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.
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%.
Hickey, S. The Guardian. Published online: 15 May 2016.
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.”
Costa, D.K. et al. American Journal of Infection Control. Published online: 12 May 2016
We 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.
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.
Arntz, P.R.H. et al. American Journal of Infection Control. Published online: 6 May 2016
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.