Hand Hygiene in Intensive Care Units: A Matter of Time?

Stahmeyer, J.T. The Journal of Hospital Infection. Published online: January 28, 2017

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Background: Healthcare-associated infections are a frequent threat to patient safety and cause significant disease burden. The most important single preventive measure is hand hygiene (HH). Barriers to adherence with HH recommendations include structural aspects, knowledge gaps, and organizational issues, especially a lack of time in daily routine.

Conclusion: Complying with guidelines is time consuming. Sufficient time for HH should be considered in staff planning.

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Effects of control interventions on Clostridium difficile infection in England

Dingle, K.E. et al. The Lancet Infectious Diseases. Published online: 24 January 2017

A colour-enhanced scanning electron micrograph image showing a cluster of Clostridium difficile on a surface.
Image source: Annie Cavanagh – Wellcome Images // CC BY-NC-ND 4.0

A colour-enhanced scanning electron micrograph image showing a cluster of Clostridium difficile on a surface.

Background: The control of Clostridium difficile infections is an international clinical challenge. The incidence of C difficile in England declined by roughly 80% after 2006, following the implementation of national control policies; we tested two hypotheses to investigate their role in this decline. First, if C difficile infection declines in England were driven by reductions in use of particular antibiotics, then incidence of C difficile infections caused by resistant isolates should decline faster than that caused by susceptible isolates across multiple genotypes. Second, if C difficile infection declines were driven by improvements in hospital infection control, then transmitted (secondary) cases should decline regardless of susceptibility.

Interpretation: Restricting fluoroquinolone prescribing appears to explain the decline in incidence of C difficile infections, above other measures, in Oxfordshire and Leeds, England. Antimicrobial stewardship should be a central component of C difficile infection control programmes.

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Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework

Iwami M. et al. (2017) BMJ Open. 7:e012520

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Objective: (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice.

Results: National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management.

Conclusions: For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings.

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Screening test recommendations for methicillin-resistant Staphylococcus aureus surveillance practices

Whittington, M.D. et al. American Journal of Infection Control. Published online: 23 January 2017

Highlights: 

  • Rapid screening tests reduce unnecessary surveillance costs.
  • Using polymerase chain reaction with universal preemptive isolation minimizes total costs.
  • Using chromogenic agar 24-hour with targeted isolation minimizes total costs.
  • Although polymerase chain reaction minimized inappropriate costs, the added cost per test was only offset with universal preemptive isolation.

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Oral care in ventilated intensive care unit patients

Diaz, T.L. et al. American Journal of Infection Control. Published online: 23 January 2017

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Highlights:

  • A quality improvement project was developed to evaluate the pre/post effects of standardized placement and supply of oral care equipment in patient rooms.
  • Daily audits were performed to assess nursing behavior related to the performance of oral care on intubated patients with components from a 24 hour kit.
  • Increasing supply and creating uniform placement of oral care tools in patient rooms contributes to increased performance of oral hygiene interventions by nurses.

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Record numbers of NHS frontline staff have had flu jab this winter

Record numbers of NHS staff have had their flu jab this winter, official figures from Public Health England (PHE) show | OnMedica

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Some 594,700 (61.8%) frontline NHS staff across England were vaccinated against flu between 1 September and 31 December last year. That figure is expected to increase in January and February.

The highest level achieved by the end of February in previous winters was 541,757 (just under 55%) in 2014-15.

PHE does not have recorded numbers of deaths from flu. But it is estimated that, in 2015-16, there were about 2,300 excess deaths over the winter linked to the time of year. Flu and extreme cold weather are the two most likely causes.

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Identification badge lanyards as infection control risk

Murphy, C.M. et al. Journal of Hospital Infection. Published online: 20 January 2017

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Staphylococcus aureus cultures from name badge lanyards were phenotypically and genotypically indistinguishable from the wearer’s nasal carrier strains by pulsed field gel electrophoresis and antibiogram. Lanyards had a mean age of 22 months and hygiene was poor with only 9 % ever having been laundered. Molecular analysis showed that 26% of S. aureus nasal carriers shared an indistinguishable strain on their lanyard. Lanyards should not be recommended for staff in frontline clinical care.

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Supporting better decision making for acute infection management in secondary care

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Background

The inappropriate use of antimicrobials drives antimicrobial resistance. We conducted a study to map physician decision-making processes for acute infection management in secondary care to identify potential targets for quality improvement interventions.

Methods

Physicians newly qualified to consultant level participated in semi-structured interviews. Interviews were audio recorded and transcribed verbatim for analysis using NVIVO11.0 software. Grounded theory methodology was applied. Analytical categories were created using constant comparison approach to the data and participants were recruited to the study until thematic saturation was reached.

Results

Twenty physicians were interviewed. The decision pathway for the management of acute infections follows a Bayesian-like step-wise approach, with information processed and systematically added to prior assumptions to guide management. The main emerging themes identified as determinants of the decision-making of individual physicians were (1) perceptions of providing ‘optimal’ care for the patient with infection by providing rapid and often intravenous therapy; (2) perceptions that stopping/de-escalating therapy was a senior doctor decision with junior trainees not expected to contribute; and (3) expectation of interactions with local guidelines and microbiology service advice. Feedback on review of junior doctor prescribing decisions was often lacking, causing frustration and confusion on appropriate practice within this cohort.

Conclusion

Interventions to improve infection management must incorporate mechanisms to promote distribution of responsibility for decisions made. The disparity between expectations of prescribers to start but not review/stop therapy must be urgently addressed with mechanisms to improve communication and feedback to junior prescribers to facilitate their continued development as prudent antimicrobial prescribers.

Full reference: Timothy Miles Rawson, T. M. et al: Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study BMC Medicine 2016 14:208

Bloodstream infections are the most common type of HCI in neonates, children, and adolescents

Zingg, W. et al. The Lancet Infectious Diseases. Published online: 12 January 2017

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Image source: ‘EM Unit, UCL Medical School, Royal Free Campus’ – Wellcome Images // CC BY-NC-ND 4.0

Background: In 2011–12, the European Centre for Disease Prevention and Control (ECDC) held the first Europe-wide point-prevalence survey of health-care-associated infections in acute care hospitals. We analysed paediatric data from this survey, aiming to calculate the prevalence and type of health-care-associated infections in children and adolescents in Europe and to determine risk factors for infection in this population.

Findings: We analysed data for 17 273 children and adolescents from 29 countries. 770 health-care-associated infections were reported in 726 children and adolescents, corresponding to a prevalence of 4·2% (95% CI 3·7–4·8). Bloodstream infections were the most common type of infection (343 [45%] infections), followed by lower respiratory tract infections (171 [22%]), gastrointestinal infections (64 [8%]), eye, ear, nose, and throat infections (55 [7%]), urinary tract infections (37 [5%]), and surgical-site infections (34 [4%]). The prevalence of infections was highest in paediatric intensive care units (15·5%, 95% CI 11·6–20·3) and neonatal intensive care units (10·7%, 9·0–12·7). Independent risk factors for infection were age younger than 12 months, fatal disease (via ultimately and rapidly fatal McCabe scores), prolonged length of stay, and the use of invasive medical devices. 392 microorganisms were reported for 342 health-care-associated infections, with Enterobacteriaceae being the most frequently found (113 [15%]).

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Hospital-wide chlorhexidine gluconate bed bathing protocol

Reese, S.M. et al. American Journal of Infection Control. Published online: 5 January 2017

The objective of this study was to determine understanding of bed bathing practices over time after the implementation of a standardized bed bathing protocol. An online survey addressing bathing practices was administered preintervention and 6 and 18 months postintervention to all nurses and technicians caring for adult patients. Survey responses suggested that the intervention resulted in sustained understanding of the standardized bed bathing protocol.

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