Infektionshygiejne i en tid med multiresistente bakterier

Transcription

1 Infektionshygiejne i en tid med multiresistente bakterier Hans Jørn Kolmos Professor, overlæge, dr.med. Klinisk Mikrobiologisk Afdeling Odense Universitetshospital hans.joern.kolmos@rsyd.dk FSFH Nyborg

2 The two basic strategies to control resistant organisms in health care settings 1. Stop selection& increase colonization resistance Reduce& targetantibiotic prescribing 2. Stop transmission Enforcehygienemeasures

3 Vejen fra smitte til infektion går over en række trin: Invasion Patient med infektion Kolonisation Brud på barrierer. Nedsættelse af immunforsvar Smitte (kontamination) Ødelæggelse af normale mikrobiom med antibiotika Rask person Dårlig hygiejne

4 Nordahl Petersen et al. Sci. Rep. 2015;5:11444 Udfordringen er global -men løsningen er lokal

5 Twosets of hygienemeasures 1. General precautions applied to all patients 2. Specific precautions onlyimplementedafteridentifyinga problem, e.g. Highly contagious patient Multi-drug resistant organism

6 General precautions Hand hygiene Cleaning of contact surfaces Uniforms Targeted use of gloves, aprons& face protection Spot disinfection of spills Decontamination of utensils& equipment Restrictive use of antibiotics and catheters

7 General precautionsarethe basis of infection control in hospitals MRSA ESBL CPO C dif VRE General precautions The Nordic House, Tórshavn

8 MRSA guidelines in Denmark since 2006, based on Search & Destroy principle Search: Screening for MRSA Contain: Single-roomisolation Destroy: Eradicationof MRSA carriage Follow-up

9 How accuratearedanish MRSA guidelines to identify MRSA carriers? Questionsaskedon admission according to guidelines: 1. Previouslydiagnosedwith MRSA? 2. Householdcontactwith MRSA positive person past 6 mths? 3. Treatment at hospital or clinic abroad past 6 mths? 4. Contact with live pigs past6 mths? Investigationof 1,220/1,945 patients: The questions identified 18-27% of MRSA carriers 97% of patients were isolated unnecssarily 91% of MRSA carriers were not isolated Mogensen et al. Dan Med J 2015;62(11):A5151

10 HA-MRSA at OUH: Low level irrespective of MRSA questions asked on admission MRSA guidelines DDKM Accreditation OUH Clinical Microbiology Annual Report 2016

11 Is single-room isolation effective against HA-MRSA? 1-year prospective study in ICU in UK Isolated Not isolated Compliance with hand hygiene: 21 % Delay in availability of MRSA results Cepeda et al Lancet 2005; 365:

12 Single room isolation + hand hygiene reduce MRSA in ICUs SARS Cheng et al. BMC Infect Dis 2010;10:263

13 Comparisonof strategiesto reducemrsa in surgicalpatients: Multicentre intervention trial - 33 wards, 10 hospitals, 9 countries C: 49-64% C: 31-24% C: 49-64% Lee et al. BMJ Open 2013;3:e003126

14 Cleanyourhands campaign England & Wales bedside alcohol hand rub, materials promoting hand hygiene, institutional engagement, audits Stone et al BMJ 2012;344:e3005

15 Meta-analysis of hand hygiene interventions in hospitals: Comprehensive programmes lead to higher compliance Luangasanatip et al. BMJ 2015;351:h3728

16 Improving hand hygiene from high to very high compliance leads to further reduction of HAI Sickbert-Bennett et al. Emerg Infect Dis 2016;22:

17 Compliance issues in hand hygiejne: Remember to do it and do it right 46% 33% 21% correct insufficient amount defects WHO: My 5 moments for handhygiene Kolmos et al JHI 2006

18 Relationship between environmental bioburden and hospital-acquired infections in an ICU Hygiene failures: ACC >2.5 CFU/cm 2 and/or Presence of S. aureus Dancer. Clin Microbiol Rew 2014;27:665-90

19 Transmission of drug-resistant organisms from the environment: Risk of organism acquisition from prior room occupants Mitchell et al. J Hosp Infect 2015;91:211-7

20 Survival times and infectious doses of selected nosocomial pathogens on dry surfaces Dancer. Clin Microbiol Reviews 2014;27:665-90

21 Roomdisinfectionas a supplement to detergent cleaning on patient discharge H 2 O 2 vapour/ aerosol UV light Mitchel et al. BMJ Open 2014;4:e

22 Do liquid disinfectants enhance recolonization of environment with S. aureus? Hypochlorous acid Detergent Stewart et al. ICHE 2014;35:

23 An alternative approach: Cleaningof surfaceswith probiotic-basedproducts (Bacillus) reduces coliforms and S. aureus Coliforms S.aureus Caselliet al. PLoSONE 2016 Vandiniet al. PLoSONE 2014

24 Currentissuesin hospital cleaning The two basic questions: 1. Are surfaces clean after cleaning? 2. Are surfaces cleaned often enough? Unsolved issues: Standards for hygienic cleanliness Monitoring methods Cleaning methods for daily use targeted to hygienic cleanliness Staff education The economicissue: convincehospital directors to allocate ressources Dancer 2008