I listened to Reflections’ very own Martin Kiernan share his wisdom on the challenges around hand hygiene improvement this week, and thought I’d share my own reflections on his talk. The key point seemed to be that we have some way to go in winning the hearts and minds of our frontline clinical colleagues if we are to improve hand hygiene practice across the board.
CPE in drains: a light at the end of the drain pipe?
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.
Four little words…Clean care for all
Guest bloggers Claire Kilpatrick and Julie Storr (hand hygiene consultants at the WHO, @safesafersafest) post…
Three little words, behind which lay 40 years of a global aspiration. Health for all. Last year the world recommitted to Alma Ata and renewed the global focus on health as a fundamental human right. In 2019, WHO’s 5 May global hand hygiene campaign evokes the spirit of health for all with its own four words: Clean care for all. How is this relevant to infection prevention and control (IPC) on a day to day basis, particularly for the other 364 days of the year?
Persistence and transmission of Candida auris on and from gloves
Interesting results from Jabeen et al. that many of us might have missed, as they are published in a mycology journal and not in an infection control journal. Persistence of Candida spp. on latex and nitrile gloves was highest for C. auris and C. parapsilosis. Interestingly, persistence on nitril gloves was generally less than on latex gloves. Transmission of Candida spp. from gloves (latex, nitril not tested) to urinary catheter surface was most effective for C. auris and C. albicans.
To be frank, the chosen methods and set-up of the experiments leave quite some room for improvement, but the basic idea of the experiment and the message it conveys are – while not new – of importance: Glove use can be an important factor in the spread of all microorganisms, and in this case, especially C. auris.
Previously it has been shown that glove-use may negatively effect hand hygiene behavior. After years of focusing our attention on hand hygiene compliance and hand-rub technique, this publication is an important reminder, to not forget about adequate glove-use.
Jabeen K, Mal PB, Tharwani A,Hashmi M, Farooqi J. Persistence of Candida auris on latex and nitrile gloves with transmission to sterile urinary catheters. Medical Mycology, 2019, 0, 1–5 doi: 10.1093/mmy/myz033 Advance Access Publication Date: 0 2019
“It’s in Your Hands” – time to sing along
Friends and colleagues in Geneva have just released a song written and performed for the upcoming World Hand Hygiene Day. It’s a catchy tune with a nicely produced video – and a strong message in the chorus:
‘Hands are such a simple thing, but our hands can change most everything. Keep care safe and take a stand, clean care for all – it’s in your hands.”
Have a listen and see what you think:
The winner takes it all for S. aureus
As usual, some of the most interesting presentations at ECCMID were in the late-breakers “clinical trials” session. Four of 5 presentations were on treatment or prevention of S. aureus infection, the other one on oral treatment in patients with refractory fungal disease. With all respect to fungi, the meat was in the aureus, with nothing less than a Shakespearian tragedy. Continue reading
The continuous need of outcome data of continuous beta-lactam infusion (or not?)
When I received this invitation for a PRO-CON, I accepted within 1 minute. Only later to realize that it was on “Optimised dosing according to PK/PD principles in patients – does it improve the efficacy of antibiotics?” Luckily I was given the CON, but I was in a poor position upfront: In a twitter poll 93% of voters were PRO (bias not excluded) and my opponent was Jason Roberts. So, this was my line of reasoning: Continue reading
That sinking feeling
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.
Using qualitative methods to understand determinants of antibiotic prescribing
A couple of new studies provide insight into determinants of antibiotic prescribing using qualitative methodology. A systematic review in the Journal of Hospital Infection highlights the tension between the immediate need of the sick patient (“give ‘em broad spectrum antibiotics and keep ‘em on them for as long as I can get away with” [my caricature]) and the societal needs related to AMR (“we need to balance the individual needs of the patient with the bigger picture of AMR” [again, my caricature]). Also, a clever study by Esmita Charani and colleagues from Imperial College London provides new insight into antibiotic prescribing practice by “going native” and joining ward rounds – effectively becoming a fly on the wall to understand poor antibiotic prescribing practice. The study identified a contrast between antibiotic prescribing in Medicine, where decisions were generally multidisciplinary and policy-informed, and Surgery, where decisions were often ‘defensive’, resulting in prolonged and inappropriate antibiotic use.
From crowded house to ESBL-free house
A few weeks ago, Jon Otter blogged about a novel risk factor for ESBL Enterobacterales (ESBL-E) carriage, a “crowded house”, based on his work recently published in CMI: among 1,633 subjects in the catchment area of South-East London a crowded house, was associated with ESBL-E carriage, with an odds ratio of 1.5 (95% CI 1.1-2.2). Jon hinted towards future community-based interventions to reduce ESBL-E carriage and his blog naturally reached our research meeting. Continue reading
Reflections on Infection Prevention and Control 