Surgical site infections surveillance

Public Health England has published Surgical site infections in NHS hospitals in England 2014/15. This annual report covers surgical site infection (SSI) data collected by NHS hospitals and independent sector NHS treatment centres.  Data includes information on the number of operations performed, data quality, benchmarks, trends and risk factors. SSIs are also recorded by surgical category for each NHS Trusts in England.

How Hospitals Can Manage the Next Pandemic

Latest Health News

Falcone, R. et al. Emergency Medicine Reports. December 13, 2015

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Significant decrease in the incidence of orthopedic MRSA SSIs

  • A prevention bundle was implemented for orthopedic MRSA SSIs.
  • The bundle reinforced contact precaution and AMP stewardship.
  • The MRSA SSI rate correlated negatively with cefazolin AUD.
  • Prolonged AMP may increase the risk of MRSA SSI.
  • The bundle was associated with the decrease in the incidence of MRSA SSIs.

Full reference:Kawamura, H et al.A bundle that includes active surveillance, contact precaution for carriers, and cefazolin-based antimicrobial prophylaxis prevents methicillin-resistant Staphylococcus aureus infections in clean orthopedic surgery. American Journal of Infection Control. Available online 30 October 2015

 

Reducing health care-associated Clostridium difficile infection.

Clostridium difficile is the most frequent cause of health care–associated diarrhea and is a significant cause of morbidity and mortality.

A multidisciplinary task force, with the goal of reduction of Clostridium difficile infection (CDI) rates was formed; they instituted multiple, comprehensive interventions, including education of health care providers, proper environmental cleaning of rooms with CDI patients, and reduction in the use of fluoroquinolones.

These interventions were successful in reducing rates of health care–associated Clostridium difficile infection in the hospital.

Full reference: Waqar, S et al. Multidisciplinary performance improvement team for reducing health care–associated Clostridium difficile infection. American Journal of Infection Control 2015 Nov 3 [Epub ahead of print]

 

Infection prevention and central venous catheters: evidence round-up

By Sarah Chapman // November 27, 2015//Evidently Cochrane Blog

central venous catheters.PNG

Image source: evidentlycochrane.net

After the fascinating discussion we had, over 60 of us in a #WeNurses tweetchat, about the latest evidence on when to re-site peripheral venous catheters and whether it is reflected in current practice (catch up on it in this blog if you missed it), I’m turning my attention to central venous catheters (CVCs).

Infection prevention is of huge importance when it comes to vascular access devices. Micro-organisms can get into the bloodstream through the point where the skin has been penetrated and along the outer surface of the catheter, or internally through the catheter and its connectors. Minor infections at the entry site or in device connectors can lead to more serious bloodstream infections. The possible consequences include the whole gamut of infection-related miseries for the patient, including pain, anxiety, delayed treatments and a longer stay in hospital as well as greater demands on resources.

In the UK, the epic3 National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections should be informing practice, though I know from our tweetchat that some Trusts have policies that deviate from the recommendations. These guidelines draw on several Cochrane reviews and we also have some new and updated evidence since their publication in 2013. Here’s a round-up of Cochrane evidence. Does your practice reflect it?

Carry on reading via the Evidently Cochrane Blog

Infection prevention and control: lessons from acute care in England

Latest Health News

November 2015 | The Health Foundation

Infection control has been high on the political agenda and on the agenda of the NHS in England in recent years. There have been many successes, not least the reduction in MRSA bloodstream infections and cases of Clostridium difficile infection. However, other health care associated infections that have not been monitored as rigorously are growing in incidence. New infections, including the growing number of more resistant strains of bacteria, are in danger of spreading. As a result, infection control needs to remain central to the work of the NHS.

This learning report is based on the findings of a large research study that identified and consolidated published evidence about infection prevention and control initiatives. The researchers synthesised this with findings from qualitative case studies in two large NHS hospitals, including the perspectives of service users.

via Infection prevention and control: lessons from acute care in England | The…

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Antibiotic prescribing is higher in deprived areas of England | The BMJ

Latest Health News

BMJ 2015;351:h6117

Prescribing of antibiotics has fallen steadily over the past five years in England, but the gap in prescribing levels between the least and most deprived areas is widening, a new analysis indicates.

The charity Antibiotic Research UK and the data analysis company EXASOL used prescribing data released by the government’s Health and Social Care Information Centre on the number of antibiotic prescriptions written by GPs and subsequently dispensed between August 2010 and July 2015. From the data they produced a “heat map” showing the hotspots of antibiotic prescribing in England:

Exasol-Infographic_FINAL-121115-881x1235

via Antibiotic prescribing is higher in deprived areas of England | The BMJ.

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Model for Improvement reduced surgical site infections

An improvement collaborative implemented a care bundle to reduce surgical site infections amongst children. Over a two year period they used the Model for Improvement to develop and implement change. Organisations were encouraged to adopt all or part of the bundle. Support was provided through webinars, discussion boards, targeted messages to leaders and in-person training. Within six months, 97% of organisations were using the bundle reliably. There was a 21% reduction in surgical site infection rates, from an average of 2.5 per 100 procedures to 1.8 per 100 procedures. The reduction was sustained over the 15 month follow-up period.

Schaffzin JK, et al. Surgical site infection reduction by the Solutions for Patient Safety Hospital Engagement Network. Pediatrics. Nov;136(5)1353-60 2015.

An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial

The Lancet: Volume 386, No. 10004, p1631–1639, 24 October 2015

hand washing

Background
Handwashing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic. However, the role of handwashing is debated, and no good randomised evidence exists among adults in non-deprived settings. We aimed to assess whether an internet-delivered intervention to modify handwashing would reduce the number of RTIs among adults and their household members.

Methods
We recruited individuals sharing a household by mailed invitation through general practices in England. After consent, participants were randomised online by an automated computer-generated random number programme to receive either no access or access to a bespoke automated web-based intervention that maximised handwashing intention, monitored handwashing behaviour, provided tailored feedback, reinforced helpful attitudes and norms, and addressed negative beliefs. We enrolled participants into an additional cohort (randomised to receive intervention or no intervention) to assess whether the baseline questionnaire on handwashing would affect handwashing behaviour. Participants were not masked to intervention allocation, but statistical analysis commands were constructed masked to group. The primary outcome was number of episodes of RTIs in index participants in a modified intention-to-treat population of randomly assigned participants who completed follow-up at 16 weeks. This trial is registered with the ISRCTN registry, number ISRCTN75058295.

Findings
Across three winters between Jan 17, 2011, and March 31, 2013, we enrolled 20 066 participants and randomly assigned them to receive intervention (n=10 040) or no intervention (n=10 026). 16 908 (84%) participants were followed up with the 16 week questionnaire (8241 index participants in intervention group and 8667 in control group). After 16 weeks, 4242 individuals (51%) in the intervention group reported one or more episodes of RTI compared with 5135 (59%) in the control group (multivariate risk ratio 0·86, 95% CI 0·83–0·89; p<0·0001). The intervention reduced transmission of RTIs (reported within 1 week of another household member) both to and from the index person. We noted a slight increase in minor self-reported skin irritation (231 [4%] of 5429 in intervention group vs 79 [1%] of 6087 in control group) and no reported serious adverse events.

Interpretation
In non-pandemic years, an effective internet intervention designed to increase handwashing could have an important effect in reduction of infection transmission. In view of the heightened concern during a pandemic and the likely role of the internet in access to advice, the intervention also has potential for effective implementation during a pandemic.

via An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial – The Lancet.

Handwashing and community management of infections

 The Lancet: Volume 386, No. 10004, p1603–1604, 24 October 2015

Summary

Influenza has a strong potential to transfer from individual to individual, and encounters in everyday life play an important part in its diffusion in the population. Wherever people meet—at work, in shops, on public transport—there is the risk of transmission, suggesting that the community is the context in which protection against further spread has to be orchestrated. Vaccination, personal hygiene (including handwashing), and measures against crowding are recommended measures.1Primary care is important in influenza vaccination because it can reach large numbers of people at high risk of influenza complications and provide them with effective protection against the virus.

via Handwashing and community management of infections – The Lancet.