More evidence that chlorhexidine reduces MDRO colonisation in the ICU

A US before-after study evaluated the impact of introducing chlorhexidine daily CHGbathing in an ICU setting. In line with other studies, the rate of acquisition of key hospital pathogens, including VRE, MRSA, and antibiotic-resistant Gram-negative bacteria reduced in response to the introduction of chlorhexidine, and remained lower over time.

The 8 month before-after study was performed in a 24 bed ICU in the US, with a 1 month pre-intervention period and an 8-month intervention period. Admission and discharge screening was performed for important hospital pathogens (VRE, MRSA, and antibiotic-resistant Gram-negative bacteria). There was a significant reduction in the prevalence and incidence of both VRE and antibiotic-resistant Gram-negative bacteria associated with the introduction of chlorhexidine daily bathing. Whilst this reduction was sustained throughout the intervention phase, it did not trend down further; the authors suggest that focus on implementing daily chlorhexidine bathing waned after initial enthusiasm. This supports the need for continuous education to ensure compliance with best practice infection prevention interventions.

Whilst there was no randomisation or concurrent control group, this study reinforces that chlorhexidine bathing results in a clear and sustained reduction in the transmission of key hospital pathogens in the ICU setting.

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Time to wipe away C. difficile from patients’ hands?

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A US study has found that around 15% of patients with C. difficile infection have C. difficile contaminated hands, and that removing these spores from patients’ hands is challenging.

The study was performed in a 500-bed US hospital. Around 50 patients with C. difficile infection were enrolled in the study, and randomised to either hand hygiene using either alcohol-based hand rub (ABHR) or hand washing using soap and water. The hands of patients were sampled both before and after hand hygiene. 7 (15%) of the patients had contamination with C. difficile before hand hygiene; C. difficile persisted despite hand hygiene on the hands of all three patients in the ABHR arm, and on 2/4 patients in the soap and water arm. It is important to note that patients with limited mobility (and so had to wash their hands at the bedside rather than at the sink) were less likely to clear hand contamination with C. difficile. Interestingly, C. difficile was recovered from the hands of 3 (6%) of patients who didn’t have C. difficile contamination before hand hygiene!

The level of hand hygiene identified on patients with symptomatic C. difficile was lower than in a previous study (15% in this study vs. 32% in the previous study). However, the study illustrates the persistence of C. difficile on the hands of patients, and highlights the challenges of delivering effective hand hygiene to patients with limited mobility. A recent study found that wipes designed for patient hand hygiene were as effective as soap and water for removing microbes in a laboratory setting. These wipes would be a useful way to improve patient hand hygiene, especially for patients with limited mobility.

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GAMA Healthcare updates from
Infection Prevention 2017

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We all enjoyed Infection Prevention 2017 — and hope that you did too! Here's a few scientific updates relating to our product range that were presented at the conference, published in the Journal of Infection Prevention:

  • Abstracts 90 and 106. Gateshead NHS Trust collaborated with GAMA to deliver a back-to-basics cleaning education campaign. The campaign consisted of 28 face-to-face training sessions supported by various electronic resources. Whilst it can be tricky to measure the impact of this sort of campaign, questionnaires issued before and after the campaign reported an increase in awareness of correct cleaning techniques. The details of a new app-based method for gathering information on the effectiveness of the training is described in Abstract 106, detailing the new AskMe app from GAMA.
  • Abstract 102. Luton and Dunstable University Hospital NHS Trust trialled the Commode Audit App from GAMA to replace a paper-based audit of commode disinfection to ‘go paper free and save a tree’! The audit proved to be time-saving and eased the burden or report-writing, so has been adopted by the Trust.
  • Abstract 28. Joining up the dots to improve surface hygiene by use of fluorescent markers. This pilot study in Derby identified the key local touch points to monitor in order to configure a surface disinfection improvement programme based on fluorescent markers.
  • Abstracts #86 and #87. Taiwanese researchers compared standard disinfection approaches using chlorine solution to Clinell wipes for tackling contamination with VRE and difficile. High levels of contamination were identified both before and after disinfection using chlorine solution: 20% of sites remained contaminated with C. difficile and 40% with VRE after chlorine disinfection. In contrast Clinell Universal Wipes virtually eradicated VRE and Clinell Sporicidal Wipes virtually eradicated C. difficile (with only 3% of sites remaining contaminated after disinfection for both). Whilst it is not clear whether it was the improved disinfection process using wipes, or the differences in the chemicals used, the result is that the wipes delivered considerably improved disinfection compared with chlorine solution (combined with improved staff safety)!
  • Abstract #60. Emergency Department patient trolleys: A service evaluation. This qualitative study from Scottish researchers evaluated staff perceptions on the contamination risk from trolleys in the ED. Staff agreed that the trolleys are difficult to clean, and often remained contaminated following standard approaches. At IPS, GAMA launched a trolley cover, which is designed to be single patient use and reduce the risk from trolley contamination.
  • Abstract 96. The imaginatively titled ‘It takes two to tango’ by GAMA's clinical director Martin Kiernan describes the importance of ensuring compatibility between hospital disinfectants and hospital surface materials. The review identified an evidence-free zone, concluding that more work is needed to ensure that disinfection and material compatibility are optimised during hospital surface disinfection.
  • Please feel free to contact us if you’d like any more information about these updates.

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    Using bleach once a week is linked to fatal lung disease

    Lungs_image_cropped

    A French study has found that weekly use of disinfectants by nurses is associated with developing chronic pulmonary obstructive disease (COPD). The study supports urgent reconsideration of the widespread use of liquid disinfectants in favour of safer alternatives, including
    disinfectant-impregnated wipes.

    The large longitudinal study followed 55, 185 US nurses from 2009-2017, and evaluated risk factors for developing COPD. A total of 663 (1%) of nurses developed COPD during the study. Weekly exposure to disinfectants for surface disinfection was a significant risk factor for developing COPD (odds ratio 1.2), even after adjusting for other factors that may cause COPD (such as smoking). Also, exposure to specific disinfectants was a risk factor for COPD (including chlorine, aldehydes, and quaternary ammonium compounds). Unsurprisingly, the study has prompted some coverage in mainstream news outlets, like the Metro, Independent, and Guardian.

    Other studies have found that some disinfectants are associated with developing asthma, but this is the largest dataset to link the use of disinfectants with COPD. It is important to note that the study focussed on nurses, and other staff groups (especially cleaners) are likely to be at even greater risk of disinfectant-associated COPD. This study argues strongly for rapidly phasing out the use of liquid disinfectants and replacing them with alternative approaches, including disinfectant-impregnated wipes.

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    An interview with Martin Kiernan: education, education, education!

    Screen Shot 2017-09-08 at 15.58.12 IVupdate have published an interview with Martin Kiernan (our very own clinical director) by Andrew Jackson of IVTeam.com, which is well worth a listen. The interview covers Martin’s career (listen out for the words of wisdom from used car sales…), proudest moments, views on patient safety, and the importance of bundle implementation.

    The focus of the interview is around bundles to reduce the risk of vascular line-associated infection. Chlorhexidine bathing is gaining increasing acceptance of as a key component of vascular-line associated infection prevention bundles, but it is only part of the picture. Whilst it could be said that the very existence of bundles represents an evidence gap, because we are often unclear which elements of the bundle are effective, one thing is certain: a bundle will not be effective if it’s not implemented correctly. And the way to ensure a bundle is implemented effectively? Education, education, education! Top down approaches do not work; front-line staff need to understand the importance of the issue, and believe in the bundle for it to be implemented in the busy healthcare setting.

    If we get the implementation of bundles to prevent vascular line-associated infection right, we should begin to see reductions in line-associated infections due to MSSA and some contribution to the ambition to reduce E. coli and other Gram-negative BSIs.

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