Infection Control Matters

Identifying healthcare cleaning research priorities in resource-limited settings

In this episode, Martin Kiernan talks to Dr Giorgia Gon, Assistant Professor of Epidemiology, London School of Hygiene and Tropical Medicine about a briefing paper that  identifies research priorities for healthcare cleaning in resource-limited settings. We discuss the process of determining the priorities, the groups involved and the final areas that should be targeted with research funding, including cost-effectiveness, the use of biocides or detergents and minimum requirements.
You can find a copy of the CLEAN Briefing here
Other papers of interest:
1. Cross S, Gon G, Morrison E, Afsana K, Ali SM, Manjang T, et al. An invisible workforce: the neglected role of cleaners in patient safety on maternity units. Glob Health Action. 2019;12:1480085. https://www.ncbi.nlm.nih.gov/pubmed/31154993
2. Gon G, Kabanywanyi AM, Blinkhoff P, Cousens S, Dancer SJ, Graham WJ, et al. The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals. Antimicrob Resist Infect Control. 2021;10:8. https://www.ncbi.nlm.nih.gov/pubmed/33413647
3. Storr J, Kilpatrick C, Lee K. Time for a renewed focus on the role of cleaners in achieving safe health care in low- and middle-income countries. Antimicrob Resist Infect Control. 2021;10:59. https://www.ncbi.nlm.nih.gov/pubmed/33762000

Sinks in ICU Patient Rooms. Lower numbers of sinks equals lower infection rates?

In this episode, Martin talks to Giovanni-Battista Fucini about a recent paper from Germany that examined infection rates in critical care in which it was reported that hospitals without sinks in patient rooms have lower infection rates. Newer hospitals in Germany tend not to have sinks in the patient rooms in ICU.
The paper we discuss is here:
Giovanni-Battista, F., C. Geffers, F. Schwab, M. Behnke, W. Sunder, J. Moellmann & P. Gastmeier (2023) Sinks in patient rooms in the ICU are associated with higher rates of hospital-acquired infections. A retrospective analysis of 552 ICUs. J Hosp Infect, 10.1016/j.jhin.2023.05.018. https://doi.org/10.1016/j.jhin.2023.05.018
Other papers of interest are:
Kotay, S. M., H. I. Parikh, K. Barry, H. S. Gweon, W. Guilford, J. Carroll & A. J. Mathers (2020) Nutrients influence the dynamics of Klebsiella pneumoniae carbapenemase producing enterobacterales in transplanted hospital sinks. Water Res, 176, 115707. https://www.ncbi.nlm.nih.gov/pubmed/32224328
Constantinides, B., K. K. Chau, T. P. Quan, G. Rodger, M. I. Andersson, K. Jeffery, S. Lipworth, H. S. Gweon, A. Peniket, G. Pike, J. Millo, M. Byukusenge, M. Holdaway, C. Gibbons, A. J. Mathers, D. W. Crook, T. E. A. Peto, A. S. Walker & N. Stoesser (2020) Genomic surveillance of Escherichia coli and Klebsiella spp. in hospital sink drains and patients. Microb Genom, 6. https://www.ncbi.nlm.nih.gov/pubmed/32553019
Mathers, A. J., K. Vegesana, I. German Mesner, K. E. Barry, A. Pannone, J. Baumann, D. W. Crook, N. Stoesser, S. Kotay, J. Carroll & C. D. Sifri (2018) Intensive Care Unit Wastewater Interventions to Prevent Transmission of Multispecies Klebsiella pneumoniae Carbapenemase-Producing Organisms. Clin Infect Dis, 67, 171-178. https://www.ncbi.nlm.nih.gov/pubmed/29409044
Grabowski, M., J. M. Lobo, B. Gunnell, K. Enfield, R. Carpenter, L. Barnes & A. J. Mathers (2018) Characterizations of handwashing sink activities in a single hospital medical intensive care unit. J Hosp Infect, 100, e115-e122. https://www.ncbi.nlm.nih.gov/pubmed/29738784
Kotay, S., W. Chai, W. Guilford, K. Barry & A. J. Mathers (2017) Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs. Appl Environ Microbiol, 83. https://www.ncbi.nlm.nih.gov/pubmed/28235877
Garvey, M. I., N. Williams, A. Gardiner, C. Ruston, M. A. C. Wilkinson, M. Kiernan, J. T. Walker & E. Holden (2023) The sink splash zone. J Hosp Infect, 135, 154-156. https://www.ncbi.nlm.nih.gov/pubmed/36870392

Future directions for surveillance

Martin chats to Phil in Melbourne following a recent presentation. Yes, two old farts reminiscing about the days of wearing out the boot leather collecting surveillance data talk with envy about the potential of HAI surveillance in the era of the electronic medical record, automation and artificial intelligence.
Phil refers to data in these two publications:
Designing Surveillance of Healthcare-Associated Infections in the Era of Automation and Reporting Mandates
The prevalence of healthcare associated infections among adult inpatients at nineteen large Australian acute-care public hospitals: a point prevalence survey

C. difficile and One Health with Prof Tom Riley

We discuss One Health in this episode with Professor Tom Riley, using C.difficile as the example of explaining why the concept of One Health is so important.
 
Tom is a Fellow of the Royal College of Pathologists, the Australian Society for Microbiology, the American Academy of Microbiology, the Society for Healthcare Epidemiology of America and the Faculty of Science of the Royal College of Pathologists of Australasia, and has published over 400 book chapters and refereed publications.

Saving time and increasing IPC efficiency using Robotic Process Automation

This week, Martin talks to Jincy Jerry, Assistant Director of Nursing in Infection Prevention and Control at the Mater Misericordiae University Hospital, Dublin, Ireland. Jincy is a pioneer in the use of Robotic Process Automation in clinical settings within Irish Healthcare. Robotic process automation (RPA) is a software technology that makes it easy to build, deploy, and manage software robots that emulate humans actions interacting with digital systems and software. In 2021, the project received Prix Hubert Tuor Innovation Academy Award at the 6th International Conference on Prevention and Infection Control (ICPIC), in Geneva.
We discuss the potential and actual benefits, including the freeing up of hours of IP time as well as the use of AI (Artificial Intelligence) in the infection prevention world.
 
A review paper on this topic can be found here:
Piaggio, D., M. Zarro, S. Pagliara, M. Andellini, A. Almuhini, A. Maccaro & L. Pecchia (2023) The use of smart environments and robots for infection prevention control: A systematic literature review. Am J Infect Control, 10.1016/j.ajic.2023.03.005. https://www.ncbi.nlm.nih.gov/pubmed/36924997

A CLEEN study chat and a rude interruption!

In this podcast, we talk about the CLEEN and I-CLEEN studies. These are a RCT and quasi-experimental genomics study aiming to determine the effect of additional cleaning of shared medical equipment of the frequency of healthcare associated infections.  We also make phone call mid podcast...
A shout out to all the team involved in this project, including being wonderfully coordinated by Dr Kate Browne and with great support from Georgia Matterson.  Full details on the website below.
Link to study website: https://cleenstudy.com/
Link to study protocol: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-023-07144-z
This project is funded by a National Health and Medical Research Council Emerging Leadership Investigator grant (Prof Brett Mitchell, (GNT2008392)).

Surgical site infection, quality improvement and patient involvement with Sinéad Horgan

In this episode, Martin Kiernan talks to Sinèad Horgan, Director of Nursing South/South West Hospital Group, and School of Nursing and Midwifery, College of Medicine and Health, University College Cork in Ireland. We discuss a journey towards surgical site sueveillance and quality improvement and her recent papers on this topic. We discuss knowledge, attitudes, gaining engagement, buy-in and the importance of patient involvement in SSI prevention.
Papers discussed include:
Horgan S, et al. Healthcare professionals' knowledge and attitudes of surgical site infection and surveillance: A narrative systematic review. Nurse Educ Pract. 2023;69:103637.  HTTPS://doi:10.1016/j.nepr.2023.103637
Horgan S, et al. Impact of a quality improvement intervention on the incidence of surgical site infection in patients undergoing colorectal surgery: Pre-test-post-test design. J Clin Nurs. 2023.  HTTPS://doi:10.1111/jocn.16690
Troughton R, et al. Understanding determinants of infection control practices in surgery: the role of shared ownership and team hierarchy. Antimicrob Resist Infect Control. 2019;8:116.  https://doi:10.1186/s13756-019-0565-8

Implementation of HAP Prevention - not what you do but the way that you do it

In this episode, we discuss a paper in the Lancet Infectious Disease about preventing non-ventilator associate pneumonia including the determinants of implementationsuccess. Brett and Martin chat with Dr Aline Wolfensberger and Professor Hugo Sax, authors of this paper about this important work.
Link to paper: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00812-X/fulltext
 
Dr Aline Wolfensberger is a medical doctor, certified in Internal Medicine and in Infectious Diseases and Hospital Epidemiology. She works at the Department of Infectious Diseases and Hospital Epidemiology of the University Hospital Zurich with Professor Hugo Sax. Prof Hugo Sax is a Swiss ID physician who worked for the last 20 years as a leader in infection prevention and control.
 
 

Have gloves and gowns had their day?

Brett Mitchell talks to Dr Sarah Browning and Professor Josh Davis about a recent paper in Infection, Disease and Health - "Have gloves and gowns had their day?" The evidence for gloves and gowns is discussed, as well as results from a recent survey into their use in Australia and New Zealand.
Sarah is an infectious disease physician and Director of Infection Prevention and Control at the Hunter New England (HNE) Health District in NSW, Australia. Josh is infectious disease physician and a clinical trialist, also based at HNE and the Hunter Medical Research Institute.
 
A link to the article: https://www.idhjournal.com.au/article/S2468-0451(23)00030-5/fulltext
Reference:
Browning, S., Davis, J. S., & Mitchell, B. G. (2023). Have gloves and gowns had their day? An Australian and New Zealand practice and attitudes survey about contact precautions for MRSA and VRE colonisation. Infection, Disease & Health. DOI: 10.1016/j.idh.2023.03.006

Surveillance and Antimicrobial Stewardship in long-term care facilities

In this episode Phil talks to A/Prof Noleen Bennett* about the state of surveillance and antimicrobial stewardship and what her research has discovered in this area. Noleen also tells about an exciting project she is leading called NISPAC, a streamlined infection and antimicrobial use surveillance system for Australian Residential Aged Care Facilities.
*Associate Professor Noleen Bennett. Infection Control Consultant, Victorian Healthcare Associated Infection Surveillance Coordinating Centre and the National Centre for Antimicrobial Stewardship.
 
Further information:
NISPAC
VICNISS 
An evaluation of influenza, pneumococcal and herpes zoster vaccination coverage in Australian aged care residents, 2018 to 2022
Infection prevention quality indicators in aged care: ready for a national approach
Skin and soft tissue infections and current antimicrobial prescribing practices in Australian aged care residents