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Welcome to the Infection Control online newsfeed. Here you’ll find all the latest research, news stories, policy updates and guidelines. View our other newsfeeds for more subject-specific news.

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Funding opportunity available to UK and Chinese researchers to help tackle antimicrobial resistance (AMR)

Department of Health and Social Care, Innovate UK & Steven Brine |  March 2018  | UK-China collaboration to tackle antimicrobial resistance

The Department of Health and Social Care (DHSC) will invest up to £10 million in UK businesses and academics who work in conjunction with Chinese scientists to advance work on antimicrobial resistance (AMR). The fund is to  support the development and, where appropriate, clinical evaluation of new products or services, which must be of value in addressing the threat from AMR.

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Innovate UK will deliver the funding to UK researchers (£750,000) and The Chinese Ministry of Science and Technology  will invest up to 60 million Renminbi (RMB) to fund the project.  Projects can last up to 3 years.

UK applicants must demonstrate that projects are primarily and directly relevant to the needs of people in low and middle income countries (LMICs), including China, as defined by the Organisation for Economic Co-operation and Development (OECD). There must be a clear economic and societal benefit to LMICs from their proposed project. The competition will open on 3 April 2018  (Innovation Funding Service)

Projects must address the specified criteria at DHSC here  

Full details including eligibility criteria are available from DHSC 

How safe is washing your uniform at home?

 Laird K et al  | 2018  | Domestic laundering of nurses’ uniforms: what are the risks? | Nursing Times  | ePub | Vol. 114 | 2 | P. 18-21

Researchers at De Montfort University, Leicester reviewed the literature on domestic laundering of hospital uniforms. An earlier study (2015) also at De Montfort, which  included 265 healthcare staff from across disciplines and in a range of roles  (nurses, healthcare assistants, ward clerks, housekeepers, and physiotherapists) completed a questionnaire.  It showed 43.7% laundered their uniforms below the 60°C recommended by the Department of Health; a third (33%) washed them at 40°C and 5% at 30°C.  Around a quarter of the staff sampled also revealed that they wore their uniform for two or more shifts before washing it, longer than the recommended wash after every shift (via Nursing Times).

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In a laboratory experiment, the scientists repeated the staff’s  most common laundering practices (derived from the 2015 study), and assessed the survival of Staphylococcus aureus and Escherichia colion cotton and polyester fibres (Riley et al, 2017). The data showed that both bacteria were able to survive on polyester for up to seven days and on cotton for up to 21 days.

For the authors this raises the question of the storage of dirty uniforms at home, especially with regard to potential cross-contamination with surfaces in the home environment.  They also experimented to find if cross-contamination occurred in the wash,  including sterile samples with the uniforms. Washing at 40˚C did remove most micro-organisms, but the cells that were left were in excess of 1,000, and similar numbers had been transferred to the sterile items. This highlights the risk that other items of clothing in the home could become contaminated, or that domestically laundered uniforms could re-contaminate the home and/or healthcare environment.

The full article is available from The Nursing Times 

Clostridium difficile infection objectives updated

NHS Improvement | Clostridium difficile infection objectives for NHS organisations in 2018/19, guidance on sanction implementation and notification of changes to case attribution definitions from 2019| March 2018

NHS Improvement have updated the objectives on Clostridium difficile infection (CDI). This document outlines the objectives for acute trusts and clinical commissioning groups to make continuous improvement in Clostridium difficile infection (CDI) care.

They objectives are updated every April. The updated objectives are available from NHS Improvement 

Clostridium difficile infection assessment tool and action plan guidance can be accessed from NHS England 

Background information to the CDI objectives can be read here  

 

Staff shortages threaten increased levels of infection, say Antibiotic Research UK

Antibiotic Research UK | Staff shortages could unleash superbug epidemic | March 2018

Antibiotic Research UK (ANTRUK)  believe that the over-occupancy affecting hospitals across the country makes transmitting deadly bacteria easier.  They also air concerns that a scarcity of nurses means staff will simply be too busy to notice the poor levels of cleanliness that encourage bugs thrive.  ANTRUK  is reminding patients and visitors to be vigilant and report incidents of improper cleaning to complaint bodies like Patient Advice and Liaison Service (PALS) (via ANTRUK).

cleaner-3122363_1920Professor Colin Garner, Chief Executive of ANTRUK remarked that “we need the Government, medical research organisations, the pharmaceutical
industry and the public to work together to develop new but effective medications,
fast. And while we wait for that to happen, we must do everything in our power to
prevent the spread of bacterial infections – especially in our hospitals.”

The full press release is available from ANTRUK 
Related:  Nursing Times Warning that nurse shortages and crowded wards ‘risk reversing infection prevention progress’

 

Environmental cleaning and disinfection of patient areas

The International Journal of Infectious Diseases has published a new article on environmental cleaning and disinfection of patient areas. The authors undertook a narrative review of the literature comprises hospital surfaces, other potential reservoirs of infection and the monitoring of cleaning.  Their review also considers antimicrobial ‘self-cleaning’ surfaces, cleaning robots ‘touchless’ technologies and also discuss other interventions to improve manual cleaning.   They also summarise  the strategies for environmental cleaning and disinfection of patient areas in a table.  For the researchers,  human factors will ultimately determine the quality of environmental cleaning in the hospital and will remain the patient’s best defense against invisible threats from the hospital environment.

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Abstract

The healthcare setting is predisposed to harbor potential pathogens, which in turn can pose a great risk to patients. Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections. While many approaches to environmental cleaning exist, manual cleaning supplemented with ongoing assessment and feedback may be the most feasible for healthcare facilities with limited resources.

Full reference: Doll, M., Stevens, M., &  Bearman, G. |Environmental cleaning and disinfection of patient areas | International Journal of Infectious Diseases |57| 2018 | P.52-57| Doi https://doi.org/10.1016/j.ijid.2017.10.014

The full article is available for NHS Athens users, it can be accessed here 

Is pulsed the answer to treatment of Clostridium difficile infection?

Antibiotic treatment of Clostridium difficile infection has been plagued by high rates of recurrent diarrhoea attributed to C difficile and requiring retreatment, often repeatedly. In the latest edition of The Lancet Infectious Diseases, Benoit Guery and colleagues describe a novel dosing regimen for fidaxomicin in which the standard 200 mg, 20-dose, 10-day regimen is extended (the EXTEND study) by giving 200 mg twice daily for the first 5 days, followed by 200 mg every-other-day for an additional 20 days. The comparator regimen was standard-dose vancomycin (125 mg four times daily for 10 days), which is the same comparator dose that was used in two phase 3 licensing trials of standard-dose fidaxomicin (200 mg twice daily for 10 days). (The Lancet Infectious Diseases)

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Further information can be found  at The Lancet Infectious Diseases 

Full reference: Gerding, D. N| (2017) | Is pulsed dosing the answer to treatment of Clostridium difficile infection?| The Lancet Infectious Diseases | Published online

The full article is available for Rotherham NHS staff to request here 

International study finds 1 in 8 patients have an infection following common procedures

A worldwide study which studied the incidence of surgical site infection (SSI) in over 12,000 patients who had gastro-intestinal surgery, across 66 countries has been published in The Lancet. The researchers quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. The findings of the prospective, international study included 1 in 8 patients experiencing infection post-operation for common procedures such as appendix removal.  In more than 20% of cases, patients developed infections which antibiotics should have protected them from

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Abstract 
Background Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries throughout the world.
Methods This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries
were stratified into high-income, middle-income, and low-income groups according to the UN’s Human Development Index (HDI).  The primary outcome measure was  the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models.

Findings Between Jan 4, 2016, and July 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries).
In total, 1538 (12·3%) patients  had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI.
The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries.

Interpretation Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance.

The full text article can be downloaded from The Lancet