Are you serious? From fist bumping to hand hygiene: Considering culture, context and complexity in infection prevention intervention research.

Infection prevention is an under-resourced research and development topic, with limited evidence for practice in the most basic of measures. A survey of IPS R&D members indicated that what might appear to be simple interactions and interventions in healthcare, such as hand shaking and hand hygiene, should be considered complex interventions taking account of behaviour at the individual and social level as well as contextual factors. Future studies need to be designed utilising comprehensive approaches, for example, the Medical Research Council complex interventions framework, tailored to the country and more local cultural context, if we are to be serious about evidence for infection prevention and control practice.

Neonatal influenza A/H1N1/2009 outbreak in a UK district general hospital.

Increasing numbers of cases of neonatal influenza A/H1N1/2009 are being reported in the literature but there are no specific guidelines on outbreak management. We report an outbreak of influenza A/H1N1/2009 in a newborn intensive care unit in a large district general hospital. The index case probably acquired the infection from the mother. Subsequently two other babies were infected, possibly due to the use of continuous positive airway pressure ventilation. The outbreak was brought under control with enhanced surveillance and screening of contacts, isolation of confirmed cases and the use of oseltamivir.

Infection rates associated with total parenteral nutrition.

The use of central venous access devices is increasingly common within healthcare, and such devices carry an associated risk of infection. Additional risk reduction strategies need exploring to reduce avoidable infections. A prospective 12-month audit was performed on the use of 2% chlorhexidine gluconate transparent, antimicrobial dressing to cover the catheter exit site in patients receiving total parenteral nutrition. The results showed a decrease in catheter-related bloodstream infection (CRBSI) from eight cases to zero (P=0.057), making this film dressing a possible useful addition in the goal of zero avoidable CRBSIs within this high risk group of patients.

Simple measures to reduce the rate of contamination of blood cultures in Accident and Emergency.

OBJECTIVES: To reduce the contamination rate of blood cultures taken in the Accident and Emergency (A&E) department. METHODS: The standard blood culture sampling kit was supplemented with an instruction sheet on the optimal method for drawing blood cultures and a large 62% ethyl alcohol impregnated wipe. RESULTS: There was a statistically significant reduction in the number of contaminants (p = 0.03). CONCLUSIONS: Simple measures to encourage skin disinfection and appropriate sampling technique will reduce the incidence of contamination of blood cultures in the A&E department.

A randomized trial comparing Arglaes (a transparent dressing containing silver ions) to Tegaderm (a transparent polyurethane dressing) for dressing peripheral arterial catheters and central vascular catheters.

The purpose of this trial was to prepare for a large randomized trial comparing Arglaes film dressing, a recent innovation containing silver ions, against Tegaderm, a transparent polyurethane dressing. Thirty-one patients admitted to the intensive care unit and requiring the insertion of an arterial line or central venous catheter were recruited into the study. Skin swabs were taken from the insertion sites prior to catheterization and on removal of the intravascular device to measure skin colonization rate between the two dressings. The catheter tips were also cultured on removal to establish if there was a difference between the two groups. No statistical differences were found in bacterial growth between the two dressings.

A randomized study comparing IV 3000 (transparent polyurethane dressing) to a dry gauze dressing for peripheral intravenous catheter sites.

Patients with an intravenous catheter on a cardiology unit were prospectively randomized to receive a transparent polyurethane dressing (N = 49) or sterile gauze (N = 31) dressing to compare security of fixation, dressing condition, skin condition, and rates of inflammation. The mean age of patients was 63 years of age (standard deviation, 12.57), and the average length of cannulation was 18 hours. The only significant difference between the two groups was the dressing condition in the transparent group was significantly better (P = 0.006) than that of the gauze group. The results suggest that gauze dressing may be a viable option to cover i.v. exit sites for patients requiring short-term cannulation.

The role of air ventilation and air sampling in reducing the incidence of surgical wound infection rates.

Air ventilation systems are a common feature in today's operating theatres. The main function is to decrease the bacterial load in the operating theatre, reducing the incidence of surgical wound infection rates. The ventilation system is only one of many factors which can contribute to a safe operating environment. Ever since the time of Lister the significance of airborne bacteria in the operating room has been a matter of interest and of dispute. The role of airborne bacteria acting as a source of infection for most types of operations continues to be a matter for debate. Despite the uncertainty, the development of laminar air flow and Plenum (conventional) ventilation systems has gained momentum, making it an essential standard of design and ventilation in the modern operating theatre.

Ventilator tubing change times and the infection control nurse.

In line with the dramatic revolution in healthcare delivery within the last decade, the role of the infection control nurse (ICN) as first described by Brendan Moore (1959) must change to meet today's expectations. This article suggests that ICNs should function as clinical nurse specialists (CNS). The author shows how this change in role can be used to implement research-based practice by using the example of changing ventilator tubing change times.