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The best IPC article of 2018: a blogoff with Brett Mitchell
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Category Archives: conference
Quick insight into ECCMID 2018
After a great few days at ECCMID conference in Madrid, I thought I would give some highlights. There were many good sessions and presentations, but I have picked a few that stood out for me. To set the scene, for those who haven’t been to ECCMID, it is huge. Around 15,000 delegates and 15+ sessions going at any one time. The poster area is the size of a airport hanger. Planning is key.
Petra Gastmeier contributed to many pieces of work at the conference, but on the first day, presented on “Before an outbreak – is complete sanitation of robotic surgical instruments possible?”. She discussed two key outcomes when answering this question. First, is the instrument clean or not; second, does the instrument affects surgical site infection rates. Her talk concluded by with the concept that at present, based on literature, robotics instruments do not appear to increase SSI rates. However, a strong CSSD is required. Maybe the reasons is that the process includes disinfection and sterilisation. The presentation can be viewed here.
John Rossen discussed whole genome sequencing in outbreaks. Challenges and advantanges of WHS were discussed. One issue is the cost and turnaround time. He discussed his work, which involved used WGS to develop a local PCR test – to distinguish outbreak strains from others. This overcomes the cost and timeliness issues. The presentation can be viewed here
Jon Otter, always great to listen to, was heavily involved in the conference. If you haven’t seen his blog, make sure you check it out (but don’t forget us). Jon always makes his work available on the blog as well. I have picked one of Jon’s talks,” Before an outbreak – what to do after first MDR Gram-negatives enter your hospital?”. A great interactive session with live voting. There was variation from the audience, with respect to what products (chlorine or HP) are used for control CPE. A key take home from me, was that cleaning and sinks, are a key issue. There was quite a strong focus on the role of sink in MRGN control at the conference. The presentation can be viewed here.
Ben Cooper talking about modelling. Some key things from his talk were – ‘models help us think’. I really like that motto. Time series analysis are good, but poorly analysed. The way of the future is to use models to design high quality RCTs. His presentation can be viewed here.
In something close to my heart, given some studies I am involved with, was a talk by Marc Bonton (@MarcBonten) on pragmatic trial designs. Some key takes homes: consider the natural history of the disease. It is easily to find an intervention that works, if the infection rates was trending down anyway. Cluster RCTs are good, but consider selection bias and carry over effects. His presentation can be viewed here.
There was a session that had short presentations on current / early research findings. Many topics were covered, from hand dryers to risk factors for predicting ESBL carriers. Sessions topics and presentations are here. One stand out me, for novelty, was a study that explored norvirus dispersal. It is worth a look. Norovirus was spilt in a laboratory, then cleaned. Results are very interesting. The presentation by Caroline Lopes Ciofi-Silva is worth seeing as you get a real sense of what they did. I feel for those who cleaned up the norovirus – I wonder if they got sick??
There was also an interesting study exploring contact precautions Vs standard precautions, involving 30,000+ patient in 20 non ICUs – to determine any difference in EBSL acquisition. Findings are suggesting no difference, but the key for me, is whether the rooms were single rooms. If so, they would probably would not expect to find any difference. If the ICUs were single rooms, then I think we are none the wiser – especially as most hospitals are not 100% single rooms. If there were shared rooms, this may be the catalyst to rethink contact precautions.
There was also a great “Year in review” for infection control. I could never do this justice and it is worth seeing the presentations. Hilary Humphreys presented first and went through a mountain of papers. Looking forward to hearing Hilary again at ACIPC 2018 in Brisbane.
There is plenty I have missed. You can use the ECCMID live website to find and view other presentations. I also tweeted about other presentations. Speaking of Twitter, there were some great interactions on Twitter at the conference, including those who were not present. It is a great way to find out they key discussion points at conferences.
Some take aways from #ACIPC17 Conference, Canberra
Congratulations to the organisers of ACIPC Conference 2017 
in Canberra. Well done to the Conference Committee and the Scientific Committee. A great program and venue adding to the always enjoyable catch up with colleagues local, national and international.
There were many highlights. Due to other commitments, I missed a few of the major plenaries. Nevertheless, I came away with some clear take home messages from those I did get to, here are just a few of them…
- An emerging theme from the presentations was that of public reporting and financial penalties (PR&FP) associated with healthcare associated infections (HAIs). The likelihood that Australia needs to accept that these are inevitable for a range of HAIs is clear. In case you missed it, Benjamin Magid presented an excellent talk touching on the Australian Commission for Safety and Quality in Health Care use of what are called Hospital Acquired Complications, that use administrative coding data to detect healthcare associated infections, and which I have blogged about previously.
One of the many advantages of living and working in Australia and hosting keynotes from the US is that they often provide a window to the future. At various stages, Prof Pat Stone, A/Prof Dev Anderson and Dr Susan Huang all related stories about their experience of PR&FP. From their experience it would seem, at some point in time, the implementation of PR&FPs does eventually turn into a positive for infection prevention (and hence our patients). From what we hear, PR&FPs seem to result in a recognition of infection prevention that subsequently provide opportunities to increase resources. Thats not to say there was no pain during the “journey”, and we should be prepared for that. Although Dev Anderson did argue against the notion of PR&FPs in the final debate, he was quick to tweet afterwards that in fact he does support it! Finally on this point, we should continue to explore better use of existing data if validated, strive to minimise the burden of data collection, and consider whether current HAI definitions are suitable for the PR&FP environment. - The quality of the free papers gets better every year. The addition of the quick poster presentations and the new format of the 3 minute research presentations was a celebration of the excellent research being undertaken in our field. Updates on current studies (e.g. the large and complex REACH project) further added to our awareness of exciting work being undertaken by our colleagues. The next few years will see many of these projects yield new knowledge and fill sessions of conferences to come!
- The consumer voice is powerful. The presentation delivered by Mathew Ames left many in the auditorium not only in tears, but also resolute about the work we undertake.
- Finally for now, I believe the pop up sessions during lunch were a big winner. Informal yet intimate, a great way to get close to those people who are always hard to find at conferences. A great initiative hopefully here to stay..
But thats just some of my impressions from the sessions I saw. You might have seen something completely different. If so, comment below and let us know…
Looking forward to Brisbane in 2018.
TIP: Next year, if you have trouble remembering the correct Twitter hashtag, think character count efficiency...save the character count by dropping the “20” from “2018”
#ACIPC18
Phil
Disclosure – ACIPC Board member (President Elect) and member of the ACIPC Conference Scientific Committee 2017
#A Trawl for Trends
In the lead up to the ACIPC conference in Canberra next week, I thought it might be timely to write something about the use of Twitter at infection control conferences. Thanks to Gabby Milgate for assisting with this blog.
Some of you might know that last year, a group of us reviewed tweets from four infection control/ID conferences – UK Infection Prevention Society, ID Week2016, The Federation of Infectious Society/Hospital Infection Society and the Australasian College for Infection Prevention and Control. Read the article here .
Twitter as a medium for infection control content has grown from 181 Tweets at IPS2011 to 11,457 tweets at IPS2016. This rapid growth seems to suggest the twitter epidemic is contagious! The analysis of tweets from these four conferences identified trends in conference-related twitter activity.
Here are some evidence-based trends to help your infection prevention twee
ts fly!
- Tweets with web-links are more likely to be retweeted, all things considered
- Picture are out – these are less likely to be re-tweeted, all things considered
- Tweeting on topics such as ‘Cleaning’, “Media@, ‘Clostridium Difficile’, ‘Antiseptic’, ‘Infection prevention and control’ and ‘Hand hygiene’ are more often retweeted.
I’ll be talking more about this at the ACIPC conference next week – the abstract is here
Not only has Twitter been used to broaden conference exposure and encourage attendees to further engage with content but the Royal Society of Chemistry hosted an entire conference on Twitter. The conference had an audience of 380,000 online users, without a ‘face-to-face’ component. The conference was both cost-effective and far-reaching. Additionally, its virtual delivery eliminated risks of airborne or droplet transmission of infections!
Twitter may serve as a useful tool for infection control professionals and enthusiasts to broaden their networks, providing a platform for infection related discourse and a mode of communication for health promotion and education to the general public of social media users.
Perhaps a future trending topic: ‘Twitterer’s twiddling their thumbs on their devices practice excellent hand hygiene’.
For those attending the Australasian College for Infection Prevention and Control or want to follow what is happening from a distance, follow #ACIPC17 – and of course the authors of this blog!
Network Analysis: A line (edge) between usernames, indicates a relationship – a tweet sent by one person that included the username the other. (IPS = Infection Prevention Society)
#SHEA2017 & Behaviour Change (bundle?)
Clearly the current toolkit for the ICP extends well beyond knowledge of infection prevention and control. Amongst others throw in a dose of psychology, implementation science and behaviour change.
Matthew Kreuter is a leading national public health expert in the field of health communications at Washington University in St Louis, and at the SHEA Spring Conference presented a plenary titled May the Forces be with You: Understanding How to Change Behaviour. Krueter packed in a lot of useful information in his presentation. Much of what he said I believe really underlined the importance of a comprehensive implementation strategy.
There is no substitute for taking time to understand the people you are dealing with and the environment they work in. One of the biggest challenges in behaviour change and infection prevention is we don’t always see the consequences of our action (the missed hand hygiene > unclean hand > contaminated environment > patient colonisation > breach of first line defences > infection), and not every bad action will necessarily result in an adverse outcome. Furthermore, HCW’s may suffer from a curse of “smartness”, i.e. “I know my patients best” which can lead to rejection of guidelines.
Some of the key messages I took away from this talk include:
- The easiest behaviours to change are the simple ones that have clear and immediate benefits “to me”
- When planning behaviour change, focus on identifying meaningful benefits and personalise the consequences. The consequences need to be relevant
- Utilise authentic stories of the consequences. Sadly we have no end of patients who have suffered as a result of a HAI, consider involving them and their stories
- Other factors that work include credible messengers (peers, champions) performance feedback and aspirational identity
Kreuter concluded by listing 4 factors that work MORE:
- Policies
- Environment
- Organisational Culture
- Engineering and Design, or
- a combination of these
note he didn’t use the term “Bundle”!
Phil
#SHEA2017 Spring Conference and the International Ambassador Program
Some of the SHEA IAP’s at the Arch in St Louis, Mo
I was recently honoured to be a member of the Society for Healthcare Epidemiology of America (SHEA) International Ambassador Program (IAP) at the SHEA Spring Conference in St Louis, Missouri.
If you don’t know about the SHEA IAP, I strongly encourage you to find out more about it here. It provided me the opportunity to meet 17 other ambassadors from across the globe, attend a special pre-conference program that included a visit to Barnes-Jewish Hospital, (saw my first ever fully automated microbiology lab) attend the SHEA Foundation dinner (where we were privileged to be present for a special dedication to Denis Maki), and of course attend the SHEA Spring Conference.
SHEA combine a full conference with a Training Certificate Course in Healthcare Epidemiology which is available to conference delegates. This was quite handy as I was able to junto into a few Epi sessions to brush up on a few skills.
There were many learnings and observations from my time in St. Louis, and I will get my thoughts in order and post them on this blog over the next week or so.
Phil
Declaration: The SHEA IAP is also supported financially by 3M, and I’d like to express my gratitude to both SHEA and 3M for their support.
Next national HAI initiative – CAUTI of course #ACICP conference
To conclude the ACIPC conference in Melbourne this year, three different views were proposed for what the national national HAI initiative should be. Dr Phil Russo presented a case for national surveillance, while Prof Linsday Grayson presented a case for peripheral vascular devices. I had the job of presenting a case for CAUTI.
The debate allowed 15 mintes each for us to present, followed by a panel discussion, discusion and questions from the floor, in addition to questions from Twitter (for those not present but following online).
Following some great questions, humour and some lively discussion, in the end, Phil won the debate, with 50%, followed by peripheral vascular devices (30%) and CAUTI (20%). It was clear however, that all three projects had 
support and it was strongly suggested that all three be implemented with the next 5 years.
I did make a good come back, scoring up from a prepoll of 6%!
If you would like to see the CAUTI presentation I delivered, here it is: ACIPC presentation: Next national HAI Initiative, CAUTI or in pdf format here
Brett
Disclosure: BM was the Scientific Chair or ACICP 2016, PR was on the scientific committee.
Time to change?
Interesting times with our own status of no government (though we have been here before), Brexit, upsets at UEFA Euro 2016, why not throw another curly one out there…
In the first edition of the Colleges new journal Infection Disease and Health an article by Mitchell and Ferguson report the results of a study they undertook using administrative coding data to identify healthcare associated urinary tract infection across eight hospitals. Not surprisingly, they have added to the increasing body of literature that continues to demonstrate that using coding data to identify HAIs is extremely unreliable.
We all know HAI surveillance is resource intensive. But imagine if administrative data could be used for HAI surveillance. How much of the current surveillance burden on ICPs would be lifted?
There are many issues with using administrative data, such as the skill of the coder, completeness of documentation, identifying infections incubating on admission etc, as well a mismatch between codes and current HAI definitions.
At the ECCMID 2016 conference earlier in the year, Maaike van Mourik proposed that maybe it is time to review the HAI definitions so that administrative data codes, and electronic databases can be interrogated to identify HAIs? Sure, this may not pick up all HAIs, but neither do current systems…
Keeping in mind that HAI data could be (is) used to impose financial penalties and performance manage hospitals, would you be supportive of a change in HAI definitions that would increase the likelihood of administrative data codes being used to identify HAIs and:
- be almost as accurate as current HAI surveillance definitions?
- allow more time to implement preventative interventions?
- could therefore be applied uniformly across all healthcare facilities?
Phil
ECCMID: surveillance my favourite
Welcome to Infectiondigest. On this blog you will hear thoughts, reflections and maybe the occasional rambling on issues that relate to infection prevention and control.We hope to stimulate some debate and discussion on a range of topics, in the backdrop of our geographical region.
I recently went to ECCMID in Amsterdam. With over 11,000 attendees it is certainly a conference that attracts delegates. There were a few reasons why I wanted to go: to catch up with colleagues, build networks and update knowledge both in certain areas of ID and also infection prevention and control. It ticked the box on all counts, but the IP&C content was the most disappointing. There was not much content on this topic, relative to others in my view. It is very interesting hearing about latest treatments and drugs but in the end, we are and will continue to be become more reliant on ‘basic’ infection control practices. What we really need is investment in high quality infection control studies.
For me, on IP&C, one of the highlights was a talk on the last day, before I had to quickly leave to catch my plane. Automated monitoring of nosocomial infections . This talk made me think about how far behind we are in Australia when it comes to surveillance. There we were in Amsterdam, contemplating the pros and cons of automated vs semi automated surveillance, whereas in Australia, we barely have a national HAI surveillance program. Perhaps we will leapfrog everyone else in this space, but I doubt it.
Brett Mitchell @infectiondigest
