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Thought this might provoke some discussion. The full article plus the table and all links is here: http://haicontroversies.blogspot.com.au/2016/01/rethinking-contact-precautions.html?utm_sourcefeedburner&utm_mediumemail&utm_campaignFeed:+blogspot/vutUL+(Controversies+in+Hospital+Infection+Prevention)&m1
Worth reading and voicing an opinion about, I believe.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226P Please consider the environment before printing this email
Sent by Outlook for Android on a Galaxy S5
Controversies in Hospital Infection Prevention
Controversies in Hospital Infection Prevention
Rethinking contact precautions
I’m working on a talk entitled “Rethinking Contact Precautions” for the Winter Course in Infectious Diseases. If you’ve never been to the Winter Course, it’s a great conference in a casual atmosphere with state-of-the-art lectures on a wide variety of ID topics. And there’s lots of skiing. This year, we’ll be at Big Sky, Montana, February 14-18.
This weekend, I ran across a brand new paper in Infection Control and Hospital Epidemiology on discontinuing contact precautions. This one comes from Roswell Park Cancer Center where active surveillance (weekly perianal cultures) for VRE was discontinued in March 2011. At the same time contact precautions for VRE infection and colonization were also discontinued. The investigators compared VRE bacteremia rates for the 3-year period before and the 3-year period after discontinuing active surveillance and contact precautions. The 6-year period of the study included over 1,300 patients with hematologic malignancies, bone marrow transplant and lymphoma. Over the study period there were no changes in antibiotic utilization, nurse-to-patient ratio, age, gender, underlying malignancies or length of stay. Importantly, via interrupted time series analysis, there was no significant change in the rate of VRE bacteremia (2.32 infections/1,000 patient days before vs. 1.87 after). This is the third published study and there are two more studies in abstract form all showing no change in infection rates after contact precautions were discontinued.
I also re-read Kathy Kirkland’s paper, Taking Off the Gloves: Toward a Less Dogmatic Approach to the Use of Contact Isolation (free full text here). Kathy was way ahead of the curve with her thinking on this topic. Below is a table from her paper that summarizes the likelihood of benefit for contact precautions:
As I thought more about where we are in infection prevention in 2016, it seems to me that contact precautions is a decrepit concept. When introduced 50 years ago, contact precautions made sense. At that time hand hygiene rates were abysmal, alcohol-based handrubs were not available, patients weren’t bathed with chlorhexidine, there were few single-bed hospital rooms, and there was no enhanced technology for environmental disinfection.
Putting it all together, there’s little evidence that contact precautions are effective in the non-outbreak setting, and we’re learning that nothing bad happens when contact precautions are stopped. At the University of Iowa, we’re focusing on hand hygiene, stethoscope wipe down and bare below the elbows. And the list of hospitals forgoing the plague doctor suit for MRSA and VRE grows ever longer.
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Thanks Michael.
Had a quick read of the study’s abstract at lunchtime…
Wouldn’t having only VRE bacteraemias as a sole end indicator significantly narrow their ability to objectively evaluate any VRE spread in the unit?
Discontinuing systematic VRE surveillance at the same time cuts off all data on further VRE colonization rates in the unit.
So there may be an increase in transient VRE spread and acquisition during the 3 years they ceased isolation precautions, but no one knows unless it amounts to a symptomatic infection during their patients’ stay in the unit.
Even then, VRE infection rates from other body sites are omitted from the study.
We all know that in IC.. the more you look, the more you’ll find… and the opposite applies as well.
No surveillance… no problem! (or so it may appear initially… till it hits the fan!)
I think a risk assessment based style to managing MROs would be a logical step forward (which many facilities are already doing).
Discontinuing surveillance and precautions doesn’t mitigate the risk… it’s still there… you just can’t see it (yet).
Just my 2 cents.
Kind regards,
Gerald Chan | Infection Control Manager
St John of God Murdoch Hospital
T: (08) 9428 8638 | M: | F: | E: Gerald.Chan@sjog.org.au
100 Murdoch Dve Murdoch WA 6150
http://sjog.org.au/murdoch | http://twitter.com/sjgh_murdoch | LinkedIn | http://facebook.com/stjohnofgodmurdochWe acknowledge the Traditional Owners of Country throughout Australia and recognise their continuing connection to land, waters and community.
We pay our respect to them and their cultures and to Elders past and present.Thought this might provoke some discussion. The full article plus the table and all links is here: http://haicontroversies.blogspot.com.au/2016/01/rethinking-contact-precautions.html?utm_sourcefeedburner&utm_mediumemail&utm_campaignFeed:+blogspot/vutUL+(Controversies+in+Hospital+Infection+Prevention)&m1
Worth reading and voicing an opinion about, I believe.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226P Please consider the environment before printing this email
Sent by Outlook for Android on a Galaxy S5
Controversies in Hospital Infection Prevention
Controversies in Hospital Infection Prevention
Rethinking contact precautions
I’m working on a talk entitled “Rethinking Contact Precautions” for the Winter Course in Infectious Diseases. If you’ve never been to the Winter Course, it’s a great conference in a casual atmosphere with state-of-the-art lectures on a wide variety of ID topics. And there’s lots of skiing. This year, we’ll be at Big Sky, Montana, February 14-18.
This weekend, I ran across a brand new paper in Infection Control and Hospital Epidemiology on discontinuing contact precautions. This one comes from Roswell Park Cancer Center where active surveillance (weekly perianal cultures) for VRE was discontinued in March 2011. At the same time contact precautions for VRE infection and colonization were also discontinued. The investigators compared VRE bacteremia rates for the 3-year period before and the 3-year period after discontinuing active surveillance and contact precautions. The 6-year period of the study included over 1,300 patients with hematologic malignancies, bone marrow transplant and lymphoma. Over the study period there were no changes in antibiotic utilization, nurse-to-patient ratio, age, gender, underlying malignancies or length of stay. Importantly, via interrupted time series analysis, there was no significant change in the rate of VRE bacteremia (2.32 infections/1,000 patient days before vs. 1.87 after). This is the third published study and there are two more studies in abstract form all showing no change in infection rates after contact precautions were discontinued.
I also re-read Kathy Kirkland’s paper, Taking Off the Gloves: Toward a Less Dogmatic Approach to the Use of Contact Isolation (free full text here). Kathy was way ahead of the curve with her thinking on this topic. Below is a table from her paper that summarizes the likelihood of benefit for contact precautions:
As I thought more about where we are in infection prevention in 2016, it seems to me that contact precautions is a decrepit concept. When introduced 50 years ago, contact precautions made sense. At that time hand hygiene rates were abysmal, alcohol-based handrubs were not available, patients weren’t bathed with chlorhexidine, there were few single-bed hospital rooms, and there was no enhanced technology for environmental disinfection.
Putting it all together, there’s little evidence that contact precautions are effective in the non-outbreak setting, and we’re learning that nothing bad happens when contact precautions are stopped. At the University of Iowa, we’re focusing on hand hygiene, stethoscope wipe down and bare below the elbows. And the list of hospitals forgoing the plague doctor suit for MRSA and VRE grows ever longer.
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
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