Friday, August 28, 2015

Dangers of Vaccine Refusal- Illness Onset at Later Age and with Greater Severity

With the move toward mandatory influenza vaccination in my place of employment, this article seemed timely, published in The Lancet Infectious Diseases

What are some of the potential dangers of vaccine refusal? In this modeling study, the impact of modern vaccination practices on infection risk is explored.

Although vaccination makes preventable diseases rarer, it also increases the expected severity of the disease, particularly at an older age, in the unvaccinated.This is particularly true for illnesses such as rubella, mumps and varicella.

We should understand that remaining unvaccinated in a predominantly vaccine-protected world exposes children to the most severe possible outcomes for many preventable diseases. 


Wednesday, August 26, 2015

Hospital Room Disinfection: We Have Serious Knowledge Gaps

We have focused recently on enhancing our cleaning methods at VCU Medical Center. This includes terminal hospital room disinfection assessment reports of high touch surfaces and reports related to the use of the Tru-D UVC robot, both presented monthly at the infection control committee. As a result, I read this paper with great interest.

The review is an excellent summary of the current state of hospital room disinfection and the results are less than encouraging and raise more questions than answers.
  • There is a lack of rigorous, patient centered outcome studies on the effectiveness of disinfection. 
  • What is the comparative effectiveness of different cleaning methods?
  • We do not have a best way of assessing 'cleanliness.'
  • What surfaces should be disinfected and how often?
We may be more interested in hospital room disinfection, however, the body of evidence to support and guide our efforts is weak.

In them meantime, we will press on with what we have and trust that our disinfection efforts will at the very least, do no harm. 

Tuesday, August 18, 2015

Walk in the Woods- Appalachian Trail, Break from the Hospital

I took a break from the hospital to hike the Appalachian Trail, with my brother, in the Shenandoah National Park. Over the course of six days we had some tough climbs, wet nights, foggy days, spectacular views and close encounters with bears! We also met a wide variety of day hikers, backpackers and furry animals. 

A few images are found below.

Thursday, August 13, 2015

Personal Protective Equipment- Donning and Doffing : Training Required

Here is an article that caught my eye, published in the American Journal of Infection Control. The authors assessed critical errors in the doffing of personal protective equipment during viral hemorrhagic fever preparedness. Training and practice are necessary to get in and out of the protective apparel.

We are learning that errors with donning/doffing of personal protective equipment abound, not only in a unique pathogens setting but also with the more mundane use of contact precautions. 

In a forthcoming publication that assesses healthcare worker self-contamination when doffing gowns and gloves, soon to appear in JAMA Internal Medicine, we have written the corresponding commentary. In brief, healthcare worker contamination is common and we have yet to devise achievable, sustainable training with ongoing assessments of appropriate donning and doffing of personal protective equipment. 

As we move toward using contact precautions more judiciously and selectively, as suggested here,  we must strive to ensure appropriate and consistently correct use of gowns and gloves. 

Stay tuned. More to come.  

Saturday, July 25, 2015

Medical Literary Messenger Spring 2015- Published Online.

The 2015 Spring Medical Literary Messenger is now published on line and accessible here.

The Medical Literary Messenger continues to grow by leaps and bounds. Both the number and quality of submissions exceeded our expectations. Enjoy the Spring 2015 edition of the MLM, may it touch you in unique ways and provide you new perspectives on humanism and medicine. 

Gonzalo Bearman, MD 
Editor in Chief

Thursday, July 23, 2015

Contact Precautions Revisited- Again!

In 2012, with my colleague Dr. Michael Stevens, we published a paper which no one read. The paper explored a change in the routine use of contact precautions for MRSA and VRE and may be accessed here.

We used our paper to support our argument for the discontinuation of contact precautions for the control of endemic MRSA and VRE at VCU Medical Center. The change was implemented and the strategy was a success. The results were published in Infection Control and Hospital Epidemiology.

More recently, along with collaborators from the Society for Healthcare Epidemiology of America (SHEA), we again explored the  discontinuation of contact precautions for the control of MRSA and VRE in endemic settings, published here. We report that the majority (60%) of SHEA respondents were interested in using contact precautions differently. A handful of hospitals already do not isolate for MRSA and VRE. Not unexpectedly, in our thorough review of the literature, there is scant, quality evidence to support the use of contact precautions for the control of endemic MRSA and VRE.

Local needs and resources, not mandates, should drive the use of isolation precautions in healthcare settings.

This topic may now get more attention. 

Stay tuned.

Tuesday, July 21, 2015

Statins and Effect on Pneumonia: True Effect or Bias?

Here is an elegant article published in Clinical Infectious Diseases.

Do statins truly have an anti-inflammatory effects that  positively impact certain infectious diseases? In this case, the focus is on the use of statins, in patients status post a myocardial infarction (heart attack) and the protective impact on pneumonia. The protective effect  of statins on pneumonia in these patients is based observational data where treatments were not assigned randomly.  Using sophisticated staistical modeling, the protective effects of statins were assessed by excluding the effect of non-random assignment (bias) .

The finding? After controlling for non-randomization, the protective effect of statins against pneumonia was most likely the result of nonrandom treatment assignment, in other words, bias.

Be cautious of bias when interpreting study results, particularly with non-randomized,observational data.