Hobday R.A.,8 Springvale |
Dancer S.J.,Hairmyres Hospital
Journal of Hospital Infection | Year: 2013
Background: Infections caught in buildings are a major global cause of sickness and mortality. Understanding how infections spread is pivotal to public health yet current knowledge of indoor transmission remains poor. Aim: To review the roles of natural ventilation and sunlight for controlling infection within healthcare environments. Methods: Comprehensive literature search was performed, using electronic and library databases to retrieve English language papers combining infection; risk; pathogen; and mention of ventilation; fresh air; and sunlight. Foreign language articles with English translation were included, with no limit imposed on publication date. Findings: In the past, hospitals were designed with south-facing glazing, cross-ventilation and high ceilings because fresh air and sunlight were thought to reduce infection risk. Historical and recent studies suggest that natural ventilation offers protection from transmission of airborne pathogens. Particle size, dispersal characteristics and transmission risk require more work to justify infection control practices concerning airborne pathogens. Sunlight boosts resistance to infection, with older studies suggesting potential roles for surface decontamination. Conclusions: Current knowledge of indoor transmission of pathogens is inadequate, partly due to lack of agreed definitions for particle types and mechanisms of spread. There is recent evidence to support historical data on the effects of natural ventilation but virtually none for sunlight. Modern practice of designing healthcare buildings for comfort favours pathogen persistence. As the number of effective antimicrobial agents declines, further work is required to clarify absolute risks from airborne pathogens along with any potential benefits from additional fresh air and sunlight. © 2013 The Healthcare Infection Society.
Dancer S.J.,Hairmyres Hospital
Journal of Hospital Infection | Year: 2010
In response to the rising tide of hospital-acquired infections (HAIs) in UK hospitals, governmental health departments have introduced dress codes for healthcare staff. These include measures such as the use of short sleeves, no wristwatches or jewellery, and avoidance of ties and white coats. Although hospital pathogens have been found on such items, there is no evidence that they play a major role in transmitting HAIs and these policies have received much criticism. This Leader examines the evidence underpinning the new dress codes and concludes that there is insufficient evidence to justify recent policies. Dress codes appear to have been imposed more for political purposes than in deference to effective infection control. In addition, the UK 'zero tolerance' mandate towards HAI does not balance personal accountability against a failing healthcare system. These policies may try to impose good practice but over-reliance on cheap, short-term solutions will not adequately address longer-term problems with HAI. © 2009 The Hospital Infection Society.
Dancer S.J.,Hairmyres Hospital
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2011
More evidence is emerging on the importance of the clinical environment in encouraging hospital infection. This review considers the role of cleaning as an effective means to control infection. It describes the location of pathogen reservoirs and methods for evaluating hospitals' cleanliness. Novel biocides, antimicrobial coatings and equipment are available, many of which have not been assessed against patient outcome. Cleaning practices should be tailored to clinical risk, given the wide-ranging surfaces, equipment and building design. There is confusion between nursing and domestic personnel over the allocation of cleaning responsibilities and neither may receive sufficient training and/or time to complete their duties. Since less labourious practices for dirt removal are always attractive, there is a danger that traditional cleaning methods are forgotten or ignored. Few studies have examined detergent-based regimens or modelled these against infection risk for different patient categories. Fear of infection encourages the use of powerful disinfectants for the elimination of real or imagined pathogens in hospitals. Not only do these agents offer false assurance against contamination, their disinfection potential cannot be achieved without the prior removal of organic soil. Detergent-based cleaning is cheaper than using disinfectants and much less toxic. Hospital cleaning in the 21st century deserves further investigation for routine and outbreak practices. © 2011 Springer-Verlag.
Gillespie A.,Western Infirmary of Glasgow |
Moir J.S.,Western Infirmary of Glasgow |
Miller R.,Hairmyres Hospital
Journal of Foot and Ankle Surgery | Year: 2014
Complex regional pain syndrome (CRPS) is an uncommon complication of orthopedic surgery, and few investigators have considered the incidence in foot and ankle surgery. In the present retrospective cohort study of 390 patients who had undergone elective foot and/or ankle surgery in our department from January to December 2009, the incidence of postoperative CRPS was calculated and explanatory variables were analyzed. A total of 17 patients (4.36%) were identified as meeting the International Association for the Study of Pain criteria for the diagnosis of CRPS. Of the 17 patients with CRPS, the mean age was 47.2 ± 9.7years, and 14 (82.35%) were female. All the operations were elective, and 9 (52.94%) involved the forefoot, 3 (17.65%) the hindfoot, 3 (17.65%) the ankle, and 2 (11.76%) the midfoot. Twelve patients (70.59%) had new-onset CRPS after a primary procedure, and 5 (29.41%) had developed CRPS after multiple surgeries. Three patients (17.65%) had documented nerve damage intraoperatively and thus developed new-onset CRPS type 2. Blood test results were available for 14 patients (82.35%) at a minimum of 3months postoperatively, and none had elevated inflammatory markers. Five of the patients (29.41%) were smokers, and 8 (47.06%) had had a pre-existing diagnosis of anxiety and/or depression. From our findings, we recommend that middle-age females and those with a history of anxiety or depression, who will undergo elective foot surgery, should be counseled regarding the risk of developing CRPS during the consent process. We recommend similar studies be undertaken in other orthopedic units, and we currently are collecting data from other orthopedic departments within Scotland. © 2014 American College of Foot and Ankle Surgeons.
Petti S.,University of Rome La Sapienza |
Polimeni A.,University of Rome La Sapienza |
Dancer S.J.,Hairmyres Hospital
American Journal of Infection Control | Year: 2013
Background: Environmental contamination and transmission of methicillin-resistant Staphylococcus aureus (MRSA) have been reported in dental health care settings. National professional dental associations recommend controlling surface contamination using disposable barriers or disinfection. Because these procedures may be costly, impractical, and/or toxic, we compared their effect against traditional detergent-based cleaning for decontaminating a dental chair sprayed with MRSA. Methods: Five MRSA strain suspensions were aerosolized to give a density of approximately 10 colony-forming units/cm 2 MRSA on the dental chair 5 minutes after dispersal. Three different decontamination protocols were applied: protocol 1: disposable barriers positioned before aerosol production and removed after 5 minutes; protocol 2: disinfection (wipe-rinse method) with 1:10 dilution of 5.25% to 6.15% sodium hypochlorite solution; protocol 3: cleaning (wipe-rinse method) with a sodium-lauryl-sulphate-based detergent. Contact plates containing Mannitol Salt Agar were used to assess the level of MRSA contamination. Results: All 3 protocols decreased MRSA surface load by >99%. Residual densities on the dental chair were 0.030 ± 0.010 (protocol 1), 0.029 ± 0.09 (protocol 2), and 0.030 ± 0.011 (protocol 3) colony-forming units/cm 2. Conclusion: Cleaning (wipe-rinse method) using a sodium-lauryl-sulphate-based detergent demonstrated equivalence with disposable barrier placement or disinfection-based protocol for reducing MRSA contamination on dental chairs. This has practical and cost implications for controlling MRSA transmission in dental health care settings.
Dancer S.J.,Hairmyres Hospital
Clinical Microbiology Reviews | Year: 2014
There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomy-cin-resistant enterococci (VRE), methicillin-resistant Staphylo-coccus aureus (MRSA), multiresistant Gram-negative bacilli, no-rovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the valueof physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence onthe roleof antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens. © 2014, American Society for Microbiology. All Rights Reserved.
Dancer S.J.,Hairmyres Hospital
Healthcare Infection | Year: 2013
There are enormous challenges facing infection control in the 21st century. Countries across the world are confronted by ageing populations, restricted healthcare resources, demands for modern medicine and increasing antimicrobial resistance. Problem pathogens in the community are set to invade hospitals, and those created in hospitals are seeding into the community. Continued consumption of antimicrobial agents is generating and consolidating resistance to nearly all classes of drugs. New resistance mechanisms arising in one locality rapidly spread across the 'global village' courtesy of migration, conflict and international travel. We are facing unprecedented threats to the management of infection both in healthcare and communities across the world. This review summarises the current challenges for infection control and proposes a range of solutions encompassing novel strategies and technologies aimed at protecting us against untreatable infection. © 2013 Australasian College for Infection Prevention and Control.
Fleming E.,Hairmyres Hospital
Nursing in critical care | Year: 2011
This article is a report of a study of the experiences of expert critical care nurses in their transition to the role of advanced nurse practitioner within an intensive care unit (ICU) setting. The advanced nurse practitioner role was developed to support the ICU team and to undertake many of the roles traditionally associated with junior medical staff in this specialized area. The impetus for this study therefore was generated from the need to explore the role development experiences of trainee advanced nurse practitioners to inform future developments and practice. This study used grounded theory methodology to conduct and analyse data from 25 participants. The data were collected between March 2010 and August 2010, using interview format. Data collection and analysis was conducted simultaneously using methods associated with grounded theory, theoretical sampling and the constant comparative method. 'Staying the course to advanced nursing practice' emerged as the core category, with four related major categories and substantive codes. In conjunction, the substantive theory explaining the essential processes involved comprised of three inextricably linked processes: situational, development and conceptual meaning. The developed conceptual model captures the unique experiences of expert critical care nurses during their transition to confident and competent advanced nurse practitioners. This study provides an account of the role transition from expert critical care nurse to advanced nurse practitioner, specifically the synthesis of expert nursing practice with traditional medical values. The conceptual model has the potential to be utilized as a framework for others embarking upon similar projects, informing advanced nurse practitioner roles within and out with critical care settings. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care Nurses.
Findlay J.,University of Edinburgh |
Hamouda A.,University of Edinburgh |
Dancer S.J.,Hairmyres Hospital |
Amyes S.G.B.,University of Edinburgh
Clinical Microbiology and Infection | Year: 2012
A strain of Klebsiella pneumoniae (K1) was isolated from a catheterized patient with a urinary tract infection. The patient was subsequently treated with meropenem, after which K. pneumoniae (K2) was once again isolated from the patient's urine. Susceptibility testing showed that strain K1 was fully susceptible to carbapenem antibiotics with the exception of ertapenem, to which it exhibited intermediate resistance, whilst K2 was resistant to ertapenem and meropenem. From pulsed-field gel electrophoresis profiling both strains exhibited identical banding patterns. Both contained CTX-M-15, OXA-1, SHV-1 and TEM-1 β-lactamase genes following PCR analyses. Outer membrane protein analysis demonstrated that K1 and K2 lacked an OMP of c. 40kDa, with an additional OMP of c. 36kDa missing from K2. Mutation studies showed that the K2 OMP phenotype could be selected by single-step carbapenem-resistant mutants of K1. Expression of transcriptional activator ramA and efflux pump component gene acrA were up-regulated in both strains by RT-PCR. Neither strain expressed ompK35, but ompK36 was found in both. Sequence analysis revealed gene sequences of ompK35, ompK36 and ramR in both strains; notably, ramR contained a mutation resulting in a premature stop codon. Transconjugation studies demonstrated transfer of a plasmid into E. coli encoding the CTX-M-15, TEM-1 and OXA-1 β-lactamases. We concluded that the carbapenem-resistant phenotype observed from this patient was attributable to a combination of CTX-M-15 β-lactamase, up-regulated efflux and altered outer membrane permeability, and that K2 arose from K1 as a direct result of meropenem therapy. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.
Queirazza F.,Hairmyres Hospital |
Semple D.M.,University of Edinburgh |
Lawrie S.M.,University of Edinburgh
British Journal of Psychiatry | Year: 2014
Background: The diagnostic category of acute and transient psychotic disorders (ATPD) was introduced in ICD-10. Subsequent studies have called into question its validity and reliability. Aims: To determine the pattern of diagnostic revision to schizophrenia in first-ever diagnosed ATPD. Method: Using data drawn from the Scottish Morbidity Record, we estimated incidence and diagnostic change in first-ever diagnosed ATPD in Scottish hospitals between January 1997 and December 2010 (n = 2923). Results: The average incidence of ATPD was 4.1 per 100 000 population per year. Diagnostic stability was estimated at 53.9% over an average of approximately 4 years of observation. The most common diagnostic shift was to schizophrenia (12.6%), over an average of 1.7 years. Estimates of the transition risks for schizophrenia were 80% at 2.8 years and 90% at 4.6 years. Longer first admission to hospital, younger age at onset and male gender were associated with increased risk and earlier development of schizophrenia. Conclusions: Routinely collected data suggest that approximately one in eight individuals with first-ever diagnosed ATPD will develop schizophrenia within 3-5 years. Those at high risk of transition may benefit from monitoring for possible diagnostic change.