Contact Precautions for Endemic MRSA and VRE

dilemmaby 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.

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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!

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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.

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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’!

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Reflections from ECCMID: the pink, the blue, and the new

eccmid2016

I’ve recently returned from an enjoyable few days in Amsterdam for ECCMID. I’ve not been to a conference of this scale for a few years; there was a lot of good stuff to choose from so I’ve tried to stick to key updates for the purposes of this reflection!

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Reflections from Infection Prevention 2015 Part I: Beating the bugs

time person of the year

Infection Prevention 2015, the annual conference of IPS, was held in Liverpool this year. I’m delighted to say that the abstracts from the submitted science are published Open Access in the Journal of Infection Prevention. This first instalment of my report will be “bug-focussed”, followed by another two on different themes:

Part I: Beating the bugs

Part II: Improving the systems

Part III: Thinking outside the box

Opening lectures

The conference kicked off with fellow ‘Reflections’ blogger Prof Andreas Voss. By Andreas’ own admission, he was given a curve-ball of a title: ‘CRE, VRE, C. difficle or MRSA: what should be the priority of infection prevention?’ [No idea where that could have come from…] Andreas developed a framework for grading the priority of our microbial threats, accounting for transmissibility, virulence, antibiotic resistance, at-risk patients, feasibility of decolonisation, cost, and impact of uncontrolled spread. And the result? Any and all microbes that cause HCAI should be a priority of infection prevention. Even those that seem to have less clinical impact (such as VRE) are good indicators of system failure. If we focus too much on one threat, we risk losing sight of the bigger picture.

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