(c) MRSA Action UK December 2010
Infection Matters 2010 Symposium
Hull & East Yorkshire Hospitals NHS Trust
Friday 26th November 2010
This year Hull & East Yorkshire Hospitals NHS Trust showcased some of the technologies, treatments and a wide range of expertise in the field of preventing infections to a regional audience of staff and healthcare professionals. MRSA Action UK were invited to present the patient and relative perspective and the work of our charity. Derek Butler presented "A Healthcare Infection - A Lifetime Legacy" showing how avoidable infections such as MRSA ripple through families and friends of those affected, and affect staff too.
Eileen Henderson introduced Derek to the symposium to present A Healthcare Infection, A Lifetime Legacy
Dr Mike Wright Deputy Chief Executive, Hull & East Yorkshire Hospitals NHS Trust introduced the symposium and began by outlining our fallibility and the need to build in safeguards for patient safety. The Checklist Manifesto by Atul Gwande was a recommended read.
The book's main point was simple: no matter how expert we may be, we are all fallible and well-designed check lists can improve outcomes (even for Atul Gawande's own surgical team). The Trust had an upper control limit on infections that they don't expect to peak, the aim is not to peak, it was important to remember this was not a target but an upper ceiling. There had been significant improvements over the last few years, and the Trust wished this to continue and to strive for zero tolerance to avoidable infections and untoward events.
Dr Emmanuel Nsuetebu, Locum Consultant in Infectious Diseases, Leeds Teaching Hospitals NHS Trust presented ten pearls of wisdom which infectious disease physicians recommended practitioners look out for when diagnosing patients, case studies and observations were aimed at clinicians with the relevant expertise, but it helped emphasise the importance for both professionals and lay people to understand what signs to look for if thinking about the possibility of a patient with an infection. In terms of many of our own experiences the tips brought home the need to investigate beyond local infection sites, and to consider any pneumonia and the potential for sepsis, and to always remind doctors to review previous microbiology results as giving the right antibiotic quickly can improve the patient' chances of recovery. Checking for resistance where there has been previous use of an antibiotic was crucial in ensuring a patient has the best chance to fight a serious infection.
Dr Marjan van Jer Woude, University of York asked why should healthcare professionals have an interest in biofilms? According to the CDC 65% of human bacterial infections involve biofilms. Indwelling devices quickly gather colonies, and surprisingly sutures.
Planktonic (free living) biofilms are more frequently involved in acute infection. Sessile (attached) biofilms tend to be involved in chronic infections and can involve enhanced gene transfer through plasmids, an example being NDM-1. There is no golden bullet. Biofilms present resistance, and antimicrobials do not fully penetrate them. Chlorine can only penetrate the periphery external structure of the biofilm so this presents problems in the environment too.
Multiphoton laser microscopy can be effective, this was demonstrated in laboratory tests where the biofilm on the slides showed definitive shapes in the growth where the laser had been applied.
Minimising the use and time of indwelling devices such as lines and catheters was important to reduce the opportunities for biofilms to colonise and cause problems.
Professor David Livermore spoke on emerging threats including NDM-1 and resistant ESBLs. It was important to risk assess patients then consider stepping down antiobiotic therapy rather than using the strongest as the empirical method. There was a need to balance the wider societal need and to develop much better much faster microbiology testing.
Dr William Dibb gave a thought provoking look at history and how infectious illness had impacted on populations around the world over the last two centuries. Deaths caused by the Spanish flu showed the biggest peak in the 20th century. Typhus was endemic in 1944. TB sanatoriums, leper colonies, isolation hospitals and Quarantine Island featured in his very interesting talk. People who played a significant role in the walk through Dr Dibb's history included Louise Pasteur, Joseph Lister, Ignez Semmelweiss, Clara Maas. Space travel featured and included the quarantine of astronauts as a precaution against possible infectious pathogens. Anthrax spores in US post where the spores needed to be destroyed through irradiation also featured. The threat of bioterrorism is very real.
Dr Kate Adams presentations featured new treatments in critical care and considered the use of procalcitonin as a diagnostic tool and aiding antibiotic stewardship. Calcitonin is a hormone that will have a high presence when bacterial infections are present and can be used as a biomarker to help carry out an assessment. It should not be used to make an immediate judgment however, false positives could result in the wrong diagnosis, it is a valuable adjunctive tool and can aid in deciding to stop antibiotics after 2 days if the diagnosis proves a bacterial infection is not present and the antibiotic therapy may stop.
Dr Adams also featured the LoTrach endotracheal tube and the case for using this to prevent ventilator assisted pneumonia. The device costs 20 pounds, as opposed to 2 pounds, however there was evidence to suggest the technology could reduce some of the hazards that can lead to ventilator associated pneumonia. Each incidence of VAP costs 12,000 pounds, so there is a business case to try to avoid ventilator associated pneumonia. Mortality is high with ventilator associated pneumonia and the ultimate cost is the patient's life. The LoTrach endotracheal tube has subglottic aspiration built in and an expandable cuff which stops seepage into the lungs, removing the 2 bigger hazards in ventilating critical care patients. Using the equipment if it is known the patient is likely to be ventilated for longer than 72 hours can be more cost effective if this prevents ventilator associated pneumonia.
The book's main point was simple: no matter how expert we may be, we are all fallible and well-designed check lists can improve outcomes (even for Atul Gawande's own surgical team). The Trust had an upper control limit on infections that they don't expect to peak, the aim is not to peak, it was important to remember this was not a target but an upper ceiling. There had been significant improvements over the last few years, and the Trust wished this to continue and to strive for zero tolerance to avoidable infections and untoward events.
Dr Emmanuel Nsuetebu, Locum Consultant in Infectious Diseases, Leeds Teaching Hospitals NHS Trust presented ten pearls of wisdom which infectious disease physicians recommended practitioners look out for when diagnosing patients, case studies and observations were aimed at clinicians with the relevant expertise, but it helped emphasise the importance for both professionals and lay people to understand what signs to look for if thinking about the possibility of a patient with an infection. In terms of many of our own experiences the tips brought home the need to investigate beyond local infection sites, and to consider any pneumonia and the potential for sepsis, and to always remind doctors to review previous microbiology results as giving the right antibiotic quickly can improve the patient' chances of recovery. Checking for resistance where there has been previous use of an antibiotic was crucial in ensuring a patient has the best chance to fight a serious infection.
Dr Marjan van Jer Woude, University of York asked why should healthcare professionals have an interest in biofilms? According to the CDC 65% of human bacterial infections involve biofilms. Indwelling devices quickly gather colonies, and surprisingly sutures.
Planktonic (free living) biofilms are more frequently involved in acute infection. Sessile (attached) biofilms tend to be involved in chronic infections and can involve enhanced gene transfer through plasmids, an example being NDM-1. There is no golden bullet. Biofilms present resistance, and antimicrobials do not fully penetrate them. Chlorine can only penetrate the periphery external structure of the biofilm so this presents problems in the environment too.
Multiphoton laser microscopy can be effective, this was demonstrated in laboratory tests where the biofilm on the slides showed definitive shapes in the growth where the laser had been applied.
Minimising the use and time of indwelling devices such as lines and catheters was important to reduce the opportunities for biofilms to colonise and cause problems.
Professor David Livermore spoke on emerging threats including NDM-1 and resistant ESBLs. It was important to risk assess patients then consider stepping down antiobiotic therapy rather than using the strongest as the empirical method. There was a need to balance the wider societal need and to develop much better much faster microbiology testing.
Dr William Dibb gave a thought provoking look at history and how infectious illness had impacted on populations around the world over the last two centuries. Deaths caused by the Spanish flu showed the biggest peak in the 20th century. Typhus was endemic in 1944. TB sanatoriums, leper colonies, isolation hospitals and Quarantine Island featured in his very interesting talk. People who played a significant role in the walk through Dr Dibb's history included Louise Pasteur, Joseph Lister, Ignez Semmelweiss, Clara Maas. Space travel featured and included the quarantine of astronauts as a precaution against possible infectious pathogens. Anthrax spores in US post where the spores needed to be destroyed through irradiation also featured. The threat of bioterrorism is very real.
Dr Kate Adams presentations featured new treatments in critical care and considered the use of procalcitonin as a diagnostic tool and aiding antibiotic stewardship. Calcitonin is a hormone that will have a high presence when bacterial infections are present and can be used as a biomarker to help carry out an assessment. It should not be used to make an immediate judgment however, false positives could result in the wrong diagnosis, it is a valuable adjunctive tool and can aid in deciding to stop antibiotics after 2 days if the diagnosis proves a bacterial infection is not present and the antibiotic therapy may stop.
Dr Adams also featured the LoTrach endotracheal tube and the case for using this to prevent ventilator assisted pneumonia. The device costs 20 pounds, as opposed to 2 pounds, however there was evidence to suggest the technology could reduce some of the hazards that can lead to ventilator associated pneumonia. Each incidence of VAP costs 12,000 pounds, so there is a business case to try to avoid ventilator associated pneumonia. Mortality is high with ventilator associated pneumonia and the ultimate cost is the patient's life. The LoTrach endotracheal tube has subglottic aspiration built in and an expandable cuff which stops seepage into the lungs, removing the 2 bigger hazards in ventilating critical care patients. Using the equipment if it is known the patient is likely to be ventilated for longer than 72 hours can be more cost effective if this prevents ventilator associated pneumonia.
If you or someone you care about has been affected by a healthcare infection and you wish to discuss this with us, please contact us at info@mrsaactionuk.net
