Monday, September 17, 2018

Once Again, Untested Assumptions: Microbiota, Probiotics and Patient Harm

This article is a fresh reminder of an untested assumption, something not uncommon in medicine.

Probiotics, to restore the microflora and prevent antibiotic associated diarrhea and Clostridium difficile infections, how could these be unsafe?

Probiotics are presumed low risk but we simply don't know the potential harms because adverse events are not rigorously assessed in related clinical trials.

Now when asked about the safety of probiotics,  I am obligated to modify my answer: 

Probiotics are likely safe but we simply don't know for sure.


Friday, September 14, 2018

Hand Hygiene: How Much is Enough?

I am back in the USA, back at work, preparing slides for my ID Week 2018 pro/con debate on hand hygiene tracking and monitoring.

We hold hand hygiene sacrosanct in infection prevention.  Some would argue that hand hygiene does not prevent infections, rather, it reduces the transmission of multi-drug resistant organisms, as explored here

Regardless, it is safe to say that hand hygiene is potentially one of the most important infection prevention interventions and that compliance is generally suboptimal. A good systematic review and meta-analysis of interventions to promote hand hygiene can be accessed here.

Beyond that, things become contentious.

The proportionate impact of hand hygiene on infection prevention outcomes is debatable, there are no head to head trials comparing one multi-modal hand hygiene tracking strategy to another and certainly none comparing multi-modal strategies to the emerging hand hygiene electronic monitoring systems on the market.  

What is the optimal level of hand hygiene compliance?  At what point is there a diminishing return with improved hand hygiene and infection prevention outcomes?  Which hand hygiene interventions are most reasonable and sustainable, so that they play out in the real world?

Simply put, our science (hospital infection prevention) lacks specificity

So how much hand hygiene is enough?  No one really knows but more is probably better.

Vexing.




Monday, September 10, 2018

Budapest: Hospital in the Rock

A a less known destination in Budapest is the Hospital in the Rock.

This medical bunker built within the caves of Castle Hill served as a World War II Red Cross hospital during the siege of Budapest. During most dire times, capacity soared to 600 patients! Not unexpectedly, infections were an issue with such overcrowding.

In 1956, the facility served a similar war-time hospital purpose during 1956 Hungarian revolution.

Under the Soviets, the facility was used as a nuclear bunker.

Fascinating.














Parting Images of Budapest

I am still writing a travelblogue.

Parting images include night scenes, below, from my meanderings through Budapest.

A storied city with eclectic influences from the Ottomans, the Habsburgs and the Soviets. The Széchenyi Thermal Bath was particularly unique.

Other highlights include a visit to Castle Hill, the Hospital in the Rock (blog post here), the Hungarian Parliament Palace, the Great Market Hall, the sober Shoes on the Danube Monument (to jews executed by Nazis on the Danube riverbank) and a Barons of Budapest walk through former palaces, museums and libraries in Budapest.