Marc recently posted about the second clinical outcome findings from the BETR-D study, recently published in the Lancet Infectious Diseases. Marc contended that the team may have been ‘blinded by the [UV] light’ in reaching the conclusion that enhanced terminal room disinfection led to a hospital wide reduction in acquisition of key pathogens. Here, in the spirit of healthy academic debate, I offer another perspective.
Procalcitonin-guided antibiotics for respiratory tract infections
Every day thousands of physicians worldwide are facing the dilemma whether “to treat or not to treat this coughing patient with antibiotics”. A test that safely discriminates a bacterial from a non-bacterial cause is the holy grail, and some feel that procalcitonin (PCT) is just that. Results from multiple – mostly European – studies and meta-analyses pushed them in that direction. Yet, we are not that often sure of the causative pathogen, and diagnostic research in the absence of a gold standard is tricky business. And now there is this marvelous study that perfectly addresses that uncertainty and questions all prior PCT evidence, and that was discussed in our PhD journal club. Continue reading
The antipathy against SDD explained
With the first paper on Selective Digestive Decontamination in ICU patients published in 1983, this year marks the 35th anniversary of one the fiercest controversies in intensive care medicine, infection prevention and clinical microbiology. To celebrate this, Intensive Care Medicine published 3 editorials called the “Antipathy against SDD is justified”: 1 arguing Pro, 1 Con and 1 wasn’t sure. If the contents of these editorials had been patients, a (good) physician would have called them “diagnostic”. SDD is where clinical epidemiology becomes psychology and sociology. Continue reading
The days of serial admission screening for CPE are numbered
The current national guidelines for CPE in England recommend three serial admission screens each separated by 48 hours to confirm a negative carrier status combined with pre-emptive isolation. Even leaving aside the infeasibility of pre-emptive isolation, this approach introduces a host of operational challenges. In a study just published in JHI, we find report that serial admission screens do not improving the detection of CPE. However, there was a striking apparent increase in the rate of carriage of other resistant Gram-negative bacteria in the early days of hospital admission, suggesting either an unmasking of pre-existing carriage or acquisition of resistant Gram-negative gut flora.
Attacking the fecal veneer (part 2)
Last year (Jan 17, 2017) I blogged on an excellent pragmatic cluster-randomized crossover study in which 4 patient room cleaning strategies were tested for their effectiveness to reduce acquisition of bacterial carriage for the incoming patients. The authors’ conclusion was that “enhanced terminal room disinfection decreases the risk of pathogen acquisition”, which I interpreted as “Not for C. diff, may be for MRSA and yes for VRE.” Now the same group published the effects of these interventions on infection/colonization with these pathogens in ALL patients admitted to the hospital during the study period, see. Authors’ conclusion this time: “Enhanced terminal room disinfection with UV in a targeted subset of high-risk rooms led to a decrease in hospital-wide incidence of C difficile and VRE.” Really? Continue reading
The inaugural Healthcare Cleaning Forum
Today was the inaugural Healthcare Cleaning Forum. The plan was to showcase some healthcare cleaning and disinfection science at the Interclean Conference in Amsterdam (which is a huge general cleaning show). I think we managed to create some awareness about the unique challenges of cleaning and disinfection in healthcare outside of the usual crowd.
Antibiotic resistance after the toilet is flushed
Last week Jon ended his reflection with a grade A recommendation to close the toilet lid before flushing, as the best way to minimize the potential impact of “toilet flushing plumes”. Even better: do not flush at all. This week we take it from there, in a discovery of what happens subsequently. Let’s take the loo with the highest likelihood of being soiled with antibiotic-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs): the hospital loo. Elena Buelow, former Phd student in our group and now post-doc in Limoges, France, quantified how hospital sewage contributes to the quantity and diversity of ARGs in the general sewerage system. The work was published on-line today.
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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?
Fosfomycin: the hottest drug in town!? News from ECCMID 2018
In our team Thijs ten Doesschate does a PhD in clinical epidemiology addressing some clinical aspects on fosfomycin; An old antibiotic, active against Enterobacteriaceae, and surfacing as promising alternative to beta-lactams and fluoroquinolones in times of antibiotic resistance. He is currently coordinating a multi-center double-blind placebo-controlled randomized trial to determine non-inferiority of fosfomycin (against ciprofloxaxin) in the step-down oral treatment of complicated Urinary Tract Infections (UTI). If non-inferior, we could reduce cipro usage. For himself (and now for us) he summarized fosfomycin news at ECCMID. Most presentations (O) and posters (P) can also be found on http://www.eccmidlive.org/ .
The Trojan Horse
I’ve been mulling over the issue of sinks in clinical areas a lot recently and a paper published today in the Journal of Hospital Infection has really crystallised my thoughts. Sinks are everywhere; often extra ones are installed in the quest for high hand hygiene compliance however are we really thinking about the risks that these may cause apart from the traditional ones posed by Pseudomonas and Legionella? Do we even really reflect upon what they are used for? Continue reading
Reflections on Infection Prevention and Control 