SHEA 2018- Portland, Oregon: In Pictures

Thank you to the Society for Healthcare Epidemiology of America for organizing a very high quality conference- SHEA Spring 2018.

Kudos to my VCU Team for their excellent work and scientific presentations. You make me very proud!

Images from the last several days are below.

laura Pedersen

Heather Albert, RN

Jacob Pierce, MD

Pamela Bailey, DO

Ginger Van Hoozer, RN

Barry Rittmann, MD

Salma Abbas, MD

With Drs. Mike Stevens and Michelle Doll

Dr. Michelle Doll

Dr. Michelle Doll

Dr. Mike Stevens moderates a session on infection prevention in low and middle income countries

The Hospital Epidemiologist. What's in a Name?

What's in a name, or in this case, a title? How does one define a hospital epidemiologist? We discussed this today at the SHEA Board meeting.

The following is my interpretation and does not reflect the official view of SHEA.

Hospital Epidemiologist are Doctors who Prevent Infection! This is done through:

• Leadership
• Policy
• Science and research
• Preparedness
• Antibiotic stewardship

SHEA 2018 starts tomorrow, looking forward to it.

Stay tuned.

Enhanced Recovery After Surgery (ERAS): The Way To Go

Dr. Michael Scott

My experience with surgical site infection (SSI) risk reduction is a mixed bag. Perhaps our interventions were seen as too infectious disease oriented and not in line with a global surgical quality approach.

What was desperately needed was a comprehensive, bundled approach to surgical safety with ownership by anesthesiologists and surgeons, where reduced surgical site infections are a secondary yet important collateral benefit.

Enter Enhanced Recovery After Surgery (ERAS) protocol!

I refer you to this excellent review article on ERAS published in JAMA Surgery by my VCU colleague, Dr. Michael Scott. The topic was presented at VCU Department of Medicine Grand Rounds on 4/12/18 by Dr. Scott. 

Enhanced (early) recovery after surgery results in fewer complications and fewer infections.

More information at the ERAS site. 

I am off to SHEA 2018 next week, stay tuned.

HAI Surveillance: Still Searching for the Sweet Spot with Goodhart's Law in Mind

Professor Charles Goodhart

It seems with much of what we do in infection prevention, we are searching for the sweet spot, whether it is a in how we isolate patients with contact precautions or how we order diagnostic tests (test stewardship).

I read with great interest this article in Clinical Infectious Diseases on partially automated vs. fully automated surveillance systems for hospital acquired infections. No system is perfect and both approaches have some value.

My personal bias: we should standardize and automate as much as possible but only for clinically relevant outcomes with agreed upon infection prevention risk reduction processes.  Why aggressively monitor what we are unable to change (with the current state of science)? An ongoing element of manual review seems inevitable for now.

Last, beware of gaming. As referenced in the article, any surveillance system is subject to Goodhart's Law, named after British economist Professor Charles Goodhart (London School of Economics): 

‘ Any observed statistical regularity will tend to collapse once pressure is placed on it for control purposes because actors will change their conduct when they know that the data they produce will be used to control them.'

We are still searching for the HAI surveillance sweet spot.

Take a Dump, Save a Life! The VCU Stall Street Journal Makes Fecal Microbiome Talk Mainstream

You know that the fecal microbiome has gone mainstream when you see posters such as these on the campus bathrooms.  

Published in the VCU Stall Street Journal, and hanging in VCU bathrooms, all you ever wanted to know about fecal microbiome diversity and the benefits of fecal microbiota transplantation for C. difficile infections. 

Take a dump, save a life.

Infectious diseases goes pop culture (sort of)!

De-Escalation of Contact Precautions- An Interrupted Time Series Analysis: Now Published!

Our article assessing the de-escalation of contact precautions with an interrupted time series analysis is now published electronically, print copy to follow in Infection Control and Hospital Epidemiology.

We continue to observe decreasing trends of all hospital-acquired infections (including MRSA and VRE)  with a broad based horizontal infection control program. The de-escalation of contact precautions has not negatively impacted this trend.

Special thank you to all of the collaborators, particularly Mike Edmond from the University of Iowa.

Toilet: A Love Story (and a Reflection on Open Defecation)

Yes, this film is named Toilet, and, yes, it is a love story (and about open defecation).  

The film explores the social and cultural values that are associated with indoor toilets, the ongoing problem of open defecation in India and a husband's quest to build a toilet for his wife.

To borrow a quote from the film: "If you change nothing, nothing will change"