We know that many vegetive bacteria can survive on dry surfaces for longer than you might think. For some Enterococcus species, this capability is nothing short of extraordinary. In one study, Enterococcus dried onto a surface was still viable 4 years (yes FOUR YEARS) later! How can this be? No nutrients, no water (other than ambient humidity), and not an endospore former. A recent paper in the JHI may have some answers: Enterococcus is able to form dry surface biofilms and these contain viable Enterococcus many months after inoculation, regardless of species and substrate.
Continue readingVRE
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 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 readingHow often does colonization precede infection with MDR-GNB and VRE?
Ever found yourself wondering how often colonization precedes infection with MDR-GNB and VRE? A new systematic review and meta-regression in Lancet ID gives us a pretty solid answer: about 14% of MDR-GNB and 8% for VRE. This information is helpful for us to qualify the significance of acquiring these organisms in healthcare settings.
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 readingNo CPE but a lot of VRE
Addenbrookes hospital in Cambridge (UK) have recently performed a point prevalence survey for antibiotic resistant bacteria. None of 540 patient samples grew CPE, but 130 (24%) grew VRE. So, why no CPE but so much VRE?
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.
Staff screening for MDROs: closing Pandora’s Box
A brave study from the Palmore/Frank group at NIH has opened the Pandora’s Box that is screening staff for MDROs, and, I’m delighted to say, firmly closed it with their findings! Only 3% of staff carried ESBLs, one carried a CPE, and none carried VRE, and this despite extensive contact with MDRO patients for many of the staff sampled!
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.
What do you do to prevent VRE transmission?
What do you do to prevent VRE transmission?
…you are not alone, if the answer to this question is ‘nothing special’, based on survey published in ARIC! Dale Fisher’s team in Singapore put together a simple survey, asking the global IPC community what measures they have in place to prevent the transmission of VRE. There was a huge degree of variability, ranging from ‘nothing special’ to ‘the kitchen sink’!
Reflections on Infection Prevention and Control 