Improving adherence to Standard Precautions for the control of health care-associated infections

Moralejo, D., El Dib, R., Prata, R.A, Barretti, P., Corrêa, I.| 2018|Improving adherence to Standard Precautions for the control of health care-associated infections |Cochrane Database Systematic Review|Feb |26 | 2|CD010768| DOI: 10.1002/14651858.CD010768.pub2




‘Standard Precautions’ refers to a system of actions, such as using personal protective equipment or adhering to safe handling of needles, that healthcare workers take to reduce the spread of germs in healthcare settings such as hospitals and nursing homes.


To assess the effectiveness of interventions that target healthcare workers to improve adherence to Standard Precautions in patient care.

Search Methods:

We searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, two other databases, and two trials registers. We applied no language restrictions. The date of the most recent search was 14 February 2017.

Selection Criteria:

We included randomised trials of individuals, cluster-randomised trials, non-randomised trials, controlled before-after studies, and interrupted time-series studies that evaluated any intervention to improve adherence to Standard Precautions by any healthcare worker with responsibility for patient care in any hospital, long-term care or community setting, or artificial setting, such as a classroom or a learning laboratory.

Data collection and analysis:

Two review authors independently screened search results, extracted data from eligible trials, and assessed risk of bias for each included study, using standard methodological procedures expected by Cochrane. Because of substantial heterogeneity among interventions and outcome measures, meta-analysis was not warranted. We used the GRADE approach to assess certainty of evidence and have presented results narratively in ‘Summary of findings’ tables.

Main Results:

We included eight studies with a total of 673 participants; three studies were conducted in Asia, two in Europe, two in North America, and one in Australia. Five studies were randomised trials, two were cluster-randomised trials, and one was a non-randomised trial. Three studies compared different educational approaches versus no education, one study compared education with visualisation of respiratory particle dispersion versus education alone, two studies compared education with additional infection control support versus no intervention, one study compared peer evaluation versus no intervention, and one study evaluated use of a checklist and coloured cues. We considered all studies to be at high risk of bias with different risks. All eight studies used different measures to assess healthcare workers’ adherence to Standard Precautions. Three studies also assessed healthcare workers’ knowledge, and one measured rates of colonisation with methicillin-resistant Staphylococcus aureus (MRSA) among residents and staff of long-term care facilities. Because of heterogeneity in interventions and outcome measures, we did not conduct a meta-analysis.Education may slightly improve both healthcare workers’ adherence to Standard Precautions (three studies; four centres) and their level of knowledge (two studies; three centres; low certainty of evidence for both outcomes).Education with visualisation of respiratory particle dispersion probably improves healthcare workers’ use of facial protection but probably leads to little or no difference in knowledge (one study; 20 nurses; moderate certainty of evidence for both outcomes).Education with additional infection control support may slightly improve healthcare workers’ adherence to Standard Precautions (two studies; 44 long-term care facilities; low certainty of evidence) but probably leads to little or no difference in rates of health care-associated colonisation with MRSA (one study; 32 long-term care facilities; moderate certainty of evidence).Peer evaluation probably improves healthcare workers’ adherence to Standard Precautions (one study; one hospital; moderate certainty of evidence).Checklists and coloured cues probably improve healthcare workers’ adherence to Standard Precautions (one study; one hospital; moderate certainty of evidence).

Read the full systematic review at the Cochrane Library 

Blood test identifies patients at risk of developing a secondary infection

University of Edinburgh| June 2018 | Blood test spots patients’ infection risk

A new test developed by researchers at the University of Edinburgh and the University of Cambridge could be used to identify patients in intensive care at risk of developing a secondary infection. The test is able to show three markers in the blood that are involved in fighting infections. These markers demonstrate if the cells are dysfunctional meaning they are more susceptible to disease. Patients with these dysfunctional cells have an increased risk, by two to three times, of developing an infection when compared to those who test negative for the markers. 

The authors of the study suggest the test could be used in future to pinpoint suitable patients to participate in clinical trials to test new therapies  and that it could help doctors target therapies such as antibiotics to the patients most likely to benefit (Source: University of Edinburgh).
The research findings have now been published in Intensive Care Medicine , where it is available to read in full



Cellular immune dysfunctions, which are common in intensive care patients, predict a number of significant complications. In order to effectively target treatments, clinically applicable measures need to be developed to detect dysfunction. The objective was to confirm the ability of cellular markers associated with immune dysfunction to stratify risk of secondary infection in critically ill patients.


Multi-centre, prospective observational cohort study of critically ill patients in four UK intensive care units. Serial blood samples were taken, and three cell surface markers associated with immune cell dysfunction [neutrophil CD88, monocyte human leucocyte antigen-DR (HLA-DR) and percentage of regulatory T cells (Tregs)] were assayed on-site using standardized flow cytometric measures. Patients were followed up for the development of secondary infections.


A total of 148 patients were recruited, with data available from 138. Reduced neutrophil CD88, reduced monocyte HLA-DR and elevated proportions of Tregs were all associated with subsequent development of infection with odds ratios of 2.18, 3.44  and 2.41, respectively. Burden of immune dysfunction predicted a progressive increase in risk of infection, from 14% for patients with no dysfunction to 59% for patients with dysfunction of all three markers. The tests failed to risk stratify patients shortly after ICU admission but were effective between days 3 and 9.


This study confirms our previous findings that three cell surface markers can predict risk of subsequent secondary infection, demonstrates the feasibility of standardized multisite flow cytometry and presents a tool which can be used to target future immunomodulatory therapies.

Full reference: Conway Morris, A., Datta, D., Shankar-Hari, M. et al. | 2018 |Cell-surface signatures of immune dysfunction risk-stratify critically ill patients: INFECT study| Intensive Care Med| Vol. 44| 5| P. 627-635|DOI:


Brexit Health Alliance calls for co-operation on infectious diseases

The UK risks the spread of antibiotic-resistant and other infectious diseases if it leaves the European Union’s (EU) early warning system after Brexit without an effective replacement, the Brexit Health Alliance has warned.


This briefing from the Brexit Health Alliance (BHA) and the Faculty of Public Health, a sets out how people across Europe currently benefit from the close collaboration between the UK and EU on public health, and proposes solutions to maintain and improve a high level of public health protection after the UK leaves the European Union.

The Alliance is calling for:

  • Both the EU Commission and UK government to prioritise the public’s health in negotiations on the future relationship between the UK and the EU.
  • A security partnership based on strong coordination between the UK and EU in dealing with serious cross-border health threats, such as pandemics, infectious diseases, safety of medicines (pharmacovigilance) and contamination of the food chain. Ideally, this would be by continuing access to the European Centre for Disease Prevention and Control and other relevant EU agencies, systems and databases.
  • Alignment with current and future EU regulatory and health and safety standards relating to (for example) food, medicines, transplant organs and the environment, to avoid the need for replication of inspections and non-tariff barriers at the UK/EU border.
  • The UK government to commit to a high level of human health protection when negotiating future free trade and investment agreements.

Full briefing: Protecting the public’s health across Europe after Brexit

Hotter bodies fight infections and tumours better – researchers show how

Science Daily | May 2018 | Hotter bodies fight infections and tumors better — researchers show how

Researchers from the Universities  of Manchester and Warwick have shown how individuals with higher body temperatures are better equipped to fight infections and tumours.  A Multidisciplinary team were involved in the study, with mathematicians from Warwick calculating how temperature increases make the cycle accelerate.  The researchers have demonstrated that small rises in temperature (such as during a fever) speed up the speed of a cellular ‘clock’ that controls the response to infections — and this new understanding could lead to more effective and fast-working drugs which target a key protein involved in this process (Science Daily).

Higher body temperatures speed our bodies’ responses to infections, wounds and tumours – researchers at the Universities of Warwick and Manchester prove that a slight increase in body temperature and inflammation – such as a fever – speeds up cellular ‘clock’ in which proteins switch genes on and off to respond to infection.

  • Slight rise in temperature and inflammation – such as a fever – speeds up cellular ‘clock’ in which proteins switch genes on and off to respond to infection
  • New understanding could lead to more effective and fast-working drugs which target a key inflammation protein found to be critical for the temperature response
  • Interdisciplinary team of Warwick mathematicians and Manchester biologists used modelling and lab experiments to jointly make discovery (University of Warwick)

The full news item from Science Daily can be read here 

University of Warwick Hotter bodies fight infections and tumours better – researchers show how

The research is published in the Proceedings of the National Academy of Sciences

The full article is available to read here

Full reference:

Harper, C. V. , et al | Temperature regulates NF-κB dynamics and function through timing of A20 transcriptionProceedings of the National Academy of Sciences | 2018; 201803609|  DOI: 10.1073/pnas.1803609115


“Good cholesterol” associated with raised risk of infectious diseases, according to Danish researchers

Scientists in Copenhagen have discovered that patients with both low and high rates of HDL, the so-called good cholesterol, had a higher risk of being hospitalised with an infectious disease; they also had an increased risk of dying from an infectious disease.

These findings  were based on analysis of data from 100,000 individuals from the Copenhagen General Population Study who were followed for over 6 years using national Danish health registries. The paper has just been published in the European Heart Journal (via Science Daily).



Preclinical evidence has indicated that HDL may play an important role in the immune system; however, very little is known about the role of HDL in the immune system in humans. We tested the hypothesis that low and high concentrations of HDL cholesterol are associated with risk of infectious disease in the general population.

Methods and results

We included 97 166 individuals from the Copenhagen General Population Study and 9387 from the Copenhagen City Heart Study with measurements of HDL cholesterol at baseline. The primary endpoint was any infectious disease requiring hospital admission, ascertained in the Danish health registries from baseline in 2003–13 or 1991–94 through 2014; 9% and 31% of individuals in the two studies experienced one or more infectious disease events. Using restricted cubic splines, there was a U-shaped association between concentrations of HDL cholesterol and risk of any infection. Following multifactorial adjustment, individuals with HDL cholesterol below 0.8 mmol/L (31 mg/dL) and above 2.6 mmol/L (100 mg/dL) had hazard ratios for any infection of 1.75 (95% confidence interval 1.31–2.34) and 1.43 (1.16–1.76), compared to those with HDL cholesterol of 2.2–2.3 mmol/L (85–95 mg/dL). In the Copenhagen City Heart Study, corresponding hazard ratios for any infection were 2.00 (1.16–3.43) and 1.13 (0.80–1.60).


Low and high HDL cholesterol concentrations found in 21% and 8% of individuals were associated with higher risk of infectious disease in the general population. These findings do not necessarily indicate causality.
Full reference:

Madsen, : C, M.  Varbo, A.,  Tybjærg-Hansen, A., Frikke-Schmidt, R., G Nordestgaard, B, G., |  U-shaped relationship of HDL and risk of infectious disease: two prospective population-based cohort studies |  European Heart Journal |  Vol. 39 | Issue 14 |  7 April 2018 | P. 1181–1190,

The full article is available for Rotherham NHS staff to request here 

Infectious diseases in pregnancy screening

Public Health England | April 2018 | Infectious diseases in pregnancy screening: programme standards

The Infectious Diseases in Pregnancy Screening (IDPS) Programme aims to support
health professionals and commissioners in providing a high quality screening
programme. This involves the development and regular review of quality standards
against which data is collected and reported annually. The standards provide a defined set
of measures that providers have to meet to ensure local programmes are safe and


The most recent standards apply to data collected from 1 April 2018. They replace previous versions.  Public Health England (PHE) present the national screening standards for the NHS infectious diseases in pregnancy screening (IDPS) programme in the following documents (PHE).

The standards can be downloaded by following the link



NHS staff who refuse flu vaccine this winter will have to give reasons

NHS staff who refuse to have the flu vaccine this winter will have to give reasons to their employer, as leaders make efforts to improve take-up rates|  BMJ 2017359 

Image source: Daniel Dionne – Flickr // CC BY-SA 2.0

 NHS leaders are to write to all NHS staff urging them to be vaccinated against flu as soon as possible. The letter will make it clear that staff who refuse the vaccine will have to give reasons to their employing NHS trust, which will then be recorded.

The heads of NHS England, Public Health England, the Department of Health for England, and NHS Improvement said that they were writing to remind staff of their “professional duty to protect their patients.” Trusts are also being urged to make the flu vaccine “readily available” to staff.

Although last year saw record take-up of the vaccine among staff, more than a third of NHS staff members did not take up the offer, with just a fifth being vaccinated in some trusts.

Hospitals and GP surgeries are being warned by NHS England to be prepared for a big increase in cases of flu this winter after a heavy season in the southern hemisphere.

Full story via BMJ 2017359 doi: