Fear and hierarchy as drivers for antimicrobial prescribing

Surgical antimicrobial prophylaxis (SAP) is one of the areas of strength in the infection prevention literature: we have high quality evidence that it works, and evidence-based guidance on how to do it effectively. And yet, you don’t have to spend long in an operating theatre to see that it’s not always done according to local guidelines. So, why are these evidence-based guidelines for SAP not implemented effectively? A short review in the Journal of Hospital Infection highlights social factors, specifically fear and hierarchy, as important drivers of antimicrobial prescribing.

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A rapid reflection from Infection Prevention 2017: HCAI ranking according to DALY

I am heading home from an outstanding Infection Prevention 2017. There was a fair bit of discussion about hospital-associated pneumonia (HAP). HAP does not get the attention it deserves and there is more that we can and should be doing to prevent it. Although, we need to keep an eye out for unintended consequences in tackling HAP.

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SSIs – time to de-invest in laminar flow?

Laminar flow is a very embedded technology for the prevention of SSI in some types of surgery (especially hip and knee arthroplasty). However, it seems from a recent Lancet ID review that this widely adopted practice is way ahead of the evidence supporting it: the bottom line finding of the review is we should stop wasting time and money on laminar flow theatres for some procedures, and focus on basic prevention initiatives (especially getting antibiotic prophylaxis right) in all surgical categories.

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Mycobacterium chimaera and heater-cooler units: a briefing

This post provides a briefing on the current status of the Mycobacterium chimaera issue related to heater-cooler units (HCUs) used in cardiothoracic surgery. You can download some accompanying slides here. Also, I found this recent ICHE review on the subject very helpful to bring me up to speed.

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The silent Mycobacterium chimaera epidemic

hcu

There has been much discussion about the risk of Mycobacterium chimaera infections associated with contaminated heater-cooler units (HCUs) used in cardiothoracic surgery. A study published recently in CID explores the risk in the UK, and provides further evidence to link these tricky-to-treat infections to contaminated HCUs.

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SSI – It’s not what you do, but the way that you do it?

20140801-135-see-rock_festival_2014-rick_parfittAnother of my favourite guitarists succumbed to sepsis following surgery just before Xmas, with the sad passing of Rick Parfitt following shoulder surgery, spookily the day after his band Status quo performed their final electric gig (which I was at). The other was Rory Gallagher, who died a few years ago now of MRSA.  Surgical procedures are normally carried out under what should be the most controllable of conditions, yet there are variations in practice, a paucity of quality studies on even the most basic of interventions (such as pre-op bathing) and even when there is good evidence, it is ignored. However I do also wonder if we have been missing something. A paper that suggests no difference between Chlorhexidine (CHG) and Povidone Iodine (PI) for pre-surgical skin prep (both aqueous) recently piqued my interest. It was an RCT (non-blinded) undertaken in clean-contaminated upper gastrointestinal or hepatobiliary–pancreatic open surgery, however that wasn’t the aspect that I became interested in. Continue reading

“HCAI”

Airquotes

I read a Controversies blog today, reflecting on a recent editorial suggesting that, because of frequent over-diagnosis, we should use quote marks every time we write “CAUTI” – and even use air quotes every time we say it! But why stop at CAUTI? Should we be talking about “CLABSI”, “CDI”, “SSI” and, well, any “HCAI” really?

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