Infection Control Matters

After his excellent session atthe ECCMID meeting, Martin talks to Dr Gonzalo Bearman (Chief of Infectious Diseases at VCU Health, Editor in Chief of Antimicrobial Stewardship Healthcare Epidemiology (ASHE), footballer and drummer) about the removal of contact precautions for endemic organisms like MRSA and VRE and how evidence can change practice. Challenges of applying evidence from one setting to another are also discussed. Some of Gonzalo's papers on this subject are here: Bearman GM, et al. A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms. Am J Infect Control. 2007;35(10):650-655.  https://10.1016/j.ajic.2007.02.011 McLemore A, et al. Effect of contact precautions on wait time from emergency room disposition to inpatient admission. Infect Control Hosp Epidemiol. 2011;32(3):298-299.  https://doi:10.1086/658913 Banach DB, et al. Duration of Contact Precautions for Acute-Care Settings. Infect Control Hosp Epidemiol. 2018:1-18.  https://doi:10.1017/ice.2017.245 Bearman G, et al. Impact of Discontinuing Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: An Interrupted Time Series Analysis. Infect Control Hosp Epidemiol. 2018;39(6):676-682.  https://doi:10.1017/ice.2018.57 Godbout EJ, et al. Impact of discontinuation of contact precautions on central-line associated bloodstream infections in an academic children's hospital. Infect Control Hosp Epidemiol. 2019:1-3.  Haessler S, et al. Stopping the routine use of contact precautions for management of MRSA and VRE at three academic medical centers: An interrupted time series analysis. Am J Infect Control. 2020;48(12):1466-1473.  https://doi:10.1016/j.ajic.2020.06.219 Morgan DJ, et al. Contact Precautions for Endemic MRSA and VRE: Time to Retire Legal Mandates. JAMA. 2017;318(4):329-330.  https://doi:10.1001/jama.2017.7419 Bearman G, et al. Control of drug-resistant pathogens in endemic settings: contact precautions, controversies, and a proposal for a less restrictive alternative. Curr Infect Dis Rep. 2012;14(6):620-626.  https://doi:10.1007/s11908-012-0299-8

In this podcast, Brett Mitchell talks to A/Professor Stéphane Bouchoucha about a recent article exploring the role of patient service assistants in environmental cleaning. The article is published in Infection Disease and Health. https://www.idhjournal.com.au/article/S2468-0451(22)00006-2/fulltext Dr Stéphane Bouchoucha is an Associate Professor and Associate Head of School (International) in the School of Nursing and Midwifery at Deakin University. He is also a researcher based in Deakin’s Institute for Health Transformation and the Australasian College for Infection Prevention and Control President-Elect.

In this episode recorded at the 2022 SHEA spring meeting, Martin Kiernan discussed measuring the effectiveness of cleaning with Dr Phil Carling from Boston. We also discuss how data used from environmental monitoring can be used to promote improvements in practice. Some of Phil's key papers in this area are here: Carling PC, et al. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis. 2006;42(3):385-388.  https://doi.org/10.1086/499361 Carling PC, et al. Improving environmental hygiene in 27 intensive care units to decrease multidrug-resistant bacterial transmission. Crit Care Med. 2010;38(4):1054-1059. https://doi.org/10.1097/ccm.0b013e3181cdf705 Carling PC, et al. Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool. J Hosp Infect. 2008;68(1):39-44. https://doi.org/10.1016/j.jhin.2007.09.015 Carling PC, et al. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(1):1-7.  https://doi.org/10.1086/524329

In this episode recorded at the ECCMID 2022 meeting in Lisbon, Portugal, Martin Kiernan talks to poster abstract presenter Clinical Scientist Sharon Bamber about her organisation's use of small, portable and inexpensive CO2 monitors (Airvisual Pro iQAir - other monotors are available..) that measure air quality. Through the use of these, the organisation (Wirral University Hospital Trust in the UK) was able to determine which areas of the organisation were poorly ventilated based on aur quality, allowing for mitigation measures (portable HEPA) to be implemented. If you would like to read the poster whilst listening, Sharon has kindly sent a copy, available here NERVTAG is the New and Emerging Respiratory Viruses Threats Advisory Group https://www.gov.uk/government/groups/new-and-emerging-respiratory-virus-threats-advisory-group

In this episode recorded at the 2022 SHEA Sprong meeting, Martin Kiernan talks to Dr Dian Baker, Emeritus Professor at California State University, Sacramento, USA. Dian has been a passionate advocate for action against healthcare-onset non-ventilator associated pneumonia (nVHAP) for over 12 years and as ever, it was a personal experience that motivated her to look into this important topic. Apart from the human cost, nVHAP is responsible for use of antibiotics and means huge costs for healthcare systems globally. Some of Dian's key papers are listed here: 1. Baker DL, et al. Prevention practices for nonventilator hospital-acquired pneumonia: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Infect Control Hosp Epidemiol. 2021:1-2.  http:2. Quinn B, et al. Non-ventilator health care-associated pneumonia (NV-HAP): Best practices for prevention of NV-HAP. Am J Infect Control. 2020;48(5S):A23-A27.  https://doi.org/10.1016/j.ajic.2020.03.0063. Giuliano KK, et al. The epidemiology of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control. 2018;46(3):322-327.  https://doi.org/10.1016/j.ajic.2017.09.0054. Baker D, et al. Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control. 2018;46(1):2-7.  https://doi.org/10.1016/j.ajic.2017.08.0365. Quinn B, et al. Basic nursing care to prevent nonventilator hospital-acquired pneumonia. J Nurs Scholarsh. 2014;46(1):11-19.  https://doi.org/10.1111/jnu.12050

Martin Kiernan managaed to grab a few minutes with Dr Michael Klompas, ID Physicial at Brigham and Women's Hospital, Boston and Associate Professor at Harvard Medical School, at the SHEA Spring meeting. We discuss the use of N95 masks and whether in a time of Omicron increased prevalence they should be used in all healthcare settins and not just for suspected or confirmed cases of COVID. Some of Dr Klompas' recent papers are here: 1. Klompas M, et al. Universal Use of N95 Respirators in Healthcare Settings When Community Coronavirus Disease 2019 Rates Are High. Clin Infect Dis. 2022;74(3):529-531.  doi:10.1093/cid/ciab539 2. Klompas M, et al. Preventing SARS-CoV-2 Transmission in Health Care Settings in the Context of the Omicron Variant. JAMA. 2022;327(7):619-620.  https://jamanetwork.com/journals/jama/article-abstract/2788503 3. Klompas M, et al. COVID-19's Challenges to Infection Control Dogma Regarding Respiratory Virus Transmission. Clin Infect Dis. 2022.  https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciac204/6546689 4. Baker MA, et al. Rapid control of hospital-based SARS-CoV-2 Omicron clusters through daily testing and universal use of N95 respirators. Clin Infect Dis. 2022.  https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac113/6523822 5. Klompas M, et al. Current Insights Into Respiratory Virus Transmission and Potential Implications for Infection Control Programs : A Narrative Review. Ann Intern Med. https://pubmed.ncbi.nlm.nih.gov/34748374/

In this week's episode, Martin Kiernan talks to Dr Judith Tanner, Professor of Adult Nursing at the University of Nottingham, UK about a paper in which a mixed methods approach to examining potential and actual barriers to implementation of patient warming were examined. Papers discussed during the session include:   Tanner J, et al. Using a comprehensive audit to identify local context prior to care bundle design and implementation for inadvertent perioperative hypothermia in colorectal surgery. BMJ Open Qual. 2021;10(1).   doi:10.1136/bmjoq-2020-001132  https://bmjopenquality.bmj.com/content/10/1/e001132 Melling AC, et al. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet. 2001;358(9285):876-880.  doi:10.1016/S0140-6736(01)06071-8 Tanner J, et al. Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery. Ann R Coll Surg Engl. 2016;98(4):270-274.  doi:10.1308/rcsann.2016.0072 Tanner J, et al. Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery. 2015;158(1):66-77.  doi:10.1016/j.surg.2015.03.009

In this episode, Phil Russo flies solo and discusses strategies for prevention of SSI with Professor Charles Edmiston, Emeritus Professor at the Medical College of Wisconsin in Milwaukee. Chuck has a longstanding interest in SSI prevention and a few of his papers are listed below. As ever, 'compliance' with interventions is a key issue. Parvizi, J., S. Barnes, N. Shohat & C. E. Edmiston, Jr. (2017) Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty? Am J Infect Control, 45, 1267-1272. https://www.ncbi.nlm.nih.gov/pubmed/28818359 Leaper, D. J., C. E. Edmiston, Jr. & C. E. Holy (2017) Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures. Br J Surg, 104, e134-e144. https://www.ncbi.nlm.nih.gov/pubmed/28093728 Edmiston, C. E., Jr. & D. Leaper (2017) Should preoperative showering or cleansing with chlorhexidine gluconate (CHG) be part of the surgical care bundle to prevent surgical site infection? J Infect Prev, 18, 311-314. https://www.ncbi.nlm.nih.gov/pubmed/29344102 Edmiston, C. E., Jr., N. A. Ledeboer, B. W. Buchan, M. Spencer, G. R. Seabrook & D. Leaper (2016) Is Staphylococcal Screening and Suppression an Effective Interventional Strategy for Reduction of Surgical Site Infection? Surg Infect (Larchmt), 17, 158-66. https://www.ncbi.nlm.nih.gov/pubmed/26836053 Tanner, J., W. Padley, O. Assadian, D. Leaper, M. Kiernan & C. Edmiston (2015) Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery, 158, 66-77. https://www.ncbi.nlm.nih.gov/pubmed/25920911

In this episode Brett Mitchell talks to Associate Professor Holly Seale about the role of social scientists, vaccine hesitancy, booster vaccines and the potential implications for the next influenza season. Holly is an infectious disease social scientist at the School of Population Health at the University of New South Wales in Australia. She has over 15 years of experience in undertaking social science research focused on improving confidence and engagement of different at-risk groups with immunisation and other prevention strategies.

In this week's episode, Martin Kiernan talks to Alexandra Peters, who works in Prof. Didier Pittet's group at the University Hospitals of Geneva and with a WHO Collaborating Centre. We discuss a new systematic review that demonstrates that there is significant evidence that environmental decontamination reduces healthcare-associated infections and colonisations and also progress on a new Healthcare Environmentsl Hygiene (HEH) self-assessment tool, the results of which will shortly be published. Papers that we discuss are: Peters, A., Schmid, M.N., Parneix, P. et al. Impact of environmental hygiene interventions on healthcare-associated infections and patient colonization: a systematic review. Antimicrob Resist Infect Control 11, 38 (2022). https://doi.org/10.1186 - https://link.springer.com/article/10.1186/s13756-022-01075-1#article-info Accepted paper, shortly to appear in the AJIC website: Peters, A., Schmid, M., deKraker, M. et al. Results of an international pilot survey on healthcare environmental hygiene at the facility level. American Journal of Infection Control (2022)   Also mentioned: Brett G Mitchell, Lisa Hall, Nicole White, Adrian G Barnett, Kate Halton, David L Paterson, Thomas V Riley, Anne Gardner, Katie Page, Alison Farrington, Christian A Gericke, Nicholas Graves, An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial, The Lancet Infectious Diseases,Volume 19, Issue 4, 2019, Pages 410-418, https://doi.org/10.1016/S1473-3099(18)30714-X https://www.sciencedirect.com/science/article/pii/S147330991830714X Deverick J Anderson, Rebekah W Moehring, David J Weber, Sarah S Lewis, Luke F Chen, J Conrad Schwab, Paul Becherer, Michael Blocker, Patricia F Triplett, Lauren P Knelson, Yuliya Lokhnygina, William A Rutala, Daniel J Sexton, Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection), The Lancet Infectious Diseases, Volume 18, Issue 8, 2018, Pages 845-853, https://doi.org/10.1016/S1473-3099(18)30278-0 https://www.sciencedirect.com/science/article/pii/S1473309918302780    

In this week's episode, Brett Mitchell and Martin Kiernan use a recent paper published in Infection Control and Hospital Epidemiology to start a discussion about an relationship between IPC Team staffiing levels and levels of healthcare-associated infections. How are staffing levels set and is it just a number or is there more to it? The papers that we discuss are listed below. 1. Clifford RJ, Newhart D, Laguio-Vila MR, Gutowski JL, Bronstein MZ, Lesho EP. Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation. Infect Control Hosp Epidemiol. 2022:1-6. doi:10.1017/ice.2021.507 2. Mitchell BG, Hall L, MacBeth D, Gardner A, Halton K. Hospital infection control units: staffing, costs, and priorities. Am J Infect Control. 2015;43:612-6. doi:10.1016/j.ajic.2015.02.016 3. Dickstein Y, Nir-Paz R, Pulcini C, Cookson B, Beovic B, Tacconelli E, et al. Staffing for infectious diseases, clinical microbiology and infection control in hospitals in 2015: results of an ESCMID member survey. Clin Microbiol Infect. 2016;22:812 e9- e17. doi:10.1016/j.cmi.2016.06.014

In this episode, Martin Kiernan talks to Professor Gonzalo Bearman, Chair, Division of Infectious Diseases and Hospital Epidemiologist/Medical Director of VCU Healthcare and the Richard P. Wenzel Professor of Internal Medicine at the Virginia Commonwealth University Health System (full CV here)  Following on from the increase in virtual working due to the pandemic, we discuss the potential for providing healthcare facilities in low and middle income countries with virtual support and consulting. The papers that we discuss are listed here. 1. Jones, T., Marimuthu, K., Bearman, G. Virtual Infection Prevention and Control in Low- and Middle-Income Countries, International Journal of Infectious Diseases,Volume 117, 2022, Pages 93-96, https://doi.org/10.1016/j.ijid.2022.01.065. 2. Anderson, D., Miller, B., Chen, L., Adcock, L., Cook, E., Cromer, A., . . . Sexton, D. (2011). The Network Approach for Prevention of Healthcare-Associated Infections: Long-Term Effect of Participation in the Duke Infection Control Outreach Network. Infection Control & Hospital Epidemiology, 32(4), 315-322. https://doi.org/10.1086/658940 3.Pryor, R., Vokes, R., Anderson, D., & Bearman, G. (2021). Virtual infection prevention—The next frontier. Infection Control & Hospital Epidemiology, 42(11), 1374-1375. https://doi.org/10.1017/ice.2020.1404  

In this episode, Brett Mitchell and Martin Kiernan discuss methods of drying hands after hand hygiene has been performed, with a focus on hand dryers versus paper towel. Personal details about Martin's habits are disclosed as we mull this over and present some papers. Papers presented include: 1. Suen, L. K., Lung, V. Y., Boost, M. V., Au-Yeung, C. H., & Siu, G. K. (2019). Microbiological evaluation of different hand drying methods for removing bacteria from washed hands. Scientific reports, 9(1), 1-7.  https://www.nature.com/articles/s41598-019-50239-4 2. Reynolds, K. A., Sexton, J. D., Norman, A., & McClelland, D. J. (2021). Comparison of electric hand dryers and paper towels for hand hygiene: a critical review of the literature. Journal of applied microbiology, 130(1), 25-39.  https://pubmed.ncbi.nlm.nih.gov/32794646/ 3. Best, E., Parnell, P., Couturier, J., Barbut, F., Le Bozec, A., Arnoldo, L., ... & Wilcox, M. H. (2018). Environmental contamination by bacteria in hospital washrooms according to hand-drying method: a multi-centre study. Journal of Hospital Infection, 100(4), 469-475. https://pubmed.ncbi.nlm.nih.gov/30006281/

The WHO Global Outreach Alert and Response Network (GOARN) is the topic for this podcast. We talk with Dr Peta-Anne Zimmerman about the network, what is does and how to get involved. Dr Peta-Anne Zimmerman is Senior Lecturer and Program Advisor for the Griffith University and is Board Director of the Australasian College for Infection Prevention and Control. She is also a Senior Faculty and Focal Point for the Global Outbreak Alert and Response Network of the World Health Organization.   The weblink to GOARN for more information is https://extranet.who.int/goarn/

In this episode we return to another ICM favourite topic, healthcare-associated pneumonia that is not device-associated. Martin Kiernan talks to Dr Mark Garvey, Director of Infection Prevention and Helen Woodall, Senior Dental Nurse, both of University Hospitals Birmingham NHS Trust about the 'Mouth Care Matters' initiative. Education of registered nurses and healthcare assistants was a key part of the strategy, which ultimately resulted in a significant reduction in infections. Note that in England a 'Trust' is an NHS healthcare provider organisation which may be made up of more than one hospital or unit. The paper outlining the initiative and results can be found here https://www.journalofinfection.com/article/S0163-4453(21)00275-9/fulltext

In this podcast, Brett talks to Adjunct A/Professor Greg Whiteley about adenosine triphosphate (ATP). We chat about its use in healthcare as a way to evaluate environmental cleanliness.   Greg is an Adjunct Associate Professor in the Faculty of Medicine and Health at the University of Sydney, and is also an adjunct Fellow in the School of Medicine at Western Sydney University. Greg is also the Executive Chairman of Whiteley Corporation, a manufacturer of Therapeutic Goods based in the Hunter Region of New South Wales. His particular expertise is in the measurement of cleanliness, particularly based on rapid ATP testing where he is internationally renowned, published and is a regular keynote conference speaker.

In this, the first episode of 2022, Martin Kiernan talks to Dr Matt Butler, Consultant Geriatrician (Addenbrookes Hospital, Cambridge, UK), Dr Christine Peters, Consultant Microbiologist (NHS Greater Glasgow, Scotland) and Dr Evonne Curran, now an independent IPC Consultant. We start off by discussing how Matt came to design a study that looks at the effect of air filtration on a range of infections, including respiratory viruses and more 'common' pathogens like Clostridium difficile. We also discuss why it had taken so long for airborne transmission to be accepted as a mode of transmission. Books recommended by Evonne in the podcast are listed below.   Think Again: The power of knowing what you don't know by Adam Grant (https://www.adamgrant.net/book/think-again/) ISBN: 9780753553886 Seeing what others don't by Gary Klein ISBN: 9781857886788 Paper by Andrew Conway-Morris referred to in the podcast: Andrew Conway Morris, Katherine Sharrocks, Rachel Bousfield, Leanne Kermack, Mailis Maes, Ellen Higginson, Sally Forrest, Joana Pereira-Dias, Claire Cormie, Tim Old, Sophie Brooks, Islam Hamed, Alicia Koenig, Andrew Turner, Paul White, R Andres Floto, Gordon Dougan, Effrossyni Gkrania-Klotsas, Theodore Gouliouris, Stephen Baker, Vilas Navapurkar, The Removal of Airborne Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Other Microbial Bioaerosols by Air Filtration on Coronavirus Disease 2019 (COVID-19) Surge Units, Clinical Infectious Diseases, 2021;, ciab933, https://doi.org/10.1093/cid/ciab933

In this largely unedited Christmas special podcast, Martin, Phil and Brett reflect on podcasts undertaken in 2021 and the year that was. This podcast is a little longer as we "chinwag" about a range of different topics and issues and have a laugh along the way. We hope you enjoy.

In this week’s episode, Martin Kiernan talks to Professor Jennie Wilson of the Richard Wells Research Centre at the University of West London and current Infection Prevention Society President. We discuss her recent editorial, co-written with Associate Professor Jacqui Prieto from the University of Southampton. After 25 years of contact precautions, first introduced as putative best practice, the evidence to support this intervention has not appeared and there are suggestions that harms may be being caused through poor implementation. Contact precautions add PPE and physical isolation to Standard Precautions, however does this lead to over, and inappropriate use of PPE that is not required?   Papers cited during the podcast include: Wilson J, Prieto J. Re-visiting contact precautions – 25 years on. Journal of Infection Prevention. 2021;22:242-4. Doi: 1177/17571774211059988 Bearman G, Abbas S, Masroor N, Sanogo K, Vanhoozer G, Cooper K, et al. Impact of Discontinuing Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: An Interrupted Time Series Analysis. Infect Control Hosp Epidemiol. 2018;39:676-82. https://www.ncbi.nlm.nih.gov/pubmed/29580304