Leadership and management for infection prevention and control. What do we have and what do we need?

Gould, D.J. et al. The Journal of Hospital Infection. Published online: 16 July 2016

chess-316658_960_720Leadership is widely considered to be vital for infection prevention and control (IPC).1 Its purpose is to maintain progress reducing risks of healthcare-associated infections especially those caused by antimicrobial-resistant organisms, and to achieve continuous quality improvement.2 But given its importance there is little rigorous research on effective leadership for IPC. While there is indirect evidence that IPC experts and clinicians working at the frontline of patient care can assume leadership, almost nothing has been written about IPC leadership at senior level.

Read the abstract here

Infection prevention and control in the paediatric setting: the challenges

Winzor, G. & Cooke, R.P.D. Journal of Hospital Infection. Published online: 27 July 2016
Infection prevention and control (IPC) practices within the paediatric setting pose many unique challenges which are often linked to a lack of paediatric specific research. The short report in this issue of the JHI by Araujo da Silva et al1 highlights a lack of quality studies and practice recommendations for paediatric IPC.
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Assessment of a multimodal intervention for the prevention of catheter-associated urinary tract infections

Ternavasio-de la Vega, H.G. et al. The Journal of Hospital Infection. Published online: July 25 2016

Background and objectives: Catheter-associated urinary tract infections (CAUTIs) represent an important health care burden. We assessed the effectiveness of an evidence-based multimodal multidisciplinary intervention intended to improve outcomes by reducing the use of urinary catheters (UCs) and minimizing the incidence of CAUTIs in the Internal Medicine department of a university hospital.

Material and methods: A multimodal intervention was developed, including training sessions, urinary catheterization reminders, surveillance systems, and mechanisms for staff feedback of results. The frequency of UC use and incidence of CAUTIs were recorded in 3-month periods before (P1) and during the intervention (P2).

Results: The catheterization rate decreased significantly during P2 (27.8% vs. 16.9%; relative risk [RR]: 0.61; 95% confidence interval [95% CI]: 0.57-0.65). We also observed a reduction in CAUTI risk (18.3 vs. 9.8%; RR: 0.53; 95% CI: 0.30-0.93); a reduction in the CAUTI rate per 1000 patient-days (5.5 vs. 2.8; incidence ratio [IR]: 0.52; 95% CI: 0.28-0.94); and a non-significant decrease in the CAUTI rate per 1000 catheters-days (19.3 vs. 16.9; IR: 0.85; 95% CI: 0.46-1.55).

Conclusions: The multimodal intervention was effective in reducing the catheterization rate and the frequency of CAUTIs.

Read the abstract here

A Comprehensive Review of Common Respiratory Infections Encountered in Urgent and Primary Care

Beam, C. et al. Journal of Emergency Nursing. Published online: July 21 2016

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Image shows digitally colorized electron micograph of influenza virions 

Concern about antibiotic overuse has become heightened as bacterial resistance to antibiotics continues to increase. Patients experiencing respiratory symptoms frequently present to urgent/emergent care settings such as fast-track emergency care departments and primary care retail settings with the expectation that they will be prescribed antibiotics.

The Centers for Disease Control and Prevention (CDC) reports that approximately 2 million people will become ill with bacteria that are resistant to at least one antibiotic, approximately 23,000 people die as a direct result of these infections, and many others die as a result of complications related to antibiotic-resistant infections.

Read the abstract here

Meningococcal disease programme information

Public Health England | 19 July 2016

PHE has published ‘Meningococcal ACWY Immunisation Programme for Adolescents: Information for health care professionals‘. Originally published in July 2015 this document has been updated and includes details on: the purpose of the programme, who the vaccine is recommended for; when vaccines will be available to order and how to administer the vaccine.

Measles vaccination advice for young adults

Measles cases continue to be confirmed in teenagers and young adults across England. | Public Health England

Public Health England (PHE) is advising young adults to ensure they have received two doses of MMR vaccine. .

Measles can be more severe in teenagers and adults and some may need hospital treatment. Measles is also extremely infectious and summer events like music festivals and fairs where people are mixing closely with each other provide the ideal place for the infection to spread.

The vaccine also protects against other serious illnesses including mumps. Anyone who is unsure of their vaccination status should contact their GP practice to make an appointment.

Dr Gayatri Amirthalingam, measles expert for PHE, explains the importance of being immunised against measles:

NICE guidance: sepsis

B0006171 Streptococcal pyrogenic exotoxin A1
Image shows Streptococcus pyogenes. This is a bacterial superantigen capable of causing toxic shock. Source: K R Acharya, Wellcome Images // CC BY-NC-ND 4.0

NICE has published new guidance Sepsis: recognition, diagnosis and early management (NG51). This guideline covers the recognition, diagnosis and early management of sepsis for all populations. The guideline committee identified that the key issues to be included were: recognition and early assessment, diagnostic and prognostic value of blood markers for sepsis, initial treatment, escalating care, identifying the source of infection, early monitoring, information and support for patients and carers, and training and education.

The UK Sepsis Trust will support release of the NICE Clinical Guideline on sepsis with tools and resources including screening and action tools to aid with early identification and management of sepsis in children and adults (including in pregnancy) across community-based, prehospital and acute clinical environments.

Related: NICE pathway: Sepsis

Open and closed models of intensive care unit have different influences on infectious complications in a tertiary care center

El-Kersh, K. et al.American Journal of Infection Control. Published online: 7 July 2016

Infectious complications in the intensive care unit (ICU) are associated with higher morbidity, mortality, and increased health care use. Here, we report the results of implementing 2 different models (open vs closed) on infectious complications in the ICU.

The closed ICU model was associated with 52% reduction in ventilator-associated pneumonia rate (P = .038) and 25% reduction in central line-associated bloodstream infection rate (P = .631).

We speculate that a closed ICU model allows clinical leadership centralization that further facilitates standardized care delivery that translates into fewer infectious complications.

Read the abstract here

NHS Behind the Headlines – Reduced antibiotic prescribing did not raise serious infection rates

NHS Choices. Published online: July 7 2016

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“Surgeries that handed out the fewest pills do not have higher rates of serious illnesses,” the Daily Mail reports.

A new study looked at the impact of prescribing patterns of antibiotics by GPs. The researchers were particularly interested in seeing what happened in practices where GP’s did not usually prescribe antibiotics for what are known as self-limiting respiratory tract infections (RTIs).

This cohort study aimed to determine whether the incidence of some diseases was higher in general practices that prescribe fewer antibiotics for self-limiting respiratory tract infections (RTIs).

It found that alongside reductions in the rate of antibiotics prescribed, rates of incidence for peritonsillar abscesses, mastoiditis and meningitis declined. Pneumonia showed a slight increase and no clear change was observed for empyema and intracranial abscesses.

The study had a good sample size, and represented the UK population well in terms of age and sex. However, there are a few points to note:

  • As the researchers acknowledged, the study observed outcomes from a population perspective and therefore was unable to deal with variations in prescription at the individual doctor or patient level.
  • This study only looked at data collected from GP surgeries, and prescription and infection incidence rates may be higher in emergency departments or out-of-hours practices which this study was not able to capture.
  • Finally, due to its study design, these findings can’t confirm cause and effect. It is possible that unmeasured confounders influenced the reported associations.

The researchers hope these findings will potentially be used in the context of wider communication strategies to promote and support the appropriate use of antibiotics by GPs.

Patients can also help by not pressuring GPs for antibiotics “just in case” they may need them.

Read the full analysis here

Read the original research article here

Prevention of ventilator-associated pneumonia: Use of the care bundle approach

Alcan, A.O. et al. American Journal of Infection Control. Published online: 4 July 2016

Highlights

  • Ventilator-associated pneumonia is one of the most common nosocomial infections for critical care patients.
  • This study investigates the effect of using the care bundle on ventilator-associated pneumonia rates.
  • Implementation of the care bundle through nurse education is effective at reducing the rate of ventilator-associated pneumonia.

B0007348 Streptococcus pneumoniae
Image source: Debbie Marshall – Wellcome Images // CC BY-NC-ND 4.0 

Image shows colour enhanced scanning electron micrograph of a colony of Streptococcus pneumoniae

Background: The ventilator-associated pneumonia (VAP) care bundle consists of evidence-based practices to improve the outcomes of patients receiving mechanical ventilatory therapy. This study aimed to investigate the implementation of the care bundle on VAP rates in this quasiexperimental study.

Methods: The protocol of this study consisted of 3 phases. In the initial phase, observations were made to determine the VAP care bundle adherence of intensive care unit (ICU) nurses. In the second phase, education was provided to ICU nurses on the subject of the VAP care bundle. For the third phase, the effect of VAP care bundle adherence on the VAP rates after education was investigated.

Results: The nurses’ VAP care bundle adherence improved after education from 10.8% (n = 152) to 89.8% (n = 1,324) and showed statistically significant improvement (P = .0001 and P < .05). In this study, the VAP rates were determined as 15.91/103 ventilator-days before education and 8.50/103 ventilator days after education. It was found that the VAP rates after the education period were significantly lower than the VAP rates before education.

Conclusion: VAP care bundle implementation with education prepared according to evidence-based guidelines decreased VAP rates. Thus, implementation of the VAP care bundle on mechanically ventilated patients care is recommended.

Read the abstract here