Relationship between hospital ward design and healthcare associated infection rates

The systematic review published by Stiller et al. in Antimicrobial Resistance & Infection Control in November 2016 concludes that single-patient bedrooms confer a significant benefit for protecting patients from healthcare associated infection and colonization | Antimicrobial Resistance & Infection Control

This conclusion is not substantiated by the evidence included in their review which has been largely drawn from uncontrolled before and after studies in the absence of a transparent assessment of the risk of bias. There are also errors in the analysis of supporting data. Evaluating the specific impact of single rooms on preventing transmission from a sound epidemiological perspective is essential to assure safe and effective care and a clear evidence-base for infection prevention and control advice.

Full reference: Wilson, J. et al. (2017) Relationship between hospital ward design and healthcare associated infection rates: what does the evidence really tell us? Comment on Stiller et al. 2016. Antimicrobial Resistance & Infection Control. vol 6 (no. 71)

Removal of sinks and introduction of ‘water-free’ patient care

Sinks in patient rooms are associated with hospital-acquired infections | Antimicrobial Resistance & Infection Control

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Background: The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of ‘water-free’ patient care on gram-negative bacilli colonization rates.

Conclusions: Removal of sinks from patient rooms and introduction of a method of ‘water-free’ patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay.

Full reference: Hopman, J. et al. (2017) Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of ‘water-free’ patient care. Antimicrobial Resistance & Infection Control. 6:59

Reducing the Risk of Mouth to Mouth Transmission of Pathogens Via Parking Tickets.

In the initial phase of our study 598 staff members were observed entering the carpark. 21.6% of them put their parking ticket in their mouth | Journal of Hospital Infection

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Using UV dye we successfully demonstrated card-to-card cross-contamination. Swabs of the ticket machine yielded commensal bacteria: coagulase negative staphylococci and a Bacillus species.

After placing a poster on the ticket-reading machine highlighting this potential infection risk, a further 1366 observations resulted in a statistically significant and persistent decline in the proportion of staff putting their carpark tickets in their mouths (p<0.001).

Full reference: Groves, J. et al. (2017) Reducing the Risk of Mouth to Mouth Transmission of Pathogens Via Reusable, Machine-read, Parking Tickets. An observational cohort study. Journal of Hospital Infection. Published online: June 08, 2017

Are alcohol-based dispensers fomites for C difficile?

The purpose of this study was to evaluate alcohol-based dispensers as potential fomites for Clostridium difficile | American Journal of Infection Control

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A convenience sample of 120 alcohol-based dispensers was evaluated for the presence of C difficile either by culture or polymerase chain reaction for C difficile toxin. The results demonstrated that C difficile was not cultured, and C difficile toxin was not detected using polymerase chain reaction; however, gram-positive rods, Clostridium perfringens, Pantoea agglomerans, coagulase-negative Staphylococcus, Peptostreptococcus, Bacillus spp, and microaerophilic Streptococcus were present within the overflow basins of the alcohol-based dispensers.

Full reference: Hall, J.A. et al. (2017) Dipping into the Clostridium difficile pool: Are alcohol-based dispensers fomites for C difficile? American Journal of Infection Control. DOI: 10.1016/j.ajic.2017.04.284

Researchers Find Door Handles to Be Significant Source of MRSA in Hospitals

The aim of this study by Saba, et al. (2017) was to determine the prevalence and antibiotic susceptibility of S. aureus and methicillin-resistant S. aureus (MRSA) in the environments of three hospitals in Ghana | Infection Control Today

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A total of 120 swab samples were taken from door handles, stair railings and other points of contact at Tamale Teaching Hospital, Tamale Central Hospital and Tamale West Hospital. The swab samples were directly plated on Mannitol Salt and Baird Parker agar plates and incubated at 37 °C (± 2) for 18 to 24 hours. An antibiotic susceptibility test was performed using the Clinical Laboratory Standard Institute’s guidelines. Isolates resistant to both cefoxitin and oxacillin were considered to be MRSA.

The researchers conclude that the high multi-drug resistance of MRSA in hospital environments in Ghana reinforces the need for the effective and routine cleaning of door handles in hospitals. Further investigation is required to understand whether S. aureus from door handles could be the possible causes of nosocomial diseases in the hospitals.

Read the full overview via Infection Control here

The original research abstract is available here

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.

Read the full abstract here

Does Using Same Hospital Bed as Prior Patient Who Received Antibiotics Increase C. diff Risk?

Infection Control Today | Published online: 10 October 2016

11563-2Antibiotics are a risk factor for Clostridium difficile infection, the most common cause of diarrhea in the hospital that is responsible for about 27,000 deaths annually in the United States. Exposure to C. difficile is common in hospitals because spores can persist in the environment for months. Antibiotics are one of many factors that increase a host’s susceptibility to C. difficile. In a new study published online by JAMA Internal Medicine, Daniel Freedberg, MD, MS, of the Columbia University Medical Center, New York, and coauthors examined whether the receipt of antibiotics by prior occupants of a hospital bed was associated with increased risk for C. difficile infection in subsequent patients who used the same bed.

The study at four affiliated hospitals in the New York City metropolitan area used patients admitted from 2010 to 2015 if they had spent 48 hours in their first hospital bed after being admitted. The study required the prior patient to have spent at least 24 hours in the bed and to have left the bed less than one week before the next patient’s admission.

Because the study focused on incident cases of C. difficile infection, subsequent patients with a known history of CDI were excluded and they also were excluded if they tested positive for C. difficile infection within the first 48 hours after admission. The receipt of antibiotics by prior patients was assessed using data from a computerized clinician order entry system.

The study reports that among 100,615 pairs of patients who sequentially occupied a given hospital, there were 576 pairs where the subsequent patients developed C. difficile infection within two to 14 days after arriving at their bed. The median time from bed admission to C. difficile infection in the subsequent patients was 6.4 days. Subsequent patients who developed incident were more likely to have traditional C. difficile infection risk factors, including old age, increased creatinine, decreased albumin and the receipt of antibiotics.

The cumulative risk of C. difficile infection in subsequent patients was 0.72 percent when the prior occupant of the hospital bed received antibiotics compared with 0.43 percent when the prior occupant of the bed did not receive antibiotics, according to the results.

Read the full summary here

Read the original research abstract here