Later on this week, I’ll be doing a Journal Club on Journal Clubs (on Weds 21st at 1500 UK time – register here)! The aim of this Journal Club is to provide a bit of a ‘how-to’ guide on identifying and critically analysing good studies. Clearly, the definition of a “good” study will very much depend on your point of view and your interests. For example, a very well designed and conducted study in one journal may be of far less interest to you than a less well designed and / or conducted study on a more relevant topic. I picked up this BMJ Evidence Based Medicine article on Journal Clubs from 2017, which I’ve suggested as reading material before the Journal Club.
Continue readingExploring barriers to “water free” care
There is an increasingly strong rationale for going “water free” (or at least “water lite”) in our delivery of critical care to reduce the risk of antibiotic-resistant Gram-negative infections. But it’s a challenging concept in quite a few ways. In fact, when I’ve suggested it in the past, there has been a palpable gasp and quite a few objections raised! So I was struck by a recent JHI study exploring barriers to implementing water free care.
Continue readingReal world observations to prevent SSIs
This week we welcome Dr Jude Robinson as a guest blogger to Reflections to discuss a paper on surgical site infection prevention.
I feel very honored to have been asked to be a guest speaker on the esteemed IPC partners journal club. I love critiquing papers, and I honestly don’t give myself enough time to do this on a regular basis, probably the same position as many of us with our busy clinical roles. I have really enjoyed preparing for this, so I hope you are able to join Register. I have used a recognised critical appraisal framework to support me with this journal review Qualitative Studies Checklist.
Continue readingLongitudinal environmental sampling in a paediatric BMT unit identifies computer equipment as the most contaminated site!
A new study in JHI reports the findings of longitudinal environmental sampling in a paediatric BMT unit. Perhaps unsurprisingly, sites associated with frequent contact by staff (especially computer equipment) had the highest bacterial counts. These sites also had the highest bacterial diversity suggesting they are accumulating contamination from multiple sources, and acting as a bacterial possible interchange. But computer equipment is diligently cleaned and disinfected after each use, right…?
Continue readingAnnouncing: IPC Journal Club
I’m excited to let you know about a new (free!) virtual IPC Journal Club! The first event, hosted by IPC Partners, will be led by fellow Reflections blogger Phil and me, and take place next Wednesday 3rd July at 3-3.30 pm (UK time); you can register for the Journal Club here. The plan is for this to become a regular and interactive virtual forum to cover some breaking news in the world of IPC. The topic will be this study in the Journal of Hospital Infection (see Phil’s post on the study here), using whole genome sequencing to provide transmission insights into Pseudomonas aeruginosa, and evaluating the role of wastewater in transmission. Please do have a read of the paper before the session (or at least give the abstract a scan!) and come with your questions. Hope you will be able to join us next week.
How much of a drain are sinks on our healthcare organisations?
The role of wastewater systems in the transmission of healthcare associated infections (HCAIs) has been an interest of mine for several years but it was this paper published in JHI last year which highlighted just how big their contribution could be.
Papers keep coming to support the link between sinks and HCAIs. This recent paper in JHI, examined rates of HCAIs caused by Pseudomonas aeruginosa in six intensive care units (ICUs) in Ontario, Canada. Specifically, the authors investigated the role of sinks in the transmission of P. aeruginosa HCAIs.
The paper was an enjoyable read as there was real rigor in the methodology relating to the microbiological analysis of the ICU sinks, something which Dr Jon Otter and I have discussed the importance of previously. The study used a combination of microbiological sampling and whole genome sequencing as part of prospective cohort study to investigate transmission. I also really liked how the authors defined important terminology used in the analysis, providing clear differentiation between ICU acquired infections and sink acquired infections.
Over the 10-month study there were 4,263 admissions to the six ICUs involved, and 72 (1.4%) P. aeruginosa HCAIs were identified. Unsurprisingly patients who were colonised with P. aeruginosa were more likely to develop and infection and infected patients spent longer in ICU. Analysis of P. aeruginosa HCAIs found that 5-7% of infections came from a sink reservoir. The authors concluded that this rate of infection was likely to be underestimated due to challenges with sampling of the environment and when assessing patient acquisition. The authors also point out that toilets were not included in their sampling analysis, something which I blogged about the risk of recently. I tend to agree with the authors that this infection rate is underestimated given other studies have reported higher infection rates.
To conclude we have another paper which confirms the role of sinks in the transmission of infections. We need to do more to reduce the risk of these transmissions given the burden to patients and the drain on our healthcare organisations. An additional day stay in ICU has been estimated to cost £1621. We need more research into cost effective interventions to reduce the risk of transmission to reduce the sink and infection burden on our healthcare organisations.
“Through the air”
There has been a huge amount of debate, discussion (and occasional vitriol) about transmission routes for respiratory pathogens, especially SARS-CoV-2. One of the sticking points has been different perspectives on the terminology used. I was privileged to join a working group convened by WHO to propose some new terminology to underpin this discussion. The proposed new terminology has been published recently, and I’d thought I’d share some reflections! Whilst I don’t think this will turn our IPC practice upside down, it is a step towards a more informed approach to preventing the spread of respiratory pathogens.
Continue readingTowards standardisation of hospital wastewater sampling
Another guest post from Dr Phil Norville (bio below)…
Very few weeks go by without me reading a paper discussing a multidrug-resistant outbreak that is linked to contaminated water or wastewater systems. The most recent was an outbreak of Achromobacter species in 22 patients which was linked to water in contaminated tubes of a medical pressurizer (used for urology surgery). It was one the reasons Jon and I wrote a letter to the Journal of Hospital Infection calling for a move towards the standardisation of wastewater sampling.
Continue readingLifting the lid on toilets and healthcare-associated infections
Guest blogger, Dr Phil Norville (bio below) writes…
Wastewater systems (sinks, showers and more recently toilets) are attracting attention as their role in healthcare associated infections (HCAIs) continues to gathers evidence. In this blog we take a closer look at toilets and their potential role in transmission, as well highlighting some of the current challenges facing healthcare organisations around wastewater management.
Continue readingThe country lottery: where you live influences infection outcomes
I have posted before about the “postcode lottery” and it’s influence on rates of MRSA, affecting deprived postcodes (or zipcodes!) more than others. But this issue is wider than regional influence. On an international scale, your changes of a bad outcome from infectious disease varies, sometimes wildly, by where you happen to be in the world. A new article in CID on clinical outcomes from carbapenem-resistant Acinetobacter baumannii infections bears this out.
Continue reading
Reflections on Infection Prevention and Control 