Feb 182015
 
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Rapid bedside tests for diagnosis, management, and prevention of nosocomial influenza.

J Hosp Infect. 2015 Jan 24;

Authors: Bouscambert M, Valette M, Lina B

Abstract
Like other respiratory viruses, influenza is responsible for devastating nosocomial epidemics in nursing homes as well as in conventional wards and emergency departments. Patients, healthcare workers, and visitors may be the source of nosocomial influenza. Despite their limited sensitivity, rapid diagnostic tests for influenza can be of real value; they enable early introduction of measures to prevent spread and early specific antiviral treatment of cases. However, these tests cannot detect oseltamivir resistance, susceptibility testing being carried out only in specialist laboratories. Although resistance is rare, it can emerge during treatment, especially of very young children or immunocompromised patients. In the latter, the shedding of resistant influenza virus can last several weeks. Sporadic instances of nosocomial transmission among immunocompromised patients have been reported. The limitations of bedside tests for influenza make them unsuitable for use as stand-alone diagnostic tools. However, their limitations do not preclude their use for detection and subsequent management of nosocomial influenza, for which they are rapid, easy, and cost-effective. Recent developments in these tests look promising, offering prospects of increased sensitivity, increased specificity, and screening for antiviral susceptibility.

PMID: 25687248 [PubMed - as supplied by publisher]

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Feb 112015
 
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Impact of infection control interventions on rates of Staphylococcus aureus bacteraemia in National Health Service acute hospitals, East Midlands, UK, using interrupted time-series analysis.

J Hosp Infect. 2015 Jan 15;

Authors: Newitt S, Myles PR, Birkin JA, Maskell V, Slack RC, Nguyen-Van-Tam JS, Szatkowski L

Abstract
BACKGROUND: Reducing healthcare-associated infection (HCAI) is a UK national priority. Multiple national and regional interventions aimed at reduction have been implemented in National Health Service acute hospitals, but assessment of their effectiveness is methodologically challenging.
AIM: To assess the effectiveness of national and regional interventions undertaken between 2004 and 2008 on rates of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-sensitive Staphylococcus aureus (MSSA) bacteraemia within acute hospitals in the East Midlands, using interrupted time-series analysis.
METHODS: We used segmented regression to compare rates of MRSA and MSSA bacteraemia in the pre-intervention, implementation, and post-intervention phases for combined intervention packages in eight acute hospitals.
FINDINGS: Most of the change in MSSA and MRSA rates occurred during the implementation phase. During this phase, there were significant downward trends in MRSA rates for seven of eight acute hospital groups; in four, this was a steeper quarter-on-quarter decline compared with the pre-intervention phase, and, in one, an upward trend in the pre-intervention phase was reversed. Regarding MSSA, there was a significant positive effect in four hospital groups: one upward trend during the pre-intervention phase was reversed, two upward trends plateaued, and in one hospital group an indeterminate trend decreased significantly. However, there were significant increasing trends in quarterly MSSA rates in four hospital groups during the implementation or post-intervention periods.
CONCLUSION: The impact of interventions varied by hospital group but the overall results suggest that national and regional campaigns had a beneficial impact on MRSA and MSSA bacteraemia within the East Midlands.

PMID: 25659447 [PubMed - as supplied by publisher]

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Feb 072015
 
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Ebola virus disease in Africa: epidemiology and nosocomial transmission.

J Hosp Infect. 2015 Jan 20;

Authors: Shears P, O'Dempsey TJ

Abstract
The 2014 Ebola outbreak in West Africa, primarily affecting Guinea, Sierra Leone, and Liberia, has exceeded all previous Ebola outbreaks in the number of cases and in international response. There have been 20 significant outbreaks of Ebola virus disease in Sub-Saharan Africa prior to the 2014 outbreak, the largest being that in Uganda in 2000, with 425 cases and a mortality of 53%. Since the first outbreaks in Sudan and Zaire in 1976, transmission within health facilities has been of major concern, affecting healthcare workers and acting as amplifiers of spread into the community. The lack of resources for infection control and personal protective equipment are the main reasons for nosocomial transmission. Local strategies to improve infection control, and a greater understanding of local community views on the disease, have helped to bring outbreaks under control. Recommendations from previous outbreaks include improved disease surveillance to enable more rapid health responses, the wider availability of personal protective equipment, and greater international preparedness.

PMID: 25655197 [PubMed - as supplied by publisher]

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Feb 022015
 
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How to eradicate Clostridium difficile from the environment.

J Hosp Infect. 2015 Jan 7;

Authors: Barbut F

Abstract
During the last decade, Clostridium difficile has emerged as a major cause of healthcare-associated diarrhoea and death. Transmission of this spore-forming bacterium is thought to occur via the hands of healthcare providers or via the contaminated environment. Therefore, enhanced environmental cleaning/disinfection of the rooms housing C. difficile-infected patients is warranted. Guidelines from various scientific bodies have been published. They recommend performing environmental decontamination of rooms of patients with C. difficile infection (CDI) using hypochlorite (diluted 1/10) or a sporicidal product. Compliance with cleaning and disinfection is a critical point and is often suboptimal. Novel 'no-touch' methods for room disinfection have recently been introduced. Ultraviolet (UV) light or hydrogen peroxide systems are most widely used. In-vitro studies suggest that hydrogen peroxide vapour (from 30% hydrogen peroxide) methods achieve a >6 log10 reduction in C. difficile spores placed on carriers, and that aerosolized hydrogen peroxide systems (from 5% to 6% hydrogen peroxide) achieve ∼4 log10 reduction, whereas UV-based methods achieve ∼2 log10 reduction. Very few studies have assessed the impact of these devices on the transmission of C. difficile. Major limitations of these devices include the fact that they can only be used after the patient's discharge, because patients and staff must be removed from the room. The new no-touch methods for room disinfection supplement, but do not replace, daily cleaning.

PMID: 25638358 [PubMed - as supplied by publisher]

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Jan 272015
 
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Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene.

J Hosp Infect. 2014 Dec 16;

Authors: Davis R, Parand A, Pinto A, Buetow S

Abstract
BACKGROUND: Patients could help to improve the hand hygiene (HH) compliance of healthcare professionals (HCPs) by reminding them to sanitize their hands.
AIM: To review the effectiveness of strategies aimed at increasing patient involvement in reminding HCPs about their HH.
METHODS: A systematic review was conducted across Medline, EMBASE and PsycINFO between 1980 and 2013.
FINDINGS: Twenty-eight out of a possible 1956 articles were included. Of these, 23 articles evaluated the effectiveness of developed patient-focused strategies and five articles examined patients' attitudes towards hypothetical strategies. Sixteen articles evaluated single-component strategies (e.g. videos) and 12 articles evaluated multi-modal approaches (e.g. combination of video and leaflet). Overall, the strategies showed promise in helping to increase patients' intentions and/or involvement in reminding HCPs about their HH. HCP encouragement appeared to be the most effective strategy. However, the methodological quality of the articles in relation to addressing the specific aims of this review was generally weak.
CONCLUSION: A number of strategies are available to encourage patients to question HCPs about their HH. Better controlled studies with more robust outcome measures will enhance understanding about which strategies may be most successful and why.

PMID: 25617088 [PubMed - as supplied by publisher]

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Jan 152015
 

Comparison of different hand-drying methods: the potential for airborne microbe dispersal and contamination.

J Hosp Infect. 2014 Dec 17;

Authors: Best EL, Redway K

Abstract
Efficient washing and drying of hands is important in prevention of the transfer of micro-organisms. However, knowledge surrounding the potential for microbial contamination according to hand-drying methods is limited. This study assessed the potential for airborne microbe dispersal during hand drying by four methods (paper towels, roller towel, warm air and jet air dryer) using three different models. The jet air dryer dispersed liquid from users' hands further and over a greater range (up to 1.5m) than the other drying methods (up to 0.75m), demonstrating the differing potential risks for airborne microbe dissemination, particularly if handwashing is suboptimal.

PMID: 25586988 [PubMed - as supplied by publisher]

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