A user's view of commercial mobile applications designed to measure hand hygiene compliance by direct observation.

BACKGROUND: Mobile applications (apps) that facilitate the measurement of hand hygiene (HH) compliance rates by direct observation (DO) are widely available. Their usefulness for infection prevention and control (IPC) professionals has neither been recently reviewed nor formally assessed. AIM: To present a critical analysis of hand hygiene measurement apps. METHODS: Mobile apps were identified from four sources: PubMed, Apple app store, Google Play app store, Google search engine. Individual apps were then evaluated against a novel scoring system using seven key criteria considered relevant for IPC professionals. These included availability, price, automated data analysis, training requirement, compliance measured against the World Health Organization (WHO) 5 moments of HH, recent updates, and average app store rating. For each criterion, possible scores ranged from zero to two, with a maximum available score of 14 per app. FINDINGS: A total of 32 apps were identified of which 13 were suitable for analysis. Only three apps (19%) scored ≥12. Twelve apps (92%) allowed compliance to be measured against the WHO 5 moments of HH. Five apps (38%) were completely free to use, seven apps (54%) allowed for automatic analysis and reporting of HH data and only six apps (46%) had high app store ratings. CONCLUSION: The current mobile apps available for DO of HH generally scored poorly. In order to make these apps more useful to IPC professionals, they should be user-friendly and require less training prior to use. National IPC organizations should develop core standards for these apps to guide future development.

A survey of commercially available electronic hand hygiene monitoring systems and their impact on reducing healthcare-associated infections.

BACKGROUND: Although the benefits of electronic hand hygiene monitoring systems (EHHMSs) are well described, uptake has been poor since they were first introduced over 10 years ago. There is considerable published evidence on the association between the introduction of EHHMSs and improved hand hygiene (HH) compliance rates. However, their impact on healthcare-associated infection (HCAI) reduction is much less clear-cut. METHODS: Commercial EHHMS identification was undertaken using a Google internet search and all relevant websites and marketing materials were reviewed. A structured literature search was undertaken to identify evidence of HCAI reduction through EHHMS implementation. Structured interviews were undertaken with a number of Directors of Infection Prevention and Control (DIPCs) from acute NHS Trusts in the North West of England to seek opinions on HH improvement strategies and the use of EHHMSs. RESULTS: Twenty-nine commercial EHHMSs were identified, 20 of which are currently market active. Six EHHMSs had supporting evidence, across nine published studies, demonstrating their ability to reduce HCAIs. However, most evaluation designs were quasi-experimental with only one study using a high-quality stepped-wedge cluster randomized controlled trial design. In this study the EHHMS was part of a wider HH multi-modal improvement strategy. Structured interviews were undertaken with five DIPCs who consistently expressed a reluctance to support financial investment into this type of technology until EHHMS cost-effectiveness was better established. CONCLUSIONS: The evidence base for the ability of EHHMSs to reduce HCAIs needs to improve before NHS trusts will consider procuring them.

Healthcare workers' attitudes to how hand hygiene performance is currently monitored and assessed.

Engagement of healthcare workers (HCWs) is critical to maintaining high levels of hand hygiene (HH). However, attitudes of HCWs to how compliance is monitored has been poorly described. This study explored the HCW perspective on direct observation (DO) as a gold standard for HH monitoring. It also sought their opinions on innovative technology. A survey was emailed to all staff in two NHS trusts: 1120 responses were analysed. Nursing staff and doctors accounted for the largest quantity of responses; 58% of HCWs did not strongly endorse DO assessment of HH compliance. Staff were open to considering alternative innovative technologies.

Detection of rotavirus in paediatric oncology patients with diarrhoea: the impact of rotavirus vaccine.

Seven years' data were reviewed to examine stool-testing for rotavirus in patents treated in a regional paediatric oncology unit before and after the introduction of UK-wide rotavirus immunization in July 2013. The prevalence of rotavirus positivity has diminished since the introduction of rotavirus immunization, with 21 of 416 positive samples between 2010 and 2012, but only one positive test out of 122 samples in 2015 and 2016. Based on these results, there seems to be little use for routine rotavirus-testing in children and young people with cancer presenting with diarrhoea.

Clinical value of stool culture in paediatric oncology patients: hospital evaluation and UK survey of practice.

Diarrhoea is a frequently occurring symptom in paediatric oncology patients. The role of routine testing for enteric bacteria in hospitalized patients with diarrhoea is considered limited, but the diagnostic value of testing in children with oncological conditions has not been reported. Therefore, we conducted a five-year retrospective service evaluation in our tertiary paediatric oncology unit together with a national survey of 21 centres to estimate the utility of stool cultures in oncology patients with diarrhoea and the national approach to testing. Our local survey demonstrated very low diagnostic yield using routine enteric stool cultures with only one sample out of 842 (0.1%) testing positive. The national survey demonstrated considerable variation in practice. There is little evidence to support the use of conventional stool culture for enteric bacteria in children with cancer in our centre. These findings should inform national testing policies.

Early impact of rotavirus vaccination in a large paediatric hospital in the UK.

The impact of routine rotavirus vaccination on community-acquired (CA) and healthcare-associated (HA) rotavirus gastroenteritis (RVGE) at a large paediatric hospital, UK, was investigated over a 13-year period. A total of 1644 hospitalized children aged 0-15 years tested positive for rotavirus between July 2002 and June 2015. Interrupted time-series analysis demonstrated that, post vaccine introduction (July 2013 to June 2015), CA- and HA-RVGE hospitalizations were 83% [95% confidence interval (CI): 72-90%) and 83% (95% CI: 66-92%] lower than expected, respectively. Rotavirus vaccination has rapidly reduced the hospital rotavirus disease burden among both CA- and HA-RVGE cases.

Audit of the laboratory diagnosis of Clostridium difficile infection in the UK.

A UK-wide audit of the laboratory diagnosis of Clostridium difficile infection (CDI) was undertaken by the Association of Clinical Pathologists and the Royal College of Pathologists, in conjunction with Keele University. A postal questionnaire was sent out to all Consultant Microbiologists, with eighty responses available for analysis. There was considerable variation in laboratory practices. In particular, only 56% of laboratories gave guidance on follow-up testing of toxin-negative samples, 68% provided a 7 day per week diagnostic service and 66% would routinely communicate positive inpatient toxin results to ward nursing or just medical staff. To ensure a consistent approach to the diagnosis of CDI, laboratories require more detailed and prescriptive guidance than is currently available.

Short course antibiotic therapy for Gram-negative hospital-acquired pneumonia in the critically ill.

Hospital-acquired pneumonia (HAP) is a common cause of morbidity and mortality in the critically ill, yet the optimal duration of antibiotic therapy is unknown. Too short a course may lead to treatment failure, whereas too long a course may lead to increased antibiotic resistance, antibiotic-related morbidity and increased costs. Standard duration of antibiotic therapy for Gram-negative (GN-)HAP at our institution is 5 days, significantly shorter than advocated in many current guidelines. We performed a retrospective review of all cases of GN-HAP on our critical care unit fulfilling clinical and microbiological criteria to investigate recurrence rate and mortality following short course antibiotic therapy. Seventy-nine eligible patients with GN-HAP were identified. Of these, 79% were receiving mechanical respiratory support at diagnosis; 42% had GN-HAP due to non-fermenting Gram-negative bacilli (NF-GNB) and 72% were treated with the recommended 5 day course of antibiotics. Two patients had clear evidence of non-resolution of pneumonia after 5 days of therapy. Overall recurrence rate was 14%, with relapse rates significantly higher among patients with NF-GNB when compared to patients with other Gram-negative organisms (17% vs 2%; P=0.03). The overall recurrence rate was no higher than rates reported in earlier studies (17-41%). Critical care mortality (34.2%) was also not in excess of previously reported values (18-57%). In this limited study, use of a 5 day course of appropriate antibiotics for GN-HAP does not appear to increase risk of recurrence or mortality when pneumonia resolution has been achieved prior to the cessation of therapy.

Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside.

BACKGROUND: To review the changing patterns in incidence, etiology, management, morbidity, and mortality for intracranial abscesses over the last decade and compare them with two previous studies spanning four decades, conducted at the regional neurological surgical unit on Merseyside. PATIENTS AND METHODS: A retrospective review of case notes and laboratory records of all cases of intracranial abscess admitted to the regional neurosurgical unit between January 1995 and January 2005 was performed. RESULTS: Forty-seven cases of intracranial abscesses were identified. The incidence of these, in our study, was an average of five cases per year as opposed to eight cases per year in the previous decades. The mean age at presentation was 46 years, and the male-to-female ratio was 4:1. Diagnosis by computerized tomography scan was performed in majority of patients (85.1%) within 48 h of presentation. The incidence of otogenic abscess was 12.8% (6/47), much lower than that seen in previous decades. An association with previous neurosurgical procedures was noted in 19.1% of cases, similar to that seen in the previous decade. In 73.4% (36/49) of samples, organisms were isolated. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from two patients (4.3%); an isolate not reported in the previous two studies. Nine patients (19.1%) died during their hospital stay as compared to the overall mortality of 43%and 24%seen in the earlier reviews. Of the 38 who survived, 47.3% had a good outcome at discharge. CONCLUSIONS: In comparison with the two previous studies, the overall incidence of intracranial abscesses is decreasing on Merseyside. Moreover, the predisposing factors for intracranial abscesses have changed over the decades. The number of otogenic cases has declined. The incidence of brain abscesses following neurosurgical procedures is still a major cause for concern, as is the emergence of MRSA, as a significant pathogen.

Outcome of late-onset hospital-acquired pneumonia related to causative organism.

Pneumonia caused by Pseudomonas spp. has been associated with an increase in mortality in critical care patients. Previous assessments, however, have failed to compare outcome solely with other pathogens associated with hospital-acquired pneumonia (HAP). We have performed a retrospective review of all critical care patients with late-onset HAP (hospital inpatient stay >72 h at time of diagnosis) due to pure respiratory cultures of Pseudomonas spp., meticillin-resistant Staphylococcus aureus (MRSA) or non-pseudomonal Gram-negative (NPGN) organisms from 1998 to 2007. Casenote review involved assessments of illness severity, clinical pulmonary infection scoring (CPIS), critical care and hospital survival, and critical care length of stay. Out of 252 casenotes, 204 were reviewed. There were 186 treated cases of pneumonia. Ten patients had both pseudomonal and NPGN pneumonias during the same admission and two patients presented with community-acquired infections due to these organisms. These 12 patients were excluded from further analysis. Of the remaining 174 patients, 80 were infected with pseudomonas, 40 with MRSA and 54 had NPGN organisms. The three groups of patients were well-matched, with similar age, sex, CPIS scores, incidence of bacteraemia and Acute Physiology and Chronic Health Evaluation II scores at diagnosis. There were no outcome differences between the groups with respect to hospital and critical care survival and critical care length of stay. In this series, there appears to be no survival disadvantage associated with pseudomonal pneumonia when compared with other hospital-acquired organisms associated with HAP, where disease severity between the groups is similar.