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

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.

Handwashing and community management of infections

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


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.

European Antibiotic Awareness Day

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The objective for the 2015 Antibiotic Guardian campaign is for at least 100,000 healthcare professionals and members of the public to have committed to at least one pledge for prudent use of antibiotics on the Antibiotic Guardian website.

Antibiotic Guardian

These letters are to the NHS, local authorities, professional organisations and universities to:

  • inform about Antibiotic Guardian
  • request the registration of planned activities

To help Public Health England (PHE) identify opportunities to promote events, avoid duplication of effort and help inform the annual EAAD evaluation report,PHE invites organisations to register planned activities for EAAD via the online registration form.

via European Antibiotic Awareness Day: letters to NHS, local authority and professional organisations – Publications – GOV.UK.

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Universal vs Risk Factor Screening for Methicillin-Resistant Staphylococcus aureus in a Large Multicenter Tertiary Care Facility in Canada

Infect. Control Hosp. Epidemiol. 2015;00(0):1–8


OBJECTIVE To assess the clinical effectiveness of a universal screening program compared with a risk factor–based program in reducing the rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) among admitted patients at the Ottawa Hospital.

DESIGN Quasi-experimental study.

SETTING Ottawa Hospital, a multicenter tertiary care facility with 3 main campuses, approximately 47,000 admissions per year, and 1,200 beds.

METHODS From January 1, 2006 through December 31, 2007 (24 months), admitted patients underwent risk factor–based MRSA screening. From January 1, 2008 through August 31, 2009 (20 months), all patients admitted underwent universal MRSA screening. To measure the effectiveness of this intervention, segmented regression modeling was used to examine monthly nosocomial MRSA incidence rates per 100,000 patient-days before and during the intervention period. To assess secular trends, nosocomial Clostridium difficile infection, mupirocin prescriptions, and regional MRSA rates were investigated as controls.

RESULTS The nosocomial MRSA incidence rate was 46.79 cases per 100,000 patient-days, with no significant differences before and after intervention. The MRSA detection rate per 1,000 admissions increased from 9.8 during risk factor–based screening to 26.2 during universal screening. A total of 644 new nosocomial MRSA cases were observed in 1,448,488 patient-days, 323 during risk factor–based screening and 321 during universal screening. Secular trends in C. difficile infection rates and mupirocin prescriptions remained stable after the intervention whereas population-level MRSA rates decreased.

CONCLUSION At Ottawa Hospital, the introduction of universal MRSA admission screening did not significantly affect the rates of nosocomial MRSA compared with risk factor–based screening.

Perceived barriers to infection prevention and control for nursing home certified nursing assistants: A qualitative study

Geriatric Nursing: Volume 36, Issue 5, September–October 2015, Pages 355–360

Healthcare-associated infections, while preventable, result in increased morbidity and mortality in nursing home (NH) residents. Frontline personnel, such as certified nursing assistants (CNAs), are crucial to successful implementation of infection prevention and control (IPC) practices.

The purpose of this study was to explore barriers to implementing and maintaining IPC practices for NH CNAs as well as to describe strategies used to overcome these barriers. We conducted a multi-site qualitative study of NH personnel important to infection control. Audio-recorded interviews were transcribed verbatim and transcripts were analyzed using conventional content analysis.

Five key themes emerged as perceived barriers to effective IPC for CNAs:

1) language/culture;

2) knowledge/training;

3) per-diem/part-time staff;

4) workload;

5) accountability.

Strategies used to overcome these barriers included: translating in-services, hands on training, on-the-spot training for per-diem/part-time staff, increased staffing ratios, and inclusion/empowerment of CNAs. Understanding IPC barriers and strategies to overcome these barriers may better enable NHs to achieve infection reduction goals.

via Perceived barriers to infection prevention and control for nursing home certified nursing assistants: A qualitative study.

Risk Factors for Invasive Methicillin-resistant Staphylococcus aureus Infection after Recent Discharge from an Acute Care Hospitalization, 2011-2013

Significant progress has been made in reducing methicillin-resistant Staphylococcus aureus (MRSA) infections among hospitalized patients. However, the decreases in invasive MRSA infections among recently discharged patients have been less substantial. We assessed risk factors for developing invasive MRSA infections following acute care hospitalizations to inform prevention strategies.

We conducted a prospective, matched case-control study. A case was defined as MRSA cultured from a normally sterile body site in a patient discharged from a hospital within the prior 12 weeks. Eligible cases were identified from 15 hospitals across 6 U.S. states. For each case, two controls were matched on hospital, month of discharge, and age group. Medical record reviews and telephone interviews were performed. Conditional logistic regression was used to identify independent risk factors for post-discharge invasive MRSA.

From February 1, 2011 through March 31, 2013, 194 cases and 388 matched controls were enrolled. The median time between hospital discharge and positive culture was 23 days (range: 1–83 days). Factors independently associated with post-discharge MRSA infection included MRSA colonization (mOR 7.71, 95%CI 3.60-16.51), discharge to a nursing home (mOR 2.65, 95%CI 1.41-4.99), presence of a chronic wound during the post-discharge period (mOR 4.41, 95%CI 2.14-9.09), and discharge with a central venous catheter (CVC) (mOR 2.16, 95%CI 1.13-4.99) or a non-CVC invasive device (mOR 3.03, 95%CI 1.24-7.39) in place.

Prevention efforts should target patients with MRSA colonization or those with invasive devices or chronic wounds at hospital discharge. In addition, MRSA prevention efforts in nursing homes are warranted.

Full reference: Epstein, L. et al Risk Factors for Invasive Methicillin-resistant Staphylococcus aureus Infection after Recent Discharge from an Acute Care Hospitalization, 2011-2013  Clinical Infectious Diseases. First published online: September 2015

Reducing infection transmission in the playroom: Balancing patient safety and family-centered care

Family-centered care requires that institutions develop strategies to allow sibling visitors to hospitalized children while reducing risks of infectious disease transmission. Most guidelines recommend that siblings not be permitted to visit playrooms. This approach was not seen as consistent with family-centered care in our setting; therefore, in a pilot project we developed an approach for screening siblings with cooperation of families, child life specialists, the care team, and the infection prevention and control service.

A literature review using CINAHL and PubMed databases from 2004-2014 did not uncover formal established methods for reducing playroom infectious disease exposures. Benchmarking with other Canadian centers revealed a diversity of approaches. Child life, the ward staff, and infection prevention and control at this center collaborated to develop a sibling screening strategy.

The collaborative approach led to a process based on a screening form that is introduced to the family during admission. The process requires the cooperation of the admitting nurse, parents, and child life staff. In the first 2 years of the project, approximately 10% of screened siblings had a potentially communicable illness.

A collaborative multidisciplinary approach based on family center care principles led to a process whereby siblings of hospitalized children can be allowed to visit playrooms, while reducing risk of infectious disease transmission.

Full reference: Ivany, A. et al. Reducing infection transmission in the playroom: Balancing patient safety and family-centered care. American Journal of Infection Control. published online September 2015