Sep 232014
 
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Microbiological comparison of hand-drying methods: the potential for contamination of the environment, user, and bystander.

J Hosp Infect. 2014 Aug 27;

Authors: Best EL, Parnell P, Wilcox MH

Abstract
BACKGROUND: The efficiency of hand drying is important in preventing pathogen spread, but knowledge surrounding which drying methods contribute least towards contamination of the environment and users is limited.
AIM: To compare the propensity of three common hand-drying methods (jet air, warm air dryers, and paper towels) to contaminate the environment, users, and bystanders.
METHODS: Hands were coated in lactobacilli to simulate poorly washed, contaminated hands, and dried. The investigation comprised 120 air-sampling tests (60 tests and 60 controls), divided into close and 1m proximity from the drying process. Separate tests used hands coated in paint to visualize droplet dispersal.
FINDINGS: Air bacterial counts in close proximity to hand drying were 4.5-fold higher for the jet air dryer (70.7cfu) compared with the warm air dryer (15.7cfu) (P = 0.001), and 27-fold higher compared with use of paper towels (2.6cfu) (P < 0.001). Airborne counts were also significantly different during use of towel drying versus warm air dryer (P = 0.001). A similar pattern was seen for bacterial counts at 1m away. Visualization experiments demonstrated that the jet air dryer caused the most droplet dispersal.
CONCLUSION: Jet air and warm air dryers result in increased bacterial aerosolization when drying hands. These results suggest that air dryers may be unsuitable for use in healthcare settings, as they may facilitate microbial cross-contamination via airborne dissemination to the environment or bathroom visitors.

PMID: 25237036 [PubMed - as supplied by publisher]

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Sep 182014
 
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Clostridium difficile ribotype 027 is most prevalent among inpatients admitted from long-term care facilities.

J Hosp Infect. 2014 Jul 30;

Authors: Archbald-Pannone LR, Boone JH, Carman RJ, Lyerly DM, Guerrant RL

Abstract
Intestinal inflammation was evaluated using faecal lactoferrin and ribotype in 196 hospitalized adults with Clostridium difficile infection to determine the impact of ribotype 027 in long-term care facilities (LTCFs). LTCF residents (n = 28) had greater antibiotic use (P = 0.049) and more ribotype 027 infection [odds ratio (OR): 4.87; 95% confidence interval (CI): 2.02-11.74; P < 0.01], compared to those admitted from home. Patients infected with ribotype 027 strains had worse six-month mortality (OR: 1.90; 95% CI: 1.08-3.34; P = 0.03) and more inflammation (95.26 vs 36.08μg/mL; P = 0.006), compared to those infected with non-027 strains. This study was not designed to determine acquisition site, but, in this population, suggests that the location from which the patient has been admitted is strongly associated with ribotype 027 and more severe C. difficile disease.

PMID: 25228227 [PubMed - as supplied by publisher]

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Jul 062014
 
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Hospitalization stay and costs attributable to Clostridium difficile infection: a critical review.

J Hosp Infect. 2014 May 17;

Authors: Gabriel L, Beriot-Mathiot A

Abstract
In most healthcare systems, third-party payers fund the costs for patients admitted to hospital for Clostridium difficile infection (CDI) whereas, for CDI cases arising as complications of hospitalization, not all related costs are refundable to the hospital. We therefore aimed to critically review and categorize hospital costs and length of hospital stay (LOS) attributable to Clostridium difficile infection and to investigate the economic burden associated with it. A comprehensive literature review selected papers describing the costs and LOS for hospitalized patients as outcomes of CDI, following the use of statistics to identify costs and LOS solely attributable to CDI. Twenty-four studies were selected. Estimated attributable costs, all ranges expressed in US dollars, were $6,774-$10,212 for CDI requiring admission, $2,992-$29,000 for hospital-acquired CDI, and $2,454-$12,850 where no categorization was made. The ranges for LOS values were 5-13.6, 2.7-21.3, and 2.8-17.9 days, respectively. The categorization of CDI attributable costs allows budget holders to anticipate the cost per CDI case, a perspective that should enrich the design of appropriate incentives for the various budget holders to invest in prevention so that CDI prevention is optimized globally.

PMID: 24996516 [PubMed - as supplied by publisher]

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Jun 252014
 

National European guidelines for the prevention of Clostridium difficile infection: a systematic qualitative review.

J Hosp Infect. 2014 May 28;

Authors: Martin M, Zingg W, Knoll E, Wilson C, Dettenkofer M, the PROHIBIT study group

Abstract
BACKGROUND: Clostridium difficile is the most frequent infectious cause of nosocomial diarrhoea and a major topic in infection prevention.
AIM: To overview current national European guidelines for C. difficile infection (CDI) prevention and review the recommendations in respect of their evidence base and conformity to each other and the European Centre for Disease Control and Prevention (ECDC) guidance.
METHODS: In 34 European countries, the ECDC healthcare-associated infection (HCAI) surveillance National Contact Points and other HCAI experts (NCPs) were invited to complete an online questionnaire and to supply their guidelines. Guidelines not available in English, French or German were translated into English. For the qualitative analysis, a matrix with key measures based on the 2008 ECDC guidance was established. The review process was conducted independently by two reviewers.
RESULTS: All 34 NCPs responded to the questionnaire and supplied 15 guidelines in total. Six of 34 (18%) countries reported having used the ECDC guidance as a basis for the development or revision of their national guideline. There was wide variation in the scope and detailing. Only six of the documents and the ECDC guidance supplied a rating for the strength of recommendations. The rating systems varied in how the categories were defined. Furthermore, the stated strength for similar measures varied across different guidelines.
CONCLUSION: The ECDC guidance has not yet had a strong influence on the development or revision of national CDI prevention guidelines. One possible explanation for the variations is the necessity to adapt recommendations to national conditions. The use of internationally recognized instruments for the development of guidelines could help to improve their quality. Recommendations about monitoring or auditing the implementation would make them more useful.

PMID: 24957805 [PubMed - as supplied by publisher]

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Jun 152014
 
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Implications of targeted versus universal admission screening for meticillin-resistant Staphylococcus aureus carriage in a London hospital.

J Hosp Infect. 2014 May 10;

Authors: Otter JA, Tosas-Auguet O, Herdman MT, Williams B, Tucker D, Edgeworth JD, French GL

Abstract
Universal admission screening for meticillin-resistant Staphylococcus aureus (MRSA) has been performed in England since 2010. We evaluated the predictive performance of a regression model derived from the first year of universal screening for detecting MRSA at hospital admission. If we had used our previous targeted screening policy, 75% fewer patients (21,699 per year) would have been screened. However, this would have identified only ∼55% of all MRSA carriers, 65% of healthcare-associated MRSA strains, and 40% of community-associated strains. Failing to identify ∼45% of patients (262 per year) carrying MRSA at hospital admission may have implications for MRSA control.

PMID: 24928784 [PubMed - as supplied by publisher]

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Jun 152014
 
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Outbreak of invasive group A streptococcus infection: contaminated patient curtains and cross-infection on an ear, nose and throat ward.

J Hosp Infect. 2014 May 10;

Authors: Mahida N, Beal A, Trigg D, Vaughan N, Boswell T

Abstract
BACKGROUND: Outbreaks of group A streptococcus (GAS) infections may occur in healthcare settings and have been documented in surgical, obstetrics and gynaecology, and burns units. The environment may serve as a reservoir and facilitate transmission via contaminated equipment.
AIM: To describe the investigation and control of an outbreak of healthcare-associated GAS infection on an ear, nose and throat (ENT) ward in a tertiary referral centre.
METHODS: Two patients with laryngeal cancer developed invasive GAS infection (bacteraemia) with associated tracheostomy wound cellulitis within a 48h period. The outbreak team undertook an investigation involving a retrospective review of GAS cases, prospective case finding, healthcare worker screening and sampling of patient curtains. Immediate control measures included source isolation, a thorough rolling clean with a chlorine-based disinfectant and hydrogen peroxide decontamination of patient equipment.
FINDINGS: Prospective patient screening identified one additional patient with carriage of GAS from a tracheostomy wound swab. Staff screening identified one healthcare worker who acquired GAS during the outbreak and who subsequently developed pharyngitis. Environmental sampling demonstrated that 10 out of 34 patient curtains on the ward were contaminated with GAS and all isolates were typed as emm-1.
CONCLUSION: This is the first outbreak report to demonstrate patient curtains as potential source for GAS cross-transmission, with implications in relation to hand hygiene and frequency of laundering. Based on this report we recommend that during an outbreak of GAS infection all patient curtains should be changed as part of the enhanced decontamination procedures.

PMID: 24928787 [PubMed - as supplied by publisher]

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