That sinking feeling

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I’m at ECCMID in Amsterdam currently listening to a nice report of an OXA-48 Klebsiella pneumoniae outbreak in Gran Canaria in which sinks were found to be contaminated and replaced. Earlier today I listened to a nice paper on how sinks that drain slowly are more likely to contaminate the local environment for up to 1 metre from Paz Aranega Bou who, together with Ginny Moore and other colleagues has published this nice paper . So many papers on sinks now and I do wonder if we have lost sight of what they do and what they really are.

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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?

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Painting the hospital room blue

This recent study from the Donskey group could provide hospital cleaning staff with a powerful visual cue to help assure adequate disinfectant coverage. The addition of a chemical widget to bleach solution gives it a bright blue hue when applied to surfaces, so allowing a cleaner to track their progress visually!

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The silent Mycobacterium chimaera epidemic

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There has been much discussion about the risk of Mycobacterium chimaera infections associated with contaminated heater-cooler units (HCUs) used in cardiothoracic surgery. A study published recently in CID explores the risk in the UK, and provides further evidence to link these tricky-to-treat infections to contaminated HCUs.

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Back to the floor..

flooringA little while ago I blogged about the excellent study from Nottingham that demonstrated significant VRE and MRSA contamination on socks used to prevent falls in the hospitalised elderly. This has been followed by another paper suggesting that shoe coverings undurprisingly become contaminated. So, what? How does this really impact on transmission? A new study from Curtis Donskey’s group has looked at hand contamination in patients directly relating to floor contamination. Continue reading

PPE for preventing highly infectious diseases

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The use of PPE and the protection of HCWs against highly infectious diseases was (and is) a topic of major importance, around the globe. The recent Cochrane review by Verbeek et al. was probably hoping to offer this “vital” information.

Unfortunately, they found no studies on the effects of goggles, face shields, long-sleeved gloves or taping on the risk of contamination. All they found was very low quality evidence, with high risk of bias and uncertain estimates of effect, that:

  • More breathable types of PPE offer more comfort without increasing the risk of contamination
  • Double gloving and CDC doffing guidance appear to decrease the risk of contamination, and
  • Active more than passive training in PPE use may reduce PPE and doffing errors.

Their conclusions are obvious: we need high-quality studies of the materials, their use and protective effects, safe ways of doffing, and the most adequate training to achieve safe use of PPE for HCWs in the presence of highly infectious diseases or those (even less infectious) that may cause severe harm to HCWs.

But what to do until than? My personal opinion is that we should only use PPE, we are used to and know how to use. First-time users, even if supplied with the best available products, will inevitably fail to remove the PPE without error. Consequently, institutions should have a stable selection of PPE, and in the case of preventing highly infectious diseases, a selected group of HCWs with continuous active training, as it is too late to start when the next epidemic is hitting our healthcare centers.

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