A new JHI study highlights the dangers associated with reusable PPE, and related to PPE doffing in general. The study used a clinical simulation suite to monitor the spread of fluorescent material added to the outside of an N95 respirator during routine care for mannequin adult patients (with COVID-19!). Whilst some modes of PPE reuse were better than others, all of the clinicians involved in the study ended up contaminating the clinical environment with fluorescent material originating from the mask.Continue reading
We have just had a study published in Clinical Infectious Diseases exploring the extent and magnitude of hospital surface and air contamination with SARS-CoV-2 during the (first!) peak of COVID-19 in London. The bottom line is that we identified pretty extensive surface and air contamination with SARS-CoV-2 RNA but did not culture viable virus. We concluded that this highlights the potential role of contaminated surfaces and air in the spread of SARS-CoV-2.
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.
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?
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!
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.
A very enjoyable few days in Edinburgh this week for the Federation of Infection Societies / Healthcare Infections Society (FIS/HIS) meeting. Some reflections follow…
A 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
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.
I edited a paper for Journal of Hospital Infection a few years ago on the potential risk of warm air dryers and especially jet air dryers compared with paper towels in spreading microbial contamination via the air. The paper showed that hands dipped in a concentrated bacterial suspension resulted in fairly widespread bacterial contamination of the air; jet air dryers were the worst culprit, followed by warm air dryers, with paper towels resulting in markedly less contamination. They also did some cool paint splatter experiments to visualize potential contamination routes (see image above, from the paper).