I was asked to do a talk today on the modes of CPE transmission at a PHE Workshop on tackling CPE. It caused me to do a lot of thinking and write a new presentation, so I thought I’d share. You can download the slides here.
Well I was looking for a Friday afternoon sort of post and you know when you wait a while and two come at once?.. So firstly, some may recall that I have previously highlighted the utility of a sensitive nose in detecting a variety of things in a previous post. In a study just posted online first in the Journal of Hospital Infection, a springer spaniel was trained to detect C. difficile in the environment with a fair degree of success, especially for detecting rooms in which C. difficile was not present. Continue reading
The World Health Organisation has updated its 2009 Guidelines on Core Components of Infection Prevention and Control Programmes. The report highlights eight ‘core components’ for IPC:
Thought I’d share some key points from the 2016 HIS Spring Meeting.
Outlining the problem(s)
Prof Gary French kicked off the meeting with a (sic) historical perspective, describing how the perceived importance of the environment in transmission has oscillated from important (in the 40s and 40s) to unimportant in the 70s and 80s to important again in the 2000s. Gary cited a report from the American Hospital Association Committee on Infections Within Hospitals from 1974 to prove the point: ‘The occurrence of nosocomial infection has not been related to levels of microbial contamination of air, surfaces and fomites … meaningful standards for permissible levels of such contamination do not exist.’ Gary covered compelling data that contaminated environmental surfaces make an important contribution to the transmission of Gram-positive bacteria and spores, highlighting that C. difficile in particular is a tricky customer, not helped by the fact that many ‘sporicides’ are not sporicidal!
They say that things come in threes, so following hot on the heels of blogs about MRSA and other MDROs in nursing homes, I was struck by a recent outbreak report of CRE associated with nursing homes the Netherlands.
Following the admission of a patient from a Greek ICU, a nosocomial transmission of CRE (ST258 KPC K. pneumoniae) occurred. By the way, this occurred despite the hospital recognising the risk of CRE at the time of admission from the Greek ICU, perform an admission screening and implementing pre-emptive contact precautions. Then the index patient was transferred to a nursing home, where subsequent transmission occurred to four other patients.
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:
- Who’s harbouring CRE? (Published 22nd December 2014)
- ECDC data shows progressive, depressing increase in antibiotic resistance in Europe (Published 16th December 2014)
- Is deliberately seeding hospital rooms with Bacillus spores a good idea? No, I don’t think so either! (Published 8th December 2014)
- Filling the gaps in the guidelines to control resistant Gram-negative bacteria (Published 2nd December 2014)
- Journal Roundup November 2014: Journal Roundup: Ebola (again), The rise (and rise) and fall of MRDOs & Infection Prevention 2014 (Published 28th November 2014)
- The inanimate environment doesn’t contribute to pathogen transmission in the operating room…OR does it? (Published 27th November 2014)
- Being bitten by antibiotic resistant CRAB hurts! (Acinetobacter that is.) (Published 25th November 2014)
- Reflections from HIS 2014, Part III: Education, communication, and antibiotic resistance (Published 21st November 2014)
- Reflections from HIS 2014, Part II: Dealing with the contaminated environment (Published 20th November 2014)
- Reflections from HIS 2014, Part I: Updates on C. difficile, norovirus and other HCAI pathogens (Published 19th November 2014)
- What’s trending in the infection prevention and control literature? (Published 16th November 2014)
- HIS Poster Round: Dealing with contaminated hands, surfaces, water and medical devices (Published 15th November 2014)
- Carbapenem-resistant Enterobacteriaceae (CRE): so what should an infection prevention and control team do now? (Published 11th November 2014)
- A postcard from Portugal: “Some days we don’t have any needles on the ICU” (Published 5th November 2014)
- Ebola: infection prevention and control considerations (Published 30th October 2014)
- ID Week 2014 as seen by an Infection Preventionist (Published 28th October 2014)
- Selective Digestive Decontamination (SDD) is dead; long live faecal microbiota transplantation (FMT) (Published 27th October 2014)
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.