Year in IPC 6/23/17 Andreas Voss 1 Elaine Larson, RN, PhD, FAAN, CIC Anna C. Maxwell Professor of Nursing Research Associate Dean for Research Columbia University School of Nursing Andreas Voss, MD, PhD, FSHEA, FESCMID Professor of Infection Control, Radboudumc Clinical Microbiologist, CWZ, Nijmegen, NL both speakers declare no conflict of interest Storr et al. Antimicrob Resist Infect Control (2017) 6:6 Boyce ARIC (2016) 5:10 Do you think to know all that is needed about (nosocomial) virus infections Not me! Chow & Mermel, Open Forum Infectious Diseases 2017, DOI: 10.1093/o d/ofx006
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Year in IPC 6/23/17
Andreas Voss 1
Elaine Larson,RN,PhD,FAAN,CICAnnaC.MaxwellProfessorofNursing Research
To controltheoutbreak,thesinks and their plumbings werereplaced by newones with
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Hopman etalARIC2017;6:59
¤ Theaim ofthis study wasto evaluate the effectofremoval ofsinks from theIntensiveCareUnit(ICU)patient roomsand the introduction of‘water-free’patient careongram-negative bacilli colonization rates.
¤ 2-yearpre/postquasi-experimental study that compared monthly gram-negative bacilli colonization rates pre- and post-intervention usingsegmented regression analysisofinterrupted timeseriesdata
¤ FiveICUs ofatertiary caremedical center
¤Outconme:monthly colonization rate with gram-negative bacilli (GNB)
¤This study showsthat removal ofthe sinks from all patientroomsand the introduction of‘water-free’patient careisassociated with astatisticallysignificantlower number ofICUpatients thatbecome colonized with GNB,includingMDR-GNB,especially among patientswith alonger length ofstay attheICU.
Hopman etalARIC2017;6:59
DeckeretalClin Mirobiol Infect2017
¤ 200bedNIHClinical Center,¤ 400HCWs with patient contact/labstaff with clinical specimencontactversus400staff
withoutrecentdirectpatient contactasacomparator.¤ Two perirectal swabs separated by afewdays¤ Datasetwasanonomysed¤ 4.0%ofHCWs and 3.2%ofthe controlgrew ESBLs,nonegrew VRE,and one ofthe control
participants grew aCPE.¤ Nosignificantriskfactorswere associated with ESBLcarriage
FormorecommentshavealookatReflectionsIPC
Thus,the boxstays shut,butshould be looked atagain
¤Overall,areasonably firmconclusion can be reached thatroutinecontactisolation forendemicMRSAand VREisunnecessary (and may beharmful)when there isactivemaintenanceofhandhygiene,environmental cleaning,andchlorhexidine bathing
¤Aglobal responseto acomplexhealththreat — commonlytermed 'antimicrobial resistance (AMR)’— requiresengagementfrom amuch broader arrayofplayers,fromgovernments,regulatorsand the public,to expertsinhealth,food,the environment,economics,trade and industry.
¤Many ofthe terms routinely used to describe the problem aremisunderstood,interpreted differently orloaded with unhelpfulconnotations for the people from differentdomeins
Mendelson etal.Nature2017
¤A2015WHOsurvey:people areunfamiliarity with the languageofantibiotic resistance.Fewer than halfofthe nearly 10,000respondents hadheard ofthe term'antimicrobial resistance'.Only one-fifth were aware ofits abbreviated form'AMR'.
¤Simple,clear and unambiguous terminology isneeded to ensureglobal actionsagainst AMR
• Can Bibles inpatient's roomsactasavehiclefor the spreadofnosocomialinfections
• Samplesfrom 50Bibles invarious general wards ofthe hospital and 99hymnals from the hospital chapel
• Results:mainly apathogenic organisms plusAspergillus spp.• Bibles showed pathogen bacteria inalownumber.• Noinvasive infections with those pathogens could be documented during the
Directcarestaff reported using gowns and gloves primarily asself-protection against contactwith bodily fluids:not to prevent MRSAtransmission.Glove use wasdescribed ascommonand moreacceptable to staff and residents than gownuse.Administrators were surprised that MRSAtransmissionto healthcareworker handsandclothing occurred during activities when directcarestaff perceives nocontactwith bodilyfluids.Staff and administrators expressed willingness to use gowns and gloves for high-riskcareactivities,particularly if use istargeted toward specific typesofresidents such asthose withpressure ulcers.There wasaknowledge deficitabout MRSAtransmissionand infection among directcarestaff and residents
Albrecht etal.JAMDA2017;18:158-161 Albrecht etal.JAMDA2017;18:158-161
Nursing homeresidents expressed negative impressions ofgown use until they learned that gowns could helppreventMRSAtransmission,suggesting that education onMRSAmaydispel misconceptions.