I blogged recently about the new ESCMID guidelines on resistant Gram-negative carriage and decolonisation, which supported a “once positive, always positive” approach to CPE carriers due to the lack of effective decolonisation options. A new study suggests that a large majority (75%) of patients who were once identified as CPE carriers no longer had CPE detectable when they were readmitted. This has implications for the management of CPE carriers in hospitals.
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.
I recently posted on the WHO CPE guidelines. A couple of people have alerted me to two other recently published guidelines, one from ECDC, and the other from Australian Commission on Safety and Quality in Healthcare. So, we now have a wealth of guidelines to prevent and control CPE. But how to they compare?
I am always interested in compliance. What makes staff implement an intervention reliably? What makes a patient follow the advice they’ve been given? A new retrospective cohort study purports to look at what factors influence compliance with preoperative regimes aimed at preventing surgical site infection (SSI). The authors were of the opinion that socio-economic group would be a major factor in whether individuals would be compliant with measures that are likely to reduce the risk of SSI, since this has been demonstrated to be the case in chronic health issues such as asthma. Disappointingly the authors stated that the method of determining at adherence is described elsewhere with the accompanying reference to an 4-minute abstract given at a paediatric orthopaedic conference in Toronto in 2013 which, if you weren’t there, you’ve missed it. However they do provide a small amount of detail and of the 2-5 protocol tasks they only mention bathing and decolonisation of those screened.
There is an emerging feeling that we need to start spreading the focus of infection prevention and control beyond acute hospitals. There has always been a sense that standards of infection control outside of acute settings are, shall we say, “different” to acute hospitals (aka non-existent) so it’s great to see a study of an infection control intervention in nursing homes.
The study was a cluster randomised controlled trial of MRSA screening, decolonisation and enhanced environmental disinfection vs. standard precautions in 104 of 157 nursing homes in a Swiss region. The authors chose a rather unusual, pragmatic endpoint of the prevalence of MRSA colonisation after 12 months.