Risk of Central Line-Associated Bloodstream Infection in Neonates

Umbilical venous catheters (UVC) or peripherally inserted central catheters (PICC), commonly used in high risk neonates, may have a threshold dwell time for subsequent increased risk of central line associated blood stream infection (CLABSI) | The Journal of Hospital Infection

Aim: To evaluate the CLABSI risks in neonates having either UVC, PICC or those having both sequentially.

Methods: Study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional Neonatal Intensive Care Units: 1392 having UVC only (Group 1), 1317 PICC only (Group 2) and 1276 both UVC and PICC (Group 3).

Results: There were 403 CLABSI among 6000 venous catheters inserted, totalling 43302 catheter days. CLABSI rates were higher in Group 3 infants who were of lowest gestation (16.9/1000 UVC days and 12.5/1000 PICC days; median 28 weeks) when compared with Group 1 (3.3/1000 UVC days; 37 weeks) and Group 2 (4.8/1000 PICC days; 30 weeks). Life table and Kaplan-Meier hazard analysis showed UVC CLABSI rate increased stepwise to 42/1000 UVC days by day 10, with the highest rate in Group 3 (85/1000 UVC days). PICC CLABSI rates remained relatively stable at 12-20/1000 PICC days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among Group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk, than late replacement.

Conclusions: There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 could be considered.

Full reference: Sanderson, E. et al. (2017) Dwell Time and Risk of Central Line-Associated Bloodstream Infection in Neonates. The Journal of Hospital Infection. Published online: 24 June 2017

Disinfection of gloved hands for multiple activities with indicated glove use on the same patient

Most hand hygiene guidelines recommend that gloves should be changed during patient care when an indication for hand disinfection occurs | The Journal of Hospital Infection

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Observational studies indicate that the majority of healthcare workers (HCWs) do not disinfect their hands at all during continued glove wear. The aim of this narrative review is to assess the potential benefits and risks for disinfecting gloved hands during patient care for multiple activities with indicated glove use on the same patient.

Continued glove wear for multiple activities on the same patient often results in performing procedures, including aseptic procedures with contaminated gloves, especially in a setting where there are many indications in a short time, e.g. anaesthetics or accident and emergency departments. Of further note is that hand hygiene compliance is often lower when gloves are worn. To date, three independent studies have shown that decontamination is at least as effective on gloved hands as on bare hands and that puncture rates are usually not higher after up to 10 disinfections. One study on a neonatal intensive care unit showed that promotion of disinfecting gloved hands during care on the same patient resulted in a significant reduction in the incidence of late-onset infections and of necrotizing enterocolitis.

We conclude that disinfection of gloved hands by HCWs can substantially reduce the risk of transmission when gloves are indicated for the entire episode of patient care and when performed during multiple activities on the same patient.

Full reference: Kampf, G. & Lemmen, S. (2017) Disinfection of gloved hands for multiple activities with indicated glove use on the same patient. The Journal of Hospital Infection. Published online: June 22 2017

Removal of sinks and introduction of ‘water-free’ patient care

Sinks in patient rooms are associated with hospital-acquired infections | Antimicrobial Resistance & Infection Control

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Background: The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of ‘water-free’ patient care on gram-negative bacilli colonization rates.

Conclusions: Removal of sinks from patient rooms and introduction of a method of ‘water-free’ patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay.

Full reference: Hopman, J. et al. (2017) Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of ‘water-free’ patient care. Antimicrobial Resistance & Infection Control. 6:59

The Scottish enhanced Staphylococcus aureus bacteraemia surveillance program

Staphylococcus aureus bacteraemia (SAB) is the second most common source of positive blood cultures after Escherichia coli (E. coli) reported within NHS Scotland. Laboratory surveillance has been mandatory in Scotland for SAB since 2001 | Journal of Hospital Infection

Aim: To gain an understanding of the epidemiology of SAB cases and associated risk factors for healthcare and true community onset. Identifying these factors and patient populations most at risk allows focused improvement plans to be developed.

Methods: All NHS Boards within NHS Scotland take part in the mandatory enhanced surveillance collecting data by trained data collectors using nationally agreed definitions.

Findings: Between 1st October 2014 and 31st March 2016, 2256 episodes of SAB in adults were identified. The blood cultures were taken in 58 hospitals and across all 15 Scottish health boards. The data demonstrated that approximately one third of all SAB cases are true community cases. Vascular access devices (VAD) continue to be the most reported entry point (25.7%) in persons who receive healthcare, whereas, skin and soft tissue risk factors are present in all origins. A significant risk factor unique to community cases are in people who inject drugs (PWID).

Conclusion: Improvement plans for reduction of SAB should be more widely targeted than solely in hospital care settings.

Full reference: Murdoch, F. et al. (2017) The Scottish enhanced Staphylococcus aureus bacteraemia surveillance program: The first 18 months data in adults. Journal of Hospital Infection. Published online: June 08, 2017

Reducing the Risk of Mouth to Mouth Transmission of Pathogens Via Parking Tickets.

In the initial phase of our study 598 staff members were observed entering the carpark. 21.6% of them put their parking ticket in their mouth | Journal of Hospital Infection

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Using UV dye we successfully demonstrated card-to-card cross-contamination. Swabs of the ticket machine yielded commensal bacteria: coagulase negative staphylococci and a Bacillus species.

After placing a poster on the ticket-reading machine highlighting this potential infection risk, a further 1366 observations resulted in a statistically significant and persistent decline in the proportion of staff putting their carpark tickets in their mouths (p<0.001).

Full reference: Groves, J. et al. (2017) Reducing the Risk of Mouth to Mouth Transmission of Pathogens Via Reusable, Machine-read, Parking Tickets. An observational cohort study. Journal of Hospital Infection. Published online: June 08, 2017

Are alcohol-based dispensers fomites for C difficile?

The purpose of this study was to evaluate alcohol-based dispensers as potential fomites for Clostridium difficile | American Journal of Infection Control

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A convenience sample of 120 alcohol-based dispensers was evaluated for the presence of C difficile either by culture or polymerase chain reaction for C difficile toxin. The results demonstrated that C difficile was not cultured, and C difficile toxin was not detected using polymerase chain reaction; however, gram-positive rods, Clostridium perfringens, Pantoea agglomerans, coagulase-negative Staphylococcus, Peptostreptococcus, Bacillus spp, and microaerophilic Streptococcus were present within the overflow basins of the alcohol-based dispensers.

Full reference: Hall, J.A. et al. (2017) Dipping into the Clostridium difficile pool: Are alcohol-based dispensers fomites for C difficile? American Journal of Infection Control. DOI: 10.1016/j.ajic.2017.04.284

Washing hands in cold water ‘as good as hot’

A US study says there is no benefit in terms of hygiene from washing in hot water rather than cold. | BBC Health

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A small study of 20 people found using water at 15C (59F) left hands as clean as water heated to 38C (100F) . The report is published in the Journal of Food Protection,

In the UK, NHS experts say people can use cold or hot water to wash their hands. They say hands should be washed for at least 20 seconds and stress the importance of using enough soap to cover the whole surface of the hands.

Their guidance focuses on rubbing hands together in various ways to make sure each surface of each hand is clean.

Jensen DA, Macinga DR, Shumaker DJ, et al. Quantifying the Effects of Water Temperature, Soap Volume, Lather Time, and Antimicrobial Soap as Variables in the Removal of Escherichia coli ATCC 11229 from Hands. Journal of Food Protection. Published online May 15 2017