Publications by authors named "Tom S J Elliott"

18 Publications

  • Page 1 of 1

A clinical evaluation of two central venous catheter stabilization systems.

Ann Intensive Care 2019 Apr 17;9(1):49. Epub 2019 Apr 17.

Corporate Division, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.

Background: Central venous catheters (CVCs) are commonly secured with sutures which are associated with microbial colonization and infection. We report a comparison of a suture-free system with standard sutures for securing short-term CVC in an international multicentre, prospective, randomized, non-blinded, observational feasibility study. Consented critical care patients who had a CVC inserted as part of their clinical management were randomized to receive either sutures or the suture-free system to secure their CVC. The main outcome measures were CVC migration (daily measurement of catheter movement) and unplanned catheter removals.

Results: The per cent of unplanned CVC removal in the two study groups was 2% (suture group 2 out of 86 patients) and 6% (suture-free group 5 out of 85 patients). Both securement methods were well tolerated in terms of skin irritation. The time and ease of application and removal of either securement systems were not rated significantly different. There was also no significant difference in CVC migration between the two securement systems in exploratory univariate and multivariate analyses. Overall, 42% (36 out of 86) of the CVC secured with sutures and 56% (48 out of 85) of the CVC secured with the suture-free securement system had CVC migration of ≥ 2 mm.

Conclusions: The two securement systems performed similarly in terms of CVC migration and unplanned removal of CVC; however, the feasibility study was not powered to detect statistically significant differences in these two parameters.

Trial Registration: ISRCTN, ISRCTN13939744. Registered 9 July 2015, http://www.isrctn.com/ISRCTN13939744 .
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http://dx.doi.org/10.1186/s13613-019-0519-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470223PMC
April 2019

An in vitro comparison of standard cleaning to a continuous passive disinfection cap for the decontamination of needle-free connectors.

Antimicrob Resist Infect Control 2018 5;7:50. Epub 2018 Apr 5.

University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK.

Background: The optimal decontamination method for needle-free connectors is still unresolved. The objective of this study was to determine if a continuous passive disinfection cap is as effective as standard cleaning for the microbial decontamination of injection ports of two types of needle-free connectors.

Methods: The injection ports of needle-free connectors were inoculated with and allowed to dry. Disinfection caps containing 70% (/) isopropyl alcohol (IPA) were attached to the connectors for one, three or 7 days and were compared with needle-free connectors cleaned with 2% (/) chlorhexidine gluconate (CHG) in 70% () IPA. The number of remaining on the injection ports was evaluated. Median log reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test.

Results: The application of the disinfection cap resulted in a significantly higher reduction in than the 2% (/) CHG in 70% (/) IPA wipe, achieving a > 5 Log reduction in CFU at each time point.

Conclusions: The disinfection caps resulted in a significantly higher reduction in on the injection ports when compared to the use of a 2% () CHG in 70% () IPA wipe. This offers an explanation for the lower rates of central-line associated bloodstream infection (CLABSI) associated with the use of disinfection caps reported in clinical studies.
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http://dx.doi.org/10.1186/s13756-018-0342-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887218PMC
July 2019

Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy.

J Antimicrob Chemother 2012 Feb 14;67(2):269-89. Epub 2011 Nov 14.

Department of Microbiology, Freeman Hospital, Newcastle upon Tyne, UK.

The BSAC guidelines on treatment of infectious endocarditis (IE) were last published in 2004. The guidelines presented here have been updated and extended to reflect developments in diagnostics, new trial data and the availability of new antibiotics. The aim of these guidelines, which cover both native valve and prosthetic valve endocarditis, is to standardize the initial investigation and treatment of IE. An extensive review of the literature using a number of different search criteria has been carried out and cited publications used to support any changes we have made to the existing guidelines. Publications referring to in vitro or animal models have only been cited if appropriate clinical data are not available. Randomized, controlled trials suitable for the development of evidenced-based guidelines in this area are still lacking and therefore a consensus approach has again been adopted for most recommendations; however, we have attempted to grade the evidence, where possible. The guidelines have also been extended by the inclusion of sections on clinical diagnosis, echocardiography and surgery.
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http://dx.doi.org/10.1093/jac/dkr450DOI Listing
February 2012

A comparative study to evaluate surface microbial contamination associated with copper-containing and stainless steel pens used by nurses in the critical care unit.

Am J Infect Control 2011 Oct 12;39(8):e52-e54. Epub 2011 Jun 12.

University Hospitals Birmingham, National Health Service Foundation Trust, The Queen Elizabeth Hospital,. Electronic address:

A clinical study was undertaken to compare the surface microbial contamination associated with pens constructed of either a copper alloy or stainless steel used by nurses on intensive care units. A significantly lower level of microbial contamination was found on the copper alloy pens.
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http://dx.doi.org/10.1016/j.ajic.2010.12.012DOI Listing
October 2011

Antimicrobial activity of a chlorhexidine intravascular catheter site gel dressing.

J Antimicrob Chemother 2011 Aug 24;66(8):1777-84. Epub 2011 May 24.

Department of Clinical Microbiology and Infection Control, University Hospitals Birmingham NHS Foundation Trust, UK.

Objectives: The antimicrobial efficacy of a chlorhexidine gluconate (CHG) intravascular catheter gel dressing was evaluated against methicillin-resistant Staphylococcus aureus (MRSA) and an extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. Chlorhexidine deposition on the skin surface and release from the gel were determined.

Methods: The antimicrobial efficacy was evaluated in in vitro studies following microbial inoculation of the dressing and application of the dressing on the inoculated surface of a silicone membrane and donor skin [with and without a catheter segment and/or 10% (v/v) serum] on diffusion cells. Antimicrobial activity was evaluated for up to 7 days. Chlorhexidine skin surface deposition and release were also determined.

Results: MRSA and E. coli were not detectable within 5 min following direct inoculation onto the CHG gel dressing. On the silicone membrane, 3 log and 6 log inocula of MRSA were eradicated within 5 min and 1 h, respectively. Time to kill was prolonged in the presence of serum and a catheter segment. Following inoculation of donor skin with 6 log cfu of MRSA, none was detected after 24 h. Chlorhexidine was released from the gel after a lag time of 30 min and increasing amounts were detected on the donor skin surface over the 48 h test period. The CHG gel dressing retained its antimicrobial activity on the artificial skin for 7 days.

Conclusions: The CHG intravascular catheter site gel dressing had detectable antimicrobial activity for up to 7 days, which should suppress bacterial growth on the skin at the catheter insertion site, thereby reducing the risk of infection.
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http://dx.doi.org/10.1093/jac/dkr191DOI Listing
August 2011

Enhanced chlorhexidine skin penetration with eucalyptus oil.

BMC Infect Dis 2010 Sep 22;10:278. Epub 2010 Sep 22.

Life & Health Sciences, Aston University, Aston Triangle, Birmingham, UK.

Background: Chlorhexidine digluconate (CHG) is a widely used skin antiseptic, however it poorly penetrates the skin, limiting its efficacy against microorganisms residing beneath the surface layers of skin. The aim of the current study was to improve the delivery of chlorhexidine digluconate (CHG) when used as a skin antiseptic.

Method: Chlorhexidine was applied to the surface of donor skin and its penetration and retention under different conditions was evaluated. Skin penetration studies were performed on full-thickness donor human skin using a Franz diffusion cell system. Skin was exposed to 2% (w/v) CHG in various concentrations of eucalyptus oil (EO) and 70% (v/v) isopropyl alcohol (IPA). The concentration of CHG (μg/mg of skin) was determined to a skin depth of 1500 μm by high performance liquid chromatography (HPLC).

Results: The 2% (w/v) CHG penetration into the lower layers of skin was significantly enhanced in the presence of EO. Ten percent (v/v) EO in combination with 2% (w/v) CHG in 70% (v/v) IPA significantly increased the amount of CHG which penetrated into the skin within 2 min.

Conclusion: The delivery of CHG into the epidermis and dermis can be enhanced by combination with EO, which in turn may improve biocide contact with additional microorganisms present in the skin, thereby enhancing antisepsis.
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http://dx.doi.org/10.1186/1471-2334-10-278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955684PMC
September 2010

Prevention of central venous catheter-related infection: update.

Br J Nurs 2010 Jan 28-Feb 10;19(2):78, 80, 82 passim

Department of Clinical Microbiology and Infection Control, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital, Edgbaston, Birmingham.

Central venous catheters (CVCs) are an essential part of modern-day healthcare, but infections associated with these devices continue to cause significant morbidity and mortality. There are many approaches for the prevention of CVC-related infection and these are outlined in national guidelines. The Department of Health Saving Lives campaign has developed a care-bundle for the prevention of CVC-related infections that focuses on the fundamental actions to be undertaken during the catheter insertion process and ongoing care. If the rate of catheter-related infection remains high despite the implementation of these infection prevention strategies, the use of novel antimicrobial technologies and practices may be considered. These include CVCs that contain antimicrobial agents, such as antiseptics or antibiotics, needleless intravenous (IV) access devices coated with silver and/or chlorhexidine, IV dressings incorporating chlorhexidine, and the use of antimicrobial catheter lock solutions, such as antibiotics, chelators or ethanol. This article outlines the different types of CVCs available, the risk of infection associated with their use and established and novel measures for prevention of these infections.
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http://dx.doi.org/10.12968/bjon.2010.19.2.46289DOI Listing
May 2010

Progress in the prevention of surgical site infection.

Curr Opin Infect Dis 2009 Aug;22(4):370-5

University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.

Purpose Of Review: The present review summarizes some of the key papers on the prevention of surgical site infections (SSI) published in 2008.

Recent Findings: The National Institute for Health and Clinical Excellence published guidelines on the prevention and management of SSI. These guidelines follow a similar format to those published previously. There are, however, some important differences to previous recommendations and these are outlined in this current article. Other publications have provided additional evidence that suggests certain antiseptic agents are more efficacious than others for surgical hand antisepsis. Staphylococcus aureus decolonization has also been studied and noted to be of benefit for the prevention of SSI. Other research studies have focused on patient homeostasis, including the use of supplemental perioperative oxygen, which has resulted in mixed findings. Finally, the use of surveillance to evaluate the efficacy of 'care bundles' has been reported, which brings together many different approaches for the prevention of SSI.

Summary: Several evaluations of pre, peri and postoperative strategies for the prevention of SSI have been published in 2008, some of which have raised some fundamental questions.
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http://dx.doi.org/10.1097/QCO.0b013e32832c4048DOI Listing
August 2009

Antimicrobial central venous catheters in adults: a systematic review and meta-analysis.

Lancet Infect Dis 2008 Dec;8(12):763-76

Department of Clinical Microbiology and Infection Control, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.

Several antimicrobial central venous catheters (CVCs) are available. We did a meta-analysis to assess their efficacy in reducing microbial colonisation and preventing catheter-related bloodstream infection (CRBSI). An extensive literature search of articles in any language was undertaken. We assessed randomised clinical trials in which available antimicrobial CVCs were compared with either a standard CVC or another antimicrobial CVC. Outcomes assessed were microbial colonisation of CVCs and CRBSI. The first-generation chlorhexidine-silver sulfadiazine (CSS) CVCs reduce colonisation (odds ratio [OR] 0.51 [95% CI 0.42-0.61]) and CRBSI (OR 0.68 [0.47-0.98]), as do the minocycline-rifampicin CVCs (OR 0.39 [0.27-0.55] and OR 0.29 [0.16-0.52], respectively). The minocycline-rifampicin CVCs outperformed the first-generation CSS CVCs in reducing colonisation (OR 0.34 [0.23-0.49]) and CRBSI (OR 0.18 [0.07-0.51]). Many shortcomings in methodological quality limit our interpretation of the study results. However, the available evidence suggests that use of CSS and minocycline-rifampicin CVCs are useful if the incidence of CRBSI is above institutional goals despite full implementation of infection prevention interventions.
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http://dx.doi.org/10.1016/S1473-3099(08)70280-9DOI Listing
December 2008

Infection risks associated with needleless intravenous access devices.

Nurs Stand 2007 Nov;22(11):38-44

Department of Clinical Microbiology, University Hospital Birmingham NHS Foundation Trust, Birmingham.

Needleless intravenous (i.v.) access devices were initially introduced into clinical practice to reduce the rate of i.v. catheter-related needlestick injuries. Their efficacy for this purpose has been confirmed in subsequent reports. However, since their introduction approximately 15 years ago there have been conflicting reports about the risk of i.v. catheter-related bloodstream infection. This article reviews the risk of catheter-related bloodstream infection associated with needleless i.v. access devices and outlines the types of needleless i.v. access devices available.
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http://dx.doi.org/10.7748/ns2007.11.22.11.38.c6240DOI Listing
November 2007

Needlestick injuries: is it time for a new approach?

Br J Nurs 2007 Mar 22-Apr 11;16(6):334

Microbiology Research and Developmental Group, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital.

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http://dx.doi.org/10.12968/bjon.2007.16.6.23001DOI Listing
July 2007

Evaluation of routine microbiological techniques for establishing the diagnosis of catheter-related bloodstream infection caused by coagulase-negative staphylococci.

J Med Microbiol 2007 Feb;56(Pt 2):172-176

Department of Clinical Microbiology and Infection Control, University Hospital Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.

Microbiological diagnosis of catheter-related bloodstream infection (CR-BSI) is often based on isolation of indistinguishable micro-organisms from an explanted catheter tip and blood culture, confirmed by antibiograms. Whether phenotypic identification of coagulase-negative staphylococci (CoNS) allows an accurate diagnosis of CR-BSI to be established was evaluated. Eight patients with a diagnosis of CR-BSI had CoNS isolated from pure blood cultures and explanted catheter tips which were considered as indistinguishable strains by routine microbiological methods. For each patient, an additional three colonies of CoNS isolated from the blood and five from the catheter tip were subcultured and further characterized by antibiogram profiles, analytical profile index (API) biotyping and PFGE. PFGE distinguished more strains of CoNS compared to API biotyping or antibiograms (17, 10 and 11, respectively). By PFGE, indistinguishable micro-organisms were only isolated from pure blood and catheter tip cultures in four out of eight (50%) patients thus supporting the diagnosis of CR-BSI. In another patient, indistinguishable micro-organisms were identified in both cultures; however, other strains of CoNS were also present. The remaining three patients had multiple strains of CoNS, none of which were indistinguishable in the tip and blood cultures, thus questioning the diagnosis of CR-BSI. Phenotypic characterization of CoNS lacked discriminatory power. Current routine methods of characterizing a limited number of pooled colonies may generate misleading results as multiple strains may be present in the cultures. Multiple colonies should be studied using a rapid genotypic characterization method to confirm or refute the diagnosis of CR-BSI.
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http://dx.doi.org/10.1099/jmm.0.46568-0DOI Listing
February 2007

Diagnosis of central venous catheter related infection in adult patients.

J Infect 2005 Nov 19;51(4):267-80. Epub 2005 Aug 19.

Department of Pharmaceutical and Biological Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK.

Intravascular catheters are one of the main causes of bacteraemia and septicaemia in hospitalised patients and continue to be associated with a significant morbidity and mortality. Two main types of infections occur, they can be either localised at the catheter insertion site of systemic with a septicaemia. The clinical parameters related to these infections are presented. The laboratory diagnosis of these infections is also extensively reviewed and recommendations are made as to the most appropriate diagnostic method to be used.
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http://dx.doi.org/10.1016/j.jinf.2005.06.007DOI Listing
November 2005

Description and critical appraisal of principal components analysis (PCA) methodology applied to pulsed-field gel electrophoresis profiles of methicillin-resistant Staphylococcus aureus isolates.

J Microbiol Methods 2006 Apr 1;65(1):87-95. Epub 2005 Aug 1.

Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.

Principal components analysis (PCA) has been described for over 50 years; however, it is rarely applied to the analysis of epidemiological data. In this study PCA was critically appraised in its ability to reveal relationships between pulsed-field gel electrophoresis (PFGE) profiles of methicillin-resistant Staphylococcus aureus (MRSA) in comparison to the more commonly employed cluster analysis and representation by dendrograms. The PFGE type following SmaI chromosomal digest was determined for 44 multidrug-resistant hospital-acquired methicillin-resistant S. aureus (MR-HA-MRSA) isolates, two multidrug-resistant community-acquired MRSA (MR-CA-MRSA), 50 hospital-acquired MRSA (HA-MRSA) isolates (from the University Hospital Birmingham, NHS Trust, UK) and 34 community-acquired MRSA (CA-MRSA) isolates (from general practitioners in Birmingham, UK). Strain relatedness was determined using Dice band-matching with UPGMA clustering and PCA. The results indicated that PCA revealed relationships between MRSA strains, which were more strongly correlated with known epidemiology, most likely because, unlike cluster analysis, PCA does not have the constraint of generating a hierarchic classification. In addition, PCA provides the opportunity for further analysis to identify key polymorphic bands within complex genotypic profiles, which is not always possible with dendrograms. Here we provide a detailed description of a PCA method for the analysis of PFGE profiles to complement further the epidemiological study of infectious disease.
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http://dx.doi.org/10.1016/j.mimet.2005.06.017DOI Listing
April 2006

Staphylococcus aureus endocarditis: a consequence of medical progress.

JAMA 2005 Jun;293(24):3012-21

Duke University Medical Center, Durham, NC 27710, USA.

Context: The global significance of infective endocarditis (IE) caused by Staphylococcus aureus is unknown.

Objectives: To document the international emergence of health care-associated S aureus IE and methicillin-resistant S aureus (MRSA) IE and to evaluate regional variation in patients with S aureus IE.

Design, Setting, And Participants: Prospective observational cohort study set in 39 medical centers in 16 countries. Participants were a population of 1779 patients with definite IE as defined by Duke criteria who were enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study from June 2000 to December 2003.

Main Outcome Measure: In-hospital mortality.

Results: S aureus was the most common pathogen among the 1779 cases of definite IE in the International Collaboration on Endocarditis Prospective-Cohort Study (558 patients, 31.4%). Health care-associated infection was the most common form of S aureus IE (218 patients, 39.1%), accounting for 25.9% (Australia/New Zealand) to 54.2% (Brazil) of cases. Most patients with health care-associated S aureus IE (131 patients, 60.1%) acquired the infection outside of the hospital. MRSA IE was more common in the United States (37.2%) and Brazil (37.5%) than in Europe/Middle East (23.7%) and Australia/New Zealand (15.5%, P<.001). Persistent bacteremia was independently associated with MRSA IE (odds ratio, 6.2; 95% confidence interval, 2.9-13.2). Patients in the United States were most likely to be hemodialysis dependent, to have diabetes, to have a presumed intravascular device source, to receive vancomycin, to be infected with MRSA, and to have persistent bacteremia (P<.001 for all comparisons).

Conclusions: S aureus is the leading cause of IE in many regions of the world. Characteristics of patients with S aureus IE vary significantly by region. Further studies are required to determine the causes of regional variation.
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http://dx.doi.org/10.1001/jama.293.24.3012DOI Listing
June 2005

Molecular analysis of methicillin-resistant Staphylococcus aureus reveals an absence of plasmid DNA in multidrug-resistant isolates.

FEMS Immunol Med Microbiol 2005 Jun;44(3):297-302

Department of Molecular Biosciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK.

The number, diversity and restriction enzyme fragmentation patterns of plasmids harboured by 44 multidrug-resistant hospital-acquired methicillin-resistant Staphylococcus aureus (MR-HA-MRSA) isolates, two multidrug-resistant community-acquired MRSA (MR-CA-MRSA), 50 hospital-acquired MRSA (HA-MRSA) isolates (from the University Hospital Birmingham, NHS Trust, UK) and 34 community-acquired MRSA (CA-MRSA) isolates (from general practitioners in Birmingham, UK) were compared. In addition, pulsed-field gel electrophoresis (PFGE) type following SmaI chromosomal digest and SCCmec element type assignment were ascertained for each isolate. All MR-HA-MRSA and MR-CA-MRSA isolates possessed the type II SCCmec, harboured no plasmid DNA and belonged to one of five PFGE types. Forty-three out of 50 HA-MRSA isolates and all 34 CA-MRSA isolates possessed the type IV SCCmec and all but 10 of the type IV HA-MRSA isolates and nine CA-MRSA isolates carried one or two plasmids. The 19 non-multidrug-resistant isolates (NMR) that did not harbour plasmids were only resistant to methicillin whereas all the NMR isolates harbouring at least one plasmid were resistant to at least one additional antibiotic. We conclude that although plasmid carriage plays an important role in antibiotic resistance, especially in NMR-HA-MRSA and CA-MRSA, the multidrug resistance phenotype from HA-MRSA is not associated with increased plasmid carriage and indeed is characterised by an absence of plasmid DNA.
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http://dx.doi.org/10.1016/j.femsim.2004.12.014DOI Listing
June 2005

Analysis of clinical isolates of Propionibacterium acnes by optimised RAPD.

FEMS Microbiol Lett 2003 Nov;228(1):51-5

Microbiology Research, Life and Health Sciences, Aston University, Birmingham B4 7ET, UK.

Random amplification of polymorphic DNA (RAPD) was evaluated as a genotypic method for typing clinical strains of Propionibacterium acnes. RAPD can suffer from problems of reproducibility if parameters are not standardised. In this study the reaction conditions were optimised by adjusting template DNA concentration and buffer constituents. All isolates were typeable using the optimised RAPD protocol which was found to be highly discriminatory (Simpson's diversity index, 0.98) and reproducible. Typing of P. acnes by optimised RAPD is an invaluable tool for the epidemiological investigation of P. acnes for which no other widely accepted method currently exists.
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http://dx.doi.org/10.1016/S0378-1097(03)00720-1DOI Listing
November 2003