You may think so, with this title: “Oral mucositis as a pathway for fatal outcome among critically ill patients exposed to chlorhexidine (CHX)”, with the conclusion that the “data points to oral mucositis as the main pathway for the association between CHX exposure and enhanced in-hospital mortality.” The research letter is a post hoc analysis of a randomized clinical trial. Time to stop using CHX mouthwash? Or time to stop building strong stories on weak data? Continue reading
We have blogged a fair bit recently about the risk of antibiotic-resistant Gram-negative bacterial contamination of sinks and drains. A new study offers a novel approach to this problem: by repurposing a balloon catheter to extend the duration of contact between a disinfectant and the sink-end of the pipe.
This is a guest post by Prof Sally Bloomfield…
For many years, “5 log reduction” (LR) has been the gold standard for disinfectant efficacy despite absence of dose:response data linking it to clinical outcomes. The family of EN tests now used to support claims for disinfectant products has its origins in the European Suspension Test (5LR, 5 mins, 5 test organisms) where 5 LR was probably chosen because it is the limit of sensitivity in an assay where, traditionally, the initial bioburden is 108 colony forming units. For soap, detergent or dry wiping procedures, until recently their effectiveness has been assumed – possibly on the basis that they produce visible cleanliness? It is only recently that we have had access to efficacy data based on lab models. A trial of EN 1699 handwashing test showed a mean 2.76 LR when hands contaminated with E .coli are washed with soap.
There is a risk that an infectious aerosol is produced when toilets are flushed. One way of addressing this would be to add a disinfectant to the toilet before flushing. But would this be safe and effective?
This recent study from the Donskey group could provide hospital cleaning staff with a powerful visual cue to help assure adequate disinfectant coverage. The addition of a chemical widget to bleach solution gives it a bright blue hue when applied to surfaces, so allowing a cleaner to track their progress visually!
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
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.