Infection Control Matters

In this episode, Martin Kiernan talks to Dr Giorgia Gon, Assistant Professor of Epidemiology, London School of Hygiene and Tropical Medicine about a briefing paper that identifies research priorities for healthcare cleaning in resource-limited settings. We discuss the process of determining the priorities, the groups involved and the final areas that should be targeted with research funding, including cost-effectiveness, the use of biocides or detergents and minimum requirements. You can find a copy of the CLEAN Briefing here Other papers of interest: 1. Cross S, Gon G, Morrison E, Afsana K, Ali SM, Manjang T, et al. An invisible workforce: the neglected role of cleaners in patient safety on maternity units. Glob Health Action. 2019;12:1480085. https://www.ncbi.nlm.nih.gov/pubmed/31154993 2. Gon G, Kabanywanyi AM, Blinkhoff P, Cousens S, Dancer SJ, Graham WJ, et al. The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals. Antimicrob Resist Infect Control. 2021;10:8. https://www.ncbi.nlm.nih.gov/pubmed/33413647 3. Storr J, Kilpatrick C, Lee K. Time for a renewed focus on the role of cleaners in achieving safe health care in low- and middle-income countries. Antimicrob Resist Infect Control. 2021;10:59. https://www.ncbi.nlm.nih.gov/pubmed/33762000

In this episode, Martin talks to Giovanni-Battista Fucini about a recent paper from Germany that examined infection rates in critical care in which it was reported that hospitals without sinks in patient rooms have lower infection rates. Newer hospitals in Germany tend not to have sinks in the patient rooms in ICU. The paper we discuss is here: Giovanni-Battista, F., C. Geffers, F. Schwab, M. Behnke, W. Sunder, J. Moellmann & P. Gastmeier (2023) Sinks in patient rooms in the ICU are associated with higher rates of hospital-acquired infections. A retrospective analysis of 552 ICUs. J Hosp Infect, 10.1016/j.jhin.2023.05.018. https://doi.org/10.1016/j.jhin.2023.05.018 Other papers of interest are: https://www.ncbi.nlm.nih.gov/pubmed/32224328https://www.ncbi.nlm.nih.gov/pubmed/32553019https://www.ncbi.nlm.nih.gov/pubmed/29409044https://www.ncbi.nlm.nih.gov/pubmed/29738784https://www.ncbi.nlm.nih.gov/pubmed/28235877https://www.ncbi.nlm.nih.gov/pubmed/36870392

Martin chats to Phil in Melbourne following a recent presentation. Yes, two old farts reminiscing about the days of wearing out the boot leather collecting surveillance data talk with envy about the potential of HAI surveillance in the era of the electronic medical record, automation and artificial intelligence. Phil refers to data in these two publications: Designing Surveillance of Healthcare-Associated Infections in the Era of Automation and Reporting MandatesThe prevalence of healthcare associated infections among adult inpatients at nineteen large Australian acute-care public hospitals: a point prevalence survey

We discuss One Health in this episode with Professor Tom Riley, using C.difficile as the example of explaining why the concept of One Health is so important. Tom is a Fellow of the Royal College of Pathologists, the Australian Society for Microbiology, the American Academy of Microbiology, the Society for Healthcare Epidemiology of America and the Faculty of Science of the Royal College of Pathologists of Australasia, and has published over 400 book chapters and refereed publications.

This week, Martin talks to Jincy Jerry, Assistant Director of Nursing in Infection Prevention and Control at the Mater Misericordiae University Hospital, Dublin, Ireland. Jincy is a pioneer in the use of Robotic Process Automation in clinical settings within Irish Healthcare. Robotic process automation (RPA) is a software technology that makes it easy to build, deploy, and manage software robots that emulate humans actions interacting with digital systems and software. In 2021, the project received Prix Hubert Tuor Innovation Academy Award at the 6th International Conference on Prevention and Infection Control (ICPIC), in Geneva. We discuss the potential and actual benefits, including the freeing up of hours of IP time as well as the use of AI (Artificial Intelligence) in the infection prevention world. A review paper on this topic can be found here: Piaggio, D., M. Zarro, S. Pagliara, M. Andellini, A. Almuhini, A. Maccaro & L. Pecchia (2023) The use of smart environments and robots for infection prevention control: A systematic literature review. Am J Infect Control, 10.1016/j.ajic.2023.03.005. https://www.ncbi.nlm.nih.gov/pubmed/36924997

In this podcast, we talk about the CLEEN and I-CLEEN studies. These are a RCT and quasi-experimental genomics study aiming to determine the effect of additional cleaning of shared medical equipment of the frequency of healthcare associated infections. We also make phone call mid podcast... A shout out to all the team involved in this project, including being wonderfully coordinated by Dr Kate Browne and with great support from Georgia Matterson. Full details on the website below. Link to study website: https://cleenstudy.com/ Link to study protocol: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-023-07144-z This project is funded by a National Health and Medical Research Council Emerging Leadership Investigator grant (Prof Brett Mitchell, (GNT2008392)).

In this episode, Martin Kiernan talks to Sinèad Horgan, Director of Nursing South/South West Hospital Group, and School of Nursing and Midwifery, College of Medicine and Health, University College Cork in Ireland. We discuss a journey towards surgical site sueveillance and quality improvement and her recent papers on this topic. We discuss knowledge, attitudes, gaining engagement, buy-in and the importance of patient involvement in SSI prevention. Papers discussed include: HTTPS://doi:10.1016/j.nepr.2023.103637HTTPS://doi:10.1111/jocn.16690https://doi:10.1186/s13756-019-0565-8

In this episode, we discuss a paper in the Lancet Infectious Disease about preventing non-ventilator associate pneumonia including the determinants of implementation success. Brett and Martin chat with Dr Aline Wolfensberger and Professor Hugo Sax, authors of this paper about this important work. Link to paper: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00812-X/fulltext Dr Aline Wolfensberger is a medical doctor, certified in Internal Medicine and in Infectious Diseases and Hospital Epidemiology. She works at the Department of Infectious Diseases and Hospital Epidemiology of the University Hospital Zurich with Professor Hugo Sax. Prof Hugo Sax is a Swiss ID physician who worked for the last 20 years as a leader in infection prevention and control.

Brett Mitchell talks to Dr Sarah Browning and Professor Josh Davis about a recent paper in Infection, Disease and Health - "Have gloves and gowns had their day?" The evidence for gloves and gowns is discussed, as well as results from a recent survey into their use in Australia and New Zealand. Sarah is an infectious disease physician and Director of Infection Prevention and Control at the Hunter New England (HNE) Health District in NSW, Australia. Josh is infectious disease physician and a clinical trialist, also based at HNE and the Hunter Medical Research Institute. A link to the article: https://www.idhjournal.com.au/article/S2468-0451(23)00030-5/fulltext Reference: Browning, S., Davis, J. S., & Mitchell, B. G. (2023). Have gloves and gowns had their day? An Australian and New Zealand practice and attitudes survey about contact precautions for MRSA and VRE colonisation. Infection, Disease & Health. DOI: 10.1016/j.idh.2023.03.006

In this episode Phil talks to A/Prof Noleen Bennett* about the state of surveillance and antimicrobial stewardship and what her research has discovered in this area. Noleen also tells about an exciting project she is leading called NISPAC, a streamlined infection and antimicrobial use surveillance system for Australian Residential Aged Care Facilities. *Associate Professor Noleen Bennett. Infection Control Consultant, Victorian Healthcare Associated Infection Surveillance Coordinating Centre and the National Centre for Antimicrobial Stewardship. Further information: NISPACVICNISS An evaluation of influenza, pneumococcal and herpes zoster vaccination coverage in Australian aged care residents, 2018 to 2022Infection prevention quality indicators in aged care: ready for a national approachSkin and soft tissue infections and current antimicrobial prescribing practices in Australian aged care residents

In this episode recorded at the 2023 SHEA Spring Meeting in Seattle, Martin talks to Associate Professor Alex Sundermann about his work on sequencing all isolates from local healthcare settings and the discoveries that this enables. Healthcare infections due to previous admissions, endoscopes, even pseudo-outbreaks are all laid bare by this approach. Some recent papers from the group are listed below: 1. Sundermann AJ, et al. Two artificial tears outbreak-associated cases of XDR Pseudomonas aeruginosa detected through whole genome sequencing-based surveillance. medRxiv. 2023. https://doi:10.1101/2023.04.11.23288417 2. Sundermann AJ, et al. Sensitivity of National Healthcare Safety Network definitions to capture healthcare-associated transmission identified by whole-genome sequencing surveillance. Infect Control Hosp Epidemiol. 2023:1-3. https://doi:10.1017/ice.2023.52 3. Branch-Elliman W, et al. The future of automated infection detection: Innovation to transform practice (Part III/III). Antimicrob Steward Healthc Epidemiol. 2023;3(1):e26. https://doi:10.1017/ash.2022.333 4. Sundermann AJ, et al. Whole-genome sequencing surveillance and machine learning for healthcare outbreak detection and investigation: A systematic review and summary. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e91. https://doi:10.1017/ash.2021.241 5. Sundermann AJ, et al. Whole-Genome Sequencing Surveillance and Machine Learning of the Electronic Health Record for Enhanced Healthcare Outbreak Detection. Clin Infect Dis. 2022;75(3):476-482. https://doi:10.1093/cid/ciab946 6. Sundermann AJ, et al. Outbreak of Pseudomonas aeruginosa Infections from a Contaminated Gastroscope Detected by Whole Genome Sequencing Surveillance. Clin Infect Dis. 2021;73(3):e638-e642. https://doi:10.1093/cid/ciaa1887 7. Kumar P, et al. Method for Economic Evaluation of Bacterial Whole Genome Sequencing Surveillance Compared to Standard of Care in Detecting Hospital Outbreaks. Clin Infect Dis. 2021;73(1):e9-e18. https://doi:10.1093/cid/ciaa512 8. Sundermann AJ, et al. Automated data mining of the electronic health record for investigation of healthcare-associated outbreaks. Infect Control Hosp Epidemiol. 2019:1-6. https://doi:10.1017/ice.2018.343

In this second discussion of an abstract presented at the SHEA Spring meeting 2023 in Seattle, Martin talks to MPH candidate Olivia Hess about her work on staff opinions of automated hand hygiene monitoring. Olivia works as a member of Dr Gonzalo Bearman's group at VCU Health (Virginia Commonwealth University) in Richmond, Virginia. We discuss staff attitudes to the technology and it's utility, which are almost universally negative. Some recent papers on automated hand hygiene monitoring: https://10.1016/j.ajic.2022.05.026https://10.1016/j.jhin.2021.09.016https://10.1016/j.ajic.2022.03.010https://10.1016/j.ajic.2020.04.005And thanks to Marco Bo Hansen for reminding us of this recent paper A. R. Knudsen, et al. 2023 Individual hand hygiene improvements and effects on healthcare-associated infections: A long-term follow-up study using an electronic hand hygiene monitoring system J Hosp Infect In Press https://10.1016/j.jhin.2023.02.017

In this episode recorded at the 2023 SHEA Spring Meeting in Seattle, Martin talks to abstract presenter Dr Lamia Alam about the work of a Johns' Hopkins group on a systematic review of human factors relating to cleaning in the Operating Room. We discuss the abstract presented at the meeting and also previous work in human factors and environmental service workers from this group that are particular favourites of Martin's (detailed below). Relevant papers: 1. A. Xie, et al. 2018 Improving Daily Patient Room Cleaning: An Observational Study Using a Human Factors and Systems Engineering Approach IISE Transactions on Occupational Ergonomics and Human Factors 6 3-4 178-191 https://10.1080/24725838.2018.1487348 2. C. Rock, et al. 2016 Using a Human Factors Engineering Approach to Improve Patient Room Cleaning and Disinfection Infect Control Hosp Epidemiol 37 12 1502-1506 https://10.1017/ice.2016.219

This is the 100th episode of Infection Control Matters and includes a special announcement. A big thanks to our 110+ guests so far. In this podcast, Martin, Brett and Phil talk about what we've not covered, some stats and what is to come next. Check out out new website: https://infectioncontrolmatters.com/

In this episode, Martin Kiernan talks to Dr Valeria Fabre, Associate Professor of Medicine at Johns Hopkins University School of Medicine and Associate Medical Director of the Antimicrobial Stewardship Program and an Associate Hospital Epidemiologist at the Johns Hopkins Hospital. We discuss the recent SHEA position paper on practical aspects of diagnostic stewardship and the use of the diagnostic pathway (ie, ordering, collecting, processing, reporting, and interpreting results of a diagnostic test). Paper discussed: Fabre V, et al. Principles of diagnostic stewardship: A practical guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force. Infect Control Hosp Epidemiol. 2023;44(2):178-185. https://doi:10.1017/ice.2023.5 Other recent papers on this subject: https://doi:10.1017/ice.2022.191https://doi:10.1017/ash.2022.305https://doi:10.1001/jama.2023.1678https://doi:10.1017/ice.2022.299https://doi:10.1017/ice.2022.315

In this episode Brett and Martin talk to Mairéad Skally and Prof Fidelma Fitzpatrick about their efforts to minimise Clostridioides difficile infections in the Beaumont Hospital in Dublin, Ireland. Mairéad is a Surveillance Scientist and Fidelma is a Consultant Microbiologist and also Head of Department of Clinical Microbiology at the Royal College of Surgeons (Ireland). We discuss 10 years of surveillance in the Beaumont and analysis of a rich pool of data that has helped them achieve a status quo. The paper we discuss is here: Skally M, Bennett K, Burns K, Brennan R, Finn C, O’Connell K, et al. A decade of Clostridioides difficile infection: A constant challenge to maintain the status quo. Journal of Hospital Infection. 2023 in press https://doi:10.1016/j.jhin.2023.02.008

In this week's episode, Martin talks to Professor Jean-Yves Maillard from the Cardiff School of Pharmacy in Wales. We discuss detention, removal and prevention of biofilms in wet and dry environments. A range of papers on this topic from his group are listed below. https://doi:10.1016/j.ajic.2023.02.009https://doi:10.3390/microorganisms10071369https://doi:10.12968/hmed.2022.0274https://doi:10.1017/ice.2021.42https://doi:10.1016/j.jhin.2020.08.010

In this week's episode, Brett and Martin talk to Dr Mark Garvey, Consultant Clinical Scientist at University Hospitals Birmingham in the UK. We discuss a new paper from the UHB team which looks at the practical aspects of contamination within the splash radius of a clinical hand hygiene sink in a critical care area. The range of high risk equipment within the zone is quite interesting! Papers mentioned are as below. 1. Garvey MI, Williams N, Gardiner A, Ruston C, Wilkinson M, Kiernan M, et al. The sink splash zone. J Hosp Infect. https://doi:10.1016/j.jhin.2023.01.020 PubMed PMID: 36870392. 2. Garvey MI, Wilkinson MAC, Holden KL, Martin T, Parkes J, Holden E. Tap out: reducing waterborne Pseudomonas aeruginosa transmission in an intensive care unit. J Hosp Infect. 2019;102(1):75-81. https://doi:10.1016/j.jhin.2018.07.039 3. Garvey MI, Bradley CW, Holden E. Waterborne Pseudomonas aeruginosa transmission in a hematology unit? Am J Infect Control. 2018;46(4):383-6. Epub 20171128. https://doi:10.1016/j.ajic.2017.10.013 4. Garvey MI, Bradley CW, Wilkinson MAC, Bradley C, Holden E. Engineering waterborne Pseudomonas aeruginosa out of a critical care unit. Int J Hyg Environ Health. 2017;220(6):1014-9. https://doi:10.1016/j.ijheh.2017.05.011

We talk about the knowledge attitudes and practice of nurses regarding oral hygiene of dependent inpatients in this podcast with Dr Isabel Oliveira. Understanding these is an important element of improving oral care and potentially reducing hospital acquired pneumonia (HAP) more broadly. Isbael is a rehabilitation nurse with a particular focus and interest in dysphagia and oral care, including the prevention of HAP. She works at the Centre for Health Studies and Research of the University of Coimbra (CEISUC) in Portugal. The paper referred to in this podcast is "Knowledge, attitudes and practices of nurses regarding oral hygiene of dependent inpatients". Link: https://pubmed.ncbi.nlm.nih.gov/35680116/

In this episode, Brett talks to Associate Professor Matthew Davis about his clinical experience and recent systematic review, exploring the topic of whether indwelling vs intermittent catheterisation increases the risk of UTI. Matt is an Associate Professor of Physical Medicine & Rehabilitation at McGovern Medical School in Houston and has a strong clinician background in caring for people with Spinal Cord Injury. Here are the papers we refer to in the podcast: DAVIS, M., JETHANI, L., ROBBINS, E. & KANER, M. 2023. Is It Really the Foley? A Systematic Review of Bladder Management and Infection Risk. Top Spinal Cord Inj Rehabil, 29, 94-107. https://meridian.allenpress.com/tscir/article-abstract/29/1/94/490861/Is-It-Really-the-Foley-A-Systematic-Review-of?redirectedFrom=fulltext DAVIS, M. 2019. When guidelines conflict: patient safety, quality of life, and CAUTI reduction in patients with spinal cord injury. Spinal Cord Ser Cases, 5, 56. https://pubmed.ncbi.nlm.nih.gov/31632714/