Year in IPC 6/23/17

Andreas Voss 1

Elaine Larson,RN,PhD,FAAN,CICAnnaC.MaxwellProfessorofNursing Research

Associate Deanfor ResearchColumbiaUniversitySchoolofNursing

AndreasVoss,MD,PhD,FSHEA,FESCMIDProfessorofInfection Control,RadboudumcClinical Microbiologist,CWZ,Nijmegen,NL

bothspeakersdeclarenoconflictofinterest

Storr etal.Antimicrob Resist InfectControl(2017)6:6

Boyce ARIC(2016)5:10

Doyou think toknow all that isneeded about(nosocomial)virusinfections

Not me!

Chow&Mermel,OpenForumInfectious Diseases 2017,DOI:10.1093/od/ofx006

Year in IPC 6/23/17

Andreas Voss 2

Imaginethatyouareinchargeofcleaniningtherest-roomsofalargefasility

Yourproblem:Malesthatcan’taimandtheconsequent“spillage”

Howtousehumanfactorsengineeringforhelp?

Givethemanaimà 80%lessspillage

Batesonetal.Biol.Lett.(2006)2,412–414doi:10.1098/rsbl.2006.0509

Batesonetal.Biol.Lett.(2006)2,412–414doi:10.1098/rsbl.2006.0509

Weexamined the effectofan imageofapairofeyesoncontributions to an

honesty boxused to collectmoneyfor drinksinauniversity coffeeroom.

Batesonetal.Biol.Lett.(2006)2,412–414doi:10.1098/rsbl.2006.0509

This finding providesthe firstevidence from anaturalistic settingofthe importance ofcuesofbeing watched,andhence reputationalconcerns,onhuman

cooperative behaviour.

… leave your money at the back doorsKingetal.HealthPsychol. 2016Jan;35(1):96-101.

Year in IPC 6/23/17

Andreas Voss 3

Kingetal.HealthPsychol. 2016Jan;35(1):96-101.

Visitors to the ICUwere exposed to anolfactory prime(“clean”citrus smell)usingan aromadispenserand “eyes”

Choice smell determined inearlier study(“cleanest &freshest”)

Kingetal.HealthPsychol. 2016Jan;35(1):96-101.

olfactory >eyes

male>female eyes

Priming works(47%vs.15%)

If you don’tcite yourself,who will?

BobWeinsteinTartari etal.Antimicrob Reistance InfectControl2017;6:45

Tartari etal.Antimicrob Reistance InfectControl2017;6:45 DeGeyter etal.ARIC(2017)6:24

Year in IPC 6/23/17

Andreas Voss 4

DeGeyter etal.ARIC(2017)6:24

To controltheoutbreak,thesinks and their plumbings werereplaced by newones with

another structure

drains

screens

water

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)

Hopman etalARIC2017;6:59 Hopman etalARIC2017;6:59

Hopman etalARIC2017;6:59

Monthly gram-negative bacilli (GNB)colonization rates.

Hopman etalARIC2017;6:59

Monthly gram-negative bacilli (GNB)colonization rates.

Year in IPC 6/23/17

Andreas Voss 5

¤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

Year in IPC 6/23/17

Andreas Voss 6

¤Whole-genome sequencing identifiedcommon blaNDM-positive E.coli sharedamong farms,flies,dogs and farmers,providing directevidence ofcarbapenem-resistant E.coli transmissionandenvironmental contamination.

Wangetal.NatureMicrobiology 2017

“Softly” Killing Infection Control …

… studies not all of us were waiting for

Hygiea

InfectControlHospEpidemiol. 2016Nov;37(11):1323-1330.Epub 2016Jul 26

Discontinuingroutinecontactprecautions(CP)forendemicMRSAandVREdidnotresultinincreasedratesofMRSAorVREafter1year.Withcostsavingsonmaterials,decreasedhealthcareworkertime,andnoconcomitantincreaseinpossibleinfections,eliminationofroutineCPmayadd

substantialvaluetoinpatientcaredelivery.

Clinically significantVREoutcomesremain rare.Cessation ofallcontrolmeasures forVREhadnosignificantattributable adverseclinical impact.

¤Overall,areasonably firmconclusion can be reached thatroutinecontactisolation forendemicMRSAand VREisunnecessary (and may beharmful)when there isactivemaintenanceofhandhygiene,environmental cleaning,andchlorhexidine bathing

HillaryHumphreysISCHApril2017

Somecenterswouldbewisetocontinuewithactivescreeningtomonitortrendsandto

targetadditionalmeasuresWeshouldbereluctanttodiscontinueevenselectivescreeningandcontactprecautions

Year in IPC 6/23/17

Andreas Voss 7

Ifyoubelieveinhandhygienecompliance,thatenvironmentalcleaningiswelldone,andchlorhexidinebathingdoesnotleadtoresistanceandextracoststoyourinstitution

Ifyouconsider20-30%clinicalinfectionswithMRSAandVRE“normal”

Whenyouliketofindoutin5yearswhichotherfightyoulostdoetodroppingCP

Scheithauer etal.JHosp Infect2016;94:268

Scheithauer etal.JHosp Infect2016;94:268

Thedisinfectionefficacyforalldisinfectant/glovecombinationswasbetterwith,ratherthanwithoutgloves

but

- whataboutthenottestedcombinations- changeofthematerial/leakage- maximumfrequency

Could the (better)solutionbe less glove-use?

Mendelson etal.Nature2017

¤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

Mendelson etal.Nature2017

”Drugresistance”isatermknownbymorethantwo-thirdsofthepeople

Year in IPC 6/23/17

Andreas Voss 8

Candidaauris

Chowdhary etal.PLoS Pathog 13(5):e1006290

¤ difficulttodiagnose

¤ vastlytransmissible

¤ multi-drug-resistant

¤ highlyvirulent

¤ troubletoeliminate

Chowdhary etal.PLoS Pathog 13(5):e1006290

Year in IPC 6/23/17

Andreas Voss 9

Ross&Witzke Infection 01February 2017

• 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

investigation period• Results donot supportBibles asapossible sourceofnosocomial infections

Faithstaysagoodthing….but

• Justapilotstudy

• Notinisolationrooms

• Wedon’tknowifBibles

wereactuallyused

Year in IPC 6/23/17

Andreas Voss 10

¤AMRisnolonger aproblem for singlehospitals butofthe entire healthcaresystemà IPCmeasures need tobecoordinated

¤Controlthe dispersal ofAMRonalocal orregional level,rather than focussing onlargeproblems faraway

faraway

closeby

versus

Donkeretal.BMCMedicine 2017;15:86 Olans etal.CID206;62:84

Nursesareantibiotic firstresponders,central communicators,coordinators ofcare,aswellas24-hourmonitorsofpatient status,safety,

and responsetoantibiotic therapy.

NotwhatOlans etal.describe,butanotherreasonwhynurses

shouldbeincludedinAMS

Bingham etal.AmJInfectControl2016;44:1198

¤17HCWs from 4wound carefacilities were sampled during 46patient careencounters for the presence ofMRSA,VRE,MDR-Acinetobacter,and C.difficile

¤HCWs acquired atleast 1pathogen ontheir handsduring 28.3%ofall patient careencounters

¤Handcontamination occurred in19.6%ofinstances whereHCWs wore gloves during carecompared with 14.6%whenHCWs were ungloved

Bingham etal.AmJInfectControl2016;44:1198

Themeanbacterialreductionafter15sofhandrubbingwasnon-inferiorto30shandrubbing(0.11log10 difference)

Year in IPC 6/23/17

Andreas Voss 11

LÜBBEKEetal.ActaOrthopaedica 2016;87(2):132–138

• PJIwith BMI35–39.9(adjusted HR=2.1)

• PJIwith BMI≥40(adjusted HR=4.2).Weight≥100kgwasidentifiedasthresholdforasignificantincreaseininfection(adjustedHR=2.1).

Albrecht etal.JAMDA2017;18:158-161

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.

Bartek etal.CID2017

*don’t try this inyour hospital

Ifyoudoit,doitright!

Year in IPC 6/23/17

Andreas Voss 12

articlepreviouslypresentedbyBobWeinstein

Slightlylesscontroversial,butfarmore

sweaty

Infection Control

NotsureifIwouldgotothenextsurgicalmeeting