I’ve had the pleasure of a few days in Geneva enjoying some fine Swiss hospitality, and fine science at ICPIC 2023. Here’s rapid reflection on scaling the risks attached to plasmid-mediated transmission of CPE, and what we can do about it (or not…!).
Continue readingAuthor: Jon Otter (@jonotter)
Embracing patients as effective hand hygiene observers
We can have a long discussion about whether we should routinely collect observational hand hygiene compliance information – I think we should, but others take a different view. But if we decide to collect routine hand hygiene compliance information, there are limitations of what is achievable. A recent study in JHI evaluated using patients as hand hygiene observers in an outpatient setting, which seemed to work pretty well.
Continue readingWe might need Mr Motivator to really improve hand hygiene behaviours
Working in IPC, you get interested in hand hygiene compliance, whether you like it or not! I was struck by a recent quanti/quali (yes, qualitative!) study in the Journal of Hospital Infection exploring drivers towards hand hygiene compliance. The key findings is that, all other things considered, individual motivation is the biggest driver towards hand hygiene compliance. So, perhaps we need to enlist the services of Mr Motivator*?!
Continue readingBundles of success in SSI prevention?
Surgical site infection (SSI) frustrates me. When we undertake elective procedures, we have much more control over processes and patient flows than in most other aspects of hospital life. We have a range of evidence-based interventions, and we know that if we get them right, the risk of SSI is reduced hugely. And yet, preventable SSIs continue to occur because we don’t always get the bundle of interventions implemented. And so patients suffer harm, our theatres and precious beds have to do subsequent procedures related to SSI, costs ramp up, and we have to use more and more antibiotics. I gave a webinar last week providing an overview of the bundle of interventions at our disposal to reduce the risk of SSI.
Having a nose into nasal photodisinfection
When’s the last time you picked your nose? If you’re an adult, it was very probably earlier today – the average adult picks their nose around 4 times per day (eew). And that’s picking – touching is much more frequent: on average, we touch our eyes, mouth, nose, or chin a staggering 20 times per hour (with some estimates even higher). We’ve known for a while that nasal decolonisation is a vital component in reducing the risk of staphylococcal infection. But using mupirocin as the nasal decolonisation agent has important limitations in terms of spectrum of microbiological efficacy, compliance, and antibiotic resistance. I’ve recently come across a newer technology for nasal decolonisation: nasal photodisinfection. It’s been around for ages, but hasn’t really been adopted widely. This blog provides an overview of three studies that suggest nasal photodisinfection may have a role in reducing the risk of SSI, and in preventing and treating SARS-CoV-2 infection.
Continue readingCPE showing its teeth: mortality associated with carbapenem-resistant Gram-negative BSI
Now is a really good time to focus on carbapenem-resistant bacteria. We have spent much of the past 3 years focusing on one particular virus. But now that the clinical issues linked to SARS-CoV-2 are waning for our hospital patients, the threat of carbapenem-resistance in Gram-negative bacteria comes to the fore. An excellent study with far-reaching consequences has been published from Italy. Carbapenem resistance is bad news if you have a BSI: patients with carbapenem-resistant BSI were roughly twice as likely to die as patients with carbepenem-susceptible BSI.
Continue readingCandida auris and surface survival
Candida auris is an emerging threat to healthcare facilities worldwide. Recent, worrying, data from the US suggests that prevalence is increasing rapidly. So, we need to make sure we have every prevention base covered to reduce the chances of cross-transmission. C. auris seems to be quite an environmental organism – and a recent JHI study confirms this, showing extended survival on surfaces and tolerance to low concentrations of some biocides.
Continue readingHow often do HCW hands become contaminated with hospital pathogens during patient care?
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 readingRespiratory 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.
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Reflections on Infection Prevention and Control 