HIS Poster Round: Dealing with contaminated hands, surfaces, water and medical devices

poster round

I was delighted to be asked to lead a poster round at the Healthcare Infection Society (HIS) conference. I was a bit disappointed to see that the poster sessions are tacked on to the end of the day (when everybody’s had enough and really just wants to retreat to their hotel room for an hour before the evening’s activities). My view is that posters are the lifeblood of conferences (and I am not alone in this view); they should have much more prominence, with a “ringfenced” session integrated into the main program.

Anyway, whinge over, I thought I’d share which posters I chose, why I chose them, and what I want to know about them.

You can access the abstracts here.

GENERAL CATEGORY

#3200 Longhurst et al. Hand drying methods in NHS England Trusts, September 2013.

I chose this poster because it’s becoming increasingly clear that the choice of hand drying method can influence the degree of bacterial contamination. Also, whilst I accept the economic and environmental benefits of jet and warm air dryers, they always seem to leave my hands a bit damp. (Perhaps I just have sweaty palms.) Anyway, this is what I want to know about this poster:

  • Why did you feel the need to ‘enforce’ a response by using the Freedom of Information act?
  • Why do you think jet / warm air dryers were rare in clinical areas?
  • Do you think that jet and to a lesser extent warm air dryers result in dangerous dispersal of microbes?

#3349 Tang et al. A 3 year hand hygiene program to increase compliance rate for heatlhcare providers in the A&E Department of Tuen Mun Hospital in Hong Kong.

There’s not a lot of data on hand hygiene compliance in A&E. A 2005 study examined compliance with hand-washing in the TV show ER, reporting a hand hygiene compliance rate of 0.2%. Yep, that’s ZERO POINT TWO PERCENT! Although reality is marginally better (according to this review), there’s work to be done, so I chose this poster mainly because of the impressive impact in improving hand hygiene compliance. My questions are:

  • Which of the barriers to hand hygiene that you mention do you think is most important?
  • Who was on your task-force to decide what to do?
  • How many people completed the questionnaires?
  • How many observations were done in each time period?
  • How do you measure that the awareness of hand hygiene increased?

#3174 Khanafer et al. Hospital management of Clostridium difficile infection: a literature synthesis

This is a novel review of the literature: using the ORION checklist to capture variables that help us to determine what works to control CDI from outbreak reports and intervention studies. Here’s what I want to know:

  • Can we really derive anything useful about which intervention works when you have more than one variable, even if studies are reported in a structured way? (High school science is pretty clear: change one variable at a time!)
  • How can these % reductions be so high when (apparently) only 30% of CDI is hospital-acquired (according to some people’s interpretation of the Oxford WGS difficile study)?
  • Which is the single most important intervention to prevent CDI transmission?

ENVIRONMENT CATEGORY

#3285 Cunningham et al. VRE Outbreak Control – the Need for Speed (Use of Molecular Technology)

Two of my favourite subjects: VRE and rapid diagnostics! Here are my questions:

  • Why bother trying to control VRE? Some pretty persuasive voices are arging that it’s not worth it!
  • Are you sure that rapid diagnostics made the difference? You also introduced enhanced cleaning / disinfection, extra screening, pre-emptive isolation, and extra staff and equipment.
  • How do you explain the four clusters?
  • Did you culture in parallel? If so, what was the sensitivity and specifity of the PCR test?

#3312 Whiteley et al. The problem of rapid ATP systems may be scaling using Relative Light Units (RLU)

This poster wins the prize for the most detailed poster in conference history; I think they’ve squeezed enough words in for a full length article. But the findings are important. All ATP bioluminescence systems are not equal: a way to standardize RELATIVE light unit (RLU) output would be extremely useful.

  • What is ‘coeffecient of variance (CoV)’, and what does it mean?
  • Does lower CoV = a better ATP bioluminescence system?
  • Clearly, hand held luminometers will not match HPLC in terms of accuracy, but what should our ‘CoV’ tolerance be?
  • Do you have a way to distinguish variaibilty of sampling (i.e. pickup of ATP on the swab) from variability in ATP detection by the device?
  • Would ATP correlate better with microbial concentration if device variability were removed (e.g. through HPLC analysis)?

#3393 Maynard et al. The use of Pseudalert® for the routine analysis of water samples by engineers

I like technology and I like innovation, so this is right up my steet. Here’s my questions:

  • How does the limit of detection for Pseudalert (1 cfu / 100 mL) compare with conventional culture, in theory?
  • How much training is required to use it?
  • Why 100 mL for Pseudalert, and 500 mL for culture?
  • Is culture the gold standard method? If so, the specificity of Pseudalert in Hospital 1 is terrible!

DEVICE-RELATED INFECTION CATEGORY

#3197 Farrugia et al. Reducing methicillin resistant Staphylococcus aureus (MRSA) bacteraemia in haemodialysis patients within a high incidence setting

I chose this poster purely for the dramatic reduction in MRSA bacteraemia in a specialist setting. I would like to know:

  • Is the high initial rate explained by haemodyalisis cathethers being left in for too long?
  • ‘Prevalence of CA-MRSA 8.8%’? What does this mean? 8.8% of healthy individuals carrying CA-MRSA, or 8.8% of hospital MRSA is community-associated clones?
  • Lots of interventions – do you have a feel for which was most important?

#3277 Stenger et al. A hydrogel interpenetrating polymer network in vascular catheters loaded with thioridazine and dicloxacillin facilitates slow surface release and inhibits staphylococcal biofilm formation in vitro and in vivo

I am interested in approaches that replace the traditional use of antibiotics with biocides (which have a much lower risk of promoting bacterial resistance). Whilst this catheter was dosed with an antibiotic, I think the technology could theoretically be dosed with any biocide. Also, I’m fascinated by the application of an anti-psychotic drug in infection control:

  • Please explain the principle of ‘interpenetrating polymer network’ (IPN).
  • Could this same technology be used to dose the catheters with any drug or biocide?
  • Can you modify the rate of release?
  • Who on earth decided to see whether an anti-psychotic drug (thioridazine) has antibacterial properties?

If anybody has any answers to my questions, please fire away!

Image: Andrea Wiggins.