As is now becoming traditional, I thought I’d share a few reflections from the recent IPS conference in Harrogate. Fantastic to see the submitted abstract published, full and free, in a Journal of Infection Prevention supplement.
Thought I’d share some key points from the 2016 HIS Spring Meeting.
Outlining the problem(s)
Prof Gary French kicked off the meeting with a (sic) historical perspective, describing how the perceived importance of the environment in transmission has oscillated from important (in the 40s and 40s) to unimportant in the 70s and 80s to important again in the 2000s. Gary cited a report from the American Hospital Association Committee on Infections Within Hospitals from 1974 to prove the point: ‘The occurrence of nosocomial infection has not been related to levels of microbial contamination of air, surfaces and fomites … meaningful standards for permissible levels of such contamination do not exist.’ Gary covered compelling data that contaminated environmental surfaces make an important contribution to the transmission of Gram-positive bacteria and spores, highlighting that C. difficile in particular is a tricky customer, not helped by the fact that many ‘sporicides’ are not sporicidal!
I gave a presentation at ECCMID today on social media use by healthcare professionals (you can download my slides here). Since there isn’t a great deal of data around social media use by healthcare professionals, I thought I’d generate some! I put out this survey a few weeks ago. I was delighted that 749 healthcare professionals took the survey; thanks to everybody who took part.
I have been asked by ECCMID to do a talk on ‘Selling your colleagues and society: how to use social media.’ While there is some good data on social media use by scientists, I was struggling to find specific data on social media use by healthcare professionals. So I thought I’d generate some (and in doing so, generate the power of social media!). So, I have put together a short, simple survey that I hope you will have time to complete here.
I enjoyed my first IFIC experience over the past few days in Vienna, and thought I’d share some reflections.
I found the pro-con debate between Dr Michaal Borg and Prof Gary French on whether we need more evidence to improve infection prevention and control useful. (Clearly, my vote was for Prof French, my PhD supervisor and all-around acadmic mentor.) Prof French gave a good case for an evidence-based medicine approach to IPC, bemoaning poor-quality evidence to support IPC interventions and an over-reliance on ritual and tradition. Although decent IPC study designs are tricky (and tricker than for an antibiotic trials), they are possible, as illustrated by the small number of cluster RCTs we have at our disposal. Dr Borg argued convincingly that, even if cluster RCTs support on intervention, they would likely be performed in high-resource, academic teaching hospitals, which are a different plant to the average hospital so may well not be applicable. Furthermore, clinicans are pretty poor at following guidelines even if they are evidence-based because culture eats policy for breakfast! Michael questioned whether the ‘English MRSA Miracle’ was founded in evidence-based medicine, or a pragmatic multi-faceted intervention. On balance, the room sided with Michael, agreeing that we have enough evidence to make a big different (but all agreed that better quality evidence wouldn’t hurt)!
For the third and final installment of my blog-report from Infection Prevention 2015, I thought I’d cover some of the more innovative approaches in and around the IPC sphere:
Part III: Thinking outside the box
New technology to improve hand and environmental hygiene
I for one am pretty sick of seeing unrealistically high levels of hand hygiene compliance being reported from peer-to-peer manual auditing approaches. One way to get more realistic compliance data is through automated approaches to hand hygiene compliance, reviewed here by Drs Dawson (Warwick) and Mackrill (Imperial College London), who also presented their findings at the conference, and by another group here. Drs Dawson and Mackrill considered issues around product usage, self-reporting, direct observation, perceptions of technology (often viewed, unhelpfully, as a ‘silver bullet’), and staff perceptions of need and benefit. They divided the technology into those that monitored product usage, surveillance systems that monitored individual performance, and systems that monitored both product usage and individual performance. Although automated surveillance systems will always be imperfect and involve a degree of inference, would you rather monitor the 5 moments sporadically / badly or have robust measurements of a smaller number of moments? Automated surveillance methods will not replace manual audits – at least for now – but it’s time to take a long hard look at what is available.
Welcome to the second installment of my blog-report from Infection Prevention 2015, focused on improving the systems around the delivery of safe healthcare, and infection prevention and control:
Part II: Improving the systems
The economics of HCAI is going to become increasingly important as the NHS – and healthcare systems worldwide – continue to “seek efficiency savings” (aka demand more for less). So the overview of HCAI economics from Dr Nick Graves (QUT, Australia) was timely. I find it remarkable that we are still so reliant on the 2000 Plowman report to gauge the cost of HCAI – surely there must be a more sophisticated approach? There is something rather uncomfortable about setting an ‘acceptable’ level of HCAI, or putting a £ value that we would be prepared pay to save a life, but this is exactly what we have to do to manage the demands of scarcity. Dr Graves presented some useful worked examples to illustrate his point, around coated catheters, hip replacements, hand hygiene improvement, and MRSA screening. In most cases, there comes a point where a health benefit is too expensive to ‘purchase’, which is an uncomfortable but very real choice across all areas of healthcare (e.g. cancer drugs).
Infection Prevention 2015, the annual conference of IPS, was held in Liverpool this year. I’m delighted to say that the abstracts from the submitted science are published Open Access in the Journal of Infection Prevention. This first instalment of my report will be “bug-focussed”, followed by another two on different themes:
Part I: Beating the bugs
The conference kicked off with fellow ‘Reflections’ blogger Prof Andreas Voss. By Andreas’ own admission, he was given a curve-ball of a title: ‘CRE, VRE, C. difficle or MRSA: what should be the priority of infection prevention?’ [No idea where that could have come from…] Andreas developed a framework for grading the priority of our microbial threats, accounting for transmissibility, virulence, antibiotic resistance, at-risk patients, feasibility of decolonisation, cost, and impact of uncontrolled spread. And the result? Any and all microbes that cause HCAI should be a priority of infection prevention. Even those that seem to have less clinical impact (such as VRE) are good indicators of system failure. If we focus too much on one threat, we risk losing sight of the bigger picture.