Infection Control Matters – Details, episodes & analysis

Our guest host, Dr Sally Havers this week talks to some of authors from ClEaning and Enhancd DisinfectioN (CLEEN) study (including some regular voices..). The study was recently published in the Lancet Infectious Disease (link below).

The CLEEN study is a world first RCT that explores the impact of cleaning and disinfection of shared medical equipment on HAIs. The study reports significant reductions in HAIs associated with increased cleaning and disinfection of shared equipment.

In this chat, the background to the study is discussed, as well as some implementation and practical considerations. We also touch on the time it takes to clean, which is related to another paper from the CLEEN study recently published in the Journal of Hospital Infection.

For those attending the 2024 IPS conference in Birmingham in a few weeks, Brett will be presenting the full methodology and main effectiveness results at the conference. Early cost-effectiveness data will also be presented, as well as results from a time and motion study exploring how long it takes to clean equipment.

For those attending the 2024 ACIPC conference in Melbourne in November, there is a concurrent session on the main effectiveness results and a lightning session on how long it takes to clean equipment.

In this episode, Brett and Martin discuss a recent paper from Sarah Browning and colleagues that describes how an RCT on the ending of aspects of contact precautions (gloves and aprons) for MRSA and VRE could be conducted. The paper can be found here:

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(24)00243-X/abstract

Our other podcasts on contact precautions, gloves and aprons can be found here:

https://infectioncontrolmatters.podbean.com/e/have-gloves-had-their-day/

https://infectioncontrolmatters.podbean.com/e/reflecting-on-a-contact-precautions-talk-at-eccmid-with-dr-gonzalo-bearman/

https://infectioncontrolmatters.podbean.com/e/25-years-of-contact-precautions-but-benefit-or-harm-and-what-is-the-evidence-with-prof-jennie-wilson/

In this episode, Brett, Martin and Phil mull over the newly published WHO discussion document on respiratory particles and Martin catches up with Prof Cath Noakes from the School of Engineering in Leeds, UK to get her take on it.

You can download the document we are discussing here

https://www.who.int/publications/m/item/global-technical-consultation-report-on-proposed-terminology-for-pathogens-that-transmit-through-the-air

In this podcast, Brett and Martin reflect on the "Infection Control Papers of the Year" presented at ECCMID (AKA ESCMID Global) 2024.

Here are a selection of some of the papers mentioned:

• Decolonization in Nursing Homes to Prevent Infection and Hospitalization https://pubmed.ncbi.nlm.nih.gov/37815935/

• Reducing Hospitalizations and Multidrug-Resistant Organisms vi a Regional Decolonization in Hospitals and Nursing Homes https://pubmed.ncbi.nlm.nih.gov/38557703/

• Prevention of non-ventilator-associated hospital-acquired pneumonia in Switzerland: a type 2 hybrid effectiveness-implementation trial https://pubmed.ncbi.nlm.nih.gov/36893785/

• Skin Antisepsis before Surgical Fixation of Extremity Fractures https://www.nejm.org/doi/full/10.1056/NEJMoa2307679

• Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty https://www.nejm.org/doi/full/10.1056/NEJMoa2301401

• Investigation of individual nurses' relative hand hygiene performance using an anonymous automated electronic hand hygiene monitoring system and a nursing assignment schedule https://www.ajicjournal.org/article/S0196-6553(22)00468-0/abstract

• Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-centre, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning https://pubmed.ncbi.nlm.nih.gov/37089619/

In our first episode from ECCMID Global 2024, Martin and Brett reflect on the session on design of the healthcare environment sessions from Profs Hilary Humphries and Cath Noakes and a flash poster session featuring VRE Reservoirs in the environment and a tremendous piece of  Burkolderia sleuthing from the UKHSA

In this podcast, we chat with Dr Brian Forde about HAIviz. HAIviz an interactive dashboard for visualising and integrating healthcare-associated genomic epidemiological data. HAIviz displays and links the outbreak timeline, building map, phylogenetic tree, patient bed movements, and transmission network on a single interactive dashboard.

You can view and use the tool for free at Permana, B., Harris, P. N., Roberts, L. W., Cuddihy, T., Paterson, D. L., Beatson, S. A., & Forde, B. M. (2024). HAIviz: an interactive dashboard for visualising and integrating healthcare-associated genomic epidemiological data. Microbial Genomics, 10(2), 001200.

In this episode, Martin Kiernan talks to Mitch Clarke, Clinical Lead and Deputy Director of Infection Prevention and Control at Nottingham University Hospitals in the UK. We discuss an outbreak with a unique NDM CPE infection and look at where the investigations went, including a new reservoir that is a potential source - the floor scrubber.

Papers underpinning this work are here:

1. Benbow A, Clarke M, Yates C, Montgomery R, Staniforth K, Boswell T, et al. Hospital-wide healthcare-associated carbapenemase-producing Enterobacterales outbreak: risks of electric floor scrubbers in catering facilities and kitchens. J Hosp Infect. 2024;146:59-65. https://www.ncbi.nlm.nih.gov/pubmed/38341149 2. Prescott K, Billam H, Yates C, Clarke M, Montgomery R, Staniforth K, et al. Outbreak of New Delhi Metallo-Beta-lactamase Carbapenemase Producing Enterobacterales on a bone marrow transplant unit: Role of the environment. Infect Prev Pract. 2021;3:100125. https://www.ncbi.nlm.nih.gov/pubmed/34368742

In this episode, Martin Talks to Dr Mark Wilcox OBE, Professor of Microbiology at the University of Leeds, Head of Microbiology Research & Development at Leeds University Hospitals NHS Trust and National Clinical Director for Infection Prevention and Control at NHS England. We mull over the possible reasons for the increase in hospital-onset, hospital attributed cases in England, including ribotypes and antibiotic use. Given that the NHS is under great stress, we discuss the damage potential from a ribotype 955 which shares some genetic characteristics with the 027 ribotype that caused so many problems in the UK and worldwide in the early 2000s. One thing that we agree on is that reductions targets (with teeth) have been very successful in the past and should we venture in that direction again?

Information on data collection, hospital and national typing reports for England can be found here: https://www.gov.uk/government/collections/clostridium-difficile-guidance-data-and-analysis#epidemiology

In this episode, after an interesting discovery when searching Youtube, Brett and Martin mull over whether toilet plume is a risk factor for hospital-acquired pneumonia and C. difficile infections. The papers we discuss are listed below.

• Goforth MP, Boone SA, Clark J, Valenzuela PB, McKinney J, Ijaz MK, et al. Impacts of lid closure during toilet flushing and of toilet bowl cleaning on viral contamination of surfaces in United States restrooms. Am J Infect Control 2023. https://doi.org/10.1016/j.ajic.2023.11.020
• Best EL, Sandoe JA, Wilcox MH. Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk. J Hosp Infect 2012;80(1):1-5. https://doi.org/10.1016/j.jhin.2011.08.010
• Lai ACK, Tan TF, Li WS, Ip DKM. Emission strength of airborne pathogens during toilet flushing. Indoor Air 2018;28(1):73-9. https://doi.org/10.1111/ina.12406

We chat with Dr Deirdre Fitzgerald-Hughes and Aoife Kearney about a national survey undertaken in Ireland. In the survey, they explored CPE knowledge and practices of healthcare workers, including infection prevention and control staff.

There were some interesting findings that may be useful in informing IPC education and training, including convincing people that they need to know more.

The paper we discuss is:

• Kearney, A., Humphreys, H., & Fitzgerald-Hughes, D. (2023). Infection prevention and control policy implementation for CPE: A cross-sectional national survey of healthcare workers reveals knowledge gaps and sub-optimal practices. Journal of Hospital Infection. https://doi.org/10.1016/j.jhin.2023.12.007