A high profile article was published earlier this year in Science Translational Medicine, suggesting that Enterococcus faecium can exhibit clinically relevant levels of tolerance to alcohol-based hand hygiene products. The article has generated a huge amount of press coverage and discussion amongst experts. So, I thought it was about time I gave the article a once over. My initial thought was this would be unhelpful extrapolation of low-level tolerance to alcohol gel that wouldn’t be meaningful in a clinical setting. But having read the paper, there’s genuine concern here. Overall though, if true resistance to alcohol gel was going to be a problem, I’m pretty sure it would have reared its ugly head already.
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…
I was asked to write a series of articles in the Nursing Times (along with my colleague and co-author Tracey Galletly) on the role of nurses in environmental hygiene*. Et voila:
- Environmental decontamination 1: what is it and why is it important?
- Environmental decontamination 2: the role of the nurse
- Environmental decontamination 3: auditing cleaning and disinfection
I’ve been struggling for years to find the best ‘catch-all’ term to describe hospital cleaning or disinfection or both. And, after much thought, I’ve settled on a proposal to share with you, dear reader: “environmental hygiene”.
Have you ever wondered how on earth vegetative bacteria can survive on dry surfaces for years? Or why when you have an outbreak and you swab the environment you don’t find the outbreak strain even though you’re pretty sure it’s there? Or why a disinfectant that gets a 4-log reduction in the lab can’t eliminate a couple of hundred cfu of bacteria from a dry surface? Dry surface biofilms could be the answer to all these questions! I was involved in a multicentre survey of dry biofilms from across the UK, and we identified dry surface biofilms on 95% of the 61 samples there were tested. Worryingly, viable MRSA was identified on 58% of the surfaces! We need to think carefully about how much of a risk dry surface biofilms present, and whether we need to do more to tackle them.
Marc recently posted about the second clinical outcome findings from the BETR-D study, recently published in the Lancet Infectious Diseases. Marc contended that the team may have been ‘blinded by the [UV] light’ in reaching the conclusion that enhanced terminal room disinfection led to a hospital wide reduction in acquisition of key pathogens. Here, in the spirit of healthy academic debate, I offer another perspective.
Today was the inaugural Healthcare Cleaning Forum. The plan was to showcase some healthcare cleaning and disinfection science at the Interclean Conference in Amsterdam (which is a huge general cleaning show). I think we managed to create some awareness about the unique challenges of cleaning and disinfection in healthcare outside of the usual crowd.