CDC HAI Progress Report, Nuance and Infection Prevention Diminishing Returns

Source: University of Greenwich

I am back in my native Argentina enjoying family, food, culture and futbol. 

I am always partly disappointed when I read the CDC Current HAI Progress Report. 

On one level, these reports are potent reminders that we can always do better in our infection prevention efforts. However, important nuance, in my opinion, is missing.

The extent to which hospital acquired infections can be truly prevented with current science is explored here by us. Not all HAIs are preventable. I would argue that some infection prevention reductions, such as the 13% reduction in C. difficile infections as reported by the CDC are largely due to diagnostic stewardship strategies (reducing false positive results) rather than actually preventing infections.

I seek a performance summary of how we are faring in our efforts to reduce all potentially preventable infections  and how effectively we are implementing evidence based strategies (hand hygiene, checklists, chlorhexidine patient bathing etc). That would be telling.

Last, and this may be unpopular with some, the more we reduce potentially preventable infections, the remaining opportunities for improvement decrease, thus resulting in an infection prevention diminishing returns. 

Challenging.

For a change of pace later in the week I will be attending the VIII Congreso Internacional de la LenguaEspañola en Córdoba.

To Decolonize or Not?

Lab ID MRSA surveillance infections remain a vexing problem. The majority of these infections are from a patient's own endogenous flora.  

How can we best tackle this issue?

All infection prevention starts with the robust horizontal infection control strategy.  Hand hygiene is also critically important.  At my institution we are now starting the deployment of 5000 hand hygiene sensor badges for inpatient care, to increase reliability with foam in/foam out hand hygiene practice.  

The extent to which contact precautions prevents endemic MRSA transmission remains highly debatable, as explored here. Contact precautions may not be the way to go to reduce Lab ID MRSA infections.

Universal staphylococcal decolonization (intranasal mupirocin+CHG bathing) in ICU settings reduces clinical isolates and bloodstream infections from all pathogens, as reported here.  The same is not true (no clinical benefit) in non ICU settings as recently published in Lancet.

To reduce Lab ID MRSA infections and other hospital-acquired infections it is now time to seriously consider universal decolonization in ICU populations as part of a robust horizontal infection control program.

Heal: Mind Body Medicine and the Need for a Supportive Research Model

The busy clinic and the infectious diseases consult service have conspired to effectively keep me away from my blog the last 2 weeks. I am back yet blogging out of my infectious diseases comfort zone.

It is true, modern medicine is not generally focused on wellness.

The film Heal, on mind body medicine, is intriguing. The trailer is above.  Many of the narratives contained therein are powerful.  I certainly cannot imagine any significant harm from meditation, mindfulness and healthy diets. In fact, I try to practice all of this daily.

Critically lacking is a substantive research model to support mind body medicine as either alternatives or important complements to allopathic medicine, particularly for chronic illness. High quality evidence would possibly impact adoption and promotion of wellness activities.

If wellness is the goal, and mind body medicine is the principal driver, this would most likely impact health via prevention. Diminished stress, better diets, lower cholesterol and  decreasing obesity would decrease chronic illnesses such as diabetes, heart disease and arthritis.

That would be huge.

The film is worth watching.

Choosing Wisely and Contact Precautions: Society of Hospital Medicine Online Journal Club and Twitter Chat

For those you with interest in the Choosing Wisely campaign and the topic of contact precautions,  there will be an online journal club tonight and twitter feed on this topic (March 11, 2019- 9PM EST: Journal of Hospital Medicine (#JHMChat)

The  paper to be discussed is Things We Do for no Reason: Contact Precautions for MRSA and VRE. Our work is referenced in the paper.

I realize that this topic may not be popular with some in the  infection prevention community.

Your feedback is welcomed.

Hot of the Press: Infection Control Bundles in Intensive Care Units in Low and Middle Income Countries

The Journal of Hospital Infection recently published this article on infection control bundle implementation in low and middle income countries (LMICs).A key take home message is that LMICs need to developed their own evidence based bundles with low cost for maximal implementation. This can be done and was reported by the International Nosocomial Infection Control Consortium (INICC) here.

The ISID Guide to Infection Prevention in the Healthcare Setting also focuses on specific guidance in LMICs, free and open access to all.

In collaboration with authors from around the world, and at the request of the International Journal of Infectious Diseases, select position papers will go to press this year on topics such as preventing central line associated bloodstream infections and improving hand hygiene. These papers will focus on implementation in LMICs. I am proud to be involved in this project.

Stay tuned.

Nikolai Tesla: The Unsung Champion of Public Health

Nearly everyone knows of public health heroes such as John Snow and Edward Jenner but the  book Deadliest Enemy: Our War Against Killer Germs by Michael Osterholm and Mark Olshaker put inventor Nikolai Tesla into a new perspective for me.

Tesla was an engineer associated with the alternating-current electricity supply and its wide-use application.  Electricity brought about massive improvements in public health and infectious diseases control.  Electricity powered water pumps allowing for effective sewage systems.  Electricity also resulted in refrigeration, pasteurization, vaccine production and air conditioning (which keeps mosquitoes and other vectors out of homes). 

Not bad.

Tesla, the unsung champion of public health.

Antimicrobial Never Events! It is Time to Draw a Line in the Sand

Source:giphy.com

I  admire those who make bold, truthful statements.

This article in Infection Control and Hospital Epidemiology caught my attention. It is time for us to define and demand never events for inappropriate antibiotic use.

Antibiotic never events include antibiotic use for a non-susceptible organism,  antibiotic use for upper viral respiratory infections and antibiotic use for asymptomatic bacteriuria.

If we fancy ourselves proper stewards of antibiotic use, it is time that we draw a line in the sand.