Are we over-complicating effective hand hygiene technique?

The WHO method for hand hygiene is very well embedded as the ‘gold standard’ for hand hygiene technique. But is it feasible to perform every time in the busy clinical environment? A new study in Clinical Infectious Diseases seems to suggest that a shorter, simpler hand hygiene method be just as effective and more feasible in the real world.

Continue reading


Working while sick

Schermafbeelding 2018-11-12 om 17.08.03

Compared with the general population, healthcare workers (HCWs) have an increased risk of being exposed to respiratory pathogens including flu, causing a potential threat for their own health and their patients’ safety.  At present, the problem of HCW vaccination seems to get the main attention when dealing with influenza prevention, whereas the problem of HCWswho work while feeling sick, seems to be far less addressed.  That is, until recently when Chow et al. studied hospital-acquired respiratory viral infections, sick leave policy, and a need for culture change.

The ISAC Infection Control Study group had already piloted a survey on the topic and wishes to poll your thoughts with the present survey.

While there is nothing to earn, except of the good feeling of having helped someone, we kindly ask you to take the questionnaire (takes 4-5 minutes) and send it to others, including friends or family not in healthcare, as we are especially interested in possible differences.

Link for the survey:

Thanks for helping and of course results will be back on this blog.

Must we screen for resistant bacteria?

This is a cry for help. In 2 weeks time I have a pro-con debate on the statement “screening for highly-resistant microorganisms is a must”. I face 2 problems: the organizers gave me the “PRO” position and my opponent is professor Andreas Voss.

We will be watched by a Dutch audience, so the bacteria involved are MRSA, VRE, anything resistant to carbapenems and ESBL-producing Gram-negatives, and I (and hopefully Andreas too) interpreted the question as “screening at the time of hospital admission”.

I am desperately seeking high-level scientific evidence supporting my allocated point. 

My question to the knowledgeable reflectionsipc readership is: What do you consider the single most convincing piece of evidence underpinning my case.

As in all good practice I will provide feedback (if I survive the battle).

Mapping C. dfficile hospital acquisition: short-stay diagnostic areas are important!

Recent genomic studies have concluded that hospital-acquired acquisition of C. difficile is rare, suggesting that acquisition of C. difficile outside of hospitals followed by hospital-onset disease is the most common explanation for C. difficile infection. These studies hinge on an assumption that in-hospital patient contact occurs due to shared or recent stay on the same hospital ward. A short publication in JAMA Internal Medicine eloquently challenges this assumption, suggesting that hospital contact that we would usually assume to be casual and not a risk for acquisition of hospital pathogens (e.g. short-stay diagnostic areas such as ultrasound and endoscopy) can be an important source of acquisition.

Continue reading

Exposed: Dutch and London clinical microbiologists

Six weeks ago I blogged on the exposure of Dutch clinical microbiologists by Marcel Levi, former boss of the Academic Medical Center in Amsterdam and now leading 5 academic centers in London. Apart from describing his new “totally resistance-free” work situation, he criticized  the microbiologists in both countries for “not attempting to change the money-wasting and empty-brain practice of microbiological diagnostics”. Unfortunately, Marcel Levi is not just “another person” with an opinion. So, here are four suggestions to change his opinion, before all microbiologists have been sacked. Continue reading

Friday Afternoon: ATP vs UV vs eyeball Vs K9 and Going Commando in Surgery

Screen Shot 2017-06-02 at 12.26.42Well I was looking for a Friday afternoon sort of post and you know when you wait a while and two come at once?.. So firstly, some may recall that I have previously highlighted the utility of a sensitive nose in detecting a variety of things in a previous post. In a study just posted online first in the Journal of Hospital Infection, a springer spaniel was trained to detect C. difficile in the environment with a fair degree of success, especially for detecting rooms in which C. difficile was not present. Continue reading

C. auris questionnaire – the outcome

Overall 61 colleagues from 17 countries answered the questionnaire.  A large proportion (26 of 61) of the answers came from the UK, which might have to do with the fact that the first European outbreak was described in England.

Schermafbeelding 2017-05-25 om 01.40.50

Of the respondents 32.8% said that their institution released a warning about C. auris.  Analyzing the data separately for the UK and the other participating countries, it became clear that the first European outbreak had impact on the preparedness. In the UK 42.3% of the institutions were warned about the unique capacities of C. auris, versus 25.7 in all other countries.  Regarding the existence of a written guideline dealing with C. auris, the differences were far less pronounced, namely 26.9% versus 20.0%, respectively.

53.9% of the UK responders believe that their lab can correctly diagnose C. auris, versus 31.4% in the other countries.  In addition, the proportion of responders, who didn’t know if their lab was prepared, was higher outside the UK (45.7% versus 26.9%, respectively).

Despite the emerging spread of  C. auris clusters this questionnaire is an indication that most institutions are not adequately prepared.  Obviously the sample is really small, but the outcome was predictable.  With an increasing body of literature, including papers on diagnostic methods and infection control measures, we should hope that the situation should change very soon.  Thus, don’t lean back, start writing.