Hand hygiene edutainment via YouTube

We’re always seeking new and engaging ways to deliver IPC-related education. An interesting study in AJIC provides a useful framework to evaluate and assess the education content of YouTube videos aiming to deliver hand hygiene education.

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Focusing on the role of nurses in environmental hygiene

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:

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Are we passing too much CAUTI?

urine-bag-1449857279oSI

We have blogged before how CAUTI is rather ‘unloved’ as an HCAI prevention target. CLABSI reduction, on the other hand, is all the rage. Now, there is a key reason why this makes sense: outcome! A CLABSI is much worse news for a patient than a CAUTI. However, this doesn’t mean we should turn a blind eye to CAUTI, especially since CAUTI is a common root cause for CLABSI! In the US there is an addiional driver for preventing CAUTI: the costs associated with CAUTI are no longer reimbursed by insurers (since 2008). With this in mind, it was great to see a CAUTI reduction study published in NEJM recently (and see some interesting analysis on the Controversies blog).

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Online antimicrobial stewardship course

I found out about a new free online antimicrobial stewardship course yesterday. The course is a collaboration between the the University of Dundee and the British Society for Antimicrobial Chemotherapy, and comes highly recommended. The course is designed for healthcare professionals.

If anybody completes the course, I’d be interested to hear your feedback.

CRE: coming to a hospital near you

carbapenemase

I thought for quite some time about whether the title to this post ought to be a statement or a question. I decided on a statement: pretty much wherever you are in the world, I am certain that CRE is now one (hospital) degree of separation from you.

I gave this talk yesterday at the imaginatively named “Darling Bugs of May” IPS conference, and you can download my slides here. I’ve given similar talks before, but the whole thing took on greater significance now I have had some first hand experience of making decisions around the management of CRE patients.

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Reflections from the front line: why doctors don’t listen to the ‘impending doom’ of antibiotic resistance

Coming-Storm

Guest blogger and Acute Medicine trainee Dr Nicola Fawcett (bio below) writes…I’ve just returned from the European Conference for Clinical Microbiology and Infectious Diseases (ECCMID) in Copenhagen. I got the chance to pop into a few sessions on my first love in Microbiology – Stewardship and behaviour change. Before you all think I’m crazy, I’ll just add that I’m actually a trainee in Acute Medicine – I started out in the overlap area of how you change antibiotic use in acute admissions.

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What does it take to get an infection prevention and control service into shape?

mrsaWhilst the organisation of an infection control service isn’t everybody’s cup of tea, it is mine now. So, what are the key elements of a successful programme? A thoughtful review in Lancet ID penned by an all-star cast (including Zingg, Holmes & Pittet to name but a few) provides a framework for answering this question. Their systematic review yielded 10 key components:

  1. Organisation of infection control at the hospital level;
  2. Bed occupancy, staffing, workload, and employment of pool or agency nurses;
  3. Availability of and ease of access to materials and equipment and optimum ergonomics;
  4. Appropriate use of guidelines;
  5. Education and training;
  6. Auditing;
  7. Surveillance and feedback;
  8. Multimodal and multidisciplinary prevention programmes that include behavioural change;
  9. Engagement of champions;
  10. Positive organisational culture.

None of these are especially surprising, or that difficult to implement. It’s strange in a way that we know from multiple studies that high bed occupancy results in more transmission (specifically of MRSA). So why don’t we just reduce the rate of bed occupancy? If you account for the extended length of stay for patients who become infected, it would probably result in a net increase in patient throughput. Similarly, understaffing results in more transmission (again, specifically of MRSA). So why don’t we just make sure we hit adequate levels of staffing? I suspect the answer here is short-sighted accountancy combined with a genuine lack of the right staff to fill the necessary vacancies.

I’ve always found it a bit odd that the mere act of performing surveillance and reporting the results back to wards reduces HCAI – but there’s a fair amount of data behind this. I suspect it has to do with the type of people we are dealing with: busy healthcare professionals. If their unit’s rate of MRSA (or whatever) is, in the politest possible sense, in their face, they’re more likely to do something about it.

Finally, nurturing a positive organisational culture is crucial but somewhat philosophical. How do you measure whether your organisation has a positive culture? Perhaps perception is reality here, so the best approach is probably to consider organisational positivity as a highly transmissible infectious agent!