Kalisvar

Picture of Tresor, a health worker, checks on two-year-old Ibrahim, who is being treated for mpox, at the Nyiragongo General Referral Hospital, north of Goma in the Democratic Republic of the Congo (DRC) on 14 August 2024.

New guideline on the clinical management and infection prevention and control of #mpox.

This guidance is designed to support:
✅ Patients with mpox — whether at home, in the community, or in healthcare facilities
✅ The health workers and caregivers supporting them

🔗 bit.ly/43YOzjf

Epidemiology of Healthcare Facility-Associated Nontuberculous Mycobacteria From 2012 Through 2020 in a 10-Hospital Network in the United States Incidence rates of hospital-onset nontuberculous mycobacteria (NTM) episodes decreased from 2014 through 2020 within a hospital network, but rates varied s

New CID study out from Art Baker & team: 12,855 NTM episodes across 10 hospitals over 8 years

💥 1 in 4 were hospital-onset!
📉 HO rates ⏬ 38% over time but varied 15x btwn hospitals
▶️ They used a clean, simple definition for HO NTM (day 3+)

NTM = underestimated #IDSky

🔗 doi.org/10.1093/cid/...

Target Trial Emulation for Antibiotic Use in Acute COVID-19 This study by Pulia and colleagues1 reports results from a large population-based cohort using target trial emulation to examine the associations of antibiotic treatment with clinical outcomes in pati...

Honoured to be invited to write this commentary with @steventong.bsky.social, on an excellent target trial emulation study which showed that antibiotic use was not associated with improved outcomes in non-severe COVID-19.

jamanetwork.com/journals/jam...

#IDSky

9/
💡Key takeaway: Patient safety demands a zone-based, proactive, multidisciplinary approach to managing both water and wastewater in hospitals.
Redefining “water safety” may be one of the most important moves in the AMR era.

🧵/end

8/
📊 Whether it’s clinical handwash stations, shower design, or cleaning workflows, each part of the system needs integrated thinking.
“Clinically integrated water/wastewater safety” is the new north star—tying engineering, IPC & clinical workflows together.

7/
📉 The authors warn against a reactive mindset. Retrofitting drains after AMR outbreaks is costly—and sometimes impossible.
New builds must proactively bake in safety. Hospitals designed today will serve during peak AMR eras. We can’t afford to get it wrong.

6/
🛠️ The paper suggests renaming Water Safety Groups to Water/Wastewater Safety Groups (you get the idea) —broadening scope to include wastewater hazards, which are often invisible but just as risky.

5/
🚿 Some hospitals have responded with “water-free” or “water-lite” ICUs—removing sinks, switching to wipes, etc.
These aren’t fringe moves—they’re targeted interventions to stop recurring outbreaks when other measures fail. (Personal note: Implementation not so easy!)

4/
🔄 Zone B—the periphery—is often neglected, yet staff interact with it constantly. One ICU study showed only 4% of sink use was for handwashing 🤯
Design flaws here can spread AMR via showers, pantries, even jug-filling.

3/
🧠 The term “water safety” masks critical risk zones. The authors redefine hospital plumbing into 3 zones:

A) Main water system
B) Periphery (e.g. sinks, traps, final 2m of pipe)
C) Main wastewater system

Each zone needs separate oversight & expertise.
#BuiltEnvironment

2/
The authors argue that our traditional idea of “water safety” is outdated—especially in the age of antimicrobial resistance.
They propose a new, more precise framework that accounts for risks from both water and wastewater systems. 🚽🧫
The following are the key points (that I liked) 🧵👇

🧵1/
We need more research and reviews around “water safety” in healthcare facilities. This new paper in @thejhi.bsky.social by Weinbren et al. (2025) provides a fresh perspective—challenging the idea that it's just about legionella and outlet water quality. 🏥💧
#HospEpi #AMR

🧼 Not all endoscope brushes are created equal

A new study in @thejhi.bsky.social compared different brush types ▶️ metal shafts + DuPont fibre bristles removed organic matter >>> than plastic or microfiber brushes

More passes = cleaner scopes

📄: www.journalofhospitalinfection.com/article/S019...

Hemorrhagic Fever With Renal Syndrome After Flooding in the Yangtze River Basin This cross-sectional study examines the association between severe floods and long-term incidence of hemorrhagic fever with renal syndrome in the Yangtze River basin and explores the modifying role of...

The 2016 Severe Floods and Incidence of Hemorrhagic Fever With Renal Syndrome in the Yangtze River Basin jamanetwork.com/journals/jam... #openaccess #idsky

Dwell Time and Risk of Bloodstream Infection With Peripheral Intravenous Catheters This cohort study analyzes the association of dwell time with the risk of bloodstream infections during peripheral intravenous catheter maintenance therapy.

New: Dwell Time and Risk of Bloodstream Infection With Peripheral Intravenous Catheters #idsky #openaccess jamanetwork.com/journals/jam...

8/ Bottom line?
This Singapore study offers a real-world, real-cost case for smart PPE deescalation.
🛡️ Safety preserved
💵 Costs down
🌱 Carbon cut
It’s time to reimagine IPC and assess how we protect health workers — and the planet.

Optimizing Personal Protective Equipment for a Sustainable Future The important study by Sutjipto et al1 shows that deescalating personal protective equipment (PPE) requirements for COVID-19 can reduce cost and carbon impacts without compromising safety. This 24-mon...

6/ The accompanying editorial calls this a “larger imperative.” jamanetwork.com/journals/jam...
We’re not just talking COVID-19 here — it’s a pivot toward sustainable, evidence-aligned PPE use across all of healthcare.
The gowns we use (and toss) daily? They have a carbon footprint too.

5/But it wasn’t just about safety.
Check out the sustainability win:
💥 440,532 disposable gowns saved
♻️ 66,080 kg plastic waste avoided
🌍 398,681 kg CO₂ emissions prevented
💸 ~SGD 454k (USD ~$334k) saved

4/💡Result: No increase in infections.
COVID-19 incidence among staff tracked with community trends.
➕ Median staff-to-community infection ratio actually dropped from 2.6 to 1.5 after PPE deescalation.
Safety? ✔️

3/📊 The study looked at 12 months before & after the policy change at a major hospital campus.
⚕️ >10,000 healthcare staff
🗓️ 24 months of data
Key question: Did COVID-19 cases among staff rise post-change?

2/📍Context:
In Sept 2022, Singapore deescalated PPE guidance for routine COVID-19 care:
From → Gowns, gloves, eye protection & N95
To → Just N95s.
Controversial? Maybe.
But what happened next is worth examining.

Plastic Waste and COVID-19 Among Hospital Staff After Deescalation in PPE Use This quality improvement study evaluates whether personal protective equipment (PPE) deescalation guidelines in Singapore was associated with staff COVID-19 incidence as well as the environmental sust...

1/
🧵 New study out of Singapore's National Centre for Infectious Diseases:
Can less PPE still keep healthcare workers safe from COVID-19 — while saving the planet? Turns out, yes. Let's unpack!
#SkyThread #InfectionControl #PPE #HealthcareSustainability jamanetwork.com/journals/jam...

Flowchart for the BALANCE+ platform trial, with domains including de-escalation vs no de-escalation, oral beta-lactams vs non-beta-lactams, routine follow-up blood cultures, line retention vs removal, and ceftriaxone vs carbapenems for AmpC.

Looking forward to another packed day at #ESCMIDGlobal. Come say hi at 12:00 at Poster 0737 (Sector A/6/5) where I will be presenting our experience with the vanguard phase of the BALANCE+ Platform, our new platform trial for Gram-negative BSI. Open to new collaborators and sites to join!

Thanks to @kalisvar.bsky.social for his comprehensive overview of everything new in environmental cleaning, surface transmission dynamics, and mopping up MDROs #AntimicrobialResistance

The #ESCMIDGlobal 2025 "Year in Infection Control" symposium starts soon in Hall 1! Chairs Nico Tom Mutters and Ermira Tartari, alongside speakers Andrew James Stewardson and @kalisvar.bsky.social , will review the top papers from the past year, ongoing controversies, and take-home messages.

Veterans Affairs Research Under Threat This Viewpoint discusses the critical importance of continued funding for the intramural research program in the Department of Veterans Affairs.

VA Research Under Threat (no paywall) #openaccess #medsky
jamanetwork.com/journals/jam...

New in @thejhi.bsky.social:

A global review of guidance to reduce hospital-acquired Aspergillus infections

75 documents from 24 countries highlight gaps in prevention strategies, risk assessments, and environmental monitoring

#IDSky #EpiSky

📄: www.journalofhospitalinfection.com/article/S019...

New podcast on Infection Control Matters. nv-HAP surveillance too time-consuming? Semi-automated may be easier than you think. We chat with Dr Aline Wolfensberger

infectioncontrolmatters.com/2025/03/05/n...

#idsky #pneumonia #infectioncontrol @emrsa15.bsky.social

@andrewstewardson.bsky.social and I are diving into the best IPC papers of the past year for #ESCMID Global 2025—and we want your top picks! 🦠📜
What’s the one paper that made you rethink infection prevention and control? Drop your faves and let’s build the ultimate IPC reading list! ⬇️"

Jarisch-Herxheimer Reaction After Benzathine Penicillin G Treatment for Early Syphilis This secondary analysis of a randomized clinical trial assesses the incidence of Jarisch-Herxheimer reaction among adults with early syphilis treated with benzathine penicillin G and the factors assoc...

Jarisch-Herxheimer reaction symptoms occurred after penicillin G treatment in 23.7% participants with early syphilis. Onset of JHR was within 12 hours of treatment for 86.0% of participants, and JHR was associated with successful treatment #openaccess #idsky jamanetwork.com/journals/jam...