Reading Room
Find articles about healthcare-associated infection published in The Lancet journals

Go to The Lancet Conferences Homepage

Conference Programme: Highlights

Attend The Lancet healthcare-associated infections conference and you will hear:

Comprehensive coverage of HAIs
Updates on current best practice
A clear focus on clinically relevant advice from leading experts
How to define the responsibilities of healthcare professionals in managing HAIs
From speakers and peers how to tackle real HAI problems

History and changing epidemiology of HAIs - Andrew Pearson

Impact of mandatory surveillance and public reporting
Success of performance management in reducing MRSA bacteraemia
Changing the epidemiology of Clostridium difficile
Importance of antibiotic monitoring on the control of C. difficile associated disease

International comparison of HAI epidemiology - Hajo Grundmann

HAIs as an issue of patient safety are frequently regarded as a violation of the medical plea of "Primum non nocere" (first, do no harm)
There are many limitations to determining the burden of HAIs on a worldwide scale
Filling this knowledge gap is vital to inform the public and give HAIs the appropriate rank in the public-health agenda
Many hospitals in Europe, the United States, Canada, and Australia have subscribed to national routine surveillance systems for HAIs, demonstrating their commitment to improving quality of health-care services

International comparison of the social, media, and political context of HAIs - Tammy Boyce

This presentation will:

Review UK print media coverage of MRSA, examining key messages, frames, and sources used
Show how cleaning dominates news framing of the MRSA story and how this is done by journalists
Compare this media coverage with government statements and press releases to analyse whether media coverage differs from or adopts government messages on MRSA

Glycopeptide-resistant enterococci - Marc Bonten

After the emergence of glycopeptide-resistant enterococci (GRE) in the USA in the 1990s we now witness an increase in GRE infections in Europe
Most of these infections are caused by Enterococcus faecium, belonging to several identifiable clonal lineages, also known as CC17
The non-GRE form of this E. faecium CC17 is already highly prevalent in European hospitals
Several characteristics of CC17 have been identified that may explain ecological advantage within health care settings
There is no evidence that CC17 originates from the animal reservoir
The clinical relevance of GRE-infections are not accurately determined
Controlling spread of CC17 and CC17-GRE is and will be very problematic

Pseudomonas - Kevin Kerr

E pidemiology of the pseudomonas bacterium in hospital: which patient groups are most at risk?
Management of infection is problematic because of multi-resistance: prevention, therefore, is better than cure
Pseudomonasin the environment: how frequently is it found and does it represent a problem for your patients if you find it?
Prevention of acquisition of Pseudomonasin high-risk patient groups: how can we stop it happening?

ESBL-producing organisms - Matthew Falagas

HAIs due to enterobacteriaceae-producing, extended-spectrum, beta-lactamases (ESBLs), which hydrolyse most beta-lactam antibiotics apart from carbapenems, are becoming common in many parts of the world
There is substantial variation in the rate of production of ESBLs in enterobacteriaceae in Europe
Several recent studies have emphasised the issue that ESBL-producing Escherichia coli may be identified in an appreciable proportion of community acquired urinary tract infections in some countries
The prevalence of ESBL-producing enterobacteriaceae is especially high among patients residing in long-term care facilities

Norovirus - Marion Koopmans

Norovirus infections can complicate diseases in hospitalised patients and should be taken seriously
The recent increases in norovirus reporting are related to virus evolution
NoV is the most common cause of vomiting and dirarrhoea in the community, and will be introduced into hospitals via patients, staff, and visitors
Stringent infection control measures can reduce impact

Surgical-site infections - Hilary Humphreys

Surgical site infections (SSI): a key quality indicator of health care
Definitions: do we all agree on what are SSI?
Counting SSI: in-patient surveillance and beyond
Specific challenges - eg, orthopaedic and minimally invasive surgery
Prevention: what is possible and what may be impossible

Prevention of ventilator-associated pneumonia - Jean Yves Fagon

Risk factors may contribute to the elaboration of effective preventive strategies by indicating which patients might be most likely to benefit from prophylaxis against pneumonia
Important components of effective preventive strategies focus on basic infection control principles, such as handwashing, staff education, and optimal use of resources
There is much evidence to suggest that pharmacological and non-pharmacological strategies focused on prevention of aerodigestive tract colonisation and prevention of aspiration of contaminated secretions can be effectively used to prevent VAP
Measures to prevent VAP extend to all aspects of daily intensive care practice, including antibiotic selection, routes of intubation, sedation, weaning, patient positioning, transfusion practice, nutritional support, and glycaemic control
Effective implementation of such preventive principles can result in significant cost savings and reduce hospital mortality and morbidity for individual patients

Catheter-related infections - Jonathan Edgeworth

Vascular access device infections
Microbiology and pathogenesis
Epidemiology and clinical consequences
Prevention by improving infection control practice or antimicrobial strategies
Diagnosis and management

The role of hand hygiene - Benedetta Allegranzi

Summary of the evidence for microbial hand transmission during healthcare delivery
Review of the evidence for the effectiveness of hand hygiene to prevent HAIs
Challenges and obstacles in hand hygiene promotion: from the 19th century to the new millennium
Overview of existent national campaigns for hand-hygiene promotion worldwide
WHO multimodal strategy to improve hand hygiene and its implementation across the globe

Environmental decontamination of HAIs - Stephanie Dancer

Controversy exists over the role of hospital cleaning as a viable control mechanism for hospital-acquired infection
Certain hospital pathogens, eg. MRSA, C.difficile, Acinetobacter, norovirus and VRE, are known to survive in the hospital environment
Environmental cleaning has been shown to help control outbreaks of pathogens associated with hospital-acquired infection
Proposed hygiene standards will help provide the evidence required to assess the value of cleaning
Near-patient hand-touch sites on furniture and clinical equipment are thought to play a major role in the spread of infection

Responsibility for managing HAIs: where does the buck stop? - Brian Duerden

Prevention and control of HAIs requires a three-way partnership between clinicians (patient care), management boards (supportive corporate environment), and government/DH (priorities and targets)
Change the mindset from a system to deliver specialist clinical care, with infection prevention and control as an afterthought, to a system for safe patient care within which specialist services are delivered
A board-to-ward approach with clear reporting lines and performance management is needed to ensure delivery
Clinical care protocols and care bundles should support aseptic technique and best clinical practice
Infection prevention and control are core requirements in undergraduate and postgraduate training and should be sustained through CPD for all healthcare professionals

Community-associated MRSA as a cause of HAIs - Robert Skov

Control of MRSA in the community is an important source for HAIs.
- Spread of MRSA in the community build up the pool of MRSA across borders and lead to increasing numbers of HA-MRSA. Today's CA-MRSA will be tomorrow's HA-MRSA
Community associated carriage and infection of MRSA need to be controlled
- Colonised people with or without infections keep transmission chains going
The new potentially very large reservoir of MRSA in production animals is a serious threat to control of MRSA

Acinetobacter - Kevin Towner

Emergence of Acinetobacter as a nosocomial pathogen
Antibiotic resistance in Acinetobacter
Epidemiology of Acinetobacter
Problems in the treatment and control of Acinetobacter infections
Recommended control measures

What is more important in the control of HAI - infection control or antibiotic manipulation? - Ian Gould

Evidence base for antibiotic policies to control resistance in the hospital versus the comparable evidence base for traditional infection control measures
Control of MRSA and the effects of antibiotics on virulence, transmissibility, and pathogenicity
Implications for universal admission screening for MRSA

What is the link between antibiotic use and antibiotic resistance? - Herman Goossens

Antibiotic use
Antibiotic resistance
Issues relevant to European hospitals
Link between antibiotic use and resistance

Are targets the right way to improve infection control practice? - Michael Millar

Pros and cons of centrally determined HAI targets
Potential approaches to priority setting at local level
Comparison of HAI risks
Future research to support priority setting at a local level

Do the public have a right to know the HAI rate in your hospital? - Martin Fletcher

Bringing down the infection rate
It's all about teamwork: charismatic leadership
Success: what does it look like?
The sustainability factor

Concluding remarks - Didier Pittet

Summary of the key issues addressed by speakers over the two working days
Emphasis on the meeting "take-home" message
Discussion of perspectives for a global vision of critical issues for infection control from a public health point of view
Identification of the future challenges