I listened to Reflections’ very own Martin Kiernan share his wisdom on the challenges around hand hygiene improvement this week, and thought I’d share my own reflections on his talk. The key point seemed to be that we have some way to go in winning the hearts and minds of our frontline clinical colleagues if we are to improve hand hygiene practice across the board.
We have been posting for a while about the emerging recognition of CPE contamination of drains in clinical settings, which seems to be fueling some CPE transmission. Until now, there’s been plenty of publications identifying the problem, but very few presenting a solution. In fact, attempts to tackle CPE contamination of drains have had moderate impact, at best. A new short study in ICHE illustrates the potential of a foaming hydrogen-peroxide based disinfectant to tackle contamination with resistant Gram-negative bacteria in drains.
Guest bloggers Claire Kilpatrick and Julie Storr (hand hygiene consultants at the WHO, @safesafersafest) post…
Three little words, behind which lay 40 years of a global aspiration. Health for all. Last year the world recommitted to Alma Ata and renewed the global focus on health as a fundamental human right. In 2019, WHO’s 5 May global hand hygiene campaign evokes the spirit of health for all with its own four words: Clean care for all. How is this relevant to infection prevention and control (IPC) on a day to day basis, particularly for the other 364 days of the year?
Friends and colleagues in Geneva have just released a song written and performed for the upcoming World Hand Hygiene Day. It’s a catchy tune with a nicely produced video – and a strong message in the chorus:
‘Hands are such a simple thing, but our hands can change most everything. Keep care safe and take a stand, clean care for all – it’s in your hands.”
Have a listen and see what you think:
A couple of new studies provide insight into determinants of antibiotic prescribing using qualitative methodology. A systematic review in the Journal of Hospital Infection highlights the tension between the immediate need of the sick patient (“give ‘em broad spectrum antibiotics and keep ‘em on them for as long as I can get away with” [my caricature]) and the societal needs related to AMR (“we need to balance the individual needs of the patient with the bigger picture of AMR” [again, my caricature]). Also, a clever study by Esmita Charani and colleagues from Imperial College London provides new insight into antibiotic prescribing practice by “going native” and joining ward rounds – effectively becoming a fly on the wall to understand poor antibiotic prescribing practice. The study identified a contrast between antibiotic prescribing in Medicine, where decisions were generally multidisciplinary and policy-informed, and Surgery, where decisions were often ‘defensive’, resulting in prolonged and inappropriate antibiotic use.
We’ve been blogging for a while about the need to prevent infection to tackle AMR – and am really pleased to see that this idea is central to various AMR long-term strategies (e.g. the 5 and 20 year UK AMR strategies). So I endorse wholeheartedly this new poster from IPS promoting messages aimed at healthcare professionals around preventing infection to reduce AMR.
An interesting new Italian study has identified the mcr-1 gene, a plasmid-mediated colistin resistance gene, in 8% of environmental Enterobacteriaceae isolates. This suggests that environmental Enterobacteriaceae and perhaps even environmental surfaces themselves could be important reservoirs in the spread of mcr-1 and colistin resistance.