Anthony Harris – Infection Control

Dr. Anthony Harris is a Professor of Medicine at the University of Maryland and an expert in infection control as well as epidemiology.  He recently published a paper in JAMA on the effects of universal glove and gown use on antibiotic-resistant bacteria acquisition and colonization in the ICU with some interesting results… We were fortunate enough to have Dr. Harris come and discuss his thoughts about infection control in the ICU as well as some simple ways we can help prevent our sickest patients from getting even sicker.  Plus… he’s Canadian – so you know this has to be good.

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Pearls

The hospital is filled with bacteria – the ones we worry about most – ESKAPE bugs

• Enterococcus faecium (VRE)
• Staph aureus (MRSA)
• Klebsiella pneumoniae (CRE)
• Acinetobacter baumannii
• Pseudomonas aeruginosa
• Enterobacter spp.

Unfortunately, more than 50% of surveillance culture colonization and acquisition of nosocomial bacteria is transferred by the healthcare worker!!

How important are gloves and gowns?

Major Concepts in Infection Control

• Hand hygiene, hand hygiene, hand hygiene
• Active surveillance: Up to 90% of colonizations will be miss if you only wait for clinically (+) cultures, however, colonized patients transmit bacteria just as easy as those who are clinically infected!
  • How to perform surveillance cultures:
    • MRSA: Nares or wound swabs
    • VRE: Perianal swabs
    • ESBL: Perianal swabs
    • CRE: Perianal, urine swabs
    • MDR Acinetobacter ???
• Environmental cleaning:  If you culture objects in a room after a surveillance (+) patient is moved (and the room is cleaned), up to 20-30% of the entire room is actually clean.
• Antibiotic stewardship
• Decolonization: Promising data that suggests this could be affective – at least for MRSA.
• Universal gowning & gloving
  • Improves hand hygiene on exit
  • Found to have a large decrease in MRSA acquisition (by 40%!!)
  • No effect on VRE acquisition (unclear why)
  • Trend toward decreased adverse events – but no difference in CLABSI, CAUTI, VAP rates
• Get unnecessary catheters out early