Pretty worrying editorial in Clinical Infectious Diseases this month, discussing the issue of Polymixin resistance in Acinetobacter. So basically no treatment options and an attributable mortality of 30% from an organism that isn’t normally that virulent. Although these organisms do not seem to be causing too many problems in the UK, it is a different story in Asia. New therapeutics are some way off and there have been a few false dawns. So how about a real concerted effort to prevent infections and transmission in the first place. A good honest look at infection rates, realistic audit and feedback of hand hygiene compliance (instead of the non-credible >100% usually trumpeted), the same for assessing the effectiveness of cleaning, instead of the rose tinted spectacles that are the usual method. Infection prevention and control activity isn’t a PR activity; until new options for treatment come to fruition it may be all that we have.

Much attention on the use (and misuse) of PPE over the past months. I have always thought it to be a good thing if used well but this paper seems to suggest that universal use of gloves and gowns could be a good thing, suggesting that the 25% of staff that contaminate their clothing by only using PPE for patients with known pathogen carriage could be reduced by universal use of PPE. Whilst I agree that those not known to be carrying organisms ‘of interest‘ are a significant issue (you only know what you know after all), I also worry about the over-use of PPE and the possible blase attitude that this brings. As we all know, PPE can be a hazard if not removed in a logical order that minimises contamination to the wearer (‘correct’order TBA..), however given that training is er.. often less than comprehensive, would universal use reduce the risk? Maybe of  contamination of uniforms, but would other risks increase? I’m not totally convinced that clothing contamination is a significant risk to anyone but the wearer at the moment.

Yet another study has just appeared in AJIC ‘In Press’ that reports on a long-term, discontinuous ‘outbreak’ of Pseudomonas (see http://www.ajicjournal.org/article/S0196-6553%2815%2900138-8/abstract). Once again everything points back to the sinks in the unit and a reusable washbasin for hairwashing. So all back to water and practice issues around it. Water is dangerous you know, nearly 100% of murderers and theives have consumed it in the 24 hrs preceding their crimes and it is the leading cause of drowning. Seriously though, wouldn’t we expect to find Pseudomonas in a sink trap? It is how it gets to the patient that is the issue. I was in a hospital overseas recently where mop-heads were conveniently placed either side of the sink to soak up splashes from the basin. So, why were there splashes? The sink trap was just a hole and so the staff had placed big grilles over the bottom of the sink to prevent items going down and blocking the sink. Turning on the tap produced a very attractive set of fountains, a bit like at the end of ‘Oceans 11’. Nuff said

Leicester incontinence sufferer ‘too frightened’ to drink water – http://www.bbc.co.uk/news/uk-england-leicestershire-32222349

Is there a link between gram-negative bacteraemia and hydration? Evidence a bit thin but I find it highly plausible, especially given the papers from all over the planet demonstrating seasonality. Pads vs antibiotics. No brainer

Time to wake this sleeping blog up I think. Plenty of material out there. I’m just back from a trip to Asia, including the APSIC meeting in Taiwan. What struck me was the huge amount of interest in the environment. The meeting kicked off with a keynote on the subject and looking through the programme there was a session on environmental contamination in virtually every concurrent. Acinetobacter is the primary concern and they’ve not got started on C. difficile yet (mainly helped by not looking for it.. I wish I’d thought of that)