Give up on VRE?
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Presentation "Give up on VRE" as part of a debate at HIS 2014 (Lyon, France). Clearly not everything in here is my true opinion, but was part of "playing my part".
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Healthcare-associated infections (HAIs) have a significant impact on hospitals and patients. For patients, HAIs can lead to increased treatment, extended hospital stays, disability and even death. Hospitals experience decreased productivity, litigation costs and damage to their reputation from HAIs. At a national level, HAIs contribute to increased healthcare costs and societal losses from inability to work. The document discusses the difficulties in measuring the full economic burden of HAIs but notes it has been shown to be substantial. Prevention of HAIs should be an important part of patient care due to their associated morbidity, mortality and costs.
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This document summarizes key points from a presentation on Clostridium difficile and other healthcare-associated infections. It discusses how C. difficile can cause endemic, epidemic infections in healthcare settings. It also briefly mentions other potential pathogens like norovirus, salmonella, and cryptosporidium. The document then provides more details on C. difficile biology, symptoms, risk factors, diagnostic testing approaches, and strategies for prevention and environmental cleaning.
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Why Are We Not Making More Progress to Decrease PRRS Incidence? - Dr. Clayton Johnson, Director of Health at Carthage Veterinary Service, from the 2017 Allen D. Leman Swine Conference, September 16-19, 2017, St. Paul, Minnesota, USA.
More presentations at http://www.swinecast.com/2017-leman-swine-conference-material
HUMAN IMMUNODEFICIENCY VIRUS/HIV
The document discusses World AIDS Day which is held annually on December 1st to raise awareness about HIV/AIDS and show support for those living with the disease. It provides information about the themes, transmission, stages of HIV infection, testing, and treatment. The document also outlines the goals of increasing HIV testing and treatment to work towards eliminating HIV/AIDS by 2030.
VRE 7th GCC
This document discusses Enterococcus faecium and vancomycin-resistant Enterococcus (VRE). It notes that E. faecium is becoming more prevalent than E. faecalis in nosocomial infections. VRE can transmit between patients in healthcare settings and there is concern about a lack of antibiotic options to treat VRE infections. Controlling VRE outbreaks requires strict infection control measures like contact isolation, hand hygiene, and thorough environmental cleaning. Antibiotic use, especially broad-spectrum antibiotics, is an important factor in the selection and transmission of VRE.
approaching infection outbreak in picu
An infection control nurse informed the PICU consultant that two patients have been found to have MDR Acinetobacter infections. This may constitute an Acinetobacter outbreak. The consultant should confirm it is an outbreak by investigating patients and the environment, calculating the attack rate, and comparing it to the background rate. If confirmed, treatment and prevention measures should be implemented, including isolation, cohorting, strict sterilization and disinfection procedures.
Ycml
The document discusses the role of the hospital environment in the transmission of pathogens and healthcare-associated infections. It is estimated that 20% of pathogens causing infections in the intensive care unit come from the environment. Surfaces in patient rooms are often contaminated with pathogens, and contact with these surfaces can lead to healthcare worker contamination. Improved cleaning has been shown to reduce transmission of certain pathogens like C. difficile and VRE. The infectious dose may be very low for some environmental pathogens. The document examines various studies on the role of the environment in transmission and potential strategies to reduce environmental contamination.
Acute & Traumatics wounds - Infectious risk
This document provides guidance on acute and traumatic wound care. It recommends using protective equipment to prevent introducing more germs, and cleaning wounds with abundant washing rather than soaking. Tap water is as effective as saline for cleaning, and antisepsis is only needed prior to incision. For animal bites, wounds should be left open or drained if not easily cleaned. Antibiotics are only indicated if signs of infection are present. Tetanus vaccination status should be assessed and updated if needed based on wound type.
Dr. Jorge Garrido - Experimental Transmission of Influenza and PRRS Viruses U...
Experimental Transmission of Influenza and PRRS Viruses Using a Nurse Sow Model That Mimics Farrowing Room Practices - Dr. Jorge Garrido, from the 2018 Allen D. Leman Swine Conference, September 15-18, 2018, St. Paul, Minnesota, USA.
More presentations at http://www.swinecast.com/2018-leman-swine-conference-material
Dr. Matt Anderson - Porcine Epidemic Diarrhea virus
This document discusses Porcine Epidemic Diarrhea Virus (PEDv), which was first detected in the United States in 2013. It caused high mortality in neonatal pigs. The virus likely entered via contaminated transportation systems. Strict biosecurity is needed to prevent transmission between farms via trucks, equipment, feed, and manure. Vaccines have been developed but their efficacy varies. The industry has made progress in research and control efforts, but risks remain from international trade and catastrophic market loss if a foreign animal disease was introduced. Continual improvement in cleaning and disinfection of transportation systems is crucial to control spread.
Ni escmid-esgni-kayseri 2015
This document discusses the economic analysis of nosocomial (hospital-acquired) infections. It provides background on the incidence and impact of nosocomial infections, including increased length of stay, costs, and mortality. The document then discusses methods for calculating the excess costs of nosocomial infections and provides examples of studies estimating costs for specific types of infections like surgical site infections, bloodstream infections, and pneumonias. Overall, the document aims to outline approaches for analyzing the significant economic burden of nosocomial infections.
Economics of ni.2019
1) The document discusses the economics of nosocomial infections and antimicrobial resistance. It outlines the high costs associated with nosocomial infections, including increased length of hospital stay, excess costs of treatment, and increased mortality.
2) Several studies are summarized that estimate the excess costs of various types of nosocomial infections, such as surgical site infections, bloodstream infections, pneumonias, and central line-associated infections. Across multiple countries and healthcare settings, the estimated excess costs per infection range from thousands to tens of thousands of dollars.
3) Nosocomial infections pose a significant economic burden to healthcare systems worldwide. Reducing their incidence could save hospitals substantial costs while improving patient outcomes.
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More from Radboudumc REshape Center for Innovation
Masks ECCVID 2
This document discusses arguments for and against universal masking policies to prevent the spread of COVID-19. It notes that the definition of "universal masking" varies between countries and references studies on the effectiveness of masks. While masks may provide some protection, especially in healthcare settings, there is limited evidence on their effectiveness in community settings. Concerns about universal masking include improper use, a false sense of security, risk compensation, and lack of evidence that cloth masks work as well as medical masks. Overall, masks are presented as just one part of a comprehensive strategy, and not a replacement for other measures like distancing and isolating when sick.
Apsic 2019 Water and HAI
The document discusses the risks posed by water sources in healthcare settings. It notes that water sources can be contaminated with pathogens like Legionella, nontuberculous mycobacteria (NTM), and fungi. Heater-cooler devices used in surgery have been linked to outbreaks of M. chimaera infections. Sinks and drains in patient rooms and bathrooms have been found to harbor multidrug-resistant bacteria and have caused outbreaks through aerosolization and contact with healthcare workers' hands. Removing sinks from intensive care unit rooms and implementing water-free patient care was associated with significantly lower gram-negative bacterial colonization rates in patients.
Apsic 2019 AMS nursing home
This document summarizes work done to implement antibiotic stewardship (AMS) programs in nursing homes in the Netherlands. It finds that while AMS is established in hospitals, it is unknown in nursing homes. It discusses adapting hospital AMS guidelines for nursing homes and the unique needs of nursing homes, including limited resources and staff training. It also reports on establishing an AMS team, monitoring antibiotic use data, providing education to nurses and families, and finding room for improvement, particularly around urinary tract infections. The overall inappropriate antibiotic use for UTIs in nursing homes was found to be 32%.
APSIC 2019 Patient Engagement
This document discusses patient involvement in infection prevention and control efforts. It suggests including patients in decisions about their own care, quality improvement projects, and strategic planning. Examples of how to engage patients include providing them with information via folders, posters and videos. The document also discusses patients' current internet use to research health topics and find support. It notes that while patients may become well-informed, they still need physician guidance. The rest of the document outlines strategies for engaging patients in hand hygiene monitoring and prevention of surgical site infections and UTIs.
APSIC 2019 Hand Hygiene Monitoring
1) The document discusses various methods for monitoring hand hygiene (HH) compliance, including direct observation and electronic monitoring systems (EMS).
2) EMS can continuously monitor HH at a larger scale than direct observers, but may not accurately assess the quality of HH episodes.
3) Several challenges exist with EMS including equipment costs, ensuring dispenser coverage in all needed areas, and potential interference with other devices. Proper implementation requires a team effort.
4) Studies show that while EMS can provide prompts to improve HH, rates may fall again without active intervention. Automated monitoring provides more accurate baseline data than human observers alone.
Where are we with hand hygiene
1) Hand hygiene is important for reducing infection rates in hospitals, which average between 8-12% but can be higher in critical care units at 15-40%.
2) Compliance with hand hygiene has increased with the introduction of alcohol-based hand rubs but barriers still exist including a lack of peer pressure and leadership support for hand hygiene practices.
3) There is debate around which specific moments should require hand hygiene and how many moments are realistically feasible for healthcare workers to comply with, though the WHO guidelines of 5 moments provide a clear framework.
Preventing SSI
This document discusses various preoperative, perioperative, and postoperative factors that can influence the risk of surgical site infections (SSIs). It identifies factors that are not influenceable, not probably influenceable, can be influenced by others, and can and should be influenced by healthcare providers. It emphasizes the importance of implementing basic practices first, such as appropriate hair removal methods, proper skin antisepsis, maintenance of normothermia, and use of antibiotic prophylaxis. Studies are referenced showing the impact of these factors, such as higher SSI rates with hypothermia during surgery. The document advocates a multifaceted approach focusing on modifiable factors to optimize SSI prevention.
Five moments
This document discusses hand hygiene (HH) compliance among healthcare workers (HCWs) and different approaches to defining moments when HH should occur. It notes that past attempts to define many specific HH moments resulted in guidelines that were too complex to implement. The document advocates for a simpler approach using 5 core moments and acknowledges this still requires many HH actions per shift. It also explores social contact as a potential separate category and questions how to define such contact given microbes don't distinguish between care and social interactions. The document concludes that while the 5 moments approach may not be perfect, no better universally applicable and easy to remember alternative has been identified.
Year in Infection Control
The document discusses a presentation on infection prevention and control given by Andreas Voss. It touches on several topics:
- Human factors engineering to help males aim better in restrooms to reduce spillage and cleaning needs.
- Studies showing priming behaviors like olfactory scents and images of eyes watching can influence honesty and cooperation.
- A study finding removing sinks from ICU rooms and implementing water-free patient care reduced gram-negative bacteria colonization rates in patients.
- The need for clear, unambiguous terminology to build understanding of antimicrobial resistance across different domains to facilitate a global response.
ICPIC 2017 opening keynote
1. The document discusses challenges facing infection prevention and control (IPC) programs, including securing resources from hospital administrators who see IPC as a cost center rather than revenue generator.
2. It provides advice on how to advocate for IPC programs, including demonstrating the impact of healthcare-associated infections on costs and patient safety, using economic analyses to show potential cost savings, and leveraging crises to highlight the value of IPC.
3. The document emphasizes the importance of engaging hospital leadership in supporting a culture of patient safety and outlines a strategic vision for empowering IPC programs through appropriate structure, resources, and education.
Hand Hygiene and Behavior Change
This document summarizes strategies for improving physician compliance with hand hygiene recommendations. It begins by noting the typically low rates of compliance in Dutch hospitals and outlines factors that may contribute to non-compliance. These include perceptions that guidelines are too complex, that one's own situation is different, or simply not caring. The document then provides suggestions for addressing non-compliance, such as having repeated face-to-face conversations to emphasize evidence that non-compliance harms patients, limiting guidelines to one or two clear options to avoid decision paralysis, and appealing to peer pressure by emphasizing consistency with other institutions. The goal is to overcome barriers to compliance through effective communication and engagement strategies.
ESCMID pro-con on S. aureus decolonization
A "con" presentation of something I am really very much "pro". Still, this were the barriers I had to overcome why implementing S. aureus decolonization
Lessons learnt from ebola
Shaheen Methar's fantastic talk on Ebola at ICAN 2014 in Harare, Zimbabwe. Thanks for letting me share her talk)
Guidelines
The document discusses guidelines for infection control. It notes that guidelines are seen as both too restrictive by some and not restrictive enough by others. It emphasizes that guidelines need to be adapted to the local situation and highlights strategies for developing and implementing guidelines, including obtaining input from various stakeholders and ensuring guidelines are evidence-based. It also presents "The Ten Commandments of Infection Control" as a concise way to summarize key principles.
Writing scientific paper
The document provides guidance on writing scientific papers, including identifying topics from clinical activities, past presentations, or unfinished projects. It recommends selecting a topic of personal interest and finding a mentor. The document outlines the typical sections of a paper and advises beginning writing even before research is complete. It stresses getting feedback early in the writing process and carefully editing for accuracy and style.
Top Papers 2014
Top papers in infection prevention and control 2014, as presented by Vicky Fraser and Andreas Voss at ICAAC, Washington, DC
MRE Netzwerk Duisburg
MRE - Bildung eines Netzwerkes durch GA Duisburg (Dr. Weber) in Zusammenarbeit mit EurSafety/healthYcare
A team 7th GCC
This document provides an overview of antibiotic stewardship activities at Dutch hospitals CWZ and Radboud UMC from the perspective of Andreas Voss. It summarizes that the Dutch have many experts in antimicrobial stewardship (AMS) working at these hospitals. It then
Legionella 7th gcc
This document summarizes information about Legionnaires' disease, including its history, causes, symptoms, diagnosis and treatment. It discusses how Legionella bacteria can grow in warm water systems and infect people when inhaled as an aerosol. It also outlines recommendations for preventing Legionnaires' disease through proper maintenance and monitoring of water systems to control bacterial growth.
Nvic infection control
The document discusses infection control in ICU patients in Europe. It finds that 51% of ICU patients are infected, and the mortality rate of infected patients is over twice that of non-infected patients. Proper infection control training, communication, changing hospital culture, and leadership support could help reduce infection rates and improve patient outcomes.
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NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdf
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
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Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
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Mental Health and well-being Presentation. Exploring innovative approaches and strategies for enhancing mental well-being. Discover cutting-edge research, effective strategies, and practical methods for fostering mental well-being.
Pneumothorax and role of Physiotherapy in it.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
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Friendly Massage in Ajman - Malayali Kerala Spa Ajman
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
By offering a variety of massage services, our Ajman Spa Massage Center can tackle physical, mental, and emotional illnesses. In addition, efficient identification of specific health conditions and designing treatment plans accordingly can significantly enhance the quality of massaging.
At Malayali Kerala Spa Ajman, we firmly believe that everyone should have the option to experience top-quality massage services regularly. To achieve that goal we offer cheap massage services in Ajman.
If you are interested in experiencing transformative massage treatment at Malayali Kerala Spa Ajman, you can use our Ajman Massage Center WhatsApp Number to schedule your next massage session.
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Multimodal analgesia.
FACIAL NERVE
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
PrudentRx: A Resource for Patient Education and Engagement
PrudentRx enhances healthcare by educating patients and ensuring effective medication management in a complex, evolving landscape.
一比一原版(USF毕业证)旧金山大学毕业证如何办理
USF毕业证offer【微信95270640】《旧金山大学毕业证购买》《如何办理USF毕业证旧金山大学文凭学历》Q微信95270640实体公司，专业可靠，办理毕业证办美国成绩单,做加拿大文凭学历认证,办新西兰学位证，学位证书是什么?《制作旧金山大学毕业证多少钱》《USF学历证书丢了怎么办理》办澳洲文凭认证，办留信网认证（网上可查，实体公司，专业可靠）
专业为留学生办理旧金山大学旧金山大学硕士学位证成绩单【100%存档可查】留学全套申请材料办理。本公司承诺所有毕业证成绩单成品全部按照学校原版工艺对照一比一制作和学校一样的羊皮纸张保证您证书的质量！
如果你回国在学历认证方面有以下难题请联系我们我们将竭诚为你解决认证瓶颈
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2获得真实的国外最终学历学位但国外本科学历就读经历存在问题或缺陷。【如：国外本科是教育部不承认的或者是联合办学项目教育部没有备案的或者外本科没有正常毕业的。】
3学分转移联合办学等情况复杂不知道怎么整理材料的。时间紧迫自己不清楚递交流程的。
如果你是以上情况之一请联系我们我们将在第一时间内给你免费咨询相关信息。我们将帮助你整理认证所需的各种材料.帮你解决国外学历认证难题。
国外旧金山大学旧金山大学硕士学位证成绩单办理方法：
1客户提供办理信息：姓名生日专业学位毕业时间等（如信息不确定可以咨询顾问：我们有专业老师帮你查询旧金山大学旧金山大学硕士学位证成绩单）；
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5旧金山大学成品做好拍照或者视频给您确认；
6快递给客户（国内顺丰国外DHLUPS等快读邮寄）。头贼脑的倒也逗人喜爱日上三竿时山娃总爱窜进自家瓜棚里跟小伙伴们坐着聊天聊着聊着便忍不住往瓜田里逡巡一番抱起一只硕大的西瓜用石刀劈开抑或用拳头砸开每人抱起一大块就啃啃得满嘴满脸猴屁股般的红艳大家一个劲地指着对方吃吃地笑瓜裂得古怪奇形怪状却丝毫不影响瓜味甜丝丝的满嘴生津遍地都是瓜横七竖八的活像掷满了一地的大石块摘走二三只爷爷是断然发现不了的即便发现爷爷也不恼反而教山娃辨认孰熟孰嫩孰甜孰淡名义上是护瓜吃
nhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdf
nhs fpx 4000 assessment 4 analyzing a current health care problem or issue.pdf
Monopoly PCD Pharma Franchise in Tripura
Our company incorporates various drug formulations covering pharma tablets, syrups, capsules, gels, sachets, ointments, creams, injectables.
一比一原版(EUR毕业证)鹿特丹伊拉斯姆斯大学毕业证如何办理
EUR毕业证offer【微信95270640】《鹿特丹伊拉斯姆斯大学毕业证书原版制作EUR成绩单》【Q微信95270640】《仿制EUR毕业证成绩单鹿特丹伊拉斯姆斯大学学位证书pdf电子图》，A.为什么留学生需要操作留信认证?
留信认证全称全国留学生信息服务网认证,隶属于北京中科院。①留信认证门槛条件更低,费用更美丽,并且包过,完单周期短,效率高②留信认证虽然不能去国企,但是一般的公司都没有问题,因为国内很多公司连基本的留学生学历认证都不了解。这对于留学生来说,这就比自己光拿一个证书更有说服力,因为留学学历可以在留信网站上进行查询!
B.为什么我们提供的毕业证成绩单具有使用价值？
查询留服认证是国内鉴别留学生海外学历的唯一途径，但认证只是个体行为，不是所有留学生都操作，所以没有办理认证的留学生的学历在国内也是查询不到的，他们也仅仅只有一张文凭。所以这时候我们提供的和学校颁发的一模一样的毕业证成绩单，就有了使用价值。
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国外毕业证学位证成绩单办理流程：
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Give up on VRE?
- 1. 20-‐11-‐14 1 Andreas Voss, MD, PhD Senior Consultant Clinical Microbiology Canisius-‐Wilhelmina Hospital Professor of Infec@on Control Radboud University Medical Centre Nijmegen, The Netherlands ¤ First report in Europe (1988) ¤ Endogenous flora was considered only source for a long @me ¤ Role of environment UQley et al. Lancet 1988;57-‐58 • Enterococci in 45% of the samples. • Mostly chicken meat (65.4%) • VRE in 29% of the samples • Highest prevalence of VRE in chicken meat (76.5%) Pavia et al. J Food Protect 2000;63:912 VRE coloniza6on of Vegans versus meat eaters: 0 versus 6% Schouten et al. Lancet 1997:349:1258 ¤ Range 2-‐4% Endtz et al. J Clin Microbiol 1997;35:3026
- 2. 20-‐11-‐14 2 Meningitis Neonatal infection sepsis pneumonia UTI Surgical infection sepsis meningitis endocarditis UTI Intra-abd. infections … frequently one of a bunch! Wound infections Patient: underlying diseases, antibiotics, veel co-morbidity UQley et al. Lancet 1988;57-‐58 Care or Not? I wish VRE control would be possible • Between August 2004 and December 2010, Less 45 pa@VRE ents – outbreaks occurred in 21 of the 38 AP-‐HP s6hospitals ll outbreaks! • An ins@tu@onal control programme was implemented • The number of cases per outbreak was significantly lower ager implementa@on of the programme. … thus maybe Mike isn’t that mad ... … if VRE has established itself outside of the hospital and in the community, we’re going to see a lot more VMRSA. And an epidemic strain only has to get lucky once…
- 3. 20-‐11-‐14 3 Did anyone check Guinness for VRE? NL: only interested in VR-‐E. faecium (possibly certain CC’s)
- 4. 20-‐11-‐14 4 NL: es6mated number of infec6ons: 500, number of death: 33 when prevalence is 40% at 1% = 12.5 cases and 1.2 death ¤ Not one reason, but the consequence of mul@ple, small factors à Swiss-‐Cheese-‐Accident Model (hand)hygiene antibiotics cleaning Maintenance Werk pressure Bad luck Low compliance (Hand) hygiene antibiotics cleaning Not good enough Maintenance Work pressure Bad luck CC17, bed-‐pan washers Too much Cipro Not good enough Too high, trainees
- 5. 20-‐11-‐14 5 Low compliance (Hand) hygiene antibiotics cleaning Not good enough Maintenance Work pressure Bad luck VRE outbreak CC17, bed-‐pan washers Too much Cipro Not good enough Too high, trainees ¤ Roomservice ¤ Roomservice-‐plus ¤ Registered nurse ¤ Nurse asistant ¤ Cleaning ¤ Bedpan VRE+ despite washers were tested and validated ! Not our model ¤ Bed-‐pan washers according to EU norm A60 ² A60 = the effect of 1 min 80°C A0 value of outbreak strain: = 160 (2 min, 80C) … no one told us that we have to die at A60
- 6. 20-‐11-‐14 6 • Weekly audits including feedback • Are screening cultures* negative • Are bed pans visible clean à later dropped when switch to disposable bed-pans • Do HCWs regard HH-rules and show no mistakes during observation of contact isolation • Are all flagged patients actually in isolation (SR or cohort) • Only trained nurses taking care of VRE patients * Weekly microbiological screening of the environment and all patients in affected units (n=8) Ward Cultures (pats & en.) Cleaning HH-‐rules & isola6on Flagging/ sor6ng Trained HCWs A B C D E Reported to medical head, unit manger, head nurse, CEO …. cleaning flagging cleaning Week Cultures (pats & en.) Cleaning HH-‐rules & isola6on Flagging/ sor6ng Trained HCWs 1 2 3 4 5 6 7 …. A long 6me
- 7. 20-‐11-‐14 7 ¤ 14 month outbreak VRE HERE à VRE tiredness ¤ 450+ cases (coloniza@on) ¤ Financial pressure – insurance contracts ¤ 28.000 PCRs, 7.000 extra cultures ¤ Extra cleaners & new detergent & wipes ¤ New products & business cases ¤ Endless audits & training sessions ¤ Change of an@bio@c formulary ¤ S@gma@za@on & uncertainty ¤ Problems in returning to nursing homes/home hospital ¤ VRE-‐posi@ve for > 1 year ¤ Cases with BSI: 5 (4 cured, 1 died with VRE) IS VRE A REAL PROBLEM Mammatus Clouds
- 8. 20-‐11-‐14 8 Is that possible once we eat it? Yes, but ac6ve surveillance? Always good? But need to reduce MRSA first! No need in vanB! ¤ LiQle clinical impact (at least in most units) ¤ High cost of control ¤ S@gma@za@on of pa@ents ¤ Lack of decoloniza@on possibili@es ¤ Community spread including our food ¤ Need to waist energy to clean bedpans at 2 min/80C (or invest in disposable system) ¤ AMS changes (stop SDD?) may protect us from VRE but select for something else, far worse Not really 6me to give up, but certainly 6me to stop making such a fuzz about it ! VRE should not be seen as an An6bio6c Resistance Threat but as an indicator of a failing preven6ve system