In honour of Infection Prevention 2018, Brett Mitchell and I are having a blogoff so that you can choose the best IPC article of 2018. This post presents my case, Brett’s post (here) presents his case, and there’s a vote below so that you can choose. The results will be published next Monday morning at Infection Prevention 2018…
Continuing the theme of CPE (or CRE if you prefer) Toolkit evaluation, a US research group has performed a modelling study to evaluate the economic impact of the US CDC CRE Toolkit. Curiously, whilst all approaches generated cost savings eventually, hospitals acting independently rather than as a co-ordinated region resulted in faster but ultimately smaller cost savings.
A research group at Bristol in collaboration with PHE have just published an evaluation of the CPE Toolkit. I don’t think any of the findings are especially surprising, confirm that the Toolkit is not implementable in acute NHS hospitals, but provides useful information and guidance to build a local CPE policy.
The current national guidelines for CPE in England recommend three serial admission screens each separated by 48 hours to confirm a negative carrier status combined with pre-emptive isolation. Even leaving aside the infeasibility of pre-emptive isolation, this approach introduces a host of operational challenges. In a study just published in JHI, we find report that serial admission screens do not improving the detection of CPE. However, there was a striking apparent increase in the rate of carriage of other resistant Gram-negative bacteria in the early days of hospital admission, suggesting either an unmasking of pre-existing carriage or acquisition of resistant Gram-negative gut flora.
There have been a few important updates on the prevention and control of MDR-GNR from ECCMID, here in Madrid. I thought I’d share a couple of key reflections.
I posted recently on the potential risk of CPE contamination of sinks, drains, and hospital wastewater. The question in my mind then was whether contamination is a smoking gun or innocent bystander regarding CPE transmission? What we really need is an intervention to show that better management of sinks and drains results in reduce CPE transmission. And now, we have one! The findings suggest that attempts to control CPE will go down the drain if we don’t intervene to improvement the management of sinks and drains.