How much chlorhexidine actually makes it to a patient’s skin?

Jon Otter (@jonotter) Decolonisation , ,

CHG

There has been much impressive research of late around the use of chlorhexidine daily bathing to reduce the burden of skin contamination and protect patients from infection. This is quickly becoming en vogue, especially for ICU settings in the USA. But what is compliance like with this intervention, and how do you measure compliance? The studies that have measured compliance previous have said “Yes, this patient was given a chlorhexidine wash today”, but have rarely gone so far as to measure the actual concentration of chlorhexidine on the patient’s skin.

Continue reading →

Up-date on M. chimaera

Andreas Voss (@AVIPNL) environmental contamination , , ,

Schermafbeelding 2015-07-23 om 15.52.36

More and more reports and guidance (Ref) appear with regard to Mycobacterial infections associated with heater cooler units used during thoracic surgery. As mentioned in this blog before, the infections are attributed to aerosol generated by the contaminated heater cooler units that are located in or adjacent to the operating room (Ref).

Just now, researchers published 10 patients with disseminated Mycobacterium chimaera infections subsequent to open-heart surgery at three (CH, GER, NL) European Hospitals (Eur Heart J. 2015 Jul 17).

What makes this infections special, is the fact that the time to infection may takes months to years and that the micro-organism in question is easily missed by routine bacterial diagnostics.

The word is out, that other, difficult to diagnose micro-organisms e.g. Legionella are possibly causing post-operative infections, too. Thus, I believe that we can expect more cases with different pathogens in the near future.

Schermafbeelding 2015-07-23 om 14.52.51

You wait for ages, and then two come at once..

Martin Kiernan (@emrsa15) Epidemiology, General, Infection Prevention and Control , , ,

NH

Sometimes waiting for research highlighting an issue that you know is a problem is like waiting for a bus..  Following on from my colleague @jonotter who last week posted about MRSA spread in nursing home settings, I was interested to read this new paper from the USA, published in the Journal of the American Geriatric Society. The study notes the high prevalence of Multi-Drug Resistant Organism (MDRO) carriage in nursing homes that was in excess of that in hospital settings and sought to determine any associations. The findings are interesting, if not surprising.

Continue reading →

How can we stop nursing homes nurturing MRSA?

Jon Otter (@jonotter) MRSA , , , , , ,

4083313311_812b927533_o

There is an emerging feeling that we need to start spreading the focus of infection prevention and control beyond acute hospitals. There has always been a sense that standards of infection control outside of acute settings are, shall we say, “different” to acute hospitals (aka non-existent) so it’s great to see a study of an infection control intervention in nursing homes.

The study was a cluster randomised controlled trial of MRSA screening, decolonisation and enhanced environmental disinfection vs. standard precautions in 104 of 157 nursing homes in a Swiss region. The authors chose a rather unusual, pragmatic endpoint of the prevalence of MRSA colonisation after 12 months.

Continue reading →

We’ve got a policy, so that’s alright then..

Martin Kiernan (@emrsa15) Uncategorized

3812343931_71e99a144d_z

I’m always interested in why people don’t do what they know that they should or why things don’t happen as we think they will. Interventions that are demonstrably effective, evidenced in the literature and incorporated into guidelines are not implemented even though ‘it’s in the policy’. We have to remember that implementation often has many sides. We can spend a lot of time designing an effective intervention based on the most robust evidence and then it just doesn’t happen on the shop floor. Sometimes this is failure to engage the staff that will actually implement the measure, but what about the involvement of those to whom the deed is done? A simple two-letter word can stop healthcare provision in it’s tracks. That word is ‘No’.

Continue reading →

Man’s best friend fetching noro

Andreas Voss (@AVIPNL) Norovirus , ,

Schermafbeelding 2015-07-08 om 17.25.43

Caffy et al. identified man’s best friend, dogs (sorry for all those cat lovers), as a possible source of human norovirus.   The UK-based-researcher showed that different genotypes of human norovirus-like particles can bind to canine gastrointestinal tissue, suggesting that infection is (theoretically) possible.  In addition, some of the dogs mounted an immune response to human norovirus.

How much of a problem do we actually have? Time to let Bella & Buster go?

In my opinion this seems still to be unclear. Neither do we know whether dogs could shed human norovirus in quantities necessary to cause infections in humans, nor (and most importantly) did the researchers succeed to detected human norovirus in the canine feces samples. Thus, so far no reason to switch your best friend with a gold fish – which, by the way, might carry the risk of atypical mycobacteria!

Caddy Sl et al.  J Clin Microbiol. 2015 Jun;53(6):1873-83. doi: 10.1128/JCM.02778-14. Epub 2015 Apr 1
Continue reading →

CRE winging its way around the world

Jon Otter (@jonotter) CRE , , , ,

aeroplane

CRE are known to be adept at hitchhiking around the world, hence the focus on cross-border transmission in Europe. A startling example of this comes in a report from Poland result from the terrorist shootings in Tunisia. Two Polish nationals seriously injured in the shootings were repatriated following a 10-day stay in a hospital in Tunis, Tunisia. A grand total of four CREs were identified from the two patients!

Three of these were identified at the time of admission, so almost certainly originated in Tunisia. The fourth CRE was identified 10 days after repatriation to Poland. The authors suggest that the most likely explanation for this is poor sensitivity of admission screening. I venture, however, that it’s more likely due to in-hospital transmission in Poland, since the two patients were treated by the same staff.

Nonetheless, the most troublesome finding here is that at least three separate CREs were imported into Poland by just two patients. Can anybody find me a paper on the prevalence and epidemiology of CRE in Tunisia? No? Thought not. The implication here is that CRE is already far more established than feared in Tunisia and many other parts of the world!

Image: Aeroplane.

MRSA in Denmark

Andreas Voss (@AVIPNL) CA-MRSA, CC398, MRSA, ST398

MRSA

(from Statens Serum Institut, EPI-News, N023-2015)

‘The number of hospital­-acquired cases observed in 2014 increased to 95 from 52 cases in 2013, but still comprise only a limited share of the total number of cases (3%). The number of MRSA cases of the CC398 type, which is closely associated with pigs, increased substantially from 643 cases in 2013 to 1,276 cases in 2014 and comprised 43% of the total number of cases. Community­-acquired MRSA, i.e. in persons with no known contact to pigs, hospitals or nursing homes, comprised 946 cases in 2014, compared with 821 cases in 2013. In 478 of these cases (51%), there was known exposure to a person with MRSA, most frequently a member of the household (92%). In 56 cases, MRSA was isolated from blood, corresponding to 2.9% of all S. aureus bacteraemia cases, which is a substantial increase with respect to recent years, but the figure remains low compared with other European countries.’

And here I stop citing the report. For those interested in the complete report, please follow the link: MRSA Denmark.

Continue reading →

Biofilms make the hospital environment far from ‘inanimate’

Jon Otter (@jonotter) Biofilm, Contamination , , , ,

biofilm

Anybody doubting that biofilms really do exist on dry hospital surfaces needs to read this study: biofilms are there, they are complex, and they are common. A landmark study by the same Australian Vickery group published in 2012 first identified biofilms on a handful of dry hospital surfaces in an ICU. But this study is far more comprehensive and convincing.

Continue reading →

Fidaxomicin reduces C. difficile environmental contamination

Jon Otter (@jonotter) C. difficile, Environment , , ,

It is well-established that fidaxomicin reduces the recurrence rate of C. difficile infection (CDI), but this study from my old research group at GSTT / KCL is the first to evaluate the impact of treatment with fidaxomicin on environmental contamination. The bottom line is that patients treated with fidaxomicin had less C. difficile contamination than patients treated with vancomycin / metronidazole.

In total, the rooms of 38 / 66 (57.6%) patients treated with metronidazole / vancomycin had one or more positive environmental cultures compared with 25 / 68 (36.8%) patients treated with fidaxomicin (P = 0.02). Similarly, when considering all of the sampled environmental sites (four per room), 68 / 264 (25.8%) were positive in patients treated with metronidazole / vancomycin compared with 47 / 272 (17.3%) in patients treated with fidaxomicin (P = 0.02) (see Figure below).

Fidax CDI

Figure: Environmental contamination with C. difficile in the rooms of patients treated with fidaxomicin vs. vancomycin / metronidazole.

Continue reading →