, a frankly shocking study from a Greek ICU gives us a view of what a post-antibiotic apocalypse may look like…

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AMR strategy in the UK: IPC is high on the agenda (hooray)

Jon Otter (@jonotter) antimicrobial resistance , , , , , ,

The Department of Health have published a new 5 year National Action Plan to combat AMR (2019-2024) to follow on from the 2013-2018 edition. IPC and antimicrobial stewardship are high on the agenda – but we have a long way to go if we are to fulfil the 20 year vision for AMR: ‘By 2040, our vision is of a world in which antimicrobial resistance is effectively contained, controlled and mitigated.’

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Hand hygiene and the courage to challenge: a personal reflection

Jon Otter (@jonotter) Hand hygiene , , , , ,

Allow me to set the scene: I was visiting an elderly relative in an NHS hospital recently (they would deny being elderly – but I’m afraid it is now true). I witnessed a healthcare worker moving efficiently from bed to bed examining each patient (including direct patient contact) to take observations without any hand hygiene between patients and without decontamination of the reusable blood-pressure cuff. I explained to my relative the need to challenge this behaviour. My relative asked – almost pleaded with me – not to intervene saying “you’ll clear off and they’ll be left caring for me overnight”. So, did I have the courage to defy my relative and challenge this behaviour?

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Can we de-isolate carriers of CPE?

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

Although there’s some controversy about whether or not we should apply contact precautions (by that I mean single room isolation, enhanced PPE, enhanced disinfection etc) all the time for all organisms, it would be a brave hospital to eschew contact precautions for CPE carriers. And so the question of whether and when we should ‘de-isolate’ patients with known CPE is an FAQ. And so enter a recent study in CMI comparing the spontaneous apparent loss of colonisation with various CPEs, concluding that KPC carbapenemases seem to hang around for longer than NDM carbapenemases, but both almost always last for the duration of a single hospitalisation.

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The hottest reflections from 2018

Jon Otter (@jonotter) Updates , , ,

Now that 2018 is behind us, I thought I’d share with you, dear readers, the hottest reflections from 2018.

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Jingle all the weigh: a behavioural intervention to prevent weight gain over Christmas

Jon Otter (@jonotter) behaviour change , , ,

It’s becoming a bit of a tradition for me to post about an article from the fabulous Christmas BMJ with a spurious link to infection (see 2016 [depressing] and 2017’s [uplifting] version here). This year, it’s a short-term behavioural intervention to prevent weight gain over Christmas. And the links to infection: obesity is a big (!) risk factor for all-things-infection, and we’re all about achieving meaningful and sustained behaviour change.

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Who’s going to go for GNBSI? A reflection from HIS 2018

Jon Otter (@jonotter) GNBSI , , , , , , ,

I attended a thought-provoking session at the recent Healthcare Infection Society (HIS) conference in Liverpool on reducing GNBSI (you can download some of the speaker abstracts here). It seems that the hefty majority of E. coli BSIs are rooted in issues outwith the walls of acute hospitals. So the question is, who’s going to tackle these issues to prevent GNBSI? Who’s going to go for GNBSI (sorry, couldn’t resist another pop-culture reference to the ‘80s – who could forget ‘Going for Gold’ with Henry Kelly).

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Are we over-complicating effective hand hygiene technique?

Jon Otter (@jonotter) Uncategorized , , , ,

The WHO method for hand hygiene is very well embedded as the ‘gold standard’ for hand hygiene technique. But is it feasible to perform every time in the busy clinical environment? A new study in Clinical Infectious Diseases seems to suggest that a shorter, simpler hand hygiene method be just as effective and more feasible in the real world.

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