Tuesday, December 16, 2014

University of Nebraska Biocontainment Unit Visit

I have spent the last few days at the University of Nebraska at the Ebola Training Course. This was an excellent experience and will definitely improve the finalization of the VCU Unique Pathogens unit, which is imminent.

Back to Richmond tonight and back to ID consults tomorrow.

Wednesday, December 10, 2014

What is the optimal number of infection preventionists for a hospital?

What is the optimal number of infection preventionists for a hospital? The conventional is estimate is that one infection preventionist is needed for every 250 acute care beds.  Here is a recent article in the American Journal of Infection Control that explores an alternative formula for calculating the number of infection preventionists in a hospital. The formula assigns an 'acute care bed equivalent' to different hospital variables (ICU bed, Long Term Care, Dialysis facility, ambulatory clinic, ambulatory surgery center). The goal is to adequately capture the increased work demand  through bed adjustment.

In my opinion, the times have changed. Now, the scope of infection prevention goes far beyond performing surveillance and reporting infection rates. The onus is on us to promote and engineer best practices for the healthcare system. In other words, we are meant to play a fundamental role in implementing, measuring and sustaining best practices in infection prevention (central line checklists, hand hygiene, head of bed elevation, chlorhexidine bathing, review of urinary catheter use, staphylococcal decolonization).Our role is active and much less passive than the historical norm.

The new paradigm is on preventing infections and that takes significant time and energy. Accurately capturing this effort may require more than infection prevention staffing by bed adjustment.

We are still searching for the optimal measurement of infection prevention staffing needs. 

Sunday, December 7, 2014

Bare Below the Elbows Spoofed at VCU Medical Center

You can never to be too serious. 

Below is a funny spoof by VCU School of Medicine students on our bare below the elbows infection prevention strategy. All of the comments and actions are very tongue in cheek.

Monday, December 1, 2014

Medical Literary Messenger Fall 2014- Published!

The Fall 2014 Medical Literary Messenger is now published.

Message from the Editor:

Our adventure with the Medical Literary Messenger continues. We received the largest number of submissions to date and have selected a collection of essays, poems and images
that represent both the depth and creativity in which we hope to observe and understand the experience of medicine and disease.

Without you, both the readers and contributors of the Medical Literary Messenger, the whole of the project would be less than the
sum of its parts.

Sunday, November 23, 2014

Antimicrobial Scrubs- Still Looking for the Magic Bullet

This article, a randomized trial to decrease bacterial contamination of scrubs in a hospital setting, caught my eye over the weekend.

The investigators employed a prospective, randomized, cross-over study design to assess the impact of antimicrobial scrubs (Chitosan-Sanogiene) in 110 healthcare workers. At study conclusion, 30% of scrubs were contaminated with pathogenic bacteria, including S.aureus. There was no difference in bacterial contamination between standard and study scrub.

The science of antimicrobial scrubs is imperfect. We published a study of antimicrobial scrubs demonstrating a reduction in some bacterial counts (MRSA) but not VRE and gram negative rods. The hands of the HCWs were equally colonized regardless of the attire type.

To date, we do not know the proportionate impact of apparel on hospital acquired infections. Healthcare worker hands are colonized with pathogenic bacteria regardless of attire choice. Cross transmission of pathogens in the hospital is still most likely via the hands of the healthcare worker.

We are still searching for the infection prevention magic bullet.

Monday, November 17, 2014

12th and Marshall: What Not to Wear

The Virginia Commonwealth University School of Medicine has a new Alumni magazine titled 12th and Marshall.

I was recently featured in an article titled What Not to Wear.

The genesis of the VCU bare below the elbows infection prevention recommendation is from Mike Edmond, as neatly summarize in My New White Coat is a Cool Black Vest.

Change is afoot.

Tuesday, November 11, 2014

Fear, Ethics and Ebola

It seems that Ebola preparedness continues to occupy much of my time. My blogging has been very ''light'' as of the last month or so.

I came across some interesting articles this past weekend. Here is a thought provoking article in the New York Times on the ethics of infection. In particular, the author explores the ethical obligation of a potentially infected person, such as a healthcare worker who has cared for an Ebola patient,  to personally limit contact with others. This is an important concept as the notion of the collective good is frequently counter cultural in the USA, where individual rights prevail.  

The NY Times Magazine article on fear and Ebola by Abraham Verghese is a worthy read. Dr. Verghese likens much of the current Ebola fear to that of the panic in the early 1980's with the appearance of AIDS. Public fear can lead to concerning negative consequences such as punishing healthcare workers rather than rewarding them after they put themselves at risk by caring for patients with Ebola. We do not need fewer volunteers in this crisis.

Misguided and misinformed notions can significantly stifle the dangerous and laudable work that is required to limit the current Ebola epidemic.