A superb cluster randomised trial has just been published in Clinical Infectious Diseases testing whether improved environmental hygiene via objective monitoring and feedback reduces HCAI. The study also tests whether ATP or UV fluorescent marker monitoring is more effective. The findings reinforce that improving environmental hygiene reduces HCAI, and (I think surprisingly) suggest that ATP is more effective than UV monitoring.Continue reading
I trust you are enjoying a well-deserved summer break or packing your bags to take off. In case you missed this paper in the daily list of new ones on biorxiv, it tells you where to swim safely and where not. Elena Buelow, from Germany, a former PhD student in our lab in Utrecht and now post-doc in Limoges, France, reported. So, if you are floating quietly in a pittoresque small river and you see a hospital building on the hill near the next bend in the river, are you still in safe waters? Continue reading
We have been posting for a while about the emerging recognition of CPE contamination of drains in clinical settings, which seems to be fueling some CPE transmission. Until now, there’s been plenty of publications identifying the problem, but very few presenting a solution. In fact, attempts to tackle CPE contamination of drains have had moderate impact, at best. A new short study in ICHE illustrates the potential of a foaming hydrogen-peroxide based disinfectant to tackle contamination with resistant Gram-negative bacteria in drains.
I’m at ECCMID in Amsterdam currently listening to a nice report of an OXA-48 Klebsiella pneumoniae outbreak in Gran Canaria in which sinks were found to be contaminated and replaced. Earlier today I listened to a nice paper on how sinks that drain slowly are more likely to contaminate the local environment for up to 1 metre from Paz Aranega Bou who, together with Ginny Moore and other colleagues has published this nice paper . So many papers on sinks now and I do wonder if we have lost sight of what they do and what they really are.
Brett Mitchell and colleagues have just published the exciting findings of the Researching Effective Approaches to Cleaning in Hospitals (REACH) study in the Lancet Infectious Diseases, along with my editorial. This large 11-centre randomised intervention study found that a low-cost enhancement to environmental hygiene managed to significantly reduce VRE infections, but did not reduce S. aureus bacteraemia or C. difficile infections.
It is with great pleasure that I ask your attention for this article that appeared in the Economist. Yes, we still have low resistance rates in our hospitals and if you’re interested in how that happened, read it. The prosaic composition contains two parts; a very realistic thriller-like opening, followed by a second part with a rather unrealistic explanation. Both parts are separated by a short sentence of absolute nonsense. Time for a review. Continue reading
A paper has just been published in ARIC as the first academic output of the Healthcare Cleaning Forum. I blogged earlier this year to relate the inaugural Healthcare Cleaning forum, and this paper expands on the key themes: establishing environmental hygiene as a patient safety initiative, providing an overview of the importance of environmental hygiene in healthcare, exploring the human factors driving the standards of environmental hygiene along with the need for effective education, the possibilities and challenges of automation, and the cost and value of environmental hygiene.
One of the key aims of the forum is to be a champion for environmental hygiene professionals. There’s a famous story of when president JFK visited NASA and asked a janitor who was mopping the floor what they were doing. The answer was simple and profound: “I’m helping to put a man on the moon.” If you asked somebody working in environmental hygiene in your hospital what they were doing, would the response be: “I’m helping to maximise patient safety and prevent healthcare-associated infection.” Probably not. We need to champion the cause of environmental hygiene professionals, who lack professional status, are often not paid enough, and often have limited options for career progression.
Is environmental a treasured investment priority in hospitals?
Related to this is our perception of the cost and value of environmental hygiene in hospitals. Is our level of investment appropriate given the risks associated with inadequate environmental hygiene in hospitals? Would we really find highly valued cleaning and disinfection materials in the metaphorical safe of a hospital manager (see the cartoon above)? Probably not! We need work towards better evidence to understand the value of environmental hygiene in hospitals in the context of other investment priorities.
In honour of Infection Prevention 2018, Brett Mitchell and I are having a blogoff so that you can choose the best IPC article of 2018. This post presents my case, Brett’s post (here) presents his case, and there’s a vote below so that you can choose. The results will be published next Monday morning at Infection Prevention 2018…
I was asked to write a series of articles in the Nursing Times (along with my colleague and co-author Tracey Galletly) on the role of nurses in environmental hygiene*. Et voila:
- Environmental decontamination 1: what is it and why is it important?
- Environmental decontamination 2: the role of the nurse
- Environmental decontamination 3: auditing cleaning and disinfection
I’ve been struggling for years to find the best ‘catch-all’ term to describe hospital cleaning or disinfection or both. And, after much thought, I’ve settled on a proposal to share with you, dear reader: “environmental hygiene”.