NHS Long Term Plan to reduce toll of ‘hidden killer’ sepsis

Hospital staff urged to be more alert to ‘hidden killer’ sepsis | via NHS England

Hospital staff must alert senior doctors if patients with suspected sepsis do not respond to treatment within an hour, as part of the NHS Long Term Plan to save thousands more lives. Every trust must take action to spot and treat the killer blood condition, which costs 37,000 lives a year, under guidance that is being mandated by NHS England.

The guidance, drawn up with the Royal College of Physicians, The Royal College of GPs, NICE and the UK Sepsis Trust, states that staff should look for sepsis at an early stage in patients coming to A&Es and those who are already on wards.

Medics must ask consultants for help if patients with suspected sepsis do not respond to treatment within an hour, and hospital teams should also take sufficient note of non-specific symptoms and concerns expressed by relatives and carers such as acute changes in behaviour.

Hospitals will be contractually obliged to ensure they fully comply with the guidance coming in from April.  The initiative comes as the NHS prepares to pilot new clinical standards aimed at providing swifter diagnosis and treatment for patients arriving at A&E with suspected sepsis.

Full story at NHS England

Related guidance: Sepsis guidance implementation advice for adults

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Infection control precautions

Standard infection control precautions: national hand hygiene and personal protective equipment policy | NHS Improvement

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This national policy is a practice guide for NHS healthcare staff of all disciplines in all care settings. It covers responsibilities for organisations, staff and infection prevention and control teams. It also sets out how and when to decontaminate hands.

The national policy aims to:

  • support a common understanding (making the right thing easy to do for every patient, every time)
  • reduce variation in practice and standardise care processes
  • improve how knowledge and skills are applied in infection prevention and control
  • help reduce the risk of healthcare-associated infection
  • help to align practice, education, monitoring, quality improvement and scrutiny

Full document: Standard infection control precautions: national hand hygiene and personal protective equipment policy

 Compliance with hand hygiene in emergency medical services: an international observational study

Vikke, H.S. et al | 2019| Compliance with hand hygiene in emergency medical services: an international observational study |

An observational study, published in the Emergency Medicine Journal, identified sub-optimal levels of hand hygiene compliance among emergency medical service indications. 

The study’s results indicate a tendency to self-protection and over-reliance on gloves among emergency medical service providers (less than or equal to 15 per cent).

The research team found average hand hygiene compliance was low (3 per cent) before touching the patient and less than a fifth (19 per cent)  after having touched the patient. Gloves were worn  in more than half (54 per cent) of all hand hygiene indications.

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Abstract

Introduction Healthcare-associated infection caused by insufficient hygiene is associated with mortality, economic burden, and suffering for the patient. Emergency medical service (EMS) providers encounter many patients in different surroundings and are thus at risk of posing a source of microbial transmission. Hand hygiene (HH), a proven infection control intervention, has rarely been studied in the EMS.

Methods A multicentre prospective observational study was conducted from December 2016 to May 2017 in ambulance services from Finland, Sweden, Australia and Denmark. Two observers recorded the following parameters: HH compliance according to WHO guidelines (before patient contact, before clean/aseptic procedures, after risk of body fluids, after patient contact and after contact with patient surroundings). Glove use and basic parameters such as nails, hair and use of jewellery were also recorded.

Results Sixty hours of observation occurred in each country, for a total of 87 patient encounters. In total, there were 1344 indications for HH. Use of hand rub or hand wash was observed: before patient contact, 3%; before clean/aseptic procedures, 2%; after the risk of body fluids, 8%; after patient contact, 29%; and after contact with patient-related surroundings, 38%. Gloves were worn in 54% of all HH indications. Adherence to short or up done hair, short, clean nails without polish and no jewellery was 99%, 84% and 62%, respectively. HH compliance was associated with wearing gloves, but not associated with gender.

Conclusion HH compliance among EMS providers was remarkably low, with higher compliance after patient contacts compared with before patient contacts, and an over-reliance on gloves. We recommend further research on contextual challenges and hygiene perceptions among EMS providers to clarify future improvement strategies.

The full open-access article is available to download from the BMJ

Membrane charge and lipid packing determine polymyxin-induced membrane damage

Khondker, A. et al | 2019 | Membrane charge and lipid packing determine polymyxin-induced membrane damage | Communications Biology |10.1038/s42003-019-0297-6.

A paper published in the journal Communications Biology indicates that bacteria- as they become resistant to antibiotics- are able to produce stronger cell walls  which enables them to repel antibiotics and prevents effective treatment.

With the advent of polymyxin B (PmB) resistance in bacteria, the mechanisms for mcr-1 resistance are of crucial importance in the design of novel therapeutics. The mcr-1 phenotype is known to decrease membrane charge and increase membrane packing by modification of the bacterial outer membrane. We used X-ray diffraction, Molecular Dynamics simulations, electrochemistry, and leakage assays to determine the location of PmB in different membranes and assess membrane damage. By varying membrane charge and lipid tail packing independently, we show that increasing membrane surface charge promotes penetration of PmB and membrane damage, whereas increasing lipid packing decreases penetration and damage. The penetration of the PmB molecules is well described by a phenomenological model that relates an attractive electrostatic and a repulsive force opposing insertion due to increased membrane packing. The model applies well to several gram-negative bacterial strains and may be used to predict resistance strength (Source: Khondker et al).

Membrane charge and lipid packing determine polymyxin-induced membrane damage

In the news:

The Telegraph Bacteria develop tougher membranes to resist antibiotics, report into superbugs finds

Resevoirs of antimicrobial resistance

Houses of Parliament Parliamentary Office of Science & Technology | February 2019 | Resevoirs of antimicrobial resistance

Antimicrobial resistance (AMR) is a natural phenomenon but the spread of antimicrobial resistance is exacerbated by the widespread, and sometimes
inappropriate, use of antimicrobials in both human and veterinary medicine.

A new POSTnote from the Houses of Parliament Parliamentary Office of Science & Technology covers:

  • the spread of AMR in humans and animals;
  • the main reservoirs of AMR;
  • data for AMR in both humans and animals; and
  • future UK priorities in this area.

Resevoirs of antimicrobial resistance