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
Disinfection
Oh, the fun you can have with a urinary catheter and a drain
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.
Using “health outcomes” as the basis for developing effective and sustainable hygiene interventions – is 2019 the time for a rethink?
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.
Should we disinfect the loo BEFORE flushing?
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?
Painting the hospital room blue
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!
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.
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
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.
Back to the floor..
A 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
Reflections on Infection Prevention and Control 