Infection Control Matters

Respiratory protection preparedness in critical care healthcare workers & facial hair

In this podcast, Brett Mitchell talks to Professor Daryl Williams about respirators and facial hair. So much to learn, so much more to know. The talk was based on a paper published in Infection Disease and Health.
The article link: https://www.idhjournal.com.au/article/S2468-0451(22)00003-7/fulltext
Prof Daryl Williams is the Director of the Department of Anaesthesia and Pain Management. His clinical and research interests include neuro-anaesthesia, resuscitation, trauma medicine and advanced airway management.

Reflecting on a contact precautions talk at ECCMID with Dr Gonzalo Bearman

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

Environmental cleaning & the role of patient service assistants

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.

50 Shades of Grey - Risk assessment and communicating decisions with Dr Elaine Cloutman-Green

Measuring cleaning effectivness and improvement with Dr Phil Carling from SHEA Spring 2022

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

CO2 monitoring to find hospital areas with poor ventilation - Poster at ECCMID 2022 with Sharon Bamber

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

Human and financial cost of healthcare-associated pneumonia with Dr Dian Baker at the 2022 SHEA Spring Meeting

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

N95 Mask use for respiratory protection - a discussion with Dr Michael Klompas at the SHEA Spring Meeting

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/

Implementation of patient warming to prevent SSI - How hard can it be? With Prof. Judith Tanner

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

Surgical Site Infection (SSI) prevention with Charles Edmiston

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