tag:blogger.com,1999:blog-8066238290370557389.post1287879009847600610..comments2024-03-20T04:44:15.540-05:00Comments on Controversies in Hospital Infection Prevention: Rosie reincarnatedDan Diekemahttp://www.blogger.com/profile/10231929371552334184noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-8066238290370557389.post-68949905985213364292013-01-16T14:25:09.218-06:002013-01-16T14:25:09.218-06:00Dear Mike,
Thanks very much for your thoughtful a...Dear Mike,<br /><br />Thanks very much for your thoughtful and thought-provoking blog article about the CID article by Dr Perl’s group. My name is Jon Otter, one of the co-authors of the study. I’m the scientific director of Bioquell’s healthcare division, the “Rosie” under assessment in the study. I’m not a Jetsons fan, but I am rather fond of Wall-E and the cleaning robot comes to mind as a competitor to Rosie!<br /><br />I’d like to pick up on a few points that you made in your blog post. Firstly, whilst the significant reduction was only achieved on VRE, the trend of reduced acquisition in the patients admitted to rooms disinfected using HPV was consistent for the other pathogens studied (MRSA, C. difficile and multidrug-resistant Gram-negatives). I appreciate that the whole point of statistics is to guide us as to what is due to chance and what is a genuine difference, but I am persuaded that this non-significant trend in the other pathogens is meaningful. In fact, this is why we performed the “combined” analysis by grouping together all four pathogens under assessment to conclude that patients admitted to rooms decontaminated using HPV were 64% less likely to acquire an MDRO when the prior room occupant was infected or colonised with an MDRO.<br /><br />Secondly, it’s true that the absolute reduction in the incidence of VRE was in the region of 6%. However, remember that less than half of the rooms vacated by patients with MDROs were disinfected using HPV. If HPV had been used for the disinfection of every room vacated by a patient with an MDRO, extrapolating infection rates from all patient cohorts indicates that 17% of MDRO acquisitions would have been prevented. <br /><br />Thirdly, I agree that nobody has “nailed” a prior room occupancy study demonstrating through molecular typing that patients can acquire pathogens from previous occupants of the same room. However, the evidence from observational epidemiological studies is overwhelming (reviewed by Otter et al. Infect Control Hosp Epidemiol 2011; 32: 687-699). Furthermore, there are now two intervention studies showing that you can mitigate the increased risk from the prior room occupant to a lesser or greater degree by improving the efficacy of discharge cleaning, which strengthens the epidemiological association further (the Hopkins study by Dr Perl’s group under discussion and this one from Dr Huang’s group: Datta et al. Arch Intern Med 2011; 171: 491-494.). <br /><br />Finally, rooms will indeed quickly become recontaminated when patients shedding pathogens are admitted. This is why the most rational and evidence-based application of HPV and other automated ”no-touch” room disinfection systems is for the terminal disinfection of patient rooms, when the shedding patient has been discharged or transferred in order to protect the incoming patient (see recent review here: Otter et al. J Hosp Infect 2013; 83: 1-13). Recontamiantion caused by the incoming patient is not relevant when viewed from this perspective.<br /><br />Of course, improving terminal room disinfection will only ever prevent a minority of transmissions. But I am persuaded by the prior room occupancy studies, meaning that we need to do a better job of terminal room disinfection whether achieved through improving conventional methods or adopting NTD systems in some circumstances, or, most likely, a combination of the two. Jon Otterhttps://www.blogger.com/profile/02202655550969554425noreply@blogger.com