The day the WIP died

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Today it became official that the Dutch Workingparty on Infection Prevention (WIP) will no longer be supported by funds from the Dutch Ministry of Health. Therefore, after 30-years of coordinated, voluntary work by infection control nurses, infectious diseases specialists, and clinical microbiologists (supported and strengthened by various, topic-specific healthcare professions) the number one IPC guideline organization found a sudden and in-part unexpected death.  I am proud to have been part of the WIP, which was rightfully seen as one of the beacons of IPC, admired by many countries who had none or by far not as well organized guideline organization.  The WIP was fundamental to the success of Infection Control in the Netherlands and even if some say that it wasn’t the only contributing factor, all those doing Infection Control know that the present state of AMR and HAI control could not have been achieved without the WIP. Was all the WIP produced “gold”? Certainly not. Despite best intentions some recent guidelines went over the top, but overall the set of guidelines produced by the WIP are of high quality and an enormous treasure, that might now be lost for the future.

Rumor has it that Dutch Public Health Services, the Professional Society for Elderly Care Specialists (Verenso) and other professional medical societies will take it on them to issue infection control guidelines (in part for their own specialty).  If that is truly the case, why stop at killing coordinated and independent Infection Control guidelines, why not take over Infection Control at whole, starting with surveillance.  I can ensure (by the lessons of the past) that HAI rate will immediately drop by up to 50%.  The Dutch have a nice saying about situations that are wrong by default and don’t leave you with a lot of trust or hope: “The butcher who checks the quality and safety of his own meat”.

I believe that only an independent, integrated and coordinated approach (= by one organizational structure) can ensure the basics of effective and sound infection control.  If the Dutch Ministry of Health and the medical professional societies are serious about their engagement to control AMR and HAI, in my opinion, a future solution can only be the formation of a WIP 2.0.

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Disclaimer.  The opinion in this post is a personal  and does not reflect the opinion of the national professional boards I am a member of.

Tired of MRSA and CPE? The new superbug has arrived and it’s a yeast!

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All of a sudden, Candida auris seems to become the “new” global super villain.  Antimicrobial Resistance and Infection Control recently published the first, large European outbreak of C. auris in London with 50 cases (Schelenz et al.) and CDC just published the first 17 US cases (Vallabhaneni et al.).  While I believe that C. auris deserves our full attention, as it is a multi-resistant yeast, with increased MICs to all three major classes of antifungals, likes to evades traditional diagnostic methods, seems to be difficult to eradicate from the hospital environment, and causes invasive nosocomial infections with high mortality, I am still amazed by the fact that – despite the global society we live in – this “new” villain first has to come to Europe or even more important the US, before becoming a recognized “superbug”.

C. auris was first described in 2009 in Japan and cases of candidemia have since been reported from South Korea, India, South Africa, and Kuwait, in addition to unpublished reports from Colombia, Venezuela, and Pakistan. While “global migration” may come to mind for the rise of C. auris, it seems unlikely, as different continents and countries seem to have their own clones. Selection pressure due to the increasing use of antifungals in healthcare, livestock, and agriculture might be a more feasable explanation, but the true reasons for the recent emergence are still unknown.

I assume that many countries will issue guidelines with regard to diagnostic methods, reporting to health authorities, environmental cleaning and infection control, but as that might take time, those of us in infection control should get prepared and stay informed, not to be surprised to see C. auris emerging within their own setting.

Literature and links

Schelenz et al. First hospital outbreak of the globally emerging Candida auris in a European hospital, Antimicrobial Resistance & Infection Control20165:35
Chowdhary et al.  Multidrug resistant Candida auris: New kid on the block in hospital associated infections? Journal of Hospital Infection August 2016,  DOI: 10.1016/j.jhin.2016.08.004
Satoh et al., Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol, 2009;53:41-44
Lee et al., First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol, 2011;49:3139-42.
Chowdhary et al. New clonal strain of Candida auris, Delhi, India. Emerg Infect Dis, 2013; 19:1670-73.
CDC Q&A

WHO global guidelines on the prevention of surgical site infection

schermafbeelding-2016-11-03-om-09-46-56After years of no recent international guidelines to prevent SSI, today (November 3rd,2016), WHO published the first ever Global guidelines for the prevention of surgical site infection. They include a list of 29 concrete recommendations that are available on the WHO website (link). The recommandations are also available as publication in Lancet ID, split into 2 documents: 13 recommandations specific tot he pre-operative period (link); 16 recommendations specific to the intra-operative and post-operative periods (link).  I have seen drafts of the HICPAC guideline and would assume that this guidelines should be released soon, too, which will be interesting as I can’y wait to see the differences.

 

 

Hand hygiene in healthcare (or the lack of it)

Schermafbeelding 2016-05-19 om 12.01.35I had posted about Sanjay Saint’s great TED talk. He now wrote an article for the general public – based on his talk: “Hand washing stops infections, so why do health care workers skip it?”

While I am a big fan of hand rubbing (we don’t have the time to hand wash) I still feature his picture he included in his article. Have fun reading his article:
https://theconversation.com/hand-washing-stops-infections-so-why-do-health-care-workers-skip-it-58763

Course in Healthcare Epidemiology and Infection Control

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In the mood to up your epi skills?  This is the new ESCMID-SHEA course that was given for the first time in Australia last year (at least the first two tracks). It consists of a plenary part and 3 separate tracks. The first track is a practical exercise how to analyze a high rate of surgical site infections. Based on the results you have to draw conclusions and decide on an intervention. Finally you will determine if this has been effective.

The second track is a practical exercise how to analyze a possible outbreak with Clostridium difficile. Based on the results you will identify possible risk factors and routes of transmission. Finally you will take control measures and determine the effects.

The first two parts will require the use of a laptop with SPSS (for at least some of the participants) as participants will actually solve the problems. Don’t worry help is around, data-sets cleaned and the syntax is (just in case) written. It is actually a great way to get back into SPSS use.

The third track consists of four interactive master-classes. Faculty members will show some practical situations, which they have encountered during their careers. It will include outbreaks, high endemic rates of healthcare related infections, infections in the operating theatre and other topics.

Have a look at the folder:  Training Course in Healthcare Epidemiology and Infection Control. While part of the faculty, Eli and I will probably not be around this year, as we transfer the old course (October 2016, Vietnam) to a new faculty of (even) younger colleagues.

PPE for preventing highly infectious diseases

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The use of PPE and the protection of HCWs against highly infectious diseases was (and is) a topic of major importance, around the globe. The recent Cochrane review by Verbeek et al. was probably hoping to offer this “vital” information.

Unfortunately, they found no studies on the effects of goggles, face shields, long-sleeved gloves or taping on the risk of contamination. All they found was very low quality evidence, with high risk of bias and uncertain estimates of effect, that:

  • More breathable types of PPE offer more comfort without increasing the risk of contamination
  • Double gloving and CDC doffing guidance appear to decrease the risk of contamination, and
  • Active more than passive training in PPE use may reduce PPE and doffing errors.

Their conclusions are obvious: we need high-quality studies of the materials, their use and protective effects, safe ways of doffing, and the most adequate training to achieve safe use of PPE for HCWs in the presence of highly infectious diseases or those (even less infectious) that may cause severe harm to HCWs.

But what to do until than? My personal opinion is that we should only use PPE, we are used to and know how to use. First-time users, even if supplied with the best available products, will inevitably fail to remove the PPE without error. Consequently, institutions should have a stable selection of PPE, and in the case of preventing highly infectious diseases, a selected group of HCWs with continuous active training, as it is too late to start when the next epidemic is hitting our healthcare centers.

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Hand hygiene – social norms and compassion

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I just saw Sanjay Saint’s TEDx UofM-talk and have to say that I was impressed. The message is clear, the characters portrayed recognizable, and the conclusion something we all have to agree with. I “love” his final thoughts (and if you watch the talk to the end you know why I used “love”) and I share his views on compassion. Intentionally we branded our campaign for better infection control as “iCare”.Schermafbeelding 2016-04-26 om 21.02.03

Hope you enjoy Sanjay’s talk as much as I did: http://www.youtube.com/watch?v=U3MtvvNjUR4&sns=em