HIV and Coronary Artery DIsease

Source: CDC.gov

Here is a recent publication in the Annals of Internal Medicine that reports the association between HIV infection and coronary artery disease. The bottom line, independent of typical cardiovascular risk factors, HIV positive men, particularly those who are untreated, have accelerated rates of coronary artery disease.

I have a small battalion of HIV positive patients who are very concerned about their health and longevity. Many of these patients, specifically focus on the control of their HIV, the results of their CD4 count, viral load and cholesterol level. Many of these patients, frustratingly, still continue to smoke and are overweight.

As a growing body of evidence implicates HIV infection as a driver of cardiac disease, modifiable risk factors such as cholesterol, obesity and smoking become increasingly more important for risk reduction.

Stop smoking. Change your diet. Lose weight. Exercise.

Contact Precautions- More is Not Necessarily Better

Those who have previously followed my blog are aware that use of contact precautions is controversial. At VCU Medical center, we no longer isolate patients who are infected or colonized with MRSA or VRE.

Here is a recent study assessing the impact of increased contact precautions on compliance with best practices.  As the burden of isolation increased (20% or less to greater than 60%), a decrease in compliance with hand hygiene (43.6%-4.9%) and with all 5 components  (hand hygiene before and after patient encounter, donning of gown and glove upon entering a patient room, and doffing upon exiting)  was observed (31.5%-6.5%). 

To me this underscores the following: we are still looking for the best way to apply contact precautions and for a means to promote and maintain compliance with contact precautions when its use is deemed necessary. 

An Optimal Method for Cleaning Your Stethoscope?

It is known that both the hands of the healthcare worker and the stethoscope are similarly colonized with potential pathogens. Here is a recent article on the topic.

Is there an ideal method for disinfecting stethoscopes in between patients? Here is a brief report suggesting that stethoscopes may be either wiped down with alcohol swabs or with hand sanitizer. When using hand sanitizer,  the stethoscope is disinfected as part of the hand hygiene process, with the alcohol product rubbed onto the stethoscope by the hands of the healthcare worker.

Both are effective but which one is the most practical? 

Compliance data are lacking.

Medscape Presentation on Healthcare Worker Attire - Slide Presentation on the Web

I am still in South Africa, having just attended the International Congress on Infectious Diseaes (see posts from earlier in the week.)

I just received notification of the launch of a recent project. Along with the Society for Healthcare Epidemiology of America and Dr. Mark Rupp of the University of Nebraska, here is a Medscape presentation of healthcare worker apparel. A login is required, however, access to Medscape is free to join.

The slides are slick.

International Congress on Infectious Diseases, Cape Town, South Africa- April 4, 2014

South African song and dance

Plenary Session

Dr. Michael Stevens lecturing on infection prevention strategies

With Dr. Michael Stevens

Lecturing on healthcare worker apparel and infection prevention

We are at the International Congress on Infectious Diseases, enjoying  the scientific program and the cultural experience.

Our presentations went smoothly.

Stay tuned.

International Congress on Infectious Diseases, Cape Town, South Africa-Part 2

Here are some additional images from today.

International Congress on Infectious Diseases- Cape Town, South Africa- Part 1

I am in Cape Town, South Africa, soon to attend the International Congress on Infectious Diseases. Here are a few images from my meanderings about the city.