GPs cut antibiotic prescriptions by 2.6m in just one year

NHS Improvement says overall reduction in antibiotic prescriptions of 7.3% in just one year

https://www.flickr.com/photos/scelera/2307998410/in/photolist-4vX6w3-cU1qG7-5EqxEo-M83S3-6QyKwT-BvuhSP-fqthsg-4EffHJ-5Kzyxq-6QyKy8-54fAvn-DqUeq-29HnZx-8LykH1-fqtcKe-99m2RD-bnfvn-7Zskpt-nLFuq8-dyVHY7-5v9nZP-B5gxH4-bwN6kR-oFVkb6-fQGpp-9K1YGB-ftEPGV-4hkdao-HadHr-hNRiZ-t1cg-oM2jcH-9jo4R7-8tPiUM-nCRq68-5PSqeY-oFV6cf-nqpbiW-oWnvGE-s3KiYu-s3Kj1J-s3JcrG-aiLRoc-f5nMLV-oYnCzw-baMGGn-5zR7dG-rovDFp-4bZ3hV-78bda7/
image source: samantha celera – Flickr//CC BY-ND 2.0

The number of antibiotics being prescribed to patients by GPs in England has fallen significantly according to latest figures.

NHS Improvement say prescriptions for all types of the drug were down by more than 2.6m, compared with last year, to about 34m in 2015-16.

Heralding the drop as a “fantastic result” the health watchdog said the figures showed doctors were being careful not to over-prescribe antibiotics, the BBC reported.

More from  NHS Improvement here

BBC News: GPs praised for ‘dramatic’ cut in antibiotic prescriptions

Antimicrobial Resistance Review recommendations

The Review on Antimicrobial Resistance has published its final recommendation in the document Tackling drug-resistant infections globally: final report and recommendations.

antim
image source: http://amr-review.org/

This report discusses the problem of resistance; why action is needed; and provides an overview of the solutions that should be implemented.  It also examines the role of public awareness campaigns; the need to improve sanitation and hygiene; the introduction of rapid diagnostics and vaccines; how these solutions can be funded; and ways to build political consensus around them.

Additional links:

NICE News report      BBC News report

What should we do NOW? Review of a large NHS Trust’s meticillin-resistant Staphylococcus aureus screening

Smith, S.J. et al.Journal of Hospital Infection. Published online: 13 May 2016

Universal meticillin-resistant Staphylococcus aureus (MRSA) screening has been in effect since 2010. MRSA bacteraemia rates have declined substantially, with continuing low MRSA prevalence in hospitals.1 In 2013, the UK Department of Health (DH) commissioned a review of MRSA screening ‒ The National One Week prevalence audit (NOW) ‒ which reviewed the cost-effectiveness of a variety of screening strategies.2Modelling studies determined that the current practice of universal MRSA screening was the least cost-effective and that current compliance with screening was low at 65.7%.

Read the abstract here

 

The innovators: Irish lab develops coating to ward off superbug

Hickey, S. The Guardian. Published online: 15 May 2016.

http://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=26&_IXSR_=Y1PTh2TptHP&_IXSS_=_IXFPFX_%3dtemplates%252ft%26_IXMAXHITS_%3d250%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26_IXFIRST_%3d1%26%252asform%3dwellcome%252dimages%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26%3d%26_IXrescount%3d108%26_IXINITSR_%3dy%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26_IXshc%3dy%26%2524%253ds%3de%2bcoli&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft
Image source: David Gregory & Debbie Marshall – Wellcome Images // CC BY-NC-ND 4.0

Image shows electron micrograph of Escherichia coli.

Infections such as MRSA which have developed resistance to drugs have become a notorious threat in hospitals, where the bacteria can survive on surfaces for up to seven months. But a new discovery by scientists in Ireland could soon be working to combat them.

A research team led by Prof Suresh Pillai has developed a coating for everyday objects that prevents the spread of MRSA and E coli bacteria. The coating, which can be used on items such as smartphones, door handles and remote controls as well as surgical surfaces, has a 99.99% success rate in killing the bugs.

John Browne, the chief executive of Dublin-based company Kastus, which is working to commercialise the solution, says: “It is very hard to get rid of these things once they are there. Some studies have shown that with a deep clean on an [intensive care unit] ward where there is a critical care bed in one room … the entire room is cleaned with bleach over a 24-hour period and the bacteria are back on the surface within 24 hours.”

Read the full commentary here

Read the original research article here

The critical care nurse work environment, physician staffing, and risk for ventilator-associated pneumonia

Costa, D.K. et al. American Journal of Infection Control. Published online: 12 May 2016

11556-2We examined the relationship between intensivist physician staffing, nurse work environment, and ventilator-associated pneumonia (VAP) in 25 intensive care units. We found a significant interaction between the nurse work environment, intensivist physician staffing, and VAP. Future work may need to focus on fostering organizational collaboration between nursing and medicine to leverage skills of both clinician groups to reduce risk for VAP in critically ill patients.

Read the abstract here

Cardiac surgery, nosocomial infection, and the built environment

Sommerstein, R. et al.Journal of Hospital Infection. Published online: 10 May 2016

Heater‒cooler units (HCUs) have received considerable attention from an infection prevention viewpoint in the last two years, as their water reservoir has been linked to healthcare-associated outbreaks. Ten cases of Mycobacterium chimaera infection associated with contaminated HCUs have been described in the literature and the suspected transmission pathway by air was recently substantiated.2,3 Götting et al. now report on the difficulties of physically separating the HCU in order to divert contaminated HCU exhaust air from the surgical field and how they relied on non-fermenters as surrogate micro-organism ‒ despite their unknown significance.

Read the abstract here

Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department

Arntz, P.R.H. et al. American Journal of Infection Control. Published online: 6 May 2016

10059-2

Highlights:

  • A total of 1,007 opportunities for handrubs were recorded in the emergency department. Hand hygiene (HH) compliance increased significantly (P < .001) after the first intervention week to 40.5% (95% confidence interval [CI], 33%-48%) and stabilized (P = .075) after the second intervention week to 49.5% (95% CI, 43%-56%).
  • The total number of alcohol dispensers was increased from 25 to 55. Within every 5-m radius in the emergency department an alcohol dispenser was placed. Existing alcohol-based handrub was switched for a different brand for its proven skin friendliness.
  • Profession-specific analysis revealed a significant increase over the phases of the study in both subgroups, the physicians and nurses.
  • Regarding the frequency of hand hygiene indications, indication 4 (hand hygiene after touching a patient) composed most indications (31.6%). The increase of compliance applied for all indications; the highest and lowest relative improvements appeared to be indication 3, after contact with body fluids (700% of baseline), and indication 4, after patient contact (136% of baseline), respectively.
  • During the baseline observations, the effect of the time of day (day vs evening and week vs weekend) and the type of patient (surgical patients vs patients with infection vs others without infection) showed no significant effect on hand hygiene compliance.

Read the abstract here

Association of increased influenza vaccination in health care workers with a reduction in nosocomial influenza infections in cancer patients

Frenzel, E. et al. American Journal of Infection Control. Published online: 5 May 2016

B0004738 Immunising the population
Image source: Barbara Bellingham – Wellcome Images // CC-BY-NC-ND 4.0

Highlights: 

  • We applied a multifaceted influenza vaccination program in a cancer center.
  • Mandatory influenza vaccination program effectively increased health care worker vaccination rates.
  • Improvement in health care worker vaccination rates reduced the proportion of nosocomial infections.

Background: Vaccination of health care workers (HCWs) remains a key strategy to reduce the burden of influenza infections in cancer patients.

Methods: In this 8-year study, we evaluated the effect of a multifaceted approach, including a mandatory influenza vaccination program, on HCW vaccination rates and its effect on nosocomial influenza infections in cancer patients.

Results: The influenza vaccination rate of all employees significantly increased from 56% (8,762/15,693) in 2006-2007 to 94% (17,927/19,114) in 2013-2014 (P < .0001). The 2009 mandatory participation program increased HCW vaccination rates in the targeted groups (P < .0001), and the addition of an institutional policy in 2012 requiring influenza vaccination or surgical mask use with each patient contact further increased vaccination rates by 10%-18% for all groups in 1 year. The proportion of nosocomial influenza infections significantly decreased (P = .045) during the study period and was significantly associated with increased HCW vaccination rates in the nursing staff (P = .043) and in personnel working in high-risk areas (P = .0497).

Conclusions: Multifaceted influenza vaccination programs supported by institutional policy effectively increased HCW vaccination rates. Increased HCW vaccination rates were associated with a reduction in the proportion of nosocomial influenza infections in immunocompromised cancer patients.

Read the abstract here

Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff

Verbeek,J.H. et al. Cochrane Database of Systematic Reviews.2016, Issue 4.

Clothes and equipment for healthcare staff to prevent Ebola and other highly infective diseases

NHS Framework Documant 2008

Healthcare staff are at much greater risk of infections such as Ebola Virus Disease or SARS than people in general. One way of preventing infection is to use personal protective equipment, such as protective clothing, gloves, masks, and goggles to prevent contamination of the worker. It is unclear which type of equipment protects best and how it can best be removed after use. It is also unclear what is the best way to train workers to comply with guidance for this equipment.

Studies found

We found six studies with 295 participants in which workers’ protective clothing was sprayed with a fluorescent marker or a harmless virus to simulate what happens in hospitals. Four of these compared different types of protective clothing. Two studies compared different ways of putting clothing on and taking it off. Three studies with 905 participants compared the effect of active training on the use of protective equipment to passive training. All studies had a high risk of bias.

Various types of clothing compared

In spite of protective clothing, the marker was found on the skin of 25% to 100% of workers. In one study, more breathable clothing did not lead to more contamination than non-breathable clothing, but users were more satisfied. Gowns led to less contamination than aprons in another study. Two studies did not report enough data to enable conclusions. This evidence was of very low quality.

Various types of removal of clothing compared

In one study, two pairs of gloves led to less contamination than only one pair of gloves. The outer gloves were immediately removed after the task was finished. In another study, following CDC guidance for apron or gown removal led to less contamination. This evidence was also of very low quality.

Active training

Active training, including computer simulation and spoken instructions, led to less errors with guidance on which protection to use and how to remove it among healthcare staff compared to passive training.

Quality of the evidence

We judged the quality of the evidence to be very low because of limitations in the studies, indirectness and small numbers of participants.

What do we still need to find out?

There were no studies on the effects of goggles, face shields, long-sleeved gloves or taping on the risk of contamination. We need simulation studies with several dozens of participants, preferably using exposure to a harmless virus, to find out which type and combination is most protective. The best way to remove protective clothing after use is also unclear. We need studies that use chance to assign workers to different types of training to find out which training works best. Healthcare staff exposed to highly infectious diseases should have their protective equipment registered and be followed for their risk of infection. We urge WHO and NGOs to organise more studies.

Read the full article here

Methicillin-resistant Staphylococcus aureus in palliative care

Schmalz, O. et al. Palliative Medicine. Published online: 29 April 2016.

http://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=19&_IXSR_=mqwtZvCUUo5&_IXSS_=_IXMAXHITS_%3d250%26_IXFPFX_%3dtemplates%252ft%26_IXFIRST_%3d1%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26%252asform%3dwellcome%252dimages%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26i_pre%3d%26IXTO%3d%26t%3d%26_IXINITSR_%3dy%26i_num%3d%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26w%3d%26%2524%253ds%3dmrsa%26IXFROM%3d%26_IXSUBMIT_%3dSubmit%26_IXshc%3dy%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26_IXrescount%3d22&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft
Image source: Milos Kalab – Wellcome Images // CC BY-NC-ND 4.0

Image shows enhanced scanning electron micrograph of Staphylococcus aureus

Background: Methicillin-resistant Staphylococcus aureus is a common organism in hospitals worldwide and is associated with morbidity and mortality. However, little is known about the prevalence in palliative care patients. Furthermore, there is no standardized screening protocol or treatment for patients for whom therapy concentrates on symptom control.

Aim: Examining the prevalence of methicillin-resistant Staphylococcus aureus in palliative care patients as well as the level of morbidity and mortality.

Design: We performed a prospective study where methicillin-resistant Staphylococcus aureus screening was undertaken in 296 consecutive patients within 48 h after admission to our palliative care unit. Medical history was taken, clinical examination was performed, and the Karnofsky Performance Scale and Palliative Prognostic Score were determined. Prevalence of Methicillin-resistant Staphylococcus aureus was compared to data of general hospital patients.

Results: In total, 281 patients were included in the study having a mean age of 69.7 years (standard deviation = 12.9 years) and an average Karnofsky Performance Scale between 30% and 40%. The mean length of stay was 9.7 days (standard deviation = 7.6 days). A total of 24 patients were methicillin-resistant Staphylococcus aureus positive on the first swab. Median number of swabs was 2. All patients with a negative methicillin-resistant Staphylococcus aureus swab upon admission remained Methicillin-resistant Staphylococcus aureus negative in all subsequent swabs.

Conclusion: Our study suggests that the prevalence of Methicillin-resistantS taphylococcus aureus among patients in an in-hospital palliative care unit is much higher than in other patient populations.

Read the abstract here