Remember all of those difficult decisions during the worst of the COVID-19 pandemic? Which patient gets the ventilator? Who gets the single room? What has to stop to keep on top of the continuous flow of new SARS-CoV-2 results to investigate? Well, one of those difficult decisions was whether or not to continue with screening and contact precautions to prevent the spread of MRSA. A US team made a compelling “natural experiment” out of the discontinuation of screening and contact precautions for MRSA, showing that this was associated with an increased risk of MRSA HCAI.
Continue readingcontact precautions
We need to talk about gloves…
As we warm up for world hand hygiene day tomorrow, it’s a good time to have a talk about gloves. I challenge you to go onto a hospital ward and time how long it takes before you see some questionable glove practice. It won’t be long before you see somebody coming out of a room used by a patient on some transmission based precautions with gloves on. Or somebody commuting around the ward with gloves on. Or somebody putting gloves on in preparation for patient care who can’t quite articulate why. So, as many of us launch new patient care pathways in the next phase of the pandemic, and as the national IPC manual has just been published in England, it’s a really good time to talk about when we don’t need to use gloves, which is most of the time!
Continue readingInfection prevention and control practices for CPE in Ontario, Canada – are we doing enough?
We’re delighted to have this guest post from Dr Alainna Jamal (bio below)…
Hello from Canada! In this blog post, I’ll reflect on findings from a study by our group (the Toronto Invasive Bacterial Diseases Network), published in this month’s issue of Infect Control Hosp Epidemiol.
Can we ever de-isolate CPE carriers?
One of the questions that we often ask ourselves is whether carriers of CPE (and other MDR-GNR) can de-isolated. Most of the guidelines are pretty non-committal on this point due to lack of evidence. Some new guidelines from ESCMID-EUCIC address this issue head on. But, unfortunately, the answer is that de-isolation of CPE carriers, particularly over the course of a single hospitalisation, isn’t going to work because there’s no effective decolonisation method.
Can we de-isolate carriers of CPE?
Although there’s some controversy about whether or not we should apply contact precautions (by that I mean single room isolation, enhanced PPE, enhanced disinfection etc) all the time for all organisms, it would be a brave hospital to eschew contact precautions for CPE carriers. And so the question of whether and when we should ‘de-isolate’ patients with known CPE is an FAQ. And so enter a recent study in CMI comparing the spontaneous apparent loss of colonisation with various CPEs, concluding that KPC carbapenemases seem to hang around for longer than NDM carbapenemases, but both almost always last for the duration of a single hospitalisation.
Counting the cost of contact precautions
A Swiss study has found that the mean cost of a contact precautions day is £130. This is useful in helping us to understand the financial impact of infection prevention and HCAI.
Reflections from Infection Prevention 2016
As is now becoming traditional, I thought I’d share a few reflections from the recent IPS conference in Harrogate. Fantastic to see the submitted abstract published, full and free, in a Journal of Infection Prevention supplement.
Reducing Gram-negative BSI…by accident
We have precious little data on what works to prevent the transmission of MDR-GNR. An interesting article published recently in CID provides invaluable data that an infection control programme aimed at reducing MRSA (and succeeding) was also effective in reducing GNR BSI!
Balancing risk and resource for CPE screening
The PHE Toolkit recommends pre-emptive isolation for patients who meet one of the risk-factor triggers for CPE screening. Furthermore, the pre-emptive isolation recommended in the Toolkit should be continued until three negative screens are obtained, each separated by 48 hours. In what is best described as a data-based thought experiment, colleagues from Imperial tested the impact of various CPE screening strategies on the burden of contact precautions generated.
Should we start admission screening for C. difficile carriage? A Kiernan vs. Otter pro-con debate!
Both Martin and Jon wanted to post a blog about the same article, so thought we’d put our hands together, so to speak, into a pro-con format! We hope you find it useful.
Reflections on Infection Prevention and Control 