Knowledge @lert for Infection Control – June 2014
Guidance: UK AMR strategy: measuring success – HM Government Antimicrobial resistance is when infections caused by microorganisms survive exposure to a drug that was supposed to kill them or stop their growth, this is a particular problem with antibiotics. The measures agreed by the UK antimicrobial resistance strategy High Level Steering Group, taking advice from expert scientific advisory committees including the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI), cover 4 areas:
- trends in resistance
- quality of prescribing in primary and secondary healthcare settings
- public and professional knowledge and understanding of antimicrobials and their appropriate use.
- global security through ensuring global alignment in addressing AMR
These measures apply equally to human and animal health.
Epidemiology & Infection Volume 142 Issue 08 Epidemiology & Infection publishes original reports and reviews on all aspects of infection in humans and animals. Particular emphasis is given to the epidemiology, prevention and control of infectious diseases. The scope covers the zoonoses, outbreaks, food hygiene, vaccine studies, statistics and the clinical, social and public-health aspects of infectious disease, as well as some tropical infections. It has become the key international periodical in which to find the latest reports on recently discovered infections and new technology. For those concerned with policy and planning for the control of infections, the papers on mathematical modelling of epidemics caused by historical, current and emergent infections are of particular value.
- View the table of contents
Infection Control and Hospital Epidemiology Vol. 35, No. 6 (June 2014)
- Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update Deverick J. Anderson, MD, MPH; Kelly Podgorny, DNP, MS, RN; Sandra I. Berríos-Torres, MD; Dale W. Bratzler, DO, MPH; E. Patchen Dellinger, MD; Linda Greene, RN, MPS, CIC; Ann-Christine Nyquist, MD, MSPH; Lisa Saiman, MD, MPH; Deborah S. Yokoe, MD, MPH; Lisa L. Maragakis, MD, MPH; Keith S. Kaye, MD, MPH
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Erik R. Dubberke, MD, MSPH; Philip Carling, MD; Ruth Carrico, PhD, RN; Curtis J. Donskey, MD; Vivian G. Loo, MD, MSc; L. Clifford McDonald, MD; Lisa L. Maragakis, MD, MPH; Thomas J. Sandora, MD, MPH; David J. Weber, MD, MPH; Deborah S. Yokoe, MD, MPH; Dale N. Gerding, MD
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Leslie Grammatico-Guillon, MD; Sabine Baron, MD; Christophe Gaborit, MS; Emmanuel Rusch, MD, PhD; Pascal Astagneau, MD, PhD
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Michael V. Murphy, BA; Dongyi (Tony) Du, MD, PhD; Wei Hua, MD, PhD; Karoll J. Cortez, MD, MHS; Melissa G. Butler, PharmD, MPH, PhD; Robert L. Davis, MD, MPH; Thomas DeCoster, MD; Laura Johnson, MD; Lingling Li, PhD; Cynthia Nakasato, MD; James D. Nordin, MD, MPH; Mayur Ramesh, MD; Michael Schum, PhD; Ann Von Worley, RN, BSHS; Craig Zinderman, MD, MPH; Richard Platt, MD, MSc; Michael Klompas, MD, MPH
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Keita Morikane, MD, PhD; Hitoshi Honda, MD, PhD; Takuya Yamagishi, MD, PhD; Satowa Suzuki, MD, PhD; Mayumi Aminaka, RN, PhD
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Hoonmo L. Koo, MD, MPH; John N. Van, BA; Meina Zhao, PhD; Xunyan Ye, PhD; Paula A. Revell, PhD; Zhi-Dong Jiang, MD, DrPh; Carolyn Z. Grimes, DrPh; Diana C. Koo, MPA; Todd Lasco, PhD; Claudia A. Kozinetz, PhD; Kevin W. Garey, PharmD; Herbert L. DuPont, MD
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Walter Zingg, MD; Benedikt D. Huttner, MD, MS; Hugo Sax, MD; Didier Pittet, MD, MS
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H. L. Wald, MD, MSPH; B. Bandle, BA; A. Richard, MS, RN; S. Min, PhD
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Westyn Branch-Elliman, MD, MMSc; Judith Strymish, MD; Kalpana Gupta, MD, MPH
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Marija Vasilevska, BA; Jennifer Ku, MSc; David N. Fisman, MD, MPH, FRCPC
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Shlomi Codish, MD; Lena Novack, PhD; Jacob Dreiher, MD, MPH; Leonid Barski, MD; Alan Jotkowitz, MD, MPH; Lior Zeller, MD; Victor Novack, MD, PhD
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L. Silvia Munoz-Price, MD, PhD; Zalak Patel, MD; Shawn Banks, MD; Kristopher Arheart, EdD; Scott Eber, MD; David A. Lubarsky, MD, MBA; David J. Birnbach, MD, MPH
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Mark E. Rupp, MD; Tomas Huerta, BS; R. J. Cavalieri, RN; Elizabeth Lyden, MS; Trevor Van Schooneveld, MD; Philip Carling, MD; Philip W. Smith, MD
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Lauren Block, MD, MPH; Samantha Pitts, MD, MPH; Trish M. Perl, MD, MSc
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Irene C. Kuo, MD; Colleen Espinosa, RN, BS, CCM; Michael Forman, BS; Miriana Pehar, RN; Lisa L. Maragakis, MD, MPH; Alexandra Valsamakis, MD, PhD
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Simone Lanini, MD; Gorana Ćosić, MD; Stefano Menzo, PhD; Vincenzo Puro, MD; Predrag Đurić, MD; Anna Rosa Garbuglia, PhD; Vesna Milošević, MD; Tatjana Karać, PhD; Maria Rosaria Capobianchi, PhD; Giuseppe Ippolito, MD
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Patil Injean, BS; James A. McKinnell, MD; Peter P. Hsiue, BA; Sitaram Vangala, MS; Loren G. Miller, MD, MPH; Peyman Benharash, MD; Ralph G. Brindis, MD, MPH; Aric L. Gregson, MD
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Peter P. Hsiue, BA; Aric L. Gregson, MD; Patil Injean, BS; Sitaram Vangala, MS; Ralph G. Brindis, MD, MPH; Richard J. Shemin, MD; David M. Shahian, MD; Loren G. Miller, MD, MPH; Martin F. Shapiro, MD, PhD; Peyman Benharash, MD; James A. McKinnell, MD
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James Pellerin, MD; Gonzalo Bearman, MD, MPH; Jonathan Sorah, BS; Kakotan Sanogo, MS; Michael Stevens, MD, MPH; Michael B. Edmond, MD, MPH, MPA
Antimicrobial Resistance and Infection Control
Utility of surveillance blood cultures in patients undergoing hematopoietic stem cell transplantation Sameeh S Ghazal, Michael P Stevens, Gonzalo M Bearman, Michael B Edmond Antimicrobial Resistance and Infection Control 2014, 3:20 (4 June 2014)
Confounding by indication affects antimicrobial risk factors for methicillin-resistant Staphylococcus aureusbut not vancomycin-resistant enterococci acquisition Rupak Datta, Ken Kleinman, Sheryl Rifas-Shiman, Hilary Placzek, Julie Lankiewicz, Richard Platt, Susan S Huang, for the CDC Prevention EpicentersAntimicrobial Resistance and Infection Control 2014, 3:19 (1 June 2014)
Attributable healthcare utilization and cost of pneumoniae due to drug-resistant Streptococcus pneumoniae: a cost analysis Courtney A Reynolds, Jonathan A Finkelstein, G Ray, Matthew R Moore, Susan S HuangAntimicrobial Resistance and Infection Control 2014, 3:16 (21 May 2014)
The use of surveillance and preventative measures for methicillin-resistant staphylococcus aureus infections in surgical patients Kevin T Kavanagh, Lindsay E Calderon, Daniel M Saman, Said K AbusalemAntimicrobial Resistance and Infection Control 2014, 3:18 (14 May 2014)
Prevalence of nosocomial infections and anti-infective therapy in Benin: results of the first nationwide survey in 2012 Théodora Ahoyo, Honoré Bankolé, Franck Adéoti, Aimé Gbohoun, Sibylle Assavèdo, Marcellin Amoussou-Guénou, Dorothée Kindé-Gazard, Didier PittetAntimicrobial Resistance and Infection Control 2014, 3:17 (14 May 2014)
Controversies in Hospital Infection Prevention: Wherein we ponder vexing issues in infection prevention and control, inside and outside the hospital. – Recent blog posts
Say what?! Colonized patients (but not infected patients) contaminate the hospital environment There is a continuous debate in infection control about whether to actively screen patients for MDRO colonization and subsequent isolation. Alternatives to active screening include passive surveillance, where only patients found to be infected through clinical cultures are isolated. Frequently, passive surveillance is justified by saying that infected patients will have a higher bio-burden compared to colonized patients, so they would be more likely to contaminate healthcare workers hands and the environment. However, is this in fact true? Are infected patients more likely to contaminate their rooms than colonized patients? In part to answer this question, Lauren Knelson and colleagues from Duke and UNC just published a study in the July ICHEthat measured the contamination of rooms after patients colonized or infected with MRSA or VRE were discharged. 48 rooms (33 from colonized patients, 15 from infected patients) were sampled using Rodac plates after patient discharge but before terminal room cleaning. Numerous sites were sampled including: sinks, toilet seats, bedside tables, bed rails, chairs, floors, TV remotes, carts, and laundry bins. This is a very small study, but even with the limited sample size they found that median CFU were higher in colonized vs infected patients’ rooms (25 CFU vs 0 CFU, p=0.033). As you can see in the figure, the distribution of room contamination was greatly skewed towards higher levels of contamination at discharge from colonized patient rooms.
Stewardship Effective in C. difficile Prevention: A Meta-Analysis As Dan mentioned last week, when 15% of asymptomatic hospitalized adults carry toxigenic strains of Clostridium difficile, it should alert us to focus on antimicrobial stewardship as a way to prevent CDI. But how effective are stewardship programs and does it matter what type of program you implement in your hospital? If only there was some sort of systematic review or meta-analysis to guide or decision making. As if on queue, Leah Feazel and Marin Schweizer at University of Iowa published such a review and meta-analysis titled “Effect of antibiotic stewardship programmes on Clostridium difficile incidence” in JAC earlier this spring. Typical of projects completed by Marin and her group, they thoroughly combed the literature for papers. Here they identified 891 articles, reviewed 78 full articles and included 16 studies in their final analysis. Over all, stewardship programs were associated with a 52% reduction in CDI incidence. Importantly, programs appeared effective when implemented in whole hospital or geriatric settings and when utilizing a persuasive approach or a restrictive approach. I’ve provided the forest plot of studies below. An additional note is that the studies utilized various quasi-experimental study designs and based on the funnel plot, there appeared to be little publication bias.
Laundering White Coats – We are asking the wrong question! There is a very nice survey of bare-below-the-elbows perceptions and practice in this month’s ICHE by co-blogger Mike’s group. They asked 300 attendees (190 or 63% responded) at medical and surgical grand rounds about their beliefs and behavior concerning wearing white coats, neckties and wristwatches. I’ve posted the results below. As expected (since Mike has recommended BBE at his hospital since 2009), most thought that white coats were vectors and that not wearing a white coat would not alter patients’ perceptions of them. Most did not wear white coats daily, neckties (males only) or wristwatches. Approximately half practiced the bare-below-the-elbows approach.
The enemy within There are a couple studies out this month, one in CID (from WashU) and one in ICHE (from Houston), that carry the same message: a substantial portion (13-15%) of asymptomatic hospitalized adults carry toxigenic strains of Clostridium difficile in their GI tracts. Coming on the heels of this NEJM study using whole-genome sequencing to describe the genetic diversity ofC. difficile strains, these studies advance an evolving narrative—that many cases of C. difficile-associated disease (CDAD) are not attributable to in-hospital transmission from other symptomatic patients (and thus are impervious to transmission-prevention approaches such as hand hygiene, contact precautions, and enhanced environmental disinfection). The major take-away point for me: it’s all about the stewardship! Knowing that 15% of patients harbor toxigenic C. difficile should only increase the urgency of antimicrobial stewardship efforts.
Hand hygiene: It’s ginormous An important new paper in the American Journal of Infection Control helps to put hand hygiene compliance efforts into perspective. The authors performed the study in 12 patient rooms in an adult medical ward in a 746-bed teaching hospital. Using video surveillance, they analyzed the number of hand hygiene opportunities using the World Health Organization My 5 Moments framework. The key finding was that there are approximately 72 hand hygiene opportunities per patient-day.
Food for thought… A few months ago I blogged about a study that explored the biologic plausibility for replacing the handshake with the fist bump from an infection prevention standpoint. Now there’s a new opinion piece in JAMA (free full text here) by pediatricians at UCLA, which raises the issue of whether hospitals should become handshake-free zones.
Meager and unsatisfactory It’s nice to see antimicrobial resistance featured in a Sunday NY Times editorial—nothing that we haven’t already covered in Eli’s recent post on the WHO report, but worth reading nonetheless. If you believe that “you can’t improve what you can’t measure”*, the most disheartening sentence in this editorial about the WHO report is “…few countries track and monitor antibiotic resistance comprehensively, and there is no standard methodology for doing so.