Friday, January 13, 2017

Chlorhexidine Bathing- Practical Considerations

It has been a very busy week back on the consult service so my blogging has been light.

Chlorhexidine (CHG) bathing decreases multi-drug resistant organisms acquisition and decreases hospital acquired bloodstream infection rates, particularly in ICUs.

But having a bathing policy for CHG bathing and actually implementing it with high reliability are two different matters. The other day I met with nurse leadership at my institution to underscore the need for heightened implementation of CHG bathing.

Requiring mandatory, web-based training and re-training on bathing is the next step in raising awareness.

Option to measure CHG bathing include:

  • Choosing not to assess CHG bathing: Not likely the best option
  • Performing direct patient observation of CHG bathing: not practical, privacy concerns
  • Performing skin calorimetry assessment of CHG residue post bath, as done in research protocols: not feasible
  • Requiring electronic medical record (EMR) structured documentation with audit and feedback- bingo!

It may not be sexy and it may not be the most reliable (documentation does not confirm that bathing was done accurately) but a may be a satisfactory albeit imperfect way of measuring patient CHG bathing. 

This is exactly what we will continue to do, communicating the EMR mined bathing automated reports back to unit and hospital leadership on a monthly basis. 

Not surprisingly, CHG bathing practice and documentation is improving.

Thursday, January 5, 2017

We're Gonna Need a Bigger Boat! Caftazidime-Avibactam for CRE Infections- The Jaws Analogy

I like it when a scientific paper has en element of wit and is not so dry and formulaic.

In the editorial accompanying a clinical outcomes paper assessing ceftazidime-avibactam for the treatment of patient with carbapenem-resistant Enterobacteriaceae (CRE) infection, the authors reference the film Jaws. 

When the experienced shark hunter , Chief Brody, catches his first glimpse of the massive predator shark he famously exclaims " We're gonna need a bigger boat!"

I could not agree more.

With the growing CRE problem, the modest clinical response of treating CRE infections with ceftazidime-avibactam (59% clinical success) does indeed suggest that 'we're gonna need a bigger boat' antibiotic to manage these tough cases.

Our struggle with pesky drug resistant pathogens continues.

Monday, January 2, 2017

Rest- Not Just the Opposite of Work: Protect it and Practice it Deliberately to Maximize Creativity, Productivity and Wellness

You would think that I am writing a blog about books as of late. I promise to get back to infectious diseases and infection prevention soon.

This last book really challenged and changed my way of doing things. No more simply pressing on relentlessly or toiling blindly and inefficiently through seemingly endless work tasks. Rest, by Alex Soojung-Kim Pang, explores the concept of rest as an equal to work. 

Resting is not simply sleeping in or binge watching NetFlix. Rest is an active, deliberate activity which includes recognizing and respecting times of maximal productivity (usually in 4 hour blocks) and creating time and space for alternate, restorative activities such as napping, walking, exercising, stopping work at strategic times, cultivating hobbies with purpose and taking structured breaks (sabbaticals) to pursue invigorating yet related skills and interests.

Rest maximizes awareness, increases focus, cultivates calm, organizes our lives and allows us to achieve more under less stress.


Thursday, December 29, 2016

Top Priorities in Infection Prevention- From A European Perspective

What are the top priorities in infection prevention?  

From a survey of European infection prevention experts, published here, the rank (top to bottom) includes microbial epidemiology/resistance, surveillance and decolonization/disinfection/antiseptics.  In fourth place was organizational and behavioral change.

The list would likely be similar for North America.

I personally feel that organizational and behavioral change should be at the top of the list, under the gamut of infection prevention implementation. Although infection prevention is not a perfect science, if known, data driven risk reduction strategies are implemented reliably, consistently and to scale, this would result in a massive patient safety boon.

We need to prioritize implementation of best practices, as I have previously explored

Anything less will fall short of our patient safety goals.

Wednesday, December 28, 2016

At the Existentialist Cafe

Although I am at work this holiday week, the clinic and administrative schedules are relatively light. I have been delving into books with enthusiasm (and with time to spare).

At the Existentialist Cafe by Susan Bakewell is no boring read on the history and characters of existentialism, in fact, it reads like a novel.

Thank you Jean-Paul Sarte for reminding us that existence and 'being' comes with options, that our day to day tasks need not be pre-ordained, overly encumbered and rigid.

Food for thought.

Good read. 

Monday, December 26, 2016

Fall / Winter 2016 Medical Literary Messenger Published!

I am exceedingly proud to announce that we have just published the Fall/Winter 2016 edition of the Medical Literary Messenger (MLM).

The project website is : MLM can be downloaded in PDF or e-book format via the website. The PDF can be found here.

As always, thank you to my Associate Editors, Dr. Megan Lemay, Dr. Michael Stevens, Patricia Dodson and Celeste Lipkes. Additional heartfelt thanks to Brie Dubinsky (Managing Editor/Web Designer) and Rachel Van Hart (Design and Copy Editor), without them this project would come to a grinding halt. I also owe a huge debt of gratitude to all of the reviewers. Last, It goes without saying that without the contributors, the MLM would simply not exist.

Happy Holidays.

Wednesday, December 21, 2016

Cell Phone Text Message Reminders for Enhanced Hand Hygiene Performance

It is a well known fact that hand hygiene practice in the hospital is nearly always suboptimal.The literature on hand hygiene is replete with strategies to improve practice.

In this article published in American Journal of Infection Control, a hand hygiene reminder with either a congratulatory message or an encouragement message (for those with less than optimal hand hygiene compliance) was sent once weekly to staff in a 15 room infectious diseases ward in a French hospital.The unit employed an RFID automated hand hygiene monitoring system. Hand hygiene rose from a baseline of 15% to 23% following the alert notification.  

In my opinion the hand hygiene adherence pre/post intervention is concerning and low, especially in an infectious diseases ward! This was possibly secondary to poor capture from the RFID automated adherence technology.  What I found most interesting was the acceptability of the once weekly text message reminders by the frontline healthcare workers. There was little to no alert fatigue reported! This is promising.

If we can deploy a hand hygiene technology that accurately captures hand hygiene compliance (foam in/foam out), is coupled to targets with feedback and accountability, and, if that feedback can be automated (via text message once weekly) and tied to performance and encouragement, we may be on to a game changing strategy.

The quest for optimal hand hygiene enhancement continues...