Infecciones intra-hospitalarias / Hospital-acquired infections

Here is an interesting clip forwarded to me from a colleague. The focus is the development of a manual or guideline for treatment of hospital acquired infections in Honduras. In an extremely poor country, I can only imagine the resources for both the treatment and prevention of hospital acquired infections is extremely limited. 

Included in this manual are treatment guidelines for Leishmaniasis too! An unusal pairing, indeed, as Leishmaniasis is not hospital-acquired.

For the English translation click here.

Para la versión original, haga clic aquí

Expressive Footwear

Zebra stripes on the Internal Medicine Service

I am by no means a Sartorialist style blogger,  but I have made a casual (style) observation on the hospital floors of a trend that is growing in popularity.

As of last year, all nursing staff must wear either sky blue or white scrubs. A nurse uniform is effectively in place. Gone are the days of self expression through personalized scrubs of varying colors, patterns and styles.  

Going pink in the Intensive Care Unit

As expected, this was of mixed popularity and some grumbling was heard.

What to do? 

Glossed or Patterned in the Transitional care Unit

It's gotta be be the shoes!

Cool Kicks in the Transitional Care Unit. Check out the socks too.

Glossy pearl with accented socks on Internal Medicine. Over the top!

Yellow Scales in Internal Medicine

More patterns- Neuroscience ICU

Paisley in Orthopedics

Urbanization and Infectious Diseases

I must admit that I have a fondness for city life and consider myself to be more of an urban than country (or suburban)  type, so it was with a bit of personal interest that I perused this a recent article in The Lancet Infectious Diseases, brought to my attention by a former research coordinator of mine.

Urbanization and Infectious diseases. Right up my ally of interest. Unfortunately, these can have important health consequences. Overpopulation, high interconnectedness, economic and social disparities, chronic health conditions, drug use, poor drinking water and limited vector control (mosquitoes, flies) along with low vaccination rates (Hepatitis B), and erratic condom use/safe sex practices can lead to propogation of infectious diseases. These include TB, HIV, Hepatitis, Malaria, Leptospirosis, Yellow Fever, Plague, Leishmaniasis and pneumonia. Others include SARS and novel H1N1 influenza.

The authors propose urban planning policies that could potentially curtail disease transmission.

This is a worthwhile bedtime read.

Hunter Gatherers- Getting Back to our Primal Selves

Hunter-gatherers: a new health kick?

This was cool title that caught my eye today: Achieving hunter-gatherer fitness in the 21(st) century: back to the future- published in the American Journal of Medicine.

 

The authors argue that the systematic displacement from a physically active outdoor lifestyle (hunter-gatherers) to that of sedentary, indoor lifestyle (modern man) is the cause of many chronic diseases plaguing us.

 

The proposed solution is to simulate the hunter gatherer activity pattern to an extent that is practically achievable. The authors provide suggestions for exercise and activities such that out lives will be realigned with that of the hunter-gatherer archetype encoded in our genes. They even provide a nifty table summarizing modern activities that are equivalent to hunter gatherer activities.

 

Here are some examples from Table 2 in the manuscript:

Hunter Gatherer Activity	Modern Equivalent Activity	Caloric Expenditure (Kcal/hour)
Carrying logs	Carrying groceries	893
Carrying meat back to camp	Wearing backpack while walking	706
Digging tubers in field	Gardening	605
Tool construction	Vigorous housework	216
Butchering large animal	Splitting wood with axe	408
Picking lice off each other	Text messaging	OK, I made this one up!

 

For some, getting back to our primal selves may be a long stretch, especially when our hunting and gathering is limited to hunting for the misplaced remote control in the den and gathering snacks from the kitchen.

 

I am inspired.

 

 

Private Guns, Public Health

In the wake of the Tuscon, Arizona shootings, there has been renewed discussion about gun control. The New York Times recently published the following editorial, calling for a shift in ‘gun control without a ban’.  The approach is aimed at the person, not the gun, with the focus on increasing sensitive background checks so that guns are not sold to criminals, drug addicts and mentally ill patients.

On an average day in the United States, guns are used to kill almost eighty people.  If any other consumer product had this sort of disastrous effect, the public outcry would be deafening. For a fascinating, scholarly (yes, with references) look at gun violence as a public health issue, I refer you to David Hemenway’s book, Private Guns, Public Health.

 

The sale and supply of guns is less regulated than any other consumer product. Hemenway calls for commonsense policies to prevent unnecessary gun related violence and accidents, including childproof safety locks, licensing of gun owners and registration of hand guns; one-gun-per-month laws to reduce gunrunning; all gun transfers to go through licensed dealers with background checks; greater scrutiny of licensed dealers; and a federal agency (similar to the National Highway Traffic Safety Administration) with the power to regulate firearms as a consumer product. His argument is backed by best available evidence, case control studies, and population level data, like a proper scientific argument.

Again, the focus is public health and the prevention of injury, not a ban on guns.

Can Wal-Mart Make Us Healthier?

I just stumbled across this.

For those of you interested in nutrition, diet, obesity and food policy, allow me to direct your attention to this engaging online debate published in the New York Times.

Food for thought, indeed.

Lyme Disease Vaccine: Lessons Learned

I am going to keep this post brief.

Deer Tick: a vector of Lyme Disease

There is scholarly perspective in Clinical Infectious Diseases on Lyme Disease vaccination- lessons learned. Unlike most other infectious diseases, there is a tremendous amount of misunderstanding, shady science, advocacy groups, and emotion associated with Lyme Disease.  Despite Infectious Diseases Society of America (IDSA)  guidelines , based on best available evidence, certain physicians and advocacy groups choose to adhere to different diagnostic and treatment perspectives. For example, I refer you to International Lyme and Associated Diseases Society (ILADS).

With a strong anti-vaccine sentiment and history of class action lawsuits in the USA, a complicated vaccine administration schedule and low public demand for the vaccine, the LYMERix manufacturer voluntarily terminated vaccine production of the vaccine in 2002.

To quote the manuscript- ‘‘.media focus and swings of public opinion can pre-empt the scientific weighing of risks and benefits in determining success or failure’’

Many hurdles remain for a new Lyme Disease vaccine, not the least of which is interpreting and reporting the science in an informed, clear and unemotional fashion.

Good luck with that.

Once again, Honduras : Otra vez, Honduras

Well, it has been a busy week, but I finally found the time to publish my pictures from our Honduras trip last week. Sorry about the paucity of images, but it was raining immensely, and I did not want to damage my new camera!

Bueno, a sido una semana sumamente ocupada, pero, por fin he publicado mis fotos del viaje a Honduras de la semana pasada. Siento tener pocos imágenes pero con la lluvia torrencial, no quisiera que el agua afectara mi camera fotográfica nueva.

2011 Honduras Medical Relief Trip

The next VCU Honduras Medical Relief Trip is May 31^st- June 11, 2011

For more information click here and to make a tax deductible donation click here

2011 Brigada Médica de VCU a Honduras

La próxima brigade medica a Honduras tendrá lugar el 31 de mayo- 11 de junio de 2011. Para más información haga cliq aquí y para donar, haga cliq aquí

MRSA Body Count

MRSA on the Death Certificate: Questions about Accuracy

Surveillance for MRSA has hit the morgue. Investigators in Ireland published a manuscript on documentation of MRSA on death certificates. When reviewing 132 patients who had MRSA or MSSA isolated from blood cultures within 30 days of death, differences in death certificate documentation were noted. Fifteen (25.4%) of the 59 MRSA cases had MRSA documented on the death certificate while nine (12.2%) of the 74 patients with MSSA had MSSA documented on the death certificate. MRSA was more likely to be documented on the death certificate than MSSA (odds ratio: 2.46; 95% confidence interval: 1.01–6.01; P < 0.05). These findings suggest that inconsistencies exist in the way organisms are documented on death certificates and that there may be a bias to overemphasize MRSA on death certificates.

If death certificates to be used for surveillance of organism specific mortality, then methodology must be clear, definitions must be accurate (crude vs attributable mortality), and the process must be free of bias.

Most patients do not undergo autopsy and many death certificates, at least in the USA, are completed by fatigued interns, who likely do not review the case specifics in full prior to documenting the presumed cause if death. This will lead to documentation error and misclassification.

The morgue may not be the most meaningful place to track MRSA.