Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

PJ Online | (Meeting) Society for Healthcare Epidemiology of America

Home > PJ (Current issue) > Meetings and Conferences | Search

Return to PJ Online Home Page

The Pharmaceutical Journal
Vol 268 No 7194 p544-545
20 April 2002

Meetings & Conferences

Society for Healthcare Epidemiology of America

The 12th annual meeting of the Society for Healthcare Epidemiology of America was held in Salt Lake City, Utah, between 6 and 9 April. Ann Jacklin, chief pharmacist, and Dr Bryony Dean, principal pharmacist, clinical services and director, Academic Pharmacy Unit, Hammersmith Hospitals NHS Trust, report

Handwashing with soap and water alone no longer recommended

Hand hygiene has been elegantly and extensively researched and there is conclusive evidence that finding ways to improve hand hygiene is the biggest problem facing epidemiologists and control of infection practitioners throughout the world.

Poor hand hygiene contributes to the spread of multiresistant organisms and nosocomial infections, a major cause of morbidity, mortality and increased length of stay in hospitals. Astoundingly, despite the evidence and the apparent simplicity of this message, it became abundantly clear during the conference that most health care organisations worldwide can still only achieve compliance with good hand hygiene practice in 30?50 per cent of cases.

The current hand hygiene champions have reached a consensus that washing with soap and water will never be practical as the sole method of decontaminating hands, and no longer advocate this alone. All recent guidelines instead promote the use of alcoholic hand rubs or gels. To improve compliance rates substantially these products need to be widely and continually available at the point of patient care. As a minimum, an individual container should be available at each bedside; leading practitioners recommend that pocket sized containers are given to all health care workers.

Pharmacists must ensure that they are familiar with their local recommended practices and may be well positioned to support the improvement of hand hygiene in a number of ways: personal good practice contributes to clinical leadership, and expertise in supply and distribution can help ensure the availability of suitable products.

Some of the best hand hygiene practice in the world has been demonstrated by infection control practitioners in Geneva, who reported a compliance rate of 80 per cent, which is still rising after seven years of campaigns. They have also demonstrated a clinical impact with reduced rates of important hospital-acquired infections.

Cycling and antibiotic resistance

In contrast to the evidence for good hand hygiene, what was surprising was the weakness of the evidence associated with methods of reducing antibiotic resistance. This was demonstrated by Dr Neil Fishman, University of Pennsylvania, during a session on antibiotic cycling. An extensive literature search had yielded only six peer-reviewed papers and one abstract on true antibiotic cycling (defined as rotating antibiotics across an organisation in a cyclical fashion, including a return to the first agent). Of the six antibiotic cycling papers identified, four were published between 1973 and 1985 and described aminoglycoside cycling only. In three of these studies, rotation was between gentamicin and amikacin.

The most impressive results were presented in an abstract that described a substantial and sustained decrease in resistance, but showed that it took five years for the plasmid for gentamicin resistance to be lost in the bacterial population. Over the five years, amikacin was used for two two-year periods interspersed with one year of gentamicin.

A second seemingly impressive study, on further examination, had failed adequately to control for other changes in practice, most notably a dramatic change in case mix and improved hand hygiene practices. Hence the impact of antibiotic cycling on the reduction in resistance patterns was unproven.

In concluding, Dr Fishman felt that in the absence of evidence, institutional cycling should not be advocated until more robust and generalisable data are available. Unfortunately, the sample size required to provide more conclusive evidence was likely to be 30 to 40 hospitals. Since financial constraints mean this is unlikely to be achieved, Dr Fishman had developed a series of mathematical models. These suggest that a 50-50 mix of two different antibiotic regimens within any clinical area may be more effective than cycling in reducing resistance.

This raises the important concern of whether working to restrictive protocols will give rise to increased resistance as a result of increased homogeneity of antibiotic use. Dr Fishman believed that this could be avoided if, within protocols, different classes of antibiotic agents were used for different infections or sites of infection within individual clinical areas, preserving heterogeneity of antibiotic use across the organisation.


Home | Journals | News | Notice-board | Search | Jobs  Classifieds | Site Map | Contact us

©The Pharmaceutical Journal

Citation: The Pharmaceutical Journal URI: 20006538

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Patient Care in Community Practice

    Patient Care in Community Practice

    Patient Care in Community Practice is a unique, practical guide for healthcare professionals or carers. Covers a range of non-medicinal products suitable for use at home.

    £22.00Buy now
  • Essentials of Economic Evaluation in Healthcare

    Essentials of Economic Evaluation in Healthcare

    An introduction to economic evaluation specific to healthcare, for those with little or no knowledge of economics. Covers cost effectiveness, cost utility and cost benefit analysis.

    £33.00Buy now
  • Drugs of Abuse

    Drugs of Abuse

    A concise, easy-to-read guide for healthcare professionals who encounter drug abuse.

    £38.00Buy now
  • English Delftware Drug Jars

    English Delftware Drug Jars

    This beautiful book illustrates the art and history of the collection of English delftware drug jars in the Museum of the Royal Pharmaceutical Society of Great Britain.

    £54.00Buy now
  • Healthcare Communication

    Healthcare Communication

    Healthcare Communication is an interactive and engaging guide for healthcare professionals. It supports you in establishing rewarding professional relationships.

    £33.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Rate
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.