BioMed Central Blog
C. difficile review and commentary published in Critical Care
A new Infection thematic review series, led by Dr Steven Opal (Memorial Hospital of Rhode Island, USA) has just been launched in Critical Care, with the first article published being a timely paper documenting the global spread of Clostridium difficile.
Described as a good reference for clinicians faced with this issue, the authors Carolyn V Gould and L Clifford McDonald, from the Centers for Disease Control, detail the pathogenesis, diagnosis and possible treatment strategies in this most topical of hospital-acquired infections. The onus is on healthcare professionals to maintain awareness of the changing epidemiology of the disease, as well introducing measures to reduce the risk to patients.
In a related commentary, Aurora Pop-Vicas and Marguerite Neill (Memorial Hospital of Rhode Island) reiterate the statements made in the review, and conclude that only through following basic standards of hygiene will slow down the spread of transmission, placing the responsibility squarely ‘in our hands’.
Review
Bench-to-bedside review: Clostridium difficile colitis
Carolyn V Gould, L Clifford McDonald
Critical Care 2007, 12:203 (18 January 2008)
[Abstract] [Full text] [PDF]Commentary
Clostridium difficile: the increasingly difficult pathogen
Aurora Pop-Vicas, Marguerite A Neill
Critical Care 2008, 12:114 (7 February 2008)
[Abstract] [Full text] [PDF]
More authoritative reviews in this exciting new series will be published continuously online in the coming weeks and months. Critical Care’s reviews and commentaries require a subscription for access, but if you do not currently have a subscription to the journal, you can register for a free 30-day trial.
All research articles published in Critical Care are open access.
Surayya Johar
In-house Editor, Critical Care
Posted by Iain Hrynaszkiewicz at 13:25 Comments (2)
http://www.cbc.ca/health/story/2008/03/03/handwashing-system.html
...to save health care budgets money via reduced nosocomial infections, to presently mitigate any potential Avian Influenza pandemic, and to mitigate in the future any potential designer pandemic WMD.
Most papers on the subject suggest very cursory results that wearable alcohol rub despensors will lower nosocomial hospital infection rates. But there is one outlier that suggests alcohol rubs decrease virii counts on the hand, but have no effect on nosocomial infection rates:
"Prospective, Controlled, Cross-Over Trial of Alcohol-Based Hand Gel in Critical Care Units"
I'm just 1/2 way through the paper. Previous news blurbs have suggested the paper didn't measure infection rates long enough to note a decline.
One result I've noticed suggesting something "wrong" with the paper, is that CDAD (Clostridium difficile) rates are typically reduced much more by soap and water handwashing, than by alcohol rub hand sanitation. The physical process of alcohol rub handwashing probably removes many CDAD spores, but it is soap that actually kills them. Yet the paper, divided into a control, and a Unit A and Unit B, shows in Unit A alcohol rubs are more effective at killing CDAD on the hand than is soap and water. Unit B shows conventionally expected results.
I'm not sure why Unit A CDAD spores are killed more by alcohol than soap in the paper, but medical science knows the opposite to be true. The papers methodology seems sound; I'm not a statistician, but whatever is causing this false conclusion about CDAD, may also be responsible for diagnosing MRSA and other nosocomial infection rates as not being lessened by the use of wearable alcohol rub dispensors. I'll post more when I finish the paper and reflect.
Posted by Phillip Huggan on March 30, 2008 at 09:23 PM BST #
I was focused upon the sample size, but at the moment I don't really understand hospital clinical trials enough to speculate why CDAD infection rates would spike in opposite directions under identical protocols; how much of an outlier the CDAD stats are here.
I'll read the half dozen or so other MRSA alcohol rub papers and will post my conclusions here.
There is an article her that says paper methodological errors are far more likely than sample size errors...
Posted by Phillip Huggan on April 17, 2008 at 04:45 PM BST #