Agent Orange in spinal surgery

This week I learned from an orthopaedic surgeon that randomized trials were something that could be of use in “pharmaceutical sciences”, but that it is well-known that in the “surgical science” retrospective analyses are better for deriving evidence. We came to this when discussing the benefits of powdered vancomycin in the wounds of spinal surgery. Apparently this is something “all spinal orthopaedics do”, because it works so good. Continue reading

Time to go shopping for a UVC system?

It is great to see the long-awaited ‘Benefits of Terminal Room Disinfection’ (BETR-D) randomised controlled trial of a UVC automated room decon (ARD) system published, in the Lancet, no less! This study firms up the importance of environmental contamination in transmission, and demonstrates additional benefit of UVC over and above enhanced conventional methods for VRE, maybe for MRSA, but not for C. difficile.

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Attacking the fecal veneer*

What an excellent start of 2017. A great study from the USA today in Lancet: In a pragmatic cluster-randomized crossover study they tested 4 patient room cleaning strategies on the effectiveness to reduce acquisition with relevant bacteria for the incoming patients. The conclusion states that “enhanced terminal room disinfection decreases the risk of pathogen acquisition.” Yet, this paper is so “data-dense” that you must read the methods (and supplements) to get the picture. In one shot: Not for C. diff, may be for MRSA and yes for VRE. Continue reading

Breaking the chain of infection – hygiene is everyone’s responsibility

ifh-chain

As International Infection Prevention Week (#IIPW) continues, Prof Sally Bloomfield writes a guest blog on the principles of breaking the chain of infection. Whilst the blog is focused on home and everyday life settings, the principles are relevant to healthcare facilities too!

This is international Infection Prevention Week. To address this year’s theme “Breaking the Chain of Infection” the International Scientific Forum on Home Hygiene (IFH) has produced a simple online resource Breaking the Chain of Infection.

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Back to the floor..

flooringA little while ago I blogged about the excellent study from Nottingham that demonstrated significant VRE and MRSA contamination on socks used to prevent falls in the hospitalised elderly. This has been followed by another paper suggesting that shoe coverings undurprisingly become contaminated. So, what? How does this really impact on transmission? A new study from Curtis Donskey’s group has looked at hand contamination in patients directly relating to floor contamination. Continue reading

Diluting the efficacy of hydrogen peroxide room decontamination?

h2o2

A somewhat perplexing new study has just been published in the Journal of Hospital Infection comparing the effectiveness of two hydrogen peroxide based automated room decontamination systems: a low-concentration (5%) hydrogen peroxide system (Deprox) and a high-concentration (30%) hydrogen peroxide system (Bioquell).

The study evaluated the impact of the two systems each run in 10 single rooms containing seeded metal discs placed in five locations, with a 6-log load of MRSA, K. pneumoniae, and C. difficile spores. The MRSA and K. pneumoniae were either low soiling (0.03% BSA) or heavy soiling (10% BSA), and the C. difficile spores was either low soiling (0.03% BSA) or in body fluid. In addition, surface samples were taken from 22 surfaces in each room before and after decon using contact plates. The bottom line is that both systems achieved a >5-log reduction on all of the discs (including those with heavy soiling), and there were no real differences in the levels of surface contamination remaining. All this understandably moved the authors to conclude that ‘The starting concentration and mode of delivery of hydrogen peroxide may not improve the efficacy of decontamination in practice.’

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What are we doing to improve hospital room cleaning and disinfection?

I gave a webinar last week for 3M (you can download my slides here) on “Your hospital room can make you sick: How improved cleaning and disinfection can help”. I asked the audience what they were doing to improve cleaning and disinfection, and thought I would share the findings. I don’t know the exact size of the audience (but it’s usually a couple of hundred mainly US based IPC folks), and the audience were allowed to choose any answers that applied to them for the second two questions.

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