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 readingMRSA
Predicting colonisation with antibiotic-resistant bacteria at the time of hospital admission
A systematic review and meta-analysis identify 22 studies that used various methods to predict colonisation with antibiotic-resistant bacteria at the time of hospital admission. The models were chosen to focus on MRSA and CPO colonisation. The “performance” of these tools varied widely, with a sensitivity of 15–100% and specificity of 46–98.6% for MRSA, and sensitivity of 30–81.3% and specificity of 79.8–99.9% for CPO. I think my main take-away from this that simple risk tools for predicting colonisation with MRSA and CPO (which are often used to determine who to test) are pretty blunt instruments. However, the more advanced tools making use of big datasets and machine learning can take us forward in predicting the risk of MRSA and CPO colonisation at the time of admission.
Continue readingHCAI and AMR point prevalence from Ukraine
JHI have just published an interesting point prevalence HCAI and AMR study from Ukraine. Headlines are that rates of both HCAI and AMR are higher than you’d hope to see, especially with rates of resistant to carbapenems in Gram-negative bacteria and meticillin in S. aureus.
Continue readingHow dirty is your QWERTY?
I was recently involved in a study to examine the microbial profile of computer keyboards in a multi-centre study in the UK. The findings have just been published in the Journal of Hospital Infection.
Continue readingBeware Biofilms!
Have you ever wondered how on earth vegetative bacteria can survive on dry surfaces for years? Or why when you have an outbreak and you swab the environment you don’t find the outbreak strain even though you’re pretty sure it’s there? Or why a disinfectant that gets a 4-log reduction in the lab can’t eliminate a couple of hundred cfu of bacteria from a dry surface? Dry surface biofilms could be the answer to all these questions! I was involved in a multicentre survey of dry biofilms from across the UK, and we identified dry surface biofilms on 95% of the 61 samples there were tested. Worryingly, viable MRSA was identified on 58% of the surfaces! We need to think carefully about how much of a risk dry surface biofilms present, and whether we need to do more to tackle them.
More coffee = less AMR?
This one is for lovers of the brown stuff (no, the other brown stuff). I was taken by a large impressive epi study published in AIM showing that coffee consumption is associated with reduced all-cause mortality. Part of this seems to be tied up in a modified inflammatory response. Whilst the study didn’t mention infection specifically, clearly infection and inflammation are closely linked. So, this got me to asking whether anybody has looked at coffee consumption and infection / AMR outcomes?
Contact Precautions for Endemic MRSA and VRE
by Andreas Voss and Eli Perencevich,
intentionally posted on “Reflections” and “Controversies” at the same time as a reaction to the JAMA Viewpoint by Morgan, Wenzel & Bearman
During the recent ICPIC 2017 and a pre-meeting think tank, the sense and non-sense of RCTs looking at various infection control measures was a major point of discussion during many sessions. Data from well-designed quasi-experimental studies, epidemiological evidence, and logic seems to vanish, whenever a new RCT is published, even if the results are not applicable to situations that are non-endemic, have higher or lower compliance with the preventive measures in question, or whether the intended measures were actually applied within the intended patient group. Some studies seem to assume that the transmission during the first days of admission are of no consequence. Others assume that given endemicity and a high patient load, the intended measures such as single-room isolation can’t be applied, even if a patient was randomized to receive those measures.
Dogs can be useful – Woof of concept obtained
I’m not a dog lover. Far from it in fact, however a new paper in the Journal of Hospital Infection caught my eye today. Yesterday I was sitting in the Longitude Prize Advisory 
Committee meeting bemoaning the lack of ‘left field’ ideas coming forward. Harrison himself, winner of the original prize was such a person. He came at the problem of solving the longitude issue from a completely different direction when all of the respected science at the time was convinced that astrology was the answer. Problem: cloud, and not much of a silver lining. So we are looking for a new way to diagnose infection rapidly, distinguishing between those caused by viruses and bacteria in the hope of turning the increasing tide of resistance. So what does Fido (or Nimbus in this case) have to do with this?
How much S. aureus is hospital acquired? Mk II
I posted a blog a couple of years ago (was it really that long!) on a fascinating study suggesting that only 1/5 of S. aureus in hospital patients is hospital-acquired. My key conclusion from that study was that the number of potential sources for S. aureus that the team investigated was inadequate to draw any firm conclusions (they didn’t include staff, surfaces, or visitors). I concluded that ‘the next frontier of transmission mapping must be a more comprehensive evaluation of other potential sources…’. The authors must have been reading, because this study from the same group was published recently in Lancet ID, which is a more comprehensive evaluation of other potential sources.
Time to go shopping for a UVC system?
It is great to see the long-awaited ‘Benefits of Terminal Room Disinfection’ (BETR-D) randomised controlled trial of a UVC automated room decon (ARD) system published, in the Lancet, no less! This study firms up the importance of environmental contamination in transmission, and demonstrates additional benefit of UVC over and above enhanced conventional methods for VRE, maybe for MRSA, but not for C. difficile.
Reflections on Infection Prevention and Control 