Staff shortages threaten increased levels of infection, say Antibiotic Research UK

Antibiotic Research UK | Staff shortages could unleash superbug epidemic | March 2018

Antibiotic Research UK (ANTRUK)  believe that the over-occupancy affecting hospitals across the country makes transmitting deadly bacteria easier.  They also air concerns that a scarcity of nurses means staff will simply be too busy to notice the poor levels of cleanliness that encourage bugs thrive.  ANTRUK  is reminding patients and visitors to be vigilant and report incidents of improper cleaning to complaint bodies like Patient Advice and Liaison Service (PALS) (via ANTRUK).

cleaner-3122363_1920Professor Colin Garner, Chief Executive of ANTRUK remarked that “we need the Government, medical research organisations, the pharmaceutical
industry and the public to work together to develop new but effective medications,
fast. And while we wait for that to happen, we must do everything in our power to
prevent the spread of bacterial infections – especially in our hospitals.”

The full press release is available from ANTRUK 
Related:  Nursing Times Warning that nurse shortages and crowded wards ‘risk reversing infection prevention progress’

 

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Environmental cleaning and disinfection of patient areas

The International Journal of Infectious Diseases has published a new article on environmental cleaning and disinfection of patient areas. The authors undertook a narrative review of the literature comprises hospital surfaces, other potential reservoirs of infection and the monitoring of cleaning.  Their review also considers antimicrobial ‘self-cleaning’ surfaces, cleaning robots ‘touchless’ technologies and also discuss other interventions to improve manual cleaning.   They also summarise  the strategies for environmental cleaning and disinfection of patient areas in a table.  For the researchers,  human factors will ultimately determine the quality of environmental cleaning in the hospital and will remain the patient’s best defense against invisible threats from the hospital environment.

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Abstract

The healthcare setting is predisposed to harbor potential pathogens, which in turn can pose a great risk to patients. Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections. While many approaches to environmental cleaning exist, manual cleaning supplemented with ongoing assessment and feedback may be the most feasible for healthcare facilities with limited resources.

Full reference: Doll, M., Stevens, M., &  Bearman, G. |Environmental cleaning and disinfection of patient areas | International Journal of Infectious Diseases |57| 2018 | P.52-57| Doi https://doi.org/10.1016/j.ijid.2017.10.014

The full article is available for NHS Athens users, it can be accessed here 

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