Antimicrobial Textiles in Infection Prevetion- Reviewed and Revisited

Textiles with antimicrobial properties are the ongoing rage in the infection prevention world. Here is a well written review on the matter published in Clinical Infectious Diseases.

Most technologies for surfaces and fabrics have been assessed in vitro and have been shown to reduce bacterial numbers by two logs or more. However, apart from copper -impregnated surfaces,  few antimcorbial textiles have been studied in a clinical setting.  Salgado et al published a study that assessed the impact of copper surfaces in ICUs on the rate of hospital acquired infections (HAIs). I have previously commented on this study.

We published a study on the impact of antimicrobial scrubs on heathcare worker hand and apparel bioburden. We did not assess HAI outcomes.

An important question lingers: even with effective antimicrobial textiles, what is the expected incremental impact of these technologies on HAI rates atop a robust infection prevention program with robust hand hygiene, disinfection, central line checklists, HAI bundles, chlorhexidine patient bathing, etc?

Gastrointestinal carriage of carbepenemase resistance Enterobacteriaceae- Decolonization?

CRE Map 2012; Source CDC

Can gastrointestinal carriage of carbepenemase resistance Enterobacteriaceae (CRE) be eliminated? Here is a recent publication in the American Journal of Infection Control that suggests that GI eradication of CRE is feasible.

In this cohort,  patients whose rectal isolates were gentamicin sensitive but colistin resistant were treated with gentamicin. Patients whose isolates were colistin sensitive but gentamicin resistant were treated with colistin. Patients whose isolates were sensitive to both drugs were randomized to 3 groups of oral antibiotic treatment: gentamicin, colistin, or both. Patients whose isolates were resistant to both drugs, and those who did not consent, were followed for spontaneous eradication.

A total of 152 patients were included; 102 were followed for spontaneous eradication for a median duration of 140 days (controls), and 50 received 1 of the 3 drug regimens: gentamicin, 26; colistin, 16; both drugs, 8, followed for a median duration of 33 days. Eradication rates in the 3 treatment groups were 42%, 50%, and 37.5%, respectively, each significantly higher than the 7% spontaneous eradication rate in the control group (P < .001, P < .001, and P = .004, respectively) with no difference between the regimens.CRE eradication with non-absorbable antibiotics is better than spontaenous eradication. However, the efficacy of eradication was less than superb and the results were by no means overwhelmingly positive.  Of note, no significant adverse effects were observed.

How is this applicable? Many unanswered questions remain such as what are the optimal CRE decolonization strategies? Who should be targeted? Should CRE eradication be limited to endemic settings, high risk patients (neuropenic patients) or in outbreak settings? We are far from having an optimal approach for CRE detection, isolation and eradication.

Medical Literary Messenger Fall 2013: Inaugural Issue Published

It is with great pride that we present you the Fall 2013, inaugural issue of the Medical Literary Messenger.

Download the issue here.

Visit the site at: www.med-lit.vcu.edu

Bacteremia and Mortality from a Urinary Catheter

I am back from Argentina and back to work.

Here is an investigation on bacteremia and mortality associated with urinary catheters.
The author's focused on catheter-associated urinary tract infection (CAUTI) and catheter-associated asymptomatic bacteriuria (CAABU)  and studied the relationship between catheter-associated bacteriuria and bacteremia from a urinary source in CAUTI relative to that in CAABU.

There were 444 episodes of catheter-associated bacteriuria in 308 patients; 128 (41.6%) patients had CAUTI, and 180 (58.4%) had CAABU. Three episodes of bacteriuria were followed by bacteremia from a urinary source (0.7%). CAUTI, rather than CAABU, was associated with bacteremia from any source, but neither CAUTI nor CAABU predicted subsequent mortality.

Bacteremia from a urinary source was an infrequent event. In addition, there was no evidence of an association of mortality with symptomatic versus asymptomatic bacteriuria.  

Catheter associated urinary tract infections are the most common hospital acquired infection yet result in the least morbidity and mortality. This does not negate their relevance, however, in terms of truly impacting patient safety, the most bang for the buck is in the prevention of bloodstream infections and ventilator associated pneumonia. 

Stethoscope Disinfection

Here is a recent publication on stethoscope disinfection.

Stethoscopes are contaminated with pathogenic bacteria and pose a theoretical risk for cross transmission.

Baskets were filled with alcohol prep pads and a sticker reminding providers to regularly disinfect stethoscopes were installed outside of patient rooms. Healthcare providers' stethoscope disinfection behaviors were directly observed before and after the intervention. Multivariable logistic regression models were created to identify independent predictors of stethoscope disinfection. 

Two hundred twenty-six observations were made in the preintervention period and 261 in the postintervention period (83% were of physicians). Stethoscope disinfection compliance increased significantly from a baseline of 34% to 59% post-intervention. In adjusted analyses, the postintervention period was associated with improved disinfection among both physicians (odds ratio [OR], 2.3 [95% confidence interval (CI), 1.4-3.5]) and nurses (OR, 14.3 [95% CI, 4.6-44.6]). Additional factors independently associated with disinfection included subspecialty unit (vs general pediatrics; OR, 0.5 [95% CI, 0.3-0.8]) and contact precautions (OR, 2.3 [95% CI, 1.2-4.1]). 

So providing stethoscope disinfection supplies and visible reminders outside of patient rooms may increase stethoscope disinfection rates. 

The intervention is simple and reasonable and is consistent with a horizontal infection prevention strategy. The actual impact on healthcare associated infections is unknown.

Blogging Light This Week- On Vacation

I am back Cordoba, Argentina for the week and will be bogging light, if at all.

Saludos!

Congratulations Kate Pearson, Jeff Wang and Summer Donovan- VCU GH2DP Researchers at ASTMH 2013

Congratulations Kate Pearson, Jeff Wang and Summer Donovan- VCU GH2DP researchers at the American Society of Tropical Medicine and Hygiene (ASTMH) 2013 Annual Meeting.

As members of our VCU GH2DP Honduras team, they have done valuable research on health services satisfaction and chagas disease knowledge and perception.

L to R: Jeff Wang, Kate Pearson and Summer Donovan

Kate Pearson and Jeff Wang

Kudos!