NICE | September 2019 | Healthcare-associated infections: prevention and control
The Public health guideline on Healthcare-associated infections: prevention and control (PH36) has been checked by NICE for the need for update. NICE is now seeking responses in its consultation on this guideline, it is open until 5pm on Friday, 20 September 2019.
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.
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
Hospital-acquired infections are the most common adverse event for inpatients worldwide | BMJ Quality & Safety
Background: Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice.
Results: We found that healthcare workers’ routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving ‘from clean to dirty’ when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning.
Conclusions: Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.
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.
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.
Evans, M.E. et al. American Journal of Infection Control. 45(1) pp. 13-16
Background: Declines in methicillin-resistant Staphylococcus aureus (MRSA) health care associated infections (HAIs) were previously reported in Veterans Affairs acute care (2012), spinal cord injury (SCIU) (2011), and long-term-care facilities (LTCFs) (2012). Here we report continuing declines in infection rates in these settings through September 2015.
Conclusions: MRSA HAI rates declined significantly in acute care, SCIUs, and LTCFs over 8 years of the Veterans Affairs MRSA Prevention Initiative.
Bond, S.E. et al. The Journal of Hospital Infections. Published online: December 18 2016
Objective: Healthcare-associated Clostridium difficile infection (HCA-CDI) remains a major cause of morbidity and mortality in industrialised countries. However, few data exist on the burden of HCA-CDI in multisite non-metropolitan settings. This study examined the introduction of an antimicrobial stewardship program (ASP) in relation to HCA-CDI rates and the effect of HCA-CDI on length of stay (LOS) and hospital costs.
Conclusions: HCA-CDI placed a significant burden on our regional and rural health service through increased LOS and hospital costs. Interventions targeting HCA-CDI could be employed to consolidate the effects of ASPs.
Kerbaj, J. et al. American Journal of Infection Control. Published online 9 December 2016
Background: Health care-associated infections are a major worldwide public health issue. Hand hygiene is a major component in the prevention of pathogen transmission in hospitals, and hand hygiene adherence by health care workers is low in many studies. We report an intervention using text messages as reminders and feedback to improve hand hygiene adherence.
Conclusions: Text message feedback should be incorporated into multimodal approaches for improving hand hygiene compliance.
Saint, S. The Journal of Hospital Infection. Published online: November 28, 2016
Preventing healthcare-associated infection remains an international priority given the clinical and economic consequences of this largely preventable patient safety harm. While important strides have been made in preventing hospital infections over the past several decades, thorny issues remain, including how to consistently improve hand hygiene rates and further reduce device-related complications such as catheter-associated urinary tract infection.
Rather than relying solely on directional innovations – incremental changes that continue to serve as the bedrock of scientific advancement – perhaps we should also search for “intersectional innovations,” which represent breakthrough discoveries that emanate from the intersection of often widely divergent disciplines. Several intersectional innovations that have the potential to greatly impact infection prevention efforts include human factors engineering, sociology, and engaging the senses. Indeed, Professor Edward Joseph Lister Lowbury, the namesake of this lecture, exemplified intersectional thinking in his own life having been both an accomplished bacteriologist and poet. By incorporating approaches outside of traditional biomedical science we will hopefully provide patients with the safe care they expect and deserve.
Frost, S.A. et al. Critical Care. Published online: 23 November 2016
Background: Health care-associated infections (HAI) have been shown to increase length of stay, the cost of care, and rates of hospital deaths . Importantly, infections acquired during a hospital stay have been shown to be preventable. In particular, due to more invasive procedures, mechanical ventilation, and critical illness, patients cared for in the intensive care unit (ICU) are at greater risk of HAI and associated poor outcomes.
Conclusion: This meta-analysis of the effectiveness of CHG bathing to reduce infections among adults in the ICU has found evidence for the benefit of daily bathing with CHG to reduce CLABSI and MRSA infections. However, the effectiveness may be dependent on the underlying baseline risk of these events among the given ICU population. Therefore, CHG bathing appears to be of the most clinical benefit when infection rates are high for a given ICU population.