The Effect of Contact Precautions on Frequency of Hospital Adverse Events

Infection Control & Hospital Epidemiology: Published online 17 August 2015

OBJECTIVE To determine whether use of contact precautions on hospital ward patients is associated with patient adverse events

DESIGN Individually matched prospective cohort study

SETTING The University of Maryland Medical Center, a tertiary care hospital in Baltimore, Maryland

METHODS A total of 296 medical or surgical inpatients admitted to non–intensive care unit hospital wards were enrolled at admission from January to November 2010. Patients on contact precautions were individually matched by hospital unit after an initial 3-day length of stay to patients not on contact precautions. Adverse events were detected by physician chart review and categorized as noninfectious, preventable and severe noninfectious, and infectious adverse events during the patient’s stay using the standardized Institute for Healthcare Improvement’s Global Trigger Tool.

RESULTS The cohort of 148 patients on contact precautions at admission was matched with a cohort of 148 patients not on contact precautions. Of the total 296 subjects, 104 (35.1%) experienced at least 1 adverse event during their hospital stay. Contact precautions were associated with fewer noninfectious adverse events (rate ratio [RtR], 0.70; 95% confidence interval [CI], 0.51–0.95; P=.02) and although not statistically significant, with fewer severe adverse events (RtR, 0.69; 95% CI, 0.46–1.03; P=.07). Preventable adverse events did not significantly differ between patients on contact precautions and patients not on contact precautions (RtR, 0.85; 95% CI, 0.59–1.24; P=.41).

CONCLUSIONS Hospital ward patients on contact precautions were less likely to experience noninfectious adverse events during their hospital stay than patients not on contact precautions.

via Infection Control & Hospital Epidemiology – The Effect of Contact Precautions on Frequency of Hospital Adverse Events – Cambridge Journals Online.

NICE recommends a technology to reduce catheter infections which could save the NHS millions

NICE has recommended the use of a device to hold catheters in place securely and which reduces risk of catheter related infections – which could save the NHS up to £10 millon each year.

The medical technology guidance advises using the 3M Tegaderm CHG IV securement dressing for critically ill patients who need a central venous or arterial catheter in intensive care or high dependency units.  Catheters are thin tubes put into the body which can be used to deliver liquids such as antibiotics or other drugs, so avoiding the need for frequent needle injections.

Tegaderm CHG dressing is a sterile transparent semipermeable polyurethane adhesive dressing, with an integrated gel pad containing the antibacterial agent chlorhexidine gluconate (which is a widely used antiseptic and disinfectant).

The evidence considered showed that the Tegaderm CHG dressing offers better protection against catheter-related bloodstream infection than sterile semipermeable transparent dressings. If using the Tegaderm CHG dressing becomes standard practice, the reduction in infections has the potential to save the NHS in England an estimated £4million to £10million each year.

Full reference: The 3M Tegaderm CHG IV securement dressing for central venous and arterial catheter insertion sites

Community-acquired pneumonia

The Lancet: Published Online, 12 August 2015

Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide.

Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed.

Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria.

New approaches for fast clinical (lung ultrasound) and microbiological (molecular biology) diagnoses are promising.

Community-acquired pneumonia is associated with early and late mortality and increased rates of cardiovascular events.

Studies are needed that focus on the long-term management of pneumonia.

via Community-acquired pneumonia – The Lancet.

Respiratory tract infections: infection control

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Public Health England has published Infection control precautions to minimise transmission of acute respiratory tract infections in healthcare settings.  This document summarises recommendations for the prevention and control of acute respiratory infections in healthcare settings for clinical and public health colleagues.  The guidance explores transmission routes, hygiene and the use of personal protective equipment.  It replaces the HPA Version 1 guidance document of the same name, which was reviewed and updated in December 2014.

Understanding infection prevention and control in nursing homes: A qualitative study – Geriatric Nursing

July–August, 2015Volume 36, Issue 4, Pages 267–272


Infections have been identified as a priority issue in nursing homes (NHs). We conducted a qualitative study purposively sampling 10 NHs across the country where 6–8 employees were recruited (N = 73).

Semi-structured, open-ended guides were used to conduct in-depth interviews. Data were audiotaped, transcribed and a content analysis was performed.

Five themes emerged: ‘Residents’ Needs’, ‘Roles and Training’ ‘Using Infection Data,’ ‘External Resources’ and ‘Focus on Hand Hygiene.’ I

nfection prevention was a priority in the NHs visited. While all sites had hand hygiene programs, other recommended areas were not a focus and many sites were not aware of available resources. Developing ways to ensure effective, efficient and standardized infection prevention and control in NHs continues to be a national priority.

via Understanding infection prevention and control in nursing homes: A qualitative study – Geriatric Nursing.

A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system

American Journal of Infection Control: August 1, 2015 Volume 43, Issue 8, Pages 805–809

We assessed the effects of the components of a multifaceted and evidence-based caesarean-section surgical site infection (SSI) prevention program on the SSI rate after cesarean section using a postdischarge surveillance (PDS) system.

Multiple prevention interventions were serially implemented. SSI case finding was undertaken through active inpatient surveillance and intensive PDS using a standardized form at the 6-week postdischarge visit. SSI diagnosis was made using the Centers for Disease Control and Prevention standardized criteria. All cesarean deliveries between July 2007 and December 2012 were included. Changes in SSI rate were analyzed using segmented regression analysis.

Nine thousand four hundred forty-two cesarean sections were assessed during the study period. PDS forms were completed for 7,985 women (85%). SSI was detected in 451 cases (5.6%): 91% were superficial, 9% were deep/organ-space infections. The SSI rate decreased incrementally from 8.2% at baseline to 4.1%; significant decreases were observed after optimizing antibiotic prophylaxis timing, using a surgical safety checklist, and enhancing prenatal education to discourage prehospital self-removal of hair. Nonelective surgeries or those undertaken after >12 hours of rupture of membranes had a significantly higher rate compared with those without either risk factor (6.3% vs 3.2%; P < .001).

A multifaceted SSI prevention strategy, with periodic feedback of data, led to a significant reduction in SSI rates after cesarean section.

via A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system – American Journal of Infection Control.

Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis

BMJ 2015;351:h3728

Objective To evaluate the relative efficacy of the World Health Organization 2005 campaign (WHO-5) and other interventions to promote hand hygiene among healthcare workers in hospital settings and to summarize associated information on use of resources.

Design Systematic review and network meta-analysis.

Data sources Medline, Embase, CINAHL, NHS Economic Evaluation Database, NHS Centre for Reviews and Dissemination, Cochrane Library, and the EPOC register (December 2009 to February 2014); studies selected by the same search terms in previous systematic reviews (1980-2009).

Review methods Included studies were randomised controlled trials, non-randomised trials, controlled before-after trials, and interrupted time series studies implementing an intervention to improve compliance with hand hygiene among healthcare workers in hospital settings and measuring compliance or appropriate proxies that met predefined quality inclusion criteria. When studies had not used appropriate analytical methods, primary data were re-analysed. Random effects and network meta-analyses were performed on studies reporting directly observed compliance with hand hygiene when they were considered sufficiently homogeneous with regard to interventions and participants. Information on resources required for interventions was extracted and graded into three levels.

Results Of 3639 studies retrieved, 41 met the inclusion criteria (six randomised controlled trials, 32 interrupted time series, one non-randomised trial, and two controlled before-after studies). Meta-analysis of two randomised controlled trials showed the addition of goal setting to WHO-5 was associated with improved compliance (pooled odds ratio 1.35, 95% confidence interval 1.04 to 1.76; I2=81%). Of 22 pairwise comparisons from interrupted time series, 18 showed stepwise increases in compliance with hand hygiene, and all but four showed a trend for increasing compliance after the intervention. Network meta-analysis indicated considerable uncertainty in the relative effectiveness of interventions, but nonetheless provided evidence that WHO-5 is effective and that compliance can be further improved by adding interventions including goal setting, reward incentives, and accountability. Nineteen studies reported clinical outcomes; data from these were consistent with clinically important reductions in rates of infection resulting from improved hand hygiene for some but not all important hospital pathogens. Reported costs of interventions ranged from $225 to $4669 (£146-£3035; €204-€4229) per 1000 bed days.

Conclusion Promotion of hand hygiene with WHO-5 is effective at increasing compliance in healthcare workers. Addition of goal setting, reward incentives, and accountability strategies can lead to further improvements. Reporting of resources required for such interventions remains inadequate.

via Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis | The BMJ.

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

The Lancet: Published Online: 06 August 2015

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.

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.

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.

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.