An audit of Caesarean section surgical site infections with single-use negative pressure wound therapy

Searle, R. & Myers, D. The Journal of Hospital Infection. Published online: February 28, 2017

This article reports audit data from the introduction of a new single-use negative pressure wound therapy system (PICO) for Caesarean section (CS) patients with high body mass index (BMI) in four hospitals in the UK and Ireland. PICO was used on closed surgical incisions following CS in 399 patients with BMI≥35. 36/399 patients (9.0%) developed signs of SSI, a rate lower than a previously reported incidence of 19.3% in a similar population. The readmission incidence was 0.8%. Therefore the use of PICO on closed surgical incisions may be associated with low incidence of SSI and readmission in this high-risk group.

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Comparing Non-Safety to Safety Device Sharps Injury Incidence Data

Mitchell, A.H. et al. The Journal of Hospital Infection. Published online: 26 February 2017

The United States Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard as amended by the Needlestick Safety and Prevention Act requiring the use of safety-engineered medical devices to prevent needlesticks and sharps injuries has been in place since 2001. Injury changes over time include differences between those from non-safety compared to safety-engineered medical devices.

This research compares 2 US occupational incident surveillance systems to determine if these data can be generalized to other facilities and other countries either with legislation in place or considering developing national policies for the prevention of sharps injuries among healthcare personnel.

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Improving the catheter associated UTI rate in an intensive care unit

Galiczewski, J.M. & Shurpin, K.M. Intensive and Critical Care Nursing. Published online: 22 February 2017

Background: Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality.

Aim: The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates.

Conclusion: The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes.

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Collaboration with an infection control team for patients with infection after spine surgery

Kobayashi, K. et al. American Journal of Infection Control. Published online: 22 February 2017

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Highlights: 

  • The risk of infection after spine surgery has increased due to aging of society.
  • An infection control team (ICT) manages infected cases at our hospital.
  • The ICT guided use of antibiotics in 30 cases and investigated infection in 10.
  • The bacteria detection rate was 88% (35/40 patients) in cases treated by the ICT.
  • Early assistance from the ICT is a key to preventing onset of MRSA infection.

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Interventions to improve antibiotic prescribing practices for hospital inpatients

Davey, P. et al. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD003543.

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Image source: Cochrane

Background: Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients.

Objectives: To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement.

Authors’ conclusions:  We found high-certainty evidence that interventions are effective in increasing compliance with antibiotic policy and reducing duration of antibiotic treatment. Lower use of antibiotics probably does not increase mortality and likely reduces length of stay. Additional trials comparing antibiotic stewardship with no intervention are unlikely to change our conclusions. Enablement consistently increased the effect of interventions, including those with a restrictive component. Although feedback further increased intervention effect, it was used in only a minority of enabling interventions. Interventions were successful in safely reducing unnecessary antibiotic use in hospitals, despite the fact that the majority did not use the most effective behaviour change techniques. Consequently, effective dissemination of our findings could have considerable health service and policy impact. Future research should instead focus on targeting treatment and assessing other measures of patient safety, assess different stewardship interventions, and explore the barriers and facilitators to implementation. More research is required on unintended consequences of restrictive interventions.

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Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit

Price, J.R. et al. (2017) The Lancet Infectious Diseases. 17(2) pp. 207–214

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Background: Health-care workers have been implicated in nosocomial outbreaks of Staphylococcus aureus, but the dearth of evidence from non-outbreak situations means that routine health-care worker screening and S aureus eradication are controversial. We aimed to determine how often S aureus is transmitted from health-care workers or the environment to patients in an intensive care unit (ICU) and a high-dependency unit (HDU) where standard infection control measures were in place.

Interpretation: In the presence of standard infection control measures, health-care workers were infrequently sources of transmission to patients. S aureus epidemiology in the ICU and HDU is characterised by continuous ingress of distinct subtypes rather than transmission of genetically related strains.

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NICE guideline update – Surgical site infections: prevention and treatment

Surveillance report 2017 – Surgical site infections: prevention and treatment (2008) | NICE guideline CG74

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Surveillance decision: We will plan an update of the guideline on prevention and treatment of surgical site infections. The update will focus on:

  • nasal decontamination of Staphylococcus aureus
  • choice of preoperative skin antiseptics
  • application of intraoperative topical antiseptics/antimicrobials before wound closure
  • type of suture.

We will consider intraoperative perfusion and hydration, and intraoperative blood glucose control in a new guideline on perioperative care. Recommendations in the surgical site infection guideline will be withdrawn on publication of new recommendations in the perioperative care guideline.

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Toolkit Offers Framework to Assess, Review and Improve Antibiotic Stewardship

The AAAHC Institute for Quality Improvement has released a new toolkit to enhance antibiotic stewardship programs | Infection Control Today

The AAAHC Institute designed the Antibiotic Stewardship Toolkit to aid ambulatory health facilities in promoting appropriate antibiotic selection while reducing overuse through an overview of illnesses for which inappropriate antibiotic prescriptions are written.

The Centers for Disease Control and Prevention (CDC) define antibiotic stewardship activities as efforts to improve and measure antibiotic prescribing by minimizing inappropriate antibiotic prescribing and overuse, as well as ensuring the right drug, dose and duration are selected when antibiotics are needed.

Providers in ambulatory health care settings use the AAAHC Institute Antibiotic Stewardship Toolkit checklist as both a baseline assessment of policies and practices, and a resource for reviewing and expanding activities on a regular basis.

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