Infection Control Matters

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

Vaccine hesitancy and the role of social scientists in infection prevention with A/Professor Holly Seale

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.

Environmental decontamination reduces healthcare infections - a systematic review with Alexandra Peters

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
 
 

Infection Prevention Team Staffing levels - Less (staff) is more (infections)?

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