You may have seen some commentary and debate on a recently updated Cochrane review on physical interventions to interrupt the spread of respiratory viruses. I’m stepping into the debate only to clarify a few small points – and to provide an overview of what the review does (and does not) tell us. However, my firm advice is to read the review for yourself and come to your own conclusions.
Continue readingRCT
Finally, an RCT comparing N95s and medical masks to protect healthcare staff from COVID-19
Annals of Internal Medicine today published an RCT comparing the effectiveness of N95s vs. medical masks to protect healthcare staff from COVID-19. It’s a great piece of work, conducted over many years, and whilst the study has some important limitations, suggests that N95s don’t offer significantly increased protection than medical masks for healthcare staff caring for patients with confirmed or suspected COVID-19.
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 readingAntimicrobial copper surfaces and linen and healthcare-associated infection: a review and meta-analysis
A helpful new review and meta-analysis asks whether treating hard surfaces or linen reduces healthcare-associated infections. The review identified only a small number of studies that had both a copper-related intervention related to surfaces and/or linen and an outcome related to HCAI. But the meta-analysis of the seven studies found that, overall, the risk of HCAI was reduced by 27% (risk ratio 0.73, 95% confidence interval 0.57–0.94).
Continue readingSingle rooms for ESBLs anyone?
A comprehensive and impressive cluster randomised crossover study published in Lancet ID examines whether it makes sense to use single rooms (as compared with multi-bed bays) to apply contact precautions for patients known to be carrying ESBL-Enterobacteriaceae. I need to be careful what I say, because fellow bloggers Marc and Andreas are co-authors. However, the gist seems to be: don’t bother with single rooms for ESBL-E carriers – but many hospitals don’t have capacity to do that anyway, so this may not be a practice-changing finding in many parts of the world!
How far can environmental hygiene REACH in reducing HCAI?
Brett Mitchell and colleagues have just published the exciting findings of the Researching Effective Approaches to Cleaning in Hospitals (REACH) study in the Lancet Infectious Diseases, along with my editorial. This large 11-centre randomised intervention study found that a low-cost enhancement to environmental hygiene managed to significantly reduce VRE infections, but did not reduce S. aureus bacteraemia or C. difficile infections.
Jingle all the weigh: a behavioural intervention to prevent weight gain over Christmas
It’s becoming a bit of a tradition for me to post about an article from the fabulous Christmas BMJ with a spurious link to infection (see 2016 [depressing] and 2017’s [uplifting] version here). This year, it’s a short-term behavioural intervention to prevent weight gain over Christmas. And the links to infection: obesity is a big (!) risk factor for all-things-infection, and we’re all about achieving meaningful and sustained behaviour change.
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.
Monoclonal antibodies, the brown stuff, and preventing recurrent C. difficile infection
A fantastic NEJM study by Mark Wilcox et al. brings monoclonal antibodies* to the party in preventing recurrent C. difficile infection. In this hugely impressive RCT (well, two squashed together actually), patients who received bezlotoxumab (a monoclonal antibody against C. difficile toxin B) were significantly less likely to suffer recurrent CDI (17% for bezlotoxumab vs 27% for placebo).
Should we throw out the chlorhexidine with the bathwater?
Following hot on the heels of a series of studies showing that daily bathing using chlorhexidine reduces the risk of HCAI, a recent study suggests that chlorhexidine daily bathing does not reduce HCAI. The headline finding is that chlorhexidine bathing did not reduce HCAI. Before throwing out the chlorhexidine with the bathwater, it’s worth considering the limitations of the study.
Reflections on Infection Prevention and Control 