Infection Control Matters

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

Outbreaks you didn’t know that you had - the joy of whole genome sequencing

In this episode recorded at the 2023 SHEA Spring Meeting in Seattle, Martin talks to Associate Professor Alex Sundermann about his work on sequencing all isolates from local healthcare settings and the discoveries that this enables. Healthcare infections due to previous admissions, endoscopes, even pseudo-outbreaks are all laid bare by this approach. Some recent papers from the group are listed below:
1. Sundermann AJ, et al. Two artificial tears outbreak-associated cases of XDR Pseudomonas aeruginosa detected through whole genome sequencing-based surveillance. medRxiv. 2023.
https://doi:10.1101/2023.04.11.23288417 2. Sundermann AJ, et al. Sensitivity of National Healthcare Safety Network definitions to capture healthcare-associated transmission identified by whole-genome sequencing surveillance. Infect Control Hosp Epidemiol. 2023:1-3. https://doi:10.1017/ice.2023.52 3. Branch-Elliman W, et al. The future of automated infection detection: Innovation to transform practice (Part III/III). Antimicrob Steward Healthc Epidemiol. 2023;3(1):e26. https://doi:10.1017/ash.2022.333 4. Sundermann AJ, et al. Whole-genome sequencing surveillance and machine learning for healthcare outbreak detection and investigation: A systematic review and summary. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e91. https://doi:10.1017/ash.2021.241 5. Sundermann AJ, et al. Whole-Genome Sequencing Surveillance and Machine Learning of the Electronic Health Record for Enhanced Healthcare Outbreak Detection. Clin Infect Dis. 2022;75(3):476-482. https://doi:10.1093/cid/ciab946 6. Sundermann AJ, et al. Outbreak of Pseudomonas aeruginosa Infections from a Contaminated Gastroscope Detected by Whole Genome Sequencing Surveillance. Clin Infect Dis. 2021;73(3):e638-e642. https://doi:10.1093/cid/ciaa18877. Kumar P, et al. Method for Economic Evaluation of Bacterial Whole Genome Sequencing Surveillance Compared to Standard of Care in Detecting Hospital Outbreaks. Clin Infect Dis. 2021;73(1):e9-e18. https://doi:10.1093/cid/ciaa512 8. Sundermann AJ, et al. Automated data mining of the electronic health record for investigation of healthcare-associated outbreaks. Infect Control Hosp Epidemiol. 2019:1-6. https://doi:10.1017/ice.2018.343

Staff opinions of automated hand hygiene monitoring

In this second discussion of an abstract presented at the SHEA Spring meeting 2023 in Seattle, Martin talks to MPH candidate Olivia Hess about her work on staff opinions of automated hand hygiene monitoring. Olivia works as a member of Dr Gonzalo Bearman's group at VCU Health (Virginia Commonwealth University) in Richmond, Virginia. We discuss staff attitudes to the technology and it's utility, which are almost universally negative.
Some recent papers on automated hand hygiene monitoring:
M. A. Tremblay, et al. 2022 Investigation of Individual Nurses' Relative Hand Hygiene Performance Using an Anonymous Automated Electronic Hand Hygiene Monitoring System and a Nursing Assignment Schedule Am J Infect Control https://10.1016/j.ajic.2022.05.026
V. Mouajou, et al. 2022 Hand hygiene compliance in the prevention of hospital-acquired infections: a systematic review J Hosp Infect 119 33-48 https://10.1016/j.jhin.2021.09.016
K. J. McKay, et al. 2022 Healthcare workers' experiences of video-based monitoring of hand hygiene behaviours: a qualitative study Am J Infect Control https://10.1016/j.ajic.2022.03.010
D. J. Durant, et al. 2020 Adoption of electronic hand hygiene monitoring systems in New York state hospitals and the associated impact on hospital-acquired C. difficile infection rates Am J Infect Control 48 7 733-739 https://10.1016/j.ajic.2020.04.005
And thanks to Marco Bo Hansen for reminding us of this recent paper
A. R. Knudsen, et al. 2023 Individual hand hygiene improvements and effects on healthcare-associated infections: A long-term follow-up study using an electronic hand hygiene monitoring system J Hosp Infect In Press https://10.1016/j.jhin.2023.02.017

Human factors and cleaning in the perioperative setting

In this episode recorded at the 2023 SHEA Spring Meeting in Seattle, Martin talks to abstract presenter Dr Lamia Alam about the work of a Johns' Hopkins group on a systematic review of human factors relating to cleaning in the Operating Room. We discuss the abstract presented at the meeting and also previous work in human factors and environmental service workers from this group that are particular favourites of Martin's (detailed below).
Relevant papers:
1. A. Xie, et al. 2018 Improving Daily Patient Room Cleaning: An Observational Study Using a Human Factors and Systems Engineering Approach IISE Transactions on Occupational Ergonomics and Human Factors 6 3-4 178-191 https://10.1080/24725838.2018.1487348
2. C. Rock, et al. 2016 Using a Human Factors Engineering Approach to Improve Patient Room Cleaning and Disinfection Infect Control Hosp Epidemiol 37 12 1502-1506 https://10.1017/ice.2016.219

The 100th

This is the 100th episode of Infection Control Matters and includes a special announcement. A big thanks to our 110+ guests so far. In this podcast, Martin, Brett and Phil talk about what we've not covered, some stats and what is to come next.
 
Check out out new website: https://infectioncontrolmatters.com/

Right specimen, right time - The importance of diagnostic stewardship

In this episode, Martin Kiernan talks to Dr Valeria Fabre, Associate Professor of Medicine at Johns Hopkins University School of Medicine and  Associate Medical Director of the Antimicrobial Stewardship Program and an Associate Hospital Epidemiologist at the Johns Hopkins Hospital. We discuss the recent SHEA position paper on practical aspects of diagnostic stewardship and the use of the diagnostic pathway (ie, ordering, collecting, processing, reporting, and interpreting results of a diagnostic test).
 
Paper discussed:
Fabre V, et al. Principles of diagnostic stewardship: A practical guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force. Infect Control Hosp Epidemiol. 2023;44(2):178-185.  https://doi:10.1017/ice.2023.5
 
Other recent papers on this subject:
Warren BG, et al. Evaluation of hospital blood culture utilization rates to identify opportunities for diagnostic stewardship. Infect Control Hosp Epidemiol. 2023;44(2):200-205. https://doi:10.1017/ice.2022.191
Shallal AB, et al. Role of diagnostic stewardship in reducing healthcare-facility-onset Clostridioides difficile infections. Antimicrob Steward Healthc Epidemiol. 2023;3(1):e53. https://doi:10.1017/ash.2022.305
Morgan DJ, et al. Diagnostic Stewardship to Prevent Diagnostic Error. JAMA. 2023. https://doi:10.1001/jama.2023.1678
Chiotos K, et al. Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention. Infect Control Hosp Epidemiol. 2023;44(2):191-199. https://doi:10.1017/ice.2022.299
Advani SD, et al. Optimizing reflex urine cultures: Using a population-specific approach to diagnostic stewardship. Infect Control Hosp Epidemiol. 2023;44(2):206-209. https://doi:10.1017/ice.2022.315
 

C. difficile - a constant challenge to stay still

In this episode Brett and Martin talk to Mairéad Skally and Prof Fidelma Fitzpatrick about their efforts to minimise Clostridioides difficile infections in the Beaumont Hospital in Dublin, Ireland. Mairéad is a Surveillance Scientist and Fidelma is a Consultant Microbiologist and also Head of Department of Clinical Microbiology at the Royal College of Surgeons (Ireland). We discuss 10 years of surveillance in the Beaumont and analysis of a rich pool of data that has helped them achieve a status quo.
 
The paper we discuss is here:
Skally M, Bennett K, Burns K, Brennan R, Finn C, O’Connell K, et al. A decade of Clostridioides difficile infection: A constant challenge to maintain the status quo. Journal of Hospital Infection. 2023 in press https://doi:10.1016/j.jhin.2023.02.008

Detection, removal and prevention of environmental biofilms

In this week's episode, Martin talks to Professor Jean-Yves Maillard from the Cardiff School of Pharmacy in Wales. We discuss detention, removal and prevention of biofilms in wet and dry environments. A range of papers on this topic from his group are listed below.
D. I. Centeleghe, et al. 2023 Klebsiella pneumoniae survives on surfaces as a dry biofilm Am J Infect Control https://doi:10.1016/j.ajic.2023.02.009
T. J. Tewes, et al. 2022 Raman Microscopic Analysis of Dry-Surface Biofilms on Clinically Relevant Materials Microorganisms 10 7 https://doi:10.3390/microorganisms10071369
K. Ledwoch, et al. 2022 Dry surface biofilms: what you need to know Br J Hosp Med (Lond) 83 8 1-3 https://doi:10.12968/hmed.2022.0274
K. Ledwoch, et al. 2021 Is a reduction in viability enough to determine biofilm susceptibility to a biocide? Infection Control & Hospital Epidemiology 42 12 1486-1492 https://doi:10.1017/ice.2021.42
K. Ledwoch, et al. 2020 It's a trap! The development of a versatile drain biofilm model and its susceptibility to disinfection J Hosp Infect 106 4 757-764 https://doi:10.1016/j.jhin.2020.08.010  

The Sink Splash Zone - danger lies within?

In this week's episode, Brett and Martin talk to Dr Mark Garvey, Consultant Clinical Scientist at University Hospitals Birmingham in the UK. We discuss a new paper from the UHB team which looks at the practical aspects of contamination within the splash radius of a clinical hand hygiene sink in a critical care area. The range of high risk equipment within the zone is quite interesting! Papers mentioned are as below.
1. Garvey MI, Williams N, Gardiner A, Ruston C, Wilkinson M, Kiernan M, et al. The sink splash zone. J Hosp Infect. https://doi:10.1016/j.jhin.2023.01.020   PubMed PMID: 36870392.2. Garvey MI, Wilkinson MAC, Holden KL, Martin T, Parkes J, Holden E. Tap out: reducing waterborne Pseudomonas aeruginosa transmission in an intensive care unit. J Hosp Infect. 2019;102(1):75-81. https://doi:10.1016/j.jhin.2018.07.039
3. Garvey MI, Bradley CW, Holden E. Waterborne Pseudomonas aeruginosa transmission in a hematology unit? Am J Infect Control. 2018;46(4):383-6. Epub 20171128. https://doi:10.1016/j.ajic.2017.10.013
4. Garvey MI, Bradley CW, Wilkinson MAC, Bradley C, Holden E. Engineering waterborne Pseudomonas aeruginosa out of a critical care unit. Int J Hyg Environ Health. 2017;220(6):1014-9. https://doi:10.1016/j.ijheh.2017.05.011

Oral Hygiene - attitudes and practice. Implications for pneumonia prevention.

We talk about the knowledge attitudes and practice of nurses regarding oral hygiene of dependent inpatients in this podcast with Dr Isabel Oliveira. Understanding these is an important element of improving oral care and potentially reducing hospital acquired pneumonia (HAP) more broadly.  Isbael is a rehabilitation nurse with a particular focus and interest in dysphagia and oral care, including the prevention of HAP. She works at the  Centre for Health Studies and Research of the University of Coimbra (CEISUC) in Portugal. 
 
The paper referred to in this podcast is "Knowledge, attitudes and practices of nurses regarding oral hygiene of dependent inpatients".
Link: https://pubmed.ncbi.nlm.nih.gov/35680116/