Colleagues from GSTT in collaboration with the Royal Free and St. George’s have just published a new paper evaluating the transmission dynamics of Omicron SARS-CoV-2 vs. previous variants in hospitalised inpatients in Infection Prevention in Practice. The key finding is that the median days to inpatient contact conversion were significantly fewer for Omicron SARS-CoV-2 when compared with previous variants (median 3 days for Omicron vs. 4 days for previous variants).
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The “top 10” scientific articles influencing our IPC practice over the past year
I had the pleasure of doing a talk at Infection Prevention 2023 in Liverpool today, running down the top 10 scientific articles influencing our IPC practice over the past year. You can download my slides here.
I had some trouble selecting just 10 papers from the past year, and felt a strong sense of my own bias and limitations when going through the selection process. I have my own research and clinical interests, I don’t read anywhere near as many papers as I’d like, and 10 papers really isn’t that many! Also, I tried to countdown the papers from 10 to 1 with some kind of hierarchy. After a couple of false starts here (including the most read, most controversial, best designed), I settled on the most influential in terms of challenging our thinking or modifying our practice.
So, here goes…
Continue readingWater-free critical care demands our attention
This post follows hot on the heels of several other posts highlighting the potential benefits of water free care. A new retrospective cohort study in German ICUs has concluded that patients cared for in ICU single rooms or bays without sinks have fewer HCAI. Another nail in the coffin for sinks!
Continue readingCPE showing its teeth: mortality associated with carbapenem-resistant Gram-negative BSI
Now is a really good time to focus on carbapenem-resistant bacteria. We have spent much of the past 3 years focusing on one particular virus. But now that the clinical issues linked to SARS-CoV-2 are waning for our hospital patients, the threat of carbapenem-resistance in Gram-negative bacteria comes to the fore. An excellent study with far-reaching consequences has been published from Italy. Carbapenem resistance is bad news if you have a BSI: patients with carbapenem-resistant BSI were roughly twice as likely to die as patients with carbepenem-susceptible BSI.
Continue readingHow often do HCW hands become contaminated with hospital pathogens during patient care?
The invisible menace! I’ve often thought it would be great if there was some visible sign that your hands had become contaminated during patient care. I guess that does happen to a degree when hands are visibly soiled – and we know that compliance with hand hygiene is almost universal when that happens. But what about when there’s no visible contamination but invisible and risky contamination with pathogens that can cause HCAI? A helpful systematic review and meta-analysis from 2019 suggests that around 5-10% of HCW working in acute care hospitals or care homes are contaminated with key hospital pathogens.
Continue readingRespiratory protection for healthcare workers and SARS-CoV-2: evidence is equivocal but does that matter?
So, a double blog day today! I couldn’t resist reading the latest statement from a UKHSA expert group on “The role of respirators and surgical masks in mitigating the transmission of SARS-CoV-2 in healthcare settings: an overview of evidence (2022)”, published yesterday, as soon as it hit my desk. “Equivocal” is a word that I try to avoid. It’s one of those ‘jargony’ and overly technical words that is best worded-around in my view. But for this, it’s about right. The evidence from well controlled clinical trials that respirators (FFP2/3 or N95s) offer superior protection to healthcare workers than surgical masks is equivocal (“open to more than one interpretation”). But does that matter? If we look to the physics of SARS-CoV-2 transmission, there is a risk that the type of small, virus-laden particles emitted by patients infected with SARS-CoV-2 could circumvent the level of protection provided by surgical masks. And so, it now seems reasonable to recommend FFP2/3 or N95s for healthcare workers caring for patients with SARS-CoV-2 (and influenza for that matter). However, given the uncertainty of the evidence base, as highlighted by this review, I can understand why some have decided to continue with a policy of surgical masks when caring for patients with SARS-CoV-2 infection in most settings.
Continue readingEstablishing the transmission rate of CPE in hospitalised patients
A helpful new study has combined shoe-leather epi and WGS to establish a transmission rate of CPE in hospitalised patients. Overall, 3 (2%) of 152 exposed patients ended up colonised with the same CPE from 47 index patient exposures. None of the 54 exposed staff ended up colonised with CPE. This transmission rate is a bit lower than I would have expected, but it’s also not zero!
Continue readingOmicron COVID-19 harm and winter IPC strategy
We have just published an evaluation of Omicron COVID-19 harm as a research letter in the Journal of Infection. This multicentre study reported the findings of a retrospective review of 129 patients with healthcare-associated Omicron COVID-19, and found that the harm profile was very different to previous waves: a small proportion of patients required supplemental oxygen, escalation to critical care, had an extended length of stay, or died from COVID-19. This informs our winter IPC strategy: whilst COVID-19 is more than “just a cold”, the balance between direct and indirect harms from COVID-19 has shifted towards preventing indirect harms (like reduced hospital throughput and delayed diagnosis) and more of a focus on other issues (e.g. flu, Gram-negative BSIs etc).
Continue readingImproving environmental hygiene reduces HCAI: but which monitoring method is most effective?
A superb cluster randomised trial has just been published in Clinical Infectious Diseases testing whether improved environmental hygiene via objective monitoring and feedback reduces HCAI. The study also tests whether ATP or UV fluorescent marker monitoring is more effective. The findings reinforce that improving environmental hygiene reduces HCAI, and (I think surprisingly) suggest that ATP is more effective than UV monitoring.
Continue readingDo stand-alone air disinfection units reduce HCAI?
Wow, it’s been ages since I’ve posted – sorry about that. I’m blaming the Omicron wave and my own personal dose of COVID-19 recently (you can see my reflections about that on Twitter…)
And so to today’s blog. Lots of interest in air disinfection systems. And some important research articles coming through. This one in JHI caught my attention, because there’s a suggestion of a link between improved air hygiene and reduced HCAI. However, I am unconvinced (from this study) that this link has been demonstrated – so a key opportunity for applied research!
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Reflections on Infection Prevention and Control 