ID Week 2018 as seen by an Infection Preventionist

Guest Blogger Barley Chironda (bio below) writes…

IDWeek was held this year from Oct 3 to 7, 2018 in beautiful San Francisco. This was my fourth year in a row attending; having first attended and blogged about my first experience here in 2014. The pressure to offer IDWeek attendees a stellar conference was palpable. A week before, the city of San Francisco had hosted Dream Force. Dream Force is one of the world’s largest tech conventions with over 150,000 attendees. I’m glad to say IDWeek did not disappoint; boasting it’s highest ever attendance of over 8,000 people from over 85 countries. Given its wide and diverse audience, there are many targeted streams that allow a range of topics.

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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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Reflections from Infection Prevention 2015 Part I: Beating the bugs

time person of the year

Infection Prevention 2015, the annual conference of IPS, was held in Liverpool this year. I’m delighted to say that the abstracts from the submitted science are published Open Access in the Journal of Infection Prevention. This first instalment of my report will be “bug-focussed”, followed by another two on different themes:

Part I: Beating the bugs

Part II: Improving the systems

Part III: Thinking outside the box

Opening lectures

The conference kicked off with fellow ‘Reflections’ blogger Prof Andreas Voss. By Andreas’ own admission, he was given a curve-ball of a title: ‘CRE, VRE, C. difficle or MRSA: what should be the priority of infection prevention?’ [No idea where that could have come from…] Andreas developed a framework for grading the priority of our microbial threats, accounting for transmissibility, virulence, antibiotic resistance, at-risk patients, feasibility of decolonisation, cost, and impact of uncontrolled spread. And the result? Any and all microbes that cause HCAI should be a priority of infection prevention. Even those that seem to have less clinical impact (such as VRE) are good indicators of system failure. If we focus too much on one threat, we risk losing sight of the bigger picture.

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Sorry, as part of the ICPIC organizers, I can’t stop myself to post this.

At ICPIC 2015, there will be a large number of activities related to Ebola virus disease (EVD). Due to the unique experience of field workers and scientific experts present at ICPIC 2015, and considering the large demand, the organizers and scientific committee members are glad to inform ICPIC participants about the many activities around EVD that will take place during ICPIC 2015.

Ebola virus disease will be addressed:

  • at the pre-ICPIC workshop “Ebola: Hands On” on Tuesday 16 June (10:00 to 16:50) in the presence of more than 30 field experts and faculties. The “Ebola: Hands On” workshop is free for ICPIC participants
  • at the Opening Ceremony
  • during ICPIC at MTE, symposium, poster and poster rounds sessions

We are convinced that ICPIC participants will get the best insight and advice on Ebola virus disease out of these activities.

Ebola Activities At ICPIC

For those interested in Ebola I might add that ARIC just published “Preparedness of institutions around the world for managing patients with Ebola virus disease: an infection control readiness checklist” a first project of the newly establish ISC working group on infection prevention and control.

Ebola – Hands on, ICPIC Pre-meeting workshop

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Just before the start of ICPIC 2015

June 16, 2015 (10:00-16:50)

Field experiences with Ebola virus disease in West Africa (10:00-12:45)

Moderators : Prof. Benedetta Allegranzi ; Prof. Babacar Ndoye

1) Ebola epidemic in West Africa and WHO Ebola response roadmap (10:00)

Prof. Benedetta Allegranzi, WHO Patient Safety, WHO, Geneva

2) Using the core components of infection control programmes during the Ebola outbreak

Dr. Sergei Eremin, medical officer, WHO, Geneva (10:25)

3) Main lessons from Médecins-Sans-Frontières (MSF) engagement (10:50)

Hugues Robert, Médecins-Sans-Frontières (Doctors without Borders), MSF Switzerland

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Journal Roundup: Ebola, antibiotic abuse, and the usual suspects

bacterial spores

The latest edition of Journal Roundup is now available on the Journal of Hospital Infection website, freely accessible here.

Some highlights:

Journal Roundup is changing! As a result of feedback received from six months of Journal Roundup, I’ve decided to change the format to write a little more detail on fewer articles. This gives me a good opportunity to accept submissions from others to include in the Roundup. So, Journal Roundup is seeking submissions! If you read an article that you think should be included in the Journal Roundup, please submit a short critique (100 to 300 words) of the article as a comment below to be considered for inclusion in a future edition of the Roundup. I won’t publish the comment on this blog, but your contribution will be acknowledged, of course!

Let’s get those submissions rolling in!

Image: Bacterial spores.

Christmas 2014 Update

Christmas lights

Now that you have digested your Christmas turkey, I thought that it would be a good time to send out an update. These articles have been posted since the last update:

I’m in a rather reflective mood, so time to remind you of some of the key themes from 2014: Ebola, MERS-CoV, universal vs. targeted interventions, faecal microbiota transplantation (FMT), whole genome sequencing (WGS), carbapenem-resistant Enterobacteriaceae (CRE), and some interesting developments in environmental science. And what will we be still talking about come Christmas 2015? Let’s hope it won’t be Ebola, and I think that WGS will be a lab technique akin to a Vitek machine rather than subject matter for NEJM. But I think we still have ground to cover on whether to go for universal or targeted interventions, FMT, and improving our study designs in infection prevention and control. I can also foresee important studies on the comparative and cost-effectiveness of the various tools at our disposal.

And finally, before I sign off for 2014, a classic BMJ study on why Rudolf’s nose is red (it’s to do with the richly vascularised nasal microcirculation of the reindeer nose, apparently).

Image: Christmas #27.

Journal Roundup November 2014: Journal Roundup: Ebola (again), The rise (and rise) and fall of MRDOs & Infection Prevention 2014

This month’s Roundup, as ever freely available on the Journal of Hospital Infection website, showcases some of the useful data emerging from the field of the ongoing outbreak of Ebola in West Africa. For example, emerging data suggests that the R0 (basic reproductive number) of Ebola is around 2, meaning that two transmissions will occur from every case. This means that Ebola is not massively transmissible compared with other infectious diseases – but this hasn’t stopped it increasing more or less exponentially in parts of West Africa!

Some interesting studies on the increasing or decreasing prevalence of MDROs are also covered in the Roundup. For example, one study reported a worrying doubling of the rate of CDI in the USA, whereas another study reports impressive reductions in S. aureus bacteraemia in Australia.

The Roundup includes a brief overview of the Infection Prevention 2014 conference, covered in more detail in a previous post in this blog, and finally, features Catherine Makison-Booth’s brilliant Vomiting Larry (pictured below)!


As ever, I’d be delighted to receive your feedback as to how the Roundup should evolve.

What’s trending in the infection prevention and control literature? HIS 2012 -> HIS 2014

I was privileged to speak at the Healthcare Infection Society meeting in France today on ‘What’s trending in the infection prevention and control literature? HIS 2012 -> HIS 2014’. You can download my slides here, and view the recording below:

I have always enjoyed attending these light-hearted summary sessions at other conferences, so I hope I struck the right tone. In order to track some of the trends in the infection prevention and control literature since the last HIS conference (in late 2012), I plugged some search terms into Google trends (Figure).

Figure: Google Trends for all search terms (excluding viruses) (2004 to present). Logos and arrows represent the time of the HIS 2012 and HIS 2014 conferences. Search terms: hospital cleaning; carbapenem resistant Enterobacteriaceae, whole genome sequencing, fecal microbiota transplantation. [Note, I had to spell it ‘wrong’ (fecal v faecal) to detect a trend. Blasted Americans.]what's trending google trends

Based on my search terms, there was one infection control trend that trumped all others: Ebola. If I include in with the other Google search terms, it eclipses all others! Whilst trends in Google searches may not necessarily correlate with trends in the infection prevention and control literature, in this case, it is true that the outbreak of Ebola in West Africa has prompted a lot of publications in the literature – and consumed an awful lot of professional time for all who are connected with hospital infection prevention and control! Aside from Ebola, other trends in the infection prevention and control literature that I covered include MERS-CoV, universal vs. targeted interventions, faecal microbiota transplantation, whole genome sequencing, carbapenem-resistant Enterobacteriaceae (CRE), and some aspects of environmental science. Finally, I looked into my crystal ball and predict some of the trends in the infection prevention and control literature by the time HIS 2016 comes around.

Ebola: infection prevention and control considerations

I gave a webinar yesterday on some of the infection prevention and control considerations related to Ebola. You can view the recording and download the slides here.

Whilst preparing the webinar, it occurred to me that the real game changer in the outbreak that made the world take note was the three transmissions of Ebola in developed healthcare systems outside of West Africa. One occurred in Madrid, Spain in early October, and a further two occurred in Dallas, Texas, a few weeks later. Before these in-hospital transmissions, there was a general feeling that developed healthcare systems could handle Ebola safely. Clearly, that was not the case!

Furthermore, the ratio of secondary transmissions for dealing with Ebola cases in developed healthcare systems isn’t great: of the 13 cases that have been cared for outside of West Africa, three secondary transmissions have occurred.

The outbreak has thrown up some new challenges, outlined below.

Figure: the emerging challenges of the Ebola outbreak (the dark shaded circles indicate the new and emerging challenges).

Ebola challenges

Many of us now find ourselves scrambling to develop Ebola preparedness protocols. These must start at the hospital door, with carefully considered risk assessments for patients presenting with Ebola-like symptoms. We can’t afford to get our full PPE kits out for every patient who presents with a fever, so what should be the trigger for a suspected case? (PHE and CDC have published useful algorithms to help with this, but it’s not straightforward.)

One area of controversy is the appropriate protocols for terminal decontamination following a case of Ebola. Clearly, the most important risk in terms of transmission is direct contact with blood or body fluids from infected patients. However, despite being an enveloped virus, Ebola can surface on dry surfaces for days to weeks under some conditions in laboratory studies. Furthermore, transmission has been associated with indirect contact with contaminated environments. For example, in a recent report from the field, inadequate use of PPE for dealing with surfaces that were grossly contaminated with body fluids from confirmed cases was identified as one of the risk for acquisition. So, we need to make sure that contaminated surfaces are dealt with appropriately, and most hospitals that have dealt with cases outside of West Africa have used hydrogen peroxide vapour for terminal decontamination.

There is a suggestion today that the epi curve may be peaking in Liberia, which is the epicenter of the outbreak in West Africa. Even if that is the case, we can still expect to see more repatriations to developed healthcare systems and perhaps more cases showing up at our hospitals. So, we need to make sure we do everything in our power to prevent secondary in-hospital transmissions.