Group B streptococcal disease guideline

Group B Streptococcal Disease, Early-onset (Green-top Guideline No 36) | The Royal College of Obstetricians and Gynaecologists. 

Group B Streptococcal Disease (GBS) is recognised as the most frequent cause of severe early-onset infection in newborn infants. GBS is present in the bowel flora of 20–40% of adults (colonisation) and those who are colonised are called ‘carriers’. This includes pregnant women. There is variation in practice across the UK regarding the best strategies to prevent EOGBS disease.

In 2015, the incidence of EOGBS in the UK and Ireland was 0.57/1000 births (517 cases), a significant increase from the previous surveillance undertaken in 2000 where an incidence of 0.48/1000 was recorded.

The purpose of this guideline is to provide guidance for obstetricians, midwives and neonatologists on the prevention of early-onset (less than 7 days of age) neonatal group B streptococcal (EOGBS) disease and the information to be provided to women, their partners and families.

Group B Streptococcal Disease, Early-onset (Green-top Guideline No 36)

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Assessing the burden of Clostridium difficile infections for hospitals

Nosocomial infections place a heavy burden on the healthcare system. However, quantifying the burden raises many questions, ranging from the way to accurately estimate the extra length of stay at hospital to defining and costing the preventative methods among the different care providers | Journal of Hospital Infection

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Image source: David Goulding, Wellcome Trust Sanger Institute – Wellcome Images // CC BY 4.0

A total of 52 episodes were screened during the study period. The estimated mean cost of CDI was approximately €23,909 (SD = 17,458) for an extended length of hospital stay (N = 27). In the case of a reduced length of the hospital stay (N = 25), the mean cost was approximately € –14,697 (SD = 16,936), which represents net savings for the hospitals. The main cost/savings driver was the productivity losses/gains resulting from the nosocomial infection. A sensitivity analysis showed that the main factor explaining the amount of costs or savings due to nosocomial infections was the length of the hospital stay.

Conclusion: We discuss the notion of productivity gains in the case of deaths as a factor revealing the incompleteness of the payment systems. We then discuss the methodological issues associated with the statistical method used to control for temporality bias.

Full reference: Hebbinckuys, E. et al. (2017) Assessing the burden of Clostridium difficile infections for hospitals. Journal of Hospital Infection. Published online: September 07, 2017

Sepsis: Raising awareness

Sepsis is a serious complication triggered by an infection, and it can lead to multiple organ failure and death if not treated quickly.

Sepsis kills 44,000 people in the UK each year but many people have never heard of it. They certainly don’t know how to spot the signs and symptoms. We can all help prevent sepsis deaths if we’re aware of early symptoms in adults & older children and can get people treated immediately:

  • High temperature (fever) or low body temperature
  • Chills and shivering
  • Severe breathlessness
  • Confusion or slurred speech
  • Pale or mottled skin

In support their educational programmes to improve knowledge and management of sepsis, the UK Sepsis Trust and NHS England have developed ‘The Sepsis Game’ which helps health professionals learn how to spot and treat sepsis quickly and effectively.

The game is based around the Sepsis Six care bundle and supports the Survive Sepsis training programme. A simplified online version of the Sepsis Game  can be tried here.

Flu immunisation for early years settings including child minders

Guidance for early years childcare settings on the nasal spray flu vaccination for preschool children. | Public Health England

This guidance has been produced for the early years sector to assist staff and childminders and answers the most frequently asked questions regarding the nasal spray flu vaccination being offered to children in this age group.

It is not intended for parents and children as they have their own dedicated leaflet.

Impact of antibiotic therapy in severe community-acquired pneumonia:

Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established | Journal of Critical Care

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Highlights:

  • In SCAP patients, the use of combination of antibiotics that includes a macrolide is associated a better hospital and long term (6 months) survival.
  • Courses of antibiotic therapy longer than 7 days are not associated with survival benefit but lead to longer ICU and hospital LOS.
  • Serum lactate showed to be a good prognostic marker of hospital mortality in SCAP patients.

Full reference: Pereira, J.M. et al. (2017) Impact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci study. Journal of Critical Care. Published online: 4 September 2017

Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center?

Highlights: 

  • An educational intervention study was completed to improve patient hand hygiene opportunities for patients at a large academic medical center.
  • After the intervention, it was possible to study the effects of improved patient hand hygiene on health care facility–onset Clostridium difficile infection events.
  • C difficile infection events decreased significantly (P ≤ .05) for 6 months after the intervention.
  • Patient hand hygiene may be an underused prevention measure for C difficile disease; successful implementation requires staff to engage the patient with opportunities, reminders, and encouragement to keep their hands clean

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Full reference: Pokrywka, M. et al. (2017) Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center? American Journal of Infection Control. Vol. 45 (Issue 9) pp. 959–963

Reducing catheter-associated urinary tract infections in the ICU

This review provides a summary of CAUTI reduction strategies that are specific to the intensive care setting | Current Opinion in Critical Care

Patients in the ICU are at higher risk for catheter-associated urinary tract infection (CAUTI) due to more frequent use of catheters and lower threshold for obtaining urine cultures.

The surveillance definition for CAUTI is imprecise and measures catheter-associated bacteriuria rather than true infection. Alternatives have been proposed, but CAUTI rates measured by this definition are currently required to be reported to the Centers for Medicare and Medicaid Services and high CAUTI rates can result in financial penalties. Although CAUTI may not directly result in significant patient harm, it has several indirect patient safety implications and CAUTI reduction has several benefits. Various bundles have been successful at reducing CAUTI both in individual institutions and on larger scales such as healthcare networks and entire states.

Full reference: Sampathkumar, P. (2017) Reducing catheter-associated urinary tract infections in the ICU. Current Opinion in Critical Care. Vol. 23 (Issue 5) pp. 372–377