Tag Archives: infection control

Variation in hospital cleaning

Hospital cleanliness has a number of implications for patients and staff in addition to simply preventing the spread of infection. Aside from infection, for patients and their families, a tidy and sanitary ward greatly improves comfort and provides assurance of the quality of their treatment. For staff, a hygienic environment means a more appealing workplace.

Throw in numerous studies demostrating and articulating links between the environment and infection [1-5], it’s easy to see why effective cleaning is of utmost importance when it comes to maintaining safe and quality hospital care. In light of this, it is difficult to believe that we have no uniformity across Australian hospitals when it comes to cleaning practices, staff training, products used or even standards by which to evaluate whether a hospital environment is clean and safe.

Variation in hospital cleaning practice and process in Australian hospitals: a structured mapping exercise [6] is the first paper to identify the variations in cleaning practices present among Australian hospitals. It describes in detail a range of discrepancies found in cleaning processes used across the country, in a study of 11 private and public Capturehospitals.

This paper is the latest from The ‘Researching Effective Approaches to Cleaning in Hospitals’ (REACH). The REACH study uses a bundle of standardized interventions in an attempt to combat healthcare-associated infections, with a view of gathering evidence that could be used to inform better and more standardized cleaning methods in the future.

The variation in cleaning practice and processs highlighted in this paper, demonstrates  the need for nationally recognised standards in hospital cleaning and outlines the challenges associated with the current system – or lack thereof.

 

References

  1. Dancer SJ. The role of environmental cleaning in the control of hospital-acquired infection. J. Hosp. Infect. 2009;73:378-385
  2. Mitchell BG, Dancer SJ, Anderson M, Dehn E. Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis. J. Hosp. Infect. 2015;91:211-217.
  3. Hayden, M. K., Bonten, M. J., Blom, D. W., Lyle, E. A., van de Vijver, D. A., & Weinstein, R. A. (2006). Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clinical Infectious Diseases, 42(11), 1552-1560.
  4. Donskey CJ. Does improving surface cleaning and disinfection reduce
    health care-associated infections? Am J Infect Control. 2013;41(5):S12–9.
    http://dx.doi.org/10.1016/j.ajic.2012.12.010.
  5. Barker J, Vipond IB, Bloomfield SF. Effects of cleaning and
    disinfection in reducing the spread of Norovirus contamination via
    environmental surfaces. J Hosp Infect 2004; 58(1): 42–9. doi:10.1016/
    j.jhin.2004.04.021
  6. Mitchell, B. G., Farrington, A., Allen, M., Gardner, A., Hall, L., Barnett, A. G., . . . Graves, N. Variation in hospital cleaning practice and process in Australian hospitals: A structured mapping exercise. Infection, Disease & Health. doi:10.1016/j.idh.2017.08.001

 

 

 

The Pub Test

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For many Australians there is a long held tradition of going to the pub at the end of the day/week to discuss life’s big questions (a practice not native to Australia I’m sure). Sadly, the pubs I frequented in my youth are now apartments (because we need more of those!) and like the live music they used to support, they are gradually disappearing from our urban landscape.

Anyhow, arising from the communal attempt to discuss worldly issues, comes the term “the pub test”.  Briefly, the pub test seeks to evaluate the views of “ordinary Australians” on certain issues. In my home state of Victoria, the recent application of the pub test has resulted in the downfall of several senior politicians who were accused of rorting their privileges by making extravagant travel claims. Though arguably they may not have breached any rules (stretching them perhaps). The media applied the pub test and the punters down at the pub believed the politician’s behaviour was unacceptable. In an impressive display of the power of the popular vote, these politicians have been stood down.

Now I’m not convinced of the rigour of the pub test, not the least I suspect the results may be influenced by the pubs location and the time of night you visited, but nevertheless it got me thinking, what if we applied the pub test to the state of infection prevention in Australia?

I wonder if these statements, reflecting some of our local infection prevention issues, would pass the pub test?

  • Some people get an infection as a result of their healthcare, but we’re not really sure how many Australians this happens to.
  • If you are infected with a ‘superbug’ in some hospitals, sometimes the staff that look after you will be wearing gowns, gloves and masks, and sometimes they wont.
  • If you are placed in a room that was previously occupied by a patient with a ‘superbug’ you are probably at a higher risk of being infected with that ‘superbug’ than if you are placed in another room.
  • Not all hospitals use the same criteria to identify an infection.
  • If you ask a hospital CEO which of the surgeons in their hospital has the highest infection rate, they probably wont tell you.

(I can think of many other examples to put to the pub test, and I invite you to share yours).

What would be the reaction of the ‘ordinary Australian’ to these statements? Would the power of the popular vote on these issues catch the eye of those in authority?

 

Declarations: I occasionally go to a pub – Phil

 

 

A journey of a thousand miles begins with a single step – Laozi

(This blog was inspired by the session at ECCMID 2016 also mentioned by Brett)

There are some things we Antipodeans are good at and are arguably international leaders, and some things we’re not (sporting references will be overlooked for now).

Take for example Australia’s innovative and novel National Hand Hygiene Initiative (NHHI). Obviously declaring conflict here, but a national program rolled out across Australia that recently had over 900 healthcare facilities submit compliance data is an example of what enthusiasm, strong leadership, central coordination and jurisdictional cooperation combined with adequate resources can achieve.

Clearly the start up of the NHHI was resource intensive, and this has been well documented,  and it is difficult to measure the precise effect the NHHI has had on HAIs, particularly when HAI surveillance in Australia is so disparate. Undeniably it has bought the importance of hand hygiene to the forefront of clinicians, executive and politicians. And when these groups listen to infection prevention, it’s a good thing.

Australia also leads the way in antimicrobial stewardship. At the recent ECCMID conference in Amsterdam, AMS was a common theme in many sessions, and several Australians presented new knowledge identified through novel audit tools. Feedback from across the globe has reflected much interest at the appropriateness data being generated.

And then there are things that make us watch in awe, like surveillance. My poster on national surveillance in Australia at ECCMID received a moderate amount of visitors (and not one mistook me for being Austrian). The top two comments were “Nice layout, good colors” and “Really, you don’t have a national surveillance program?”

As Brett has mentioned in his post, the final session at ECCMID was about surveillance and public reporting, and we had Eli Perencevich present perspectives from the US and Europe. England now has a public reporting tool where consumers can drill down to Trust by infection and time period for an assortment of HAIs, presumably this will expand to all mandatory surveillance activities in the future. A presentation by Maaike van Mourik from the Netherlands about semi and fully automated surveillance systems and their utility for the numerous stakeholders was inspiring. Maaike demonstrated how a semi automated surveillance system resulted in an impressive surveillance workload reduction for ICPs and 100% case sensitivity

Will we live to see the day in Australia where electronically sourced, risk adjusted HAI data is collected by an automated surveillance program which is then analysed and interpreted by infection prevention experts, and then submitted to a central agency where data is collated, benchmarks established, and published on an interactive webpage providing complete transparency for consumers?

Unfortunately many other countries are closer to that day than Australia, but we must move in this direction… A journey of a thousand miles…

Why have a national HAI surveillance program, (I hear you ask), when the surveillance you do is perfectly adequate for your needs? Answers to that question will be provided in later blogs!

PLR

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

 

 

 

First blog post

This is the very first post on infectiondigest. We hope you find this blog enjoyable, entertaining and perhaps, shed some light on pertinent infection prevention and control issues.

Feel free to agree, disagree or anything in between to any our posts.