Tuesday, April 7, 2015

Telemedicine and Infectious Diseases

The Virtual doctor is in! 
Finally a scholarly article on telemedicine and infectious diseases.

This manuscript caught my eye as I was reviewing my medical journals, a review article on telemedicine and infectious diseases published in Clinical Infectious Diseases

I have been providing telemedicine care for over 10 years to HIV positive patients in the Virginia Department of Corrections. The article summarizes many of my personal observations over the years. For chronic medical conditions such as HIV, telemedicine is a successful mechanism of consultation. It provides specialty access, is expedient and can be easily coordinated. For complicated inpatient and outpatient consults that require a proper physical examination, telemedicine is limited. Of note, there are no publications definitively proving that telemedicine is cost effective.

Here is an article that featured VCU Telemedicine in Broadband Communities Magazine.

One last point, from an infection prevention standpoint, telemedicine must certainly have an advantage:  there is no provider-patient physical contact making cross-transmission most unlikely.

Wednesday, March 18, 2015

Conference on Hospital Acquired Infections - Mexico City

I am in México City at the Hospital Infantil de México Federico Gomez at a 3 day conference on Infecciones Asociadas a la Atención de la Salud (conference on hospital acquired infections).

My lecture was on healthcare personnel attire and infection prevention.

Both the program and the Mexican hosts have been superb.


Monday, March 16, 2015

Ebola- Personal and Public Health Lessons- NEJM Perspective

I have purposefully avoided writing much about Ebola as it is the topic du jour. After reading this perspective in the New England Journal of Medicine, I felt compelled to make some comments.

The author, Dr. Craig Spencer, both an Ebola doctor and patient, makes a few excellent points related to fear. This is why I found the article so interesting. Fear can make us sharp, and in measured doses raises awareness, increase our decision making capacity and heighten our focus. Fear can also be destabilizing and lead to irrationality, impulsiveness and harm. One need look no further than some of the stateside public health and quarantine responses to Ebola. Treating humanitarian physicians and nurses as pariahs upon return to the USA are the worst examples of fear driven responses.

To me, healthcare workers in the front line of Ebola and other dangerous outbreaks are driven by compassion, understand fear, and should be celebrated.

Sunday, March 8, 2015

Environmental Cleaning, Revisited with New Technologies

Lately I have been thinking a lot about terminal room disinfection as one of the aspects of our infection prevention program. 

For those of you who labor over similar concerns, here is an informative review on new technologies for room disinfection, published in Current Treatment Options in Infectious Diseases

There is no single best method for cleaning patient rooms. Traditional manual cleaning is still the norm however this is labor intensive and subject to issues with compliance and quality. In my opinion, there is simply too much variability in practice and too great a risk for optionalism and human error to make this a truly effective approach.

New technologies, such as UV-light robots and hydrogen peroxide robots allow for "whole room'' disinfection, following a manual wipe down of bioburden and debris. This is promising yet not salvation.These technologies are costly, add additional time to cleaning, decrease patient throughput, require a vacant room (cannot be used while patient remains in the hospital room) and may be damaging to some materials.

Last, we know that the inanimate environment is teeming with pathogens and spores. A precise estimate of the proportionate impact of environmental cleaning on decreasing hospital acquired infections, even with the employment of new technologies, is lacking.

We are still searching for the optimal strategy for cleaning our hospital environment.   

Thursday, March 5, 2015

Academic ID in Jeopardy

Here is thoughtful opinion article published in Infection by Richard Wenzel and Mike Edmond.

I thought that many of the comments were spot on. The authors call for  ‘new leadership’ in medicine, one that requires physician CEOs who have not lost sight of humanities and scholarship in medicine, who will protect and preserve the reflective and intellectual aspects of mentorship and academic medicine. 

As stated in the article, the goal is to reward value over volume, to halt the rising trend of churning out patients (volume) at the expense of value (teaching, mentorship and scholarship). The pendulum will likely swing way too far in the wrong direction before this concept gains enough traction for change.

We are still awaiting the right formula for rewarding value.

Wednesday, February 25, 2015

Can Fecal Microbiota Transplantation Result in Obesity?

Can fecal microbiota transplantation (FMT) result in obesity? Here is an intriguing report published in Scientific American detailing excessive unintentional weight gain in a normal weight individual following FMT. The donor, a relative, also experienced similar weight gain. Of note, there are animal models suggesting that FMT can trigger or contribute to obesity.

We know that FMT is very successful for the management of recurrent C.difficile infection. There is much left to learn in the FMT field such as long term side effects or potential infectious complications from unknown pathogens. 

One case report does not prove a cause and effect relationship between FMT and the onset of obesity. Regardless the finding underscores the need for a national registry or database for assessing both the efficacy and long term impacts of fecal transplantation.

In the meantime, for select patients, specifically, those with recurrent or persistent C.difficile, FMT is a reasonable and valuable treatment option in which the benefits seem to far outweigh the risks.

Sunday, February 22, 2015

Forbes: Deadly Germs May Lurk In Your Doctor's Clothing

I was surprised to read an article in Forbes about bacteria potentially lurking on the apparel of healthcare personnel.

Below is a brief an informative video about a typical doctor patient encounter

The inanimate environment is teeming with pathogens. The extent to which this drives bacterial cross transmission is not fully known but it is almost certainly not negligible.