Since the nonsense yesterday when a public health body erroneously stated that 80% of infections diseases are spread by contact....
I promised a thread....
Lets start with the @WHO Hand hygiene guideline
@LazarusLong13
In Section 9 of WHO HH guideline the relationship of HCAI and hospital pathogens is revealed
2 assertions are made
A) Semmelweis used an antiseptic and it reduced puerperal fever.
B) Substantial evidence for hand antisepsis reducing HCAI is contained in citations 58, 179, 180
Assertion A
Semmelweis did not use nor recommend an antiseptic. He recommended and used a disinfectant. Excerpt from his univ web site.
The procedure reduced PF but was intolerable & burnt HCWs' skin.
NB IS knew it was coming from the PM room and should have stopped PM visits
Oliver Wendall Holmes had recommended NEVER to do post mortems and midwifery - 4-years before Semmelweis started in Vienna.
NB Semmelweis was behind on his reading!
Semmelweis recommended the wrong control measure (disinfection) and not the correct one - stop PM room visits by doctors. Thus the WHO in their 2009 guidance got their first assertion wrong.
It was not an antiseptic - it was an intolerable to use in the long term disinfectant.
So what about Assertion B
Is there substantial evidence in 58, 179, 180?
Lets have a look
Here is citation 58
And this citation says.... its in 66 & 67 of citation 58...
Well that is convenient because the WHO cites 58, 179 & 180 and 179 & 180 just happen to be the same 2 citations included in the WHOs citation 58 as 66 and 67
Well here is the Larson 1988 paper - I am not bowled over or drowning in evidence here
179 / 66 citation numbers
And wait for it another table of somewhat similar evidence...
180/67
I am still looking for evidence that HH is the single most important measure to prevent HAI.
Clearly Pneumonia are not caused by HH, SSIs are the patient's own flora entering to infect via the air... UTI own flora, etc. etc.
Pathogens are released in bursts into the air....
Enough with overstating the impact of hand hygiene. Is it important yes! But at least as important are the pathogens travelling via the air.
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When you make a Whopper of a mistake, e.g., "airborne infections are spread by sprayed on droplets", those in charge of PH guidance should have immediately identified whether other similar errors in MoTs are present.
Consider this.
An outbreak of cryptosporidium... 1/x
As @UKHSA tell us (as well as all PH agencies)... its contact
Default to contact is what is accepted for most MoTs.
Now if they are wrong - then all advice on prevention is at least incomplete. So, is there evidence of airborne? 2/x
Well lookie here....
There appears at the least the plausibility - lets look inside 3/x
Thoughts from yesterday's @KnowlexUK conference
Its not 2020. It is more akin to when harms from, the likes of "passive smoke", "lack of seat belts" & "asbestos" became undeniable - although not visible to all.
There are significant, persistent and undeniable harms.
1/6
So where are we now, and where do we ?need to be to negate the harms
[starter for 10]
2/6
We will never get to where we need to be in one leap or by 1 action.
What is needed first?
Diagnose the problem and acknowledge the risks 3/6
No exaggeration here - this is a major article. Forget your CERN collider, here is a method for obtaining mechanistic evidence of far-afield airborne transmission. It was undertaken in a facility designed to study TB.
1/10
The authors state that there should be evidence of the transmission route to inform guidance.
Could not agree more. If only...
"Unambiguous demonstration of transmission routes is important."
Yes, Yes, Yes
By the way this wont come from RCTs!
2/10
For all the implausibility of other routes, and the evidence during outbreak settings there were laggards...
3/10
After yesterday's 17:1 (one case of community acquired CVD leading to 17 others a driver diagram to reduce nosocomial transmission.
Let's start by agreeing that nosocomial transmission is unsafe. 1/8
Action 1 is to prevent transmission to patients, staff and visitors, i.e., everyone in the care environment.
2/8
Next the only 3 actions that can prevent inhalation of virus. Segregation of people who are infectious, IAQ, and respiratory protection.
Also there must be ongoing analysis of where and why transmission is happening in the care setting to identify further safer options 3/8
I have a patient with SARS and I want to keep my other patients and staff safe.
I look up the NIPCM Scotland and find that the Main (singular) mode of transmission is both Droplet / Airborne
@P_H_S_Official this thread merits "immediate action"
The Transmission Based Precautions Section tells me there are 3 modes of transmission.
It tells me what the different precautions are aiming to achieve
Of note the definitions of respiratory infections are erroneous
In the respiratory section
It tells me you only need RPE if the pathogen is "wholly" transmitted by the airborne route, i.e., not droplet / airborne, or AGP
Off for the literature review to find the evidence for this statement