I made a flying visit to HIS today in Liverpool to have a debate with Prof Mark Wilcox on whether or not antibiotics are the most important factor in healthcare-associated C. difficile infection. Mark was arguing for the motion, and I was arguing against it. And the result…well you’ll have to read to the bottom!
ID Week 2014 as seen by an Infection Preventionist
Guest Blogger Barley Chironda (bio below) writes…
IDWeek was held this year from Oct 8 to 12, 2014 in Philadelphia. IDWeek is the combined annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS). Given its wide ranging audience, there are many targeted streams that allow a range of topics. The abstract sessions featured over 1700 posters and are now already published and available in Open Forum Infect Dis (Fall 2014) as well as the abstracts from the oral presentations.
I have decided to create ‘buckets’ to best capture the various conference topics that I attended (Global outbreak threats, Surveillance in the hospital and the community, Infection control topic by topic, and Future issues for infection prevention). You will notice an emphasis on the Infection Prevention and Control (IPC) aspects of the sessions that are summarised. Please blame this on the fact that my bread is buttered this way!
Global outbreaks threats
Ebola dominated the conference, starting with the jam-packed first talk by Dr Robert Fowler on behalf of the World Health Organization. He shared personal experience of caring for patients in Sierra Leone and supportive care measures that can be implemented in resource-poor settings. This was followed by Bruce Ribner, MD, MPH, of Emory University his talk the Opening Special Plenary Session titled Treating Patients with Ebola Virus Infection in the U.S.: Lessons Learned  addressed the unique challenges of how to manage Ebola cases. Dr Ribner drew from the experience at Emory and highlighted all the relevant issues that need critical considerations (see summary of talk). He also mentioned that the PPE type, though important, is part of a multimodal approach to infection control and therefore encouraged healthcare facilities to prepare and practice for the potential of receiving an Ebola patient.
It has been two years since the first global cases of MERS-CoV were first reported . Dr Tariq Ahmed Madani, from the Ministry of Health, Saudi Arabia, in a talk aptly titled: “MERS Coronavirus – The Second Year” shared what he felt are the main problems that caused the uncontrollable outbreaks in hospitals. He condensed it to three points; i) overcrowded emergency departments, ii) suboptimal infection prevention practices, and iii) atypical presentation of patients. He proceeded to show evidence of camel to human transmission of MERS-CoV .
Surveillance in the hospital and the community
An entire symposium was dedicated to the revision of strategies to prevent healthcare-associated infections in acute healthcare titled ‘The Compendium’ . A couple of interesting points were shared under the banner of the symposium.
- Dr Deborah Yokoe’s talk “Highlights of the Compendium of Strategies to Prevent Healthcare-associated Infections in Acute Care Hospitals: 2014 Updates”  shared the complicated collaborative process involved in updating the 2008 recommendations  on Hand Hygiene, Clostridium difficile, CLABSI, CAUTI and VAPs.
- Dr Michael Howell in his talk “From VAP to VAE: Preventing Complications of Mechanical Ventilation” stated the confusion surrounding VAP surveillance is causing incomparable surveillance patterns. Instead of the CDC VAP definition, he offered the alternative, i.e. Ventilator Associated Events (VAE), which the audience felt was a more objective and measurable way of establishing harm related to ventilators .
An entire session was dedicated to how technology is now being used to conduct surveillance and gather information on outbreaks. For example, Dr John Brownstein revealed how software applications that are used daily by the public can allow Public Health institutions to predict outbreaks sooner than the current methods of conventional flu surveillance networks. He showed how from a cancelled dinner reservations  or public searches online one can deduce that influenza outbreaks are ravaging , also showing how a computer algorithm predicted the Ebola Outbreak before the WHO announced it.
Infection control, topic by topic
Clostridium difficile (Cdiff)
- Dr Tim Peto spoke about the Clinical Treatment and trials of Cdiff, sharing research about the use of whole genomic sequencing (WGS) in evaluating efficacy of new drugs against Cdiff. Dr Peto also partnered with Dr Derrick Crook in showcasing a myriad of applications of WGS, including as an outbreak management tool in infection control.
- Dr Colleen Kelly shared her study showing that Fecal Microbiota Transplantation appears to be a safe and effective treatment for recurrent, refractory, or severe CDI especially in a high-risk population of immunocompromised patients.
- Dr Curtis Donskey’s talk was on “Frequent transmission of Clostridium difficile by Asymptomatically colonized Long-Term Care Facility Residents during Hospital Admissions”. In his study, Donskey swabbed all long-term care patients on admission to hospital and realised that asymptomatic patients shed Cdiff spores and often can cause outbreaks . Dr Donskey reminded us of the need to ‘strategize’ on asymptomatic carriage of Cdiff.
- Dr Trevor Lawley (“Identifying commensal bacteria that provide resistance against Clostridium difficile Infection”) spoke about the advances in understanding of the microbiota in dealing with bacterial infections.
Healthcare cleaning & disinfection
- Dr Mark Rupp’s “Assessing Cleanliness and Motivating Environmental Service Workers” talk went through various auditing tools including microbiological methods, fluorescence monitoring and basic observation of staff cleaning. He also shared some new studies that show that positive attitude affects the quality of hospital housekeeping. He also shared a study that the time spent cleaning a hospital room does not correlate with the thoroughness of cleaning.
- Dr Deverick Anderson’s “Evaluating No-Touch Disinfection Systems” went through Ultraviolet, Hydrogen Peroxide Vapour (HPV) and self-disinfecting surfaces. Sharing his data on reducing UV room disinfection time as well as the data on the excellent efficacy of HPV he did caution adoption of impregnated surfaces citing research that more analysis is still needed.
Posters on cleaning & disinfection
- 1363 The Iowa disinfection cleaning project: opportunities, successes and challenges of a structured programmatic intervention in 56 hospitals.
- 1366 Surfaces closest to the patient have a higher multi-drug resistant organism (MDRO) bioburden on environmental surfaces in healthcare facilities.
- 1368 Assessment of environmental cleanliness in outpatient clinics – study showed that more work is needed in outpatient clinics.
Future issues for infection prevention
Stopping contact precautions on MRSA and VRE was a topic raised by Dr Michael Edmond and he covered elements that have been raised on his blog, and featured prominently at the SHEA conference earlier in the year. He concluded that with advances in hand washing and the use of chlorhexidine, there is no need to maintain contact precautions for MRSA and VRE. In addition, it was made clear during the conference that antimicrobial stewardship will play a huge role going forward in ensuring that the antibiotics that are in formulary will still remain effective.
As an Infection Preventionist, the talks offered plentiful choice and sometimes presented a challenge as to where to go since sessions of interest often ran concurrently. Unfortunately, as cloning is not widely available, I managed to stay in the loop about all talks of interest to me by following the #IDWEEK and #IDWEEK2014 hashtags on Twitter and Instagram, where attendees where tweeting from the various sessions allowing a more complete conference experience. I managed to make a lot of friends at ID Week 2014, and I am looking forward already to ID WEEK 2015!
Barley Chironda Bio
Barley Chironda is a board Certified Infection Preventionist. He is typically found engaged in motivating hospital staff, patients and visitors on proper infection prevention practices and quality improvement interventions related to patient safety. He takes pride in sharing information via social media and is often engaging the public on Twitter™ and LinkedIn™, partaking in resource distribution related to innovative and novel infection prevention strategies. Barley serves as the Education Chair for the Infection Prevention and Control Canada-Greater Toronto Area (IPAC-GTA) Chapter. In his IPAC-GTA role, he has the responsibility to promote conference organization and promote knowledge dissemination. Barley enjoys public speaking, having presented locally and internationally. He possesses exceptional ability to incorporate humour to his presentations. This excellent speaking ability earned him the Best Oral presentation at the 2013 Canadian National Infection Prevention Conference. Follow him on @barleychironda on twitter or contact him through his company www.annexandfoster.com.
- Ribner BS. Treating patients with Ebola virus infections in the US: lessons learned. Presented at IDWeek, October 8, 2014. Philadelphia PA.
- Hill CE, Burd EM, Kraft CS, et al. Laboratory test support for Ebola patients within a high-containment facility. Lab Medicine 2014:45:e109-111.
- Minal K, Kimberly P. Clinical and Laboratory Findings of the First Imported Case of Middle East Respiratory Syndrome Coronavirus to the United States. Clin Infect Dis2014;pii:ciu635.
- Ziad A. Memish, M.D., et al. Family Cluster of Middle East Respiratory Syndrome Coronavirus Infections N Engl J Med 2013;368:2487-2494.
- Yokoe DS, Anderrson DJ, Berenholtz SM., et al. Highlights of the Compendium of Strategies to Prevent Healthcare-associated Infections in Acute Care Hospitals: 2014.
- McIver DJ, Brownstein JS. Wikipedia Usage Estimates Prevalence of Influenza-Like Illness in the United States in Near Real-Time. PLoS Comput Biol 2014 17;:e1003581.
- Nsoesie EO, Buckeridge DL, Brownstein JS Guess Who’s Not Coming to Dinner? Evaluating Online Restaurant Reservations for Disease Surveillance. J Med Internet Res 2014;16(1):e22.
- Raoof S, Baumann MH. Ventilator-Associated Events: The New Definition. Am J Crit Care 2014;23:7-9.
- Eyre DW, Babakhani F, Griffiths D, .et al Whole-Genome Sequencing Demonstrates That Fidaxomicin Is Superior to Vancomycin for Preventing Reinfection and Relapse of Infection With Clostridium difficile. J Infect Dis 2014;209:1446-1451.
- Kelly CR, Ihunnah C, Fischer M, et al. Fecal Microbiota Transplant for Treatment of Clostridium difficile Infection in Immunocompromised Patients. Am J Gastroenterol 2014;109:1065–1071.
- Donskey CJ, Venkata CK, Jencsona AJ, et al. Utility of a Commercial PCR Assay and a Clinical Prediction Rule for Detection of Toxigenic Clostridium difficile in Asymptomatic Carriers. J Clin Microbiol 2014;52:315-318.
Perspectives from ECCMID 2014: the box set
I’ve published a few ‘Perspectives from ECCMID’ on the blog over the last few days, so thought it would be useful to post a summary:
- Part I: A voice against ‘selective’ digestive decontamination.
- Part II: What to do about MDR-GNR?
- Part III: CDI synthetic “repoopulation” (bacteriotherapy) closer than you think & “CA-CDI” still pie in the sky
- Part IV: We need to stop polluting our planet with antibiotics
You may also be interested in some other updates from ECCMID elsewhere in the blogosphere:
- The Year in Infection Control 2014
- Environmental science updates
- Medscape articles
- Updates on DAV-132 (non antibiotic option for gastrointestinal suppression).