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.

1. Year in IPC 6/23/17
Andreas Voss 1
Elaine Larson, RN, PhD, FAAN, CIC
Anna C. Maxwell Professor of Nursing Research
Associate Dean for Research
Columbia University School of Nursing
Andreas Voss, MD, PhD, FSHEA, FESCMID
Professor of Infection Control, Radboudumc
Clinical Microbiologist, CWZ, Nijmegen, NL
both speakers declare no conflict of interest
Storr et al. Antimicrob Resist Infect Control (2017) 6:6
Boyce ARIC (2016) 5:10
Do you think to know all that is needed about
(nosocomial) virus infections
Not me!
Chow & Mermel, Open Forum Infectious Diseases 2017, DOI: 10.1093/o d/ofx006

2. Year in IPC 6/23/17
Andreas Voss 2
Imagine that you are in charge of cleanining
the rest-rooms of a large fasility
Your problem:
Males that can’t aim and the consequent “spillage”
How to use human factors engineering for help?
Give them an aim à 80% less spillage
Bateson et al. Biol. Lett. (2006) 2, 412–414 doi:10.1098/rsbl.2006.0509
Bateson et al. Biol. Lett. (2006) 2, 412–414 doi:10.1098/rsbl.2006.0509
We examined the effect of
an image of a pair of eyes
on contributions to an
honesty box used to collect
money for drinks in a
university coffee room.
Bateson et al. Biol. Lett. (2006) 2, 412–414 doi:10.1098/rsbl.2006.0509
This finding provides
the first evidence from a
naturalistic setting of
the importance of cues
of being watched, and
hence reputational
concerns, on human
cooperative behaviour.
… leave your money at the back doors
King et al. Health Psychol. 2016 Jan;35(1):96-101.

3. Year in IPC 6/23/17
Andreas Voss 3
King et al. Health Psychol. 2016 Jan;35(1):96-101.
Visitors to the ICU were exposed to an
olfactory prime (“clean” citrus smell) using
an aroma dispenser and “eyes”
Choice smell determined in earlier study
(“cleanest & freshest”)
King et al. Health Psychol. 2016 Jan;35(1):96-101.
olfactory > eyes
male > female eyes
Priming works
(47% vs. 15%)
If you don’t
cite yourself,
who will?
Bob Weinstein
Tartari et al. Antimicrob Reistance Infect Control 2017;6:45
Tartari et al. Antimicrob Reistance Infect Control 2017;6:45 De Geyter et al. ARIC (2017) 6:24

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Andreas Voss 4
De Geyter et al. ARIC (2017) 6:24
To control the outbreak, the
sinks and their plumbings were
replaced by new ones with
another structure
drains
screens water
Hopman et al ARIC 2017;6:59
¤ The aim of this study was to evaluate the effect of removal of sinks from the
Intensive Care Unit (ICU) patient rooms and the introduction of ‘water-free’
patient care on gram-negative bacilli colonization rates.
¤ 2-year pre/post quasi-experimental study that compared monthly gram-
negative bacilli colonization rates pre- and post-intervention using
segmented regression analysis of interrupted time series data
¤ Five ICUs of a tertiary care medical center
¤ Outconme: monthly colonization rate with gram-negative bacilli (GNB)
Hopman et al ARIC 2017;6:59 Hopman et al ARIC 2017;6:59
Hopman et al ARIC 2017;6:59
Monthly gram-negative bacilli (GNB) colonization rates.
Hopman et al ARIC 2017;6:59
Monthly gram-negative bacilli (GNB) colonization rates.

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Andreas Voss 5
¤This study shows that removal of the sinks from all patient
rooms and the introduction of ‘water-free’
patient care is associated with a statistically
significant lower number of ICU patients that
become colonized with GNB, including
MDR-GNB, especially among patients
with a longer length of stay at the
ICU.
Hopman et al ARIC 2017;6:59
Decker et al Clin Mirobiol Infect 2017
¤ 200 bed NIH Clinical Center,
¤ 400 HCWs with patient contact / lab staff with clinical specimen contact versus 400 staff
without recent direct patient contact as a comparator.
¤ Two perirectal swabs separated by a few days
¤ Dataset was anonomysed
¤ 4.0% of HCWs and 3.2% of the control grew ESBLs, none grew VRE, and one of the control
participants grew a CPE.
¤ No significant risk factors were associated with ESBL carriage
For more comments have a look at ReflectionsIPC
Thus, the box stays shut, but should be looked at again

6. Year in IPC 6/23/17
Andreas Voss 6
¤Whole-genome sequencing identified
common blaNDM-positive E. coli shared
among farms, flies, dogs and farmers,
providing direct evidence of carbapenem-
resistant E. coli transmission and
environmental contamination.
Wang et al. Nature Microbiology 2017
“Softly” Killing
Infection Control …
… studies not all of us were waiting for
Hygiea
Infect Control Hosp Epidemiol. 2016 Nov;37(11):1323-1330. Epub 2016 Jul 26
Discontinuing routine contact precautions (CP) for endemic
MRSA and VRE did not result in increased rates of MRSA or
VRE after 1 year. With cost savings on materials, decreased
healthcare worker time, and no concomitant increase in
possible infections, elimination of routine CP may add
substantial value to inpatient care delivery.
Clinically significant
VRE outcomes
remain rare.
Cessation of all
control measures for
VRE had no
significant
attributable adverse
clinical impact.
¤ Overall, a reasonably firm
conclusion can be reached that
routine contact isolation for
endemic MRSA and VRE is
unnecessary (and may be
harmful) when there is active
maintenance of hand hygiene,
environmental cleaning, and
chlorhexidine bathing
Hillary Humphreys ISCH April 2017
Some centers would be wise to continue with
active screening to monitor trends and to
target additional measures
We should be reluctant to discontinue even
selective screening and contact precautions

7. Year in IPC 6/23/17
Andreas Voss 7
If you believe in hand hygiene compliance,
that environmental cleaning is well done, and
chlorhexidine bathing does not lead to resistance
and extra costs to your institution
If you consider 20-30% clinical infections with
MRSA and VRE “normal”
When you like to find out in 5 years which
other fight you lost doe to dropping CP
Scheithauer et al. J Hosp Infect 2016;94:268
Scheithauer et al. J Hosp Infect 2016;94:268
The disinfection efficacy for all
disinfectant/glove combinations was
better with, rather than without gloves
but
- what about the not tested combinations
- change of the material/leakage
- maximum frequency
Could the (better) solution
be less glove-use?
Mendelson et al. Nature 2017
¤A global response to a complex health threat — commonly
termed 'antimicrobial resistance (AMR)’ — requires
engagement from a much broader array of players, from
governments, regulators and the public, to experts in health,
food, the environment, economics, trade and industry.
¤Many of the terms routinely used to describe the problem are
misunderstood, interpreted differently or loaded with unhelpful
connotations for the people from different domeins
Mendelson et al. Nature 2017
¤A 2015 WHO survey: people are unfamiliarity with the language
of antibiotic resistance. Fewer than half of the nearly 10,000
respondents had heard of the term 'antimicrobial resistance'.
Only one-fifth were aware of its abbreviated form 'AMR'.
¤Simple, clear and unambiguous terminology is needed to ensure
global actions against AMR
Mendelson et al. Nature 2017
”Drug resistance” is a term known by more than two-thirds of the people

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Andreas Voss 8
Candida auris
Chowdhary et al. PLoS Pathog 13(5): e1006290
¤ difficult to diagnose
¤ vastly transmissible
¤ multi-drug-resistant
¤ highly virulent
¤ trouble to eliminate
Chowdhary et al. PLoS Pathog 13(5): e1006290

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Andreas Voss 9
Ross & Witzke Infection 01 February 2017
• Can Bibles in patient's rooms act as a vehicle for the spread of nosocomial
infections
• Samples from 50 Bibles in various general wards of the hospital and 99
hymnals from the hospital chapel
• Results: mainly apathogenic organisms plus Aspergillus spp.
• Bibles showed pathogen bacteria in a low number.
• No invasive infections with those pathogens could be documented during the
investigation period
• Results do not support Bibles as a possible source of nosocomial infections
Faith stays a good thing …. but
• Just a pilot study
• Not in isolation rooms
• We don’t know if Bibles
were actually used

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Andreas Voss 10
¤AMR is no longer a problem for single
hospitals but of the entire healthcare
system à IPC measures need to be
coordinated
¤Control the dispersal of AMR on a local or
regional level, rather than focussing on
large problems far away
far away
close by
versus
Donker et al. BMC Medicine 2017;15:86 Olans et al. CID 206;62:84
Nurses are antibiotic first responders, central communicators,
coordinators of care, as well as 24-hour monitors of patient status, safety,
and response to antibiotic therapy.
Not what Olans et al.
describe, but another
reason why nurses
should be included in
AMS
Bingham et al. Am J Infect Control 2016;44:1198
¤17 HCWs from 4 wound care facilities were sampled during 46
patient care encounters for the presence of MRSA, VRE, MDR-
Acinetobacter, and C.difficile
¤HCWs acquired at least 1 pathogen on their hands during 28.3%
of all patient care encounters
¤Hand contamination occurred in 19.6% of instances where
HCWs wore gloves during care compared with 14.6% when
HCWs were ungloved
Bingham et al. Am J Infect Control 2016;44:1198
The mean bacterial reduction after 15s of hand rubbing was
non-inferior to 30 s hand rubbing ( 0.11 log10 difference)

11. Year in IPC 6/23/17
Andreas Voss 11
LÜBBEKE et al. Acta Orthopaedica 2016; 87 (2): 132–138
• PJI with BMI 35–39.9 (adjusted HR =
2.1)
• PJI with BMI ≥ 40 (adjusted HR = 4.2).
Weight ≥ 100 kg was identified as
threshold for a significant increase in
infection (adjusted HR = 2.1).
Albrecht et al. JAMDA 2017;18:158-161
Direct care staff reported using gowns and gloves primarily as self-protection against contact
with bodily fluids: not to prevent MRSA transmission.
Glove use was described as common and more acceptable to staff and residents than gown
use.
Administrators were surprised that MRSA transmission to health care worker hands and
clothing occurred during activities when direct care staff perceives no contact with bodily
fluids.
Staff and administrators expressed willingness to use gowns and gloves for high-risk care
activities, particularly if use is targeted toward specific types of residents such as those with
pressure ulcers.
There was a knowledge deficit about MRSA transmission and infection among direct care
staff and residents
Albrecht et al. JAMDA 2017;18:158-161 Albrecht et al. JAMDA 2017;18:158-161
Nursing home residents expressed negative impressions of
gown use until they learned that gowns could help prevent
MRSA transmission, suggesting that education on MRSA may
dispel misconceptions.
Bartek et al. CID 2017
* don’t try this in your hospital
If you do it, do
it right !

12. Year in IPC 6/23/17
Andreas Voss 12
article previously presented by Bob Weinstein
Slightly less
controversial,
but far more
sweaty
Infection Control
Not sure if I would go to the next surgical meeting