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In the last 12 years there has been a move to provide NHS patients with more information about their treatment. This began in 2000 with The NHS Plan, which declared that 'letters between clinicians about an individual patient's care will be copied to the patient as of right'. Although the implementation of this plan was to be achieved by April 2004, more than eight years down the line compliance with this regulation is still poor.

OBJECTIVE Contaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU). DESIGN Prospective, randomized, double-blinded, crossover study SETTING Three ICUs at a large teaching hospital PARTICIPANTS In total, 51 HCWs involved in direct patient care were enrolled in and completed the study. METHODS All HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4-7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period. RESULTS On bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; P<.0001). Both the antiseptics were well tolerated by HCWs. CONCLUSIONS In comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas. CLINICAL TRIAL IDENTIFIER Clinicaltrials.gov identifier NCT02258412 Infect Control Hosp Epidemiol 2018;39:267-271.

There may be an association between course of diarrhea and increased rate of sepsis in vitamin D-deficient CDI patients.

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Objective: Clostridioides difficile infection (CDI) causes significant morbidity and mortality; however, the diagnosis of CDI remains controversial. The primary aim of our study was to evaluate the association of polymerase chain reaction (PCR) cycle threshold (Ct) values with CDI disease severity, recurrence, and mortality among adult patients with CDI. Design: Retrospective cohort study. Setting: Single tertiary-care hospital. Patients: Adult patients diagnosed with hospital-onset, healthcare facility–associated CDI from June 2014 to September 2015. Methods: We performed a retrospective chart review of included patients. Univariate and multivariable logistic regression methods were used to evaluate the association between Ct values and CDI severity, 8-week recurrence, and 30-day mortality. Results: Among 318 included patients, 51% were male and the mean age was 62 years; ~32% of the patients developed severe CDI and 11% developed severe–complicated CDI. The 30-day all-cause mortality rate was 11% and the 8-week recurrence rate was 9.5%. The overall mean Ct value was 32.9 (range, 23–40). Multivariable analyses showed that lower values of PCR Ct were associated with increased odds of 30-day morality (odds ratio [OR] 0.83; 95% confidence interval [CI], 0.72–0.96) but were not independently associated with CDI severity (OR, 0.99; 95% CI, 0.90–1.09) or recurrence (OR, 0.88; 95% CI, 0.77–1.00). Conclusions: Our findings suggest that PCR Ct values at the time of diagnosis may have a limited predictive value and utility in clinical decision making for inpatients with CDI. Larger, prospective studies across different patient populations are needed to confirm our findings.

Most cases of Yersinia enterocolitica manifest with symptoms of enterocolitis, such as diarrhoea, fever and abdominal pain. Y. enterocolitica is a very rare cause of pneumonia, and usually occurs in immunocompromised patients. We report a case of community-acquired pneumonia (CAP) caused by Y. enterocolitica in an elderly patient who did not develop symptoms of enterocolitis. This aetiology should be considered in patients with CAP who do not respond to initial empirical therapy. Case reportThe patient was an 83-year-old female with a past medical history of paroxysmal atrial fibrillation and hypertension. She presented to the hospital with a 5 day history of shaking chills, fevers, a non-productive cough and haemoptysis. She denied any diarrhoea, abdominal pain, sick contacts, recent travel, recent hospitalization or antibiotic usage. She went to an outside hospital initially and was discharged home from their accident and emergency department with a presumed viral upper respiratory infection. She did not receive antibiotics and a chest X-ray was not performed. Her symptoms did not improve so she returned the next day to our accident and emergency department. Physical examination revealed a SpO 2 of 98 % on a BiPAP machine 10/5 cmH 2 O, pulse 87, respiratory rate 29, blood pressure 126/33 and temperature 38.7 u C. She was in moderate respiratory distress with accessory muscle use. A chest X-ray showed a right lower lobe infiltrate consistent with pneumonia. Two sets of blood culture were obtained. Due to multiple antibiotic allergies (penicillin caused hives, trimethoprim-sulfamethoxazole caused a rash and hives, moxifloxacin caused an unknown reaction), she was started on azithromycin and clindamycin empirically and admitted to the hospital. Her initial CURB-65 score was 3, with a calculated mortality rate of 17 %.On hospital day 1, two blood cultures grew Gram-negative bacilli. Intravenous aztreonam was initiated. Both urinary streptococcal and legionella antigen tests were negative. On hospital day 2, the patient's respiratory condition worsened and she was transferred to the intensive care unit. She was noted to have a temperature of 38.7 u C. Azithromycin and clindamycin were discontinued after blood cultures revealed Y. enterocolitica sensitive to amikacin, aztreonam, cefepime, ceftazidime, ceftriaxone, ciprofloxacin, doripenem, gentamicin, levofloxacin, meropenem, piperacillin-tazobactam, tobramycin and trimethoprim-sulfamethoxazole. An echocardiogram was completed which showed moderate mitral regurgitation without any vegetations. A computed tomography scan of the abdomen and pelvis with oral and intravenous contrast showed no acute colonic changes. Her condition improved and she was transferred back to the regular hospital ward on day 3. She was sent to an extended care facility on hospital day 8 for rehabilitation and to complete a 14 day course of intravenous aztreonam. DiscussionY. enterocolitica is a pleomorphic Gram-negative bacillus that belongs to the family Enterobacteriaceae. It is a lactose n...