NEWS
INDUSTRY VIEWPOINT with Dr ANDREW KEMP PhD, principal scientific officer,
Q Technologies group, University of Lincoln
It’s time to insist on excellent results
In light of the August 2018 published paper in the Science Translational Medicine titled “Increasing tolerance of hospital Enterococcus faecium to hand wash alcohols” (Pidot et al), both The Sydney Morning Herald and Guardian Newspapers have published their expert views on the data. Both Professor Paul Johnson, deputy director of Infectious Diseases at Austin Health, and Professor Tim Stinear at the Doherty Institute agree that simply using alcohol gel is no longer sufficient in the healthcare environment. “The big debate is: does it matter?” asks Professor Johnson. Associate Professor Rhonda Stuart, who heads the infection prevention team at Monash Health, thinks not, stating: “The study was unlikely to lead to changes at her hospitals.” My friend, who is a very senior management consultant advising multibillion Dollar businesses, had a very interesting response when we spoke about this: “I continue to marvel at the habit the healthcare community has of requiring more proof than is required for any given topic. Clearly there is now more than enough proof of failing efficacy with the existing, ineffective sanitizers used today. “Phrases such as ‘we may have to rethink...’ are simply astonishing. It is as if there remains a choice called denial. Why can’t zero tolerance for failure be adopted, as it is in space exploration, aerospace and underwater submarine environments? In these industries, ‘rethinking’ what I consider to be an equivalent thing - such as structural integrity - isn’t an option, it is a sonic boom-like call to action and immediate change. How healthcare can continue this culture of unnecessarily lengthy considerations of an overwhelming proof, as a way of resisting change is both baffling, and borderline negligence. This is the school of common sense.” For me this is a much bigger issue than just VRE, the ever- increasing number of bacteria that are becoming resistant to antibiotics is fairly well known and understood, however the same cannot be said for disinfectant resistant bacteria. Not only do alcohol hand sanitisers now have a significant number of resistant bacteria, but recent studies show they actually increase bacterial colony counts on the skin.
Einstein is wrongly quoted as saying that ‘doing the same thing over and over again, and expecting a different result, is a sign of mental illness’. Clearly no one in healthcare has bothered to listen to some sage words. Why is it that people outside the healthcare industry can understand this, but inside, we use quotes like this and then ignore them?
Why do we continue to use alcohol gels, even when study after study, either shows them to worsen matters over time, or shows
them to be ineffective against the bacteria and viruses (Norovirus in particular)?
Why do the CDC and WHO, still recommend the use of alcohol hand sanitisers? There can be only one of two possible answers, they are not listening, or, they are listening only to the big chemical manufacturers who pour £millions into making sure they do not change their recommendations so that they can make £billions in profit.
It is my view that Dame Sally Davies was correct in her assessment, if we do not do something to change the current situation of an ever-increasing risk of resistant infection post- surgery, at some point in our future we will have to stop doing what we now consider routine surgical operations as the risk from infection will be greater than the risk of not having surgery. Yes, Dame Sally, you are right. We need to change from a mind- set of cure to one of prevention and cure. That would mean that instead of the €4.7 bn spent on producing new antibiotics since 2016, (not spent with academic institutions or hospitals, but given to big pharmaceutical companies who must have been laughing all the way to the bank), the European Commission will spend the next €4.7 bn on developing new surface and skin tests. Incidentally that was our tax money they wasted, and we should all be furious about that! We need to first produce tests that accurately show contamination levels and species in real time (the tests regulators use now are worse than useless), so that can then be used to test the efficacy of chemical disinfectants. In order to fully understand disinfectant resistant bacteria, amongst the many things we need to do, is to routinely test immediate efficacy as well as efficacy over longer time periods of our disinfectants. This will help us to see the true picture of the surface and skin bioburden levels in our hospitals, only then will we be able to determine the true gravity of our situation. The basic chemistry of every disinfectant available today is over 60 years old. Once new, reliable, and rapid tests are available, perhaps the results will stimulate the chemical industry to produce new disinfectants that meet the needs of healthcare. For the moment, we must stop accepting poor results from our disinfectants, and start insisting on excellent results. If we do not do this now, we may end up losing both the “cure” and the “prevention” battles to the microbes. The microbes we are trying to kill are adapting and becoming resistant all the time, they are therefore clearly far smarter than some of the people responsible for infection prevention around the world.
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WWW.CLINICALSERVICESJOURNAL.COM
SEPTEMBER 2018
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