In this episode of Infection Control Matters, Martin Kiernan talks to Brett Mitchell about a new review of RCTs in IPC over the past two decades. The review identified 239 trials, with a striking increase in recent years—but the research is concentrated in a relatively small number of areas. We also explore a much bigger issue: what happens to new evidence once it has been published? If guidelines remain unchanged while new RCTs accumulate, are we really translating research into practice?

We discuss what is driving this growth, where the important evidence gaps remain, and whether IPC guidelines are keeping pace with the emerging evidence. Could living guidelines be part of the answer?

Paper we discuss: Mitchell BG, Matterson G, Carroll MR, Donnelly H, Marimuthu K, Tehan PE. Global randomised controlled trials in infection prevention and control: a bibliographic review from the past two decades. J Hosp Infect 2026. https://doi.org/10.1016/j.jhin.2026.03.037.

Direct download link: https://www.journalofhospitalinfection.com/action/showPdf?pii=S0195-6701%2826%2900129-5

Another paper that we mention on the effect of delays in implementation: Reagan KA, Chan DM, Vanhoozer G, Pryor RJ, Doll ME, Godbout EJ, et al. Resistors and constipators: Financial impact in an academic medical center, a mathematical model. Infect Control Hosp Epidemiol 2022;43(4):533–5. https://doi.org/10.1017/ice.2021.34.

In this episode, Brett and Martin discuss a cluster RCT from the Journal of Hospital Infection that took a very different approach. The researchers used social network analysis to identify the people operating room nurses naturally turned to for advice and support. Six of these informal influencers were then trained as peer champions—not as auditors or compliance police, but as positive role models who could encourage better practice through their existing relationships.

Over 12 months, hand hygiene compliance increased from 41.8% to 79.2% in the intervention group, compared with an increase from 42.6% to 59.3% with standard education. The study also reported improvements in knowledge and team climate.

But there is plenty to debate. Can we really attribute the reported reduction in surgical site infections to the intervention? And could we use the same idea to influence other IPC behaviours—perhaps getting the right people to model cleaning shared equipment, PPE use or other everyday safety behaviours?

Link to the paper is here: Ye L, Jia X, Zhengyuan C, Dan Y, Jinjing Z, Nana W. Social network analysis-informed peer champions for hand hygiene in the operating room: a cluster randomised controlled trial. J Hosp Infect 2026;171:113–9. https://doi.org/10.1016/j.jhin.2026.03.003

The other paper we mention is here: Seto WH, Ching TY, Yuen KY, Chu YB, Seto WL. The enhancement of infection control in-service education by ward opinion leaders. Am J Infect Control 1991;19(2):86–91. https://doi.org/10.1016/0196-6553(91)90044-d.

In this episode of Infection Control Matters, Brett and Martin talk to Professor Tom Riley about why we need to look well beyond the hospital to understand where Clostridioides difficile comes from.

Tom discusses the growing importance of C. difficile as a community-acquired infection and explains how antimicrobial use in agriculture, animals, animal faeces, food and the environment may all form part of the transmission pathway. We explore some findings from his research, including C. difficile contamination of potatoes and domestic kitchens.

We also discuss the challenges of controlling highly persistent spores in the environment, the potential role of foodborne transmission, and Tom's recent involvement with the Food and Agriculture Organization of the United Nations, where genomic evidence from an onion-associated outbreak provided compelling evidence for foodborne transmission.

From animal antibiotics and manure to potatoes, kitchen sinks and the wider environment, this conversation challenges us to rethink where C. difficile comes from—and where infection prevention needs to look next.

Perhaps the most important message? To understand C. difficile, we need to follow the faeces.

Access the UN FAO report on toxigenic Clostridia in food here: https://openknowledge.fao.org/items/cce3d2ab-e8d7-4ab2-a349-dacba4eda392