Top Ten Articles Infection Prevention and Control

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1 Top Ten Articles Infection Prevention and Control John M Conly MD Chingiz Amirov Just wash em! May 2018

2 Objectives Research or evidence-based guidelines in IPC Critique strengths and weaknesses Just wash em! Translate into the clinical setting

3 Selecting the Papers Infection prevention and Control Novel Timely Topical Evidence-based Knowledge translation ready Just wash em!

5 Selecting the Papers 1. Measuring and accounting for the Hawthorne effect during a direct overt observational study of intensive care unit nurses Sharon Lea Kurtz. AJIC, May Process control charts in infection prevention: Make it simple to make it happen. Timothy L. Wiemken et al. AJIC, Mar Making change easy: A peer-to-peer guide on transitioning to new hand hygiene products. Chingiz M. Amirov, et al. AJIC, Jan Clostridium difficile infection in Alberta s long-term care facilities. Cliff Lindeman et al. CJIC, Summer A Network Model of Hand Hygiene: How Good Is Good Enough to Stop the Spread of MRSA? Neal D. Goldstein et al. ICHE, Aug 2017 Just wash em!

SSI Guidelines JAMA Surg. 2017;152(8):784-791. doi:10.

6 SSI Guidelines JAMA Surg. 2017;152(8): doi: /jamasurg Published online May 3, Corrected on June 21, Lancet Infect Dis 2016; 16: e Published Online November 2, 2016http://dx.doi.org/ /S (16)

7 CDC vs WHO SSI Guidelines CDC Excluded all non randomized studies Often no recommendation offered or listed or not addressed due to inadequate evidence Referred recommendations Moved to adapted GRADE for recommendations WHO Included randomized and some non-randomized studies Excluded bundled interventions Less often no recommendation Recommendations pertinent to low and middle income settings

8 Quality of Studies Quality High High-moderate Moderate Low-moderate Low Low-Very low Very low Accepted practice CDC WHO

9 Pre-op Recommendations Topic CDC WHO Pre-op bathing Hair removal Bathe or shower with plain or antimicrobial soap or antiseptic the night before Do not remove unless hair will interfere; if necessary remove immediately preop with clippers Bathe or shower with plain or antimicrobial soap; no recommendation on CHG cloths Do not remove; if necessary use clippers Surgical prophylaxis When indicated by guidelines; time so concentration in serum/tissues is bactericidal at incision Before incision when indicated

10 Pre-op Recommendation Strength and Quality Topic CDC WHO Pre-op bathing with soap or antiseptic Hair removal Surgical prophylaxis timing Hand preparation Skin preparation Skin sealants I-B Strong recommendation/ Accepted Practice I-A; re-emphasized from 1999 document I-B Strong recommendation/ Accepted Practice I-B; re-emphasized from 1999 document I-A Strong recommendation (ETOH- I or ETOH-CHG) II- Weak recommendation/low Conditional recommendation/ Moderate Strong recommendation/ Moderate Strong recommendation/ Low Strong recommendation/ Moderate Strong recommendation/ Low-Moderate (Only ETOH-CHG) Conditional recommendation/ Very low

11 Pre-op Recommendation Strength and Quality Topic CDC WHO Surgical prophylaxis precise timing S. aureus carriers Cardiothoracic/orthopedic surgeries; mup + CHG S. aureus carriers Other surgeries; mup + CHG No recommendation/ Unresolved Not addressed Not addressed Strong recommendation/moderate Strong recommendation/ Moderate Conditional recommendation/ Moderate Mech bowel prep with oral antibiotics Mech bowel prep alone without oral antibiotics should not be used Not addressed but moderate evidence Not addressed Conditional recommendation/ Moderate Strong recommendation/ Moderate

lavage with PVI in contam/dirty abdominal procedures not necessary Do not use antibiotics to irrigate incision Consider irrigating

12 Intra- and Post-op Recommendations Topic CDC WHO Adhesive incise drapes Not needed Should not be used [Conditional /Low to very low] PVI wound irrigation Antibiotic wound irrigation Consider irrigating deep or subcutaneous tissues intra-op with PVI; Intraperitoneal lavage with PVI in contam/dirty abdominal procedures not necessary Do not use antibiotics to irrigate incision Consider irrigating incisions with PVI especially clean and clean-contaminated surgery classes [Conditional/Very low] Should not be used [Conditional/low]

13 Discontinuing Contact Precautions Infect Control Hosp Epidemiol 2018;1 7 Am J Inf Contr 46: :

14 Discontinuing Contact Precautions Infect Control Hosp Epidemiol 2018;1 7

15 Discontinuing Contact Precautions Infect Control Hosp Epidemiol 2018;1 7

16 Discontinuing Contact Precautions

17 Use of Ultraviolet Light in IPC Lancet 2017; 389: Published Online Jan 16, http. J dx.doi.org/ /s (16)

18 Effectiveness of UV-C Disinfection for Reduction of HC Associated Pathogens J Micro Immunol Infect 2017

Lancet 2017; 389: 805 14 Published Online Jan 16,

19 Lancet 2017; 389: Published Online Jan 16, http. J dx.doi.org/ /s (16)

20 Lancet 2017; 389: Published Online Jan 16, http. J dx.doi.org/ /s (16)

21 Human Factors and Use of Simulation in IPC Clinical Infectious Diseases 2018;66(6):950 8 Infect Control Hosp Epidemiol 2017;38:

22 Donning and Doffing Errors: Worse with PAPRs Infect Control Hosp Epidemiol 2017;38:

23 Fault Tree Analysis: Doffing EBOLA PPE (PAPRs) Clinical Infectious Diseases 2018;66(6):950 8

24 Ward Closure for Outbreak Control in Acute Care Hospitals Amer J Infect Contr 45: :

25 Ward Closure For Outbreak Control Nosocomial Outbreaks However, there was no significant change in the number of patients affected per hospital outbreak (r = 1.080, P = 0.517), or the number of hospital staff affected per outbreak (r = 0.651, P = 0.105). Closure of entire wards during norovirus outbreaks is not always necessary. The changes implemented at the study hospital resulted in a significant reduction in the number of bed-days lost per outbreak, and this, together with a reduction in outbreak frequency, resulted in considerable cost savings. Illingworth E et al. Is closure of entire wards necessary to control norovirus outbreaks in hospital? Comparing the effectiveness of two infection control strategies. J Hosp Infect 2011;79:32-7.

26 Outbreak Strategies used Across Canada W. Ocampo et al. American Journal of Infection Control 45 (2017)

27 Use of Ward Closure W. Ocampo et al. American Journal of Infection Control 45 (2017)

28 W. Ocampo et al. American Journal of Infection Control 45 (2017)

29 W. Ocampo et al. American Journal of Infection Control 45 (2017)

30 Summary of Findings Total 110 responses 70% of sites reported at least one hospital outbreak in 2013 Ward Closure as a tool 50% appropriate 50% sometimes (45%) or not (5%) appropriate Major issue of system capacity and no part of the country immune W. Ocampo et al. American Journal of Infection Control 45 (2017)

31 Just wash em!

Conflict of interest: We have no conflict of interest to report on this topic of SSI reduction for total knees.

Reducing SSI- Knees TIFFANY KENNERK MBA, MSN, RN, NE -BC, ONC CYNTHIA SEAMAN BSN, RN, ONC, CMSRN ~COMMUNITY HOSPITALS AND WELLNESS CENTERS~ Conflict of interest: We have no conflict of interest to report