Decision letter from other journals and peer review

I recently read with interest the decision of Clinical Microbiology and Infection (CMI) to use the decision letter from other journals, to assist in making a decision on a manuscript . Authors may submit to CMI the original version of the manuscript or an amended version, based on the feedback from the decision letter with reviewers’ comments. I welcome this as it maximises the value of the work of reviewers and follows on from another development relatively recently to use reviewers’ reports (after agreement), when transferring a manuscript from one journal to another within the same publishing stable. However, the success of using decision letters will depend on the authors being honest in not editing/altering the decision letter received from the previous journal.</p

Upgrading intensive care units--getting the design right prevents infection.

There is a severe, ongoing shortage of intensive care (ICU) unit beds in Ireland, as recently outlined.1 This needs to be addressed to ensure that patients who need admission to ICU can be admitted as the need arises and are not prematurely discharged due to pressure on beds. Adequate bed numbers and appropriate staffng will also help to ensure that ICU-acquired infection is minimised.</p

Airborne transmission of Covid-19: implications for Irish hospitals

The pandemic spread of COVID-19 raises many questions about its transmissibility. The initial consensus was that spread was primarily by contact with a contaminated surface and by inhalation of droplets. However, airborne transmission is increasingly considered probable. Clarifying COVID-19 transmission is crucial for effective infection prevention and control (IPC) and healthcare worker (HCW) protection. SARS-C0V-2 is more transmissible than influenza, with a mean reproductive number of 2.65, even if not as high as other viruses such as measles. Personal protective equipment (PPE) shortages, IPC lapses, workload intensity and other factors not yet known, may explain significant hospital transmission during the early stages of the pandemic in Ireland and elsewhere.</p

Medical education, the COVID-19 pandemic, and infection prevention: there has never been a better time.

The COVID-19 pandemic has posed a huge challenge for healthcare systems worldwide and has significantly altered medical education [1]. This change has resulted in an increase in online medical education and a greater emphasis on infection prevention and control (IPC) measures on campus and at home, to prevent acquisition by students themselves, and transmission to teaching staff, friends, and family. Some students who volunteered to assist hospitals in managing the pandemic gained valuable experience and appreciation of the importance of IPC in the healthcare setting, as well as in their day-to-day lives [2]. However, now is the time to ask, are we confident that our medical students are competent in IPC?</p

Infection prevention and control policy implementation for CPE: a cross-sectional national survey of healthcare workers reveals knowledge gaps and suboptimal practices

Background: In 2017, Ireland pioneered a unique response to the worsening epidemiology of carbapenemase-producing Enterobacterales (CPE), declaring a national public health emergency. Subsequently, CPE mitigation guidelines and policies were implemented in acute hospitals, focused on patient screening and outbreak management, often by healthcare workers (HCWs) with limited background in infection prevention and control (IPC). CPE risks from sinks and drains remain inadequately controlled. Aims: To compare CPE awareness, perceptions of the role of the environment in CPE transmission, and disposal practices of liquid waste from clinical handwashing sinks between IPC HCWs and non-IPC HCWs in Ireland. Methods: Between December 2022 and March 2023, HCWs employed in acute hospitals in Ireland between 2017 and 2022 were invited to participate anonymously in a 30-question digital survey. Findings: Responses (N=283) were received across several clinical disciplines. In total, 21.6% of respondents were working or had previously worked in IPC roles, 84.1% of whom reported no IPC-related learning needs. In comparison with non-IPC HCWs, more IPC HCWs perceived a risk of pathogen transmission from clean water plumbing (68.9% vs 39.2%; P Conclusions: Although there is general awareness of the role of the built environment in pathogen transmission, including CPE, familiarity with sink/water-related transmission is greater among IPC HCWs. There may be opportunities to improve disposal practices for liquid waste through education targeting non-IPC HCWs.</p

Preventing healthcare-associated infection through education: have surgeons been overlooked?

BACKGROUND/AIMS: Some 20-30% of HCAI are considered to be preventable through an extensive infection prevention and control programme. Through an extensive literature review we aim to critically appraise studies which have utilised education initiatives to decrease HCAI. METHODS: An extensive review of the literature was carried out in both online medical journals and through the Royal College of Surgeons in Ireland library. FINDINGS: Many studies over the last 10 years have demonstrated success in educating nursing staff, critical care healthcare workers as well as medical students and junior doctors in the infection prevention and control of infection. Comparatively few have focussed on surgical trainees. A blended learning approach, with particular focus on the small group format is important. Interventions involving web-based learning in combination with established education formats are proving successful in changing behaviour. CONCLUSIONS: The development of an educational strategy for surgical trainees focussing on infection prevention and control is overdue. Such a programme would have far reaching benefits for individual patients, contribute to significant economic savings within health services and enhance the quality and safety of patient care.</p

The Molecular Epidemiology of Resistance in Cefotaximase-Producing Escherichia coli Clinical Isolates from Dublin, Ireland.

In view of continued high clinical prevalence of infections involving extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, this study sought to characterise the blaCTX-M genes, their associated mobile genetic elements and the integrons present in 100 ESBL-producing E. coli isolates collected in a Dublin hospital and associated community healthcare facilities. Polymerase chain reaction (PCR) mapping and sequencing was used to detect blaCTX-M alleles, their associated insertion sequences (ISs) and class 1 and 2 integrons in the collection. ESBL plasmids were characterised by PCR-based replicon typing and replicon sequence typing (RST). Cefotaximases were harboured by 94% of isolates (66 blaCTX-M-15, 8 blaCTX-M-14, 7 blaCTX-M-1, 4 blaCTX-M-3, 3 blaCTX-M-9, 2 blaCTX-M-27, 2 blaCTX-M-55, 1 blaCTX-M-32 and 1 blaCTX-M-2). An ISEcp1 promoter was linked to a group 1 blaCTX-M gene in 45% of isolates. A further 34% of isolates contained blaCTX-M-15 downstream of IS26, an arrangement typical of epidemic UK strain A. Class 1 integrons were found in 66% of isolates, most carrying trimethoprim/aminoglycoside resistance genes. CTX-M plasmids were primarily of multireplicon IncF or IncI1 type, but IncN and unidentified types were also found. Novel IncF RSTs F1:A-:B-, F45:A1:B-, F45:A4:B- and a novel IncI1 sequence type, ST159, were identified. CTX-M plasmids and integrons resembled those identified recently in animal isolates from Ireland and Western Europe. The molecular epidemiology of CTX-M-producing E. coli in Dublin suggests that horizontal spread of mobile genetic elements contributes to antimicrobial resistant human infections. Further investigations into whether animals or animal products represent an important local reservoir for these elements are warranted.</p

A comparison of culture methods and polymerase chain reaction in detecting Clostridioides difficile from hospital surfaces

Introduction. Environmental surveillance for Clostridioides difficile is challenging. There are no internationally agreed recommendations on which method should be used when environmental surveillance is undertaken. Aim. To compare the detection of C. difficile by RT-PCR to culture-based methods and to determine which is more sensitive and specific in the clinical environment. Methods. Forty-four near-patient areas of C. difficile-positive patients were sampled using contact plates and moistened flocked swabs. Results. Detection using moistened flocked swabs followed by RT-PCR or culture detected more C. difficile than contact plates. The sensitivity and specificity of a RT-PCR assay for tcdB compared to the culture methods was 76 and 91 %, respectively. Conclusion. Despite the lower sensitivity and specificity, RT-PCR could potentially offer a more rapid and practical alternative. </p

Survey of recent medical graduates' knowledge and understanding of the treatment and prevention of infection.

With the increasing interest in infection and antibiotic resistance amongst the general public, we undertook to assess the knowledge, and understanding of the treatment and prevention of common infections in medical graduates, about to commence their intern or pre-registration year. A multiple choice-type questionnaire, which included 19 questions, was circulated to 199 recent graduates of three Irish medical schools and 108 (54.3%) were returned. Approximately 60% of the questions were answered correctly. However, questions on the use of antibiotics were poorly answered compared with other questions. With changes in the curricula of many medical schools, there is a need for better education on infection and the use of antibiotics as well as more sophisticated and validated methods of assessment.</p

Greater attention to flexible hospital designs and ventilated clinical facilities are a pre-requisite for coping with the next airborne pandemic

Acute care hospitals traditionally have a combination of mixed occupancy rooms, i.e. two or more patients sharing the same room with an en suite, and single rooms occupied by one patient with or without a lobby. This has been changing in recent years with a move towards single rooms for most if not all patients. Single rooms are currently prioritized for providing a protective environment for immunocompromised patients who are at particular risk of serious infection (protective isolation) or for the isolation of those patients with transmissible infections who pose a risk to other patients (source isolation). </p