Infection Control 2025 APSIC

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a smart man once said …

¤  Basics are the new black

¤  MDRO – are they all equal?

¤  Regional efforts

¤  PercepHons (InfecHon Control vs Clinicians)

¤  Less is more! (Guidelines)

¤  Help -‐ by design and by paHents

The case:

¤  You have an outbreak of VRE

¤  The OMT (including CEO) asks all HCWS to: ²  Be compliant with HH and dressing code

²  Admit paHents according to “flag”

²  Correctly use contact isolaHons measures

²  Ensure good environmental cleaning

X

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²  We sHll need to work on HH and behaviour

²  Even simple organizaHonal things don’t happen

²  Contact isolaHons – how, when, why??? ²  No money, no clue, no plan, no cleaning

¤  … while we dream of advanced infecHon control, … the truth is that we have to teach the basics,

over & over & over & ….

¤  Hand hygiene

¤  Personal hygiene

¤  IsolaHon measures

¤  Environmental cleaning

¤  Just do what you have been asked to do






¤  Help -‐ by design and paHents

¤  MRSA

¤  ESBL

¤  MDR-‐AB

¤  All other MDROs

¤  VRE

¤  CRE

¤  PRP

e.g. Cip + Genta R ESCO

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¤  All paHents at risk for MDRO carriage need to be screened and isolated on admission! (idenHcal criteria to MRSA Search & Destroy policy) ²  Yes, do it (and like it)

¤  All contacts of “unexpected” MDRO paHents needs to be screened ²  10% of all paHents are ESBL carriers and 2-‐4% carry VRE à do I really have to do the same follow up for all MDRO paHents/in all parts of the hospital?

²  is VRE = CRE Ukley et al. Lancet 1988;57-‐58

Did anyone check Guinness for VRE?

The following pictures may contain shocking details on infecHon control in The Netherlands that completele contradict their good reputaHon

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¤  Roomservice

¤  Roomservice-‐plus

¤  Registered nurse

¤  Nurse asistant

¤  Cleaning

VRE should not be seen as an An;bio;c Resistance Threat

but as an indicator of a failing preven;ve

system

E. coli K. pneumonia

Freeman et al. AnHmicrob Resistance Infect Control 2014;3:5 Freeman et al. AnHmicrobial Resistance and InfecHon Control 2014, 3:5

Rooms of paHents with ESBL-‐KP have substanHally higher contaminaHon rates than those with ESBL-‐EC. This finding may help explain the apparently higher transmissibility of ESBL-‐KP in the hospital serng

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Boring Remarkable In deep sh..

COLI

KLEBSIELLA







¤  Implement idenHcal guidelines in a region ²  exchange of personnel ²  paHent’s expectaHons

¤  Combine knowledge & experHze ¤  Share surveillance data

²  on HAI’s and MDRO incidences

¤  Include all regional healthcare serngs ²  from GP to nursing homes and specialized clinics integrated MMB, AMS and IC service




¤  Percep;ons (Infec;on Control vs Clinicians)



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Policing One-‐track mind

Guidelines

Guidelines

Guidelines

Guidelines

More guidelines

… & more ESBL CRE MRSA MDR-‐AB XDR-‐TB PRP MERS-‐Cov C.dif Noro Flu LA-‐MRSA CNR-‐GNR SARS Fungi CR-‐ESCO CA-‐MRSA TBC …

Please, no more!

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IC needs to be to-‐the-‐point

…. may not always be true, but it is with guidelines

MRSA

ESBL

C.dif & Co

CRE

…..

HAI -‐ prevenHon

CommunicaHon

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Almost Good, MD

• Education

• System change

• Motivation

… but was shown not to be sufficient to bring the message across

Nothing

new! We

are late

¤ PresenHng something new and improved does not automaHcally change bahavior !

¤ ‘The lesson from markeHng is that people are more willing to change their behaviour when they feel good, flakered, challenged powerful, sexy or proud, than when they are flooded with facts’ (Hodgkin 1999)

Onya, the Redskins cheerer (who asked that her last name be withheld, ciHng team policy), has her picture on the team's Web site in her official bikini-‐like uniform and also reclining in an actual bikini. Onya, 27, who declined to idenHfy the company she works for, is but one of several drug representa;ves who have cheered for the Redskins

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Asch conformity experiments

¤ We shouldn’t be the “weatherman” ¤ An innocent associaHon with either bad or good things will influence how people feel about us or a product ² The good looking models next to the car ² RaHng of idenHcal car changed with and without model

² Men didn’t believe that their judgment was influenced

Liking

www.sciencexpress.org / 20 November 2008 / Page 1 / 10.1126/science.1161405

§  Orderly alley: 33% likering §  GraffiH alley: §  69% likering

¤ when people observe inappropriate behavior, this weakens their concern for appropriateness

§  Orderly alley §  No graffiH sign §  Flyer on handlebar §  avoid likering

We need “order” in our hospitals and people showing appropriate behavior !

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¤  Key HCWs (MDs, RNs, helpers, cleaners, …) needs to be associated with good infecHon control pracHces

¤  Praise instead of criHcs ¤  We need beker role models

¤ Start iCare campaigne






¤  Help -‐ by design

Make things …

¤  IntuiHve ¤  TempHng

²  in air projecHng ¤  Safe ¤  Force ¤  Rewarding

Scheithauer et al. BMC InfecHous Diseases 2013, 13:367

IntervenHons were aimed at increasing compliance as well as reducing the number of HR needed by improving workflow

prac;ces.

Kramer et al. BMC Infect Dis 2006;6:130

E. coli 1.5h to 6 months Klebsiella spp. 2.0h to >30 months

… and this kind of cleaning lady is hard to get

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¤  Indicators (incidence of MDRO from BCs) as part of quarterly management rapport and public reporHng (2nd gen surveillance)

¤  IntegraHon of MMB/ID/AMS/IC at regional levels ¤  A-‐teams (anHmicrobial stewardship) in Hosp & NH ¤  Remote video assisted behavior change (audits) ¤  Nanotechnology for surfaces ¤  New ways of decolonizaHon (microbiome) ¤  Virtual reality/serious gaming… for HCWs training ¤  Robots/avatars for paHents assist

Train and improve the basics (including HH)

MDRO – pick your fight and just do it!

Reduce your guidelines

Help via design & PaHent involvement Improve communicaHon

(use behavioral science)

Work locally, but think

regional

www.ARICjournal.com

Infection Control 2025 APSIC

Health & Medicine

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