On 29 January, the Scottish Urinary Tract Network (SUTIN) launched a hard copy version of the National Catheter Passport (NCP) which will make it even easier to access.

The primary functions of the document are as:

• an education tool for the person who has a urinary catheter 
• a communication tool for health and social care staff around the person’s catheter, why they have it, when it was inserted and future plans such as trial without catheter

The NCP is a person-held document which aims to help provide seamless care for anyone who needs to use a urinary catheter as they move through the various pathways of health and social care. It also encourages self-management of their device in a way which will reduce the risk of complications such as catheter-related urinary tract infections (CAUTI). The NCP will now be available to healthcare staff whenever they order their supply of catheters. The inside front cover of the NCP is completed by the healthcare worker who issues it to the patient, along with essential contact details. Where the catheter is later removed, the passport is returned and reconciled with either the acute care or community notes (for residents care homes, this may then be retained within their care notes). 

The NCP has been developed and tested by stakeholders from various health and social care settings across Scotland. While it is aimed at improving care and communication in the use of urinary catheters, the NCP does not promote their use, but rather their prudent use and prompting early removal and trial without catheter.

SUTIN welcomes any comments or enquiries via email.

Across Europe, Listeria cases have increased among two groups of the population, people over 75 and women aged 25-44 (believed to be mainly pregnancy-related). This is one of the main conclusions of an European Food Safety Authority (EFSA) scientific opinion on Listeria monocytogenes and risks to public health from consumption of contaminated ready-to-eat food. The opinion covers the period 2008-2015.

Experts began work on the scientific opinion after the 2015 EU summary report on foodborne zoonotic diseases identified an increasing trend of listeriosis over the period 2009-2013.

EFSA experts concluded that the higher incidence of listeriosis among the elderly was likely to be linked to the increased proportion of people aged over 45 with underlying health conditions, such as cancer and diabetes. The rise in consumption of ready-to-eat foods and an improved monitoring system in some member states might also have contributed to this trend.

Most people get infected through the consumption of ready-to-eat foods such as smoked and cured fish, heat treated meat and soft and semi-soft cheese. However, other foods, such as prepared salads, can also lead to infections.

Experts estimated that one third of cases of listeriosis are due to growth of Listeria monocytogenes in food prepared and stored at home in the refrigerator. This highlights the importance of following good hygiene practices, such as respecting recommended storage temperatures and times. International organisations such as the World Health Organization (WHO) advise that foods should be refrigerated below 5°C.

Source: EFSA News Release, 24 January 2018

The current issue of the Communicable disease threats report notes that, since 1 January 2017 and as of 25 January 2018, 820 laboratory-confirmed listeriosis cases have been reported in South Africa, with a particular increase notable from May 2017 onwards.

Most cases have been reported from Gauteng Province (59%, 486/820) followed by Western Cape (13%, 105/820) and KwaZuluNatal (7%, 59/820) provinces. Cases have been diagnosed in both public (66%, 542/820) and private (34%, 278/820) healthcare sectors. Where ages were reported (n=784), they ranged from birth to 93 years (median 18 years) and 42% (329/784) were neonates aged <=28 days. Of neonatal cases, 96% (317/329) had early-onset disease (birth to <= 6 days). Females account for 55% (431/783) of cases where gender is reported. Final outcome data is available for 29% (238/820) of cases, of which 34% (82/238) died.

Listeriosis can be a serious bacterial infection acquired via ingestion of contaminated food. The infection is primarily affecting pregnant women, neonates, elderly and immunocompromised people. In pregnant women, the infection can cause premature labour and stillbirth, and neonatal meningitis in a new-born. Milder forms of the disease result in gastroenteritis, which however can lead to a severe infection in those with a weakened immune system.

Prior to the current outbreak in South Africa, the first documented outbreaks occurred in 1977 (14 cases) and 2015 (seven cases), and since then only sporadic cases have been detected throughout the country. Since October 2017, an increase in the number of neonatal cases was observed. This increase and the associated deaths are of concern, as South Africa’s population also has high prevalence of HIV infection. In addition, poorly regulated street food vendors are common across South Africa. Many people lack access to electricity and thus refrigeration.

Based on whole genome sequencing (WGS) analysis, no associated cases were reported in EU/EEA countries. The risk of spread to Europe is considered to be very low. Travellers with immune disorders, severe chronic illnesses, pregnant women and older adults should nonetheless consult their doctors or seek advice from a travel clinic, particularly with regard to effective prevention measures, before travelling.

Source: Communicable disease threats report, 26 January 2018

Further information and advice for clinicians advising travellers can be accessed on the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.

On 24 January 2018, Glasgow City Health and Social Care Partnership (HSCP) confirmed that it was pressing ahead with plans to deliver a Heroin Assisted Treatment (HAT) facility in the city centre. This work continues while the HSCP maintains a dialogue with the Scottish Government on how best to progress a Safer Drug Consumption Facility (SCDF) in the city in order to tackle the ongoing HIV outbreak affecting people who inject drugs in public.

No legal exemption is required to provide a HAT programme which can legally be delivered within the framework of existing Medicines legislation. Correspondence received from the Lord Advocate further clarifies that a HAT facility could also operate a needle exchange scheme within the bounds of existing prosecution policy.

There is well-established international evidence of the cost-effectiveness of HAT for chronic Heroin user who have not benefited from other interventions. It is the next treatment progression for people for whom current treatments have been ineffective, and who continue to use street drugs, with all the risks that entails including injecting-related infections and overdose. 

The programme is a highly specialised clinical intervention in which diamorphine is prescribed for the treatment of heroin addiction. It can only be undertaken by doctors with a licence allowing them to prescribe the medication.

Source: NHS Greater Glasgow and Clyde News Release, 24 January 2018

On 29 January 2018, The World Health Organization (WHO) published its first release of surveillance data on antibiotic resistance which demonstrates high levels of resistance to a number of serious bacterial infections in both high- and low-income countries.

WHO’s new Global Antimicrobial Surveillance System (GLASS) reveals widespread occurrence of antibiotic resistance among 500 000 people with suspected bacterial infections across 22 countries. 

The most commonly reported resistant bacteria were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae, followed by Salmonella spp. The system does not include data on resistance of Mycobacterium tuberculosis, which causes tuberculosis (TB), as WHO has been tracking it since 1994 and providing annual updates in the global tuberculosis report. 

Among patients with suspected bloodstream infection, the proportion with bacteria resistant to at least one of the most commonly used antibiotics ranged dramatically between different countries, from zero to 82%. Resistance to penicillin, the medicine used for decades worldwide to treat pneumonia, ranged from zero to 51% among reporting countries, while between 8% to 65% of E. coli associated with urinary tract infections presented resistance to ciprofloxacin, an antibiotic commonly used to treat this condition.

Data presented in this first GLASS report vary widely in quality and completeness. Some countries face major challenges in building their national surveillance systems, including a lack of personnel, funds and infrastructure. However, WHO is supporting more countries to set up national antimicrobial resistance surveillance systems that can produce reliable, meaningful data. GLASS is helping to standardize the way that countries collect data and enable a more complete picture about antimicrobial resistance patterns and trends.

Source: WHO News Release, 29 January 2018

The Food Standards Agency (FSA) has taken action to stop any product from leaving sites operated by Russell Hume because of concerns about non-compliance with food hygiene regulations. These concerns were uncovered as the result of an unannounced audit at one site which then led to a wider investigation in the following days across all their plants and also into products held in cold stores.

Based on the evidence gathered, the FSA became concerned that there was a more systemic and widespread problem which was more serious in terms of its scale and nature. It was only at this stage that issues of serious non-compliance were uncovered. These related to a number of issues including concerns about procedures and processes around ‘use by’ dates. There is no indication that people have become ill from eating meat supplied by Russell Hume.

The FSA investigation is taking a proportionate approach based on the findings, and is working in partnership with Food Standards Scotland (FSS) to do this.

As a result of these further investigations which highlighted the serious issues of non-compliance, Russell Hume has been required to stop all production at the plants and detain all products. The agencies then worked with the company to initiate a voluntary recall of all affected products. Until the business can provide assurances that they are complying with the relevant legislation and that they are producing safe food, no meat can leave their sites.

Source: FSA News Release, 26 January 2018 

The FSS have also released a statement on this subject.

After assessing the safety of hydroxyanthracene derivatives when added to food, the European Food Safety Authority (EFSA) has concluded that they can damage DNA and may cause cancer.

This group of substances naturally occurs in plants such as aloe or senna species. Extracts containing them are used in food supplements for their laxative effect.

In 2013, EFSA found that hydroxyanthracene derivatives in food could improve bowel function, but advised against long-term use and consumption at high doses due to potential safety concerns. The European Commission subsequently asked EFSA to assess the safety of these plant ingredients when used in foods, and to provide advice on a daily intake not associated with adverse health effects.

Based on the available data, EFSA concluded that certain hydroxyanthracene derivatives are genotoxic (they can damage DNA). It was not possible therefore to set a safe daily intake. When tested in animal studies, some of these substances have been shown to cause cancer in the intestine.

These conclusions are in line with previous assessments on the botanical sources of these substances by other European and international bodies, including the World Health Organization (WHO), the European Medicines Agency and, most recently, Germany’s Federal Institute for Risk Assessment.

Source: EFSA News Release, 23 January 2018