Duty of candour and communication during an infection control incident in a paediatric ward of a Scottish hospital: how can we do better?

Duty of candour legislation was introduced in Scotland in 2018. However, literature and experience of duty of candour when applied to infection control incidents/outbreaks is scarce. We describe clinician and parental perspectives with regard to duty of candour and communication during a significant infection control incident in a haemato-oncology ward of a children's hospital. Based on the learning from this incident, we make recommendations for duty of candour and communication to patients and families during future infection control incidents. These include the need to consider a crisis management approach, the importance of not underestimating psychological harm in incidents of a prolonged duration and embedding the existing legislation pertaining to the rights of the child.

Colonisation with toxigenic Corynebacterium diphtheriae in a Scottish burns patient, June 2015.

On 12 June 2015, Corynebacterium diphtheriae was identified in a skin swab from a burns patient in Scotland. The isolate was confirmed to be genotypically and phenotypically toxigenic. Multilocus sequence typing of three patient isolates yielded sequence type ST 125. The patient was clinically well. We summarise findings of this case, and results of close contact identification and screening: 12 family and close contacts and 32 hospital staff have been found negative for C. diphtheriae.

Implementation and barriers to waterless care: A questionnaire study of infection prevention and control practitioners, clinicians, and engineers.

Water and wastewater in healthcare settings is recognised to represent a risk to patients however waterless care has not been widely implemented in UK healthcare settings. A questionnaire study of Infection Prevention and Control practitioners, non-IPC clinicians, and estates managers and engineers was undertaken to establish barriers to implementation of waterless care. Alternates to water present challenges in perceived acceptability to patients, particularly cleansing wipes for bathing and dry shampoo. There are concerns about cleansing wipes in terms of storage, disposal, sustainability and contamination during manufacture. Estates and engineering concerns include relative water tank size for water turnover and clinical disruption due to works. Further work is required on acceptability of reduced water scenarios and patient views but the results of this questionnaire provide a grounding for sentiment from healthcare workers on waterless care.

Factors to consider in the safe design of intensive care units - Part 1: historical aspects and ventilation systems.

Background: Evidence linking the role of ventilation systems in transmission of infection to patients in intensive care units has increased in recent years. Aims: This research-based commentary set out to identify the historical aspect of intensive care unit design, current problems and some potential solutions with respect to ventilation systems. Methods: Databases and open source information was used to obtain data on the historical aspects and current guidance in ICU, and the authors experiences have been used to suggest potential solutions to ventilation problems in ICU. Findings: The authors found a number of problems with ventilation in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk. Discussion: The NHS is now at the start of major new investments in healthcare facilities in England and this together with the end of the antibiotic era mandates new guidance to address these major concerns.

Implementing changes to reduce infections in ICU patients. Water services and waste systems.

Background: Evidence linking the role of water services in transmission of infection to patients in ICUs has increased in recent years. Aims: This research based commentary set out to identify potential solutions for water and wastewater systems in ICU settings. Methods: Databases and open source information was used to obtain data on approaches to water and wastewater-related issues in ICU settings. This and the authors experiences have been used to describe approaches to these problems. Findings: The lack of updated guidance has required some ICUs to develop unique responses, including 'water free' patient care combined with reduction in water services. The options consider guidance, compliance, training and education as key factors to successful outcomes and protecting vulnerable patients in ICU. Discussion: The authors found a number of problems with water and wastewater systems in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk. As an interim measure a series of solutions suitable for existing units and new builds need to be considered.

Aspects and problems associated with the water services to be considered in intensive care units.

Background: Water is a product taken for granted and assumed to be a safe commodity in intensive care units (ICU). Biofilm readily becomes established in complex water services presenting a risk to vulnerable patients. Harboured within biofilms are opportunistic pathogens which can be transmitted via hand contact, splashing, aerosol and indirect contact through medical equipment. Evidence linking the role of water services in transmission of infection to patients in ICUs has increased in recent years. Aims: This research based commentary set out to identify current problems with water and wastewater systems in ICU settings. Methods: Databases and open source information was used to obtain data on current water and wastewater-related issues in ICU settings. This and the authors experiences have been used to describe current challenges. Findings: the authors found a number of problems with water systems in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk. Discussion: Hand hygiene stations are frequently misused or close enough to patients such that splashing poses a transmission risk. The wastewater system (drain) also presents a risk, from where Gram-negative antibiotic resistant organisms may be dispersed resulting in untreatable patient infections. The water and wastewater system provide a superhighway for the movement of pathogenic microorganisms and these risks need to be addressed if we are to safeguard vulnerable users in ICU.

Epidemiology and urological pathogenic potential of Aerococcus species in greater Glasgow and Clyde (Descriptive study of Aerococcus urinae in blood culture and urinary samples: clinical importance and potential marker of urinary tract pathology).

Introduction. Aerococcus species in particular A. urinae are increasingly reported as causative agents of bacteraemia, urinary tract infection, sepsis, and endocarditis. We sought to establish the epidemiology of A. urinae in Glasgow hospitals and whether the presence of the organism in clinical isolates could be an indicator of undiagnosed urinary tract pathology.Hypothesis/Gap statement. The knowledge gap among clinical staffs on Aerococcus species as emerging pathogens can be filled by understanding its epidemiology and clinical importance.Aim. Describe the epidemiology and clinical importance of Aerococcus urinae.Methodology. We reviewed positive blood cultures with Aerococcus species (2017-2021) and urinary isolates (2021) in Glasgow hospitals. Data were collected from clinical and laboratory database systems.Results. All 22 positive blood cultures were A. urinae and sensitive to amoxicillin, vancomycin, and ciprofloxacin. The median age was 80.5; the majority was male (18). In total, 15/22 (68 %) were diagnosed with urinary tract infection. Thirteen were treated with amoxicillin. No cases of infective endocarditis were noted. One patient was subsequently diagnosed with bladder carcinoma. All 83 positive urinary isolates in 72 patients were A. urinae. One was resistant to amoxicillin; two to ciprofloxacin; all sensitive to nitrofurantoin and vancomycin. The majority was female (43/83), the median age was 80. The commonest risk factors were underlying malignancy including bladder cancer (5/18), chronic kidney disease (17) and diabetes (16). Clinical data was unavailable in 24 episodes. Of these, 41/59 (69.5 %) were diagnosed with urinary tract infection. One patient was subsequently diagnosed with metastatic renal cancer while bladder wall lesions were identified in three patients, two of whom were waiting for an urology review at the time of study. Thirteen patients (18 %) had 1 year recurrent bacteriuria and three were not treated on initial episode.Conclusion. A. urinae are emerging pathogens and are likely to become more common due to advances in laboratory technologies and an ageing population. Clinical teams should be aware of their urological pathogenic potential and not dismiss them as contaminants. Whether Aerococcus infection is a potential indicator for undiagnosed urinary tract malignancy warrants further studies.

A syphilis-positive organ donor -- management of the cardiac transplant recipient: a case report and review of the literature.

Syphilis as a public health problem has not been resolved. Because donor organs are scarce, Treponema pallidum seropositivity is no longer considered a contraindication to transplant. However, there is little guidance on the management and monitoring on the recipient of organs from patients with syphilis. We present a case of a patient successfully transplanted with a heart from a seropositive donor and a review of the literature.

Genomic epidemiology of a Cryptococcus neoformans case cluster in Glasgow, Scotland, 2018.

In 2018, a cluster of two cases of cryptococcosis occurred at the Queen Elizabeth University Hospital (QEUH) in Glasgow, Scotland (UK). It was postulated that these cases may have been linked to pigeon droppings found on the hospital site, given there have been previous reports of Cryptococcus neoformans associated with pigeon guano. Although some samples of pigeon guano taken from the site yielded culturable yeast from genera related to Cryptococcus, they have since been classified as Naganishia or Papiliotrema spp., and no isolates of C. neoformans were recovered from either the guano or subsequent widespread air sampling. In an attempt to further elucidate any possible shared source of the clinical isolates, we used whole-genome sequencing and phylogenetic analysis to examine the relationship of the two Cryptococcus isolates from the QEUH cases, along with two isolates from sporadic cases treated at a different Glasgow hospital earlier in 2018. Our work demonstrated that these four clinical isolates were not clonally related; while all isolates were from the VNI global lineage and of the same mating type (MATα), the genotypes of the two QEUH isolates were separated by 1885 base changes and belonged to different sub-lineages, recently described as the intercontinental sub-clades VNIa-93 and VNIa-5. In contrast, one of the two sporadic 2018 clinical isolates was determined to belong to the VNIb sub-lineage and the other classified as a VNIV/VNI hybrid. Our work demonstrated that the two 2018 QEUH isolates and the two prior C. neoformans clinical isolates were all genetically distinct. It was not possible to determine whether the QEUH genotypes stemmed from independent sources or from the same source, i.e. pigeons carrying different genotypes, but it should be noted that whilst members of allied genera within the Tremellomycetes were isolated from the hospital environment, there were no environmental isolations of C. neoformans.

Diagnosis of pneumococcal pericarditis using antigen testing and polymerase chain reaction.

Following the advent of antibiotics, pneumococcal pericarditis has become a rare clinical diagnosis. We discuss 2 cases of pneumococcal pericarditis that were preceded by community-acquired pneumonia. Cultures were negative in both patients and the diagnosis was made by antigen testing and polymerase chain reaction (PCR) of the pericardial fluid. PCR or antigen testing of pericardial fluid for pneumococci should be considered in patients with a typical history, particularly when culture-negative and with a history of prior antibiotics.

Non-toxigenic Vibrio cholerae bacteraemia: case report and review of the literature.

Vibrio cholerae is a serious public health problem worldwide, but in the UK, V. cholerae infections are rare. Here, we report a case of V. cholerae bacteraemia in an elderly patient. To our knowledge, this is the first non-travel-related V cholerae bacteraemia in the UK.

Septic arthritis following anterior cruciate ligament reconstruction secondary to Clostridium sporogenes; a rare clinical pathogen.

A case of septic arthritis post anterior cruciate ligament reconstruction secondary to Clostridium sporogenes is described in a 19-year-old man. C sporogenes is a rare clinical pathogen and this is believed to be the first case of septic arthritis due to the organism. The patient responded to arthroscopic washout, synovectomy and combination antibiotic therapy. A review of the literature is also presented.