The Dirty Stethoscope

The revered and honored stethoscope is as dirty as the doctor's hands, or so a new study would suggest. 

Here is a news report in NPR on the matter.

To what extend the stethoscope causes hospital acquired infections is unknown.

Using the Electronic Medical Record and an Electronic Dashboard to Decrease Catheter Associated Bloodstream Infections

I am always on the look out for novel approaches to improve infection prevention practices. Here is an article published in Pediatrics on the use of the electronic medical record (EMR) to decrease the rate of catheter associated bloodstream infections (CLABSI).

CLABSI rates decreased from 2.6 CLABSIs per 1000 line-days before intervention to 0.7 CLABSIs per 1000 line-days after intervention.  There was increased daily documentation of line necessity from 30% to 73% (P < .001), increased compliance with dressing changes from 87% to 90% (P = .003), increased compliance with cap changes from 87% to 93% (P < .001), and increased compliance with port needle changes from 69% to 95% (P < .001). Ironically, decreased compliance with insertion bundle documentation was reported from 67% to 62% (P = .001). 

The EMR may be an important adjunct for the consistent implementation of infection prevention strategies. Linking EMR alerts to rounds and to provider documentation may prompt and enhance compliance with expected practices. A highly visible, real time, unit based dashboard may provide the visual stimulus to maintain an infection prevention effort.

This may be promising.

Re-Humanizing Medicine: Why Physicians Need to Be More Than Automated Medical Kiosks

At times we lose ourselves in the technology and science of medicine. Here is an excellent perspective (free, open access) on bringing the human touch back into medicine.The author explores the erosion of humanism with technology and proposes corrective measures to re-align the profession of medicine.  

I have previously blogged about the physical exam as a transformative experience, as a means of enriching the doctor-patient relationship.

Technological progress may come at the expense of human interaction, particularly in medicine. Technology is not salvation from suffering. As we embrace technology, we must also know when to set it aside in favor of high quality human interactions between doctor and patient and to assist in decision making, ease uncertainty and relieve suffering.

This is not easy. This is the ''art'' of modern medicine.

Why I Read

I have been away from the hospital for a few days so permit me this distraction. While away in a very cold and snowy Syracuse, NY, I had the opportunity to read the book  Why I Read,  by Wendy Lesser. The book is reviewed here by the NY Times.

Although the book is at times slightly pedantic, the subject of reading is explored in beautiful prose. The pleasure of reading can come from entertainment, novelty, style, plot, character development or simply the physical attraction of a book.

Bibliophiles take note, this book is worth reading.

State of Infection Prevention in US Hospitals

I read with interest this report on the state of infection prevention in US Hospitals.

Of the 3,374 eligible hospitals, 975 provided data (29% response rate). Some of the results are worth highlighting:

• The average number of infection preventionists (IPs) per 100 beds was 1.2, below published guidelines
• Certification of infection prevention (IP) staff varied across institutions - about 1/3rd of institutions had no certified IPs
• The average hours per week devoted to data management and secretarial support were generally low, little time was spent on prevention education
• Only 32% of hospitals reported having an electronic data surveillance system
• There was variation in infection prevention practice with generally poor adherence to many of the infection prevention policies
• Although policies exists for the prevention of catheter associated bloodstream infections and ventilator associated pneumonias, many institutions reported a low uptake of catheter associated urinary tract infection prevention policies, surprising as these infections are common and was the first hospital acquired infection for non-payment 

The state of infection prevention in US Hospitals, despite heightened public interest, is varied and sub-optimal. 

Eye-opening.

Statins and the Increased Incidence of Herpes Zoster (Shingles)

As I was perusing medical journals this weekend I came across this interesting study in Clinical Infectious Diseases.

Statins are some of the most commonly prescribed medications on the market, particularly in elderly patients. Although by no means conclusive, in this retrospective cohort study of Ontario residents (age >65), the rate of herpes zoster was higher among users of statins relative to nonusers of these drugs (13.25 vs 11.71 per 1000 person-years, respectively; hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.10-1.17). The 13% increased risk of herpes zoster is presumably due to the immunodulatory properties of statins. 

Although the absolute risk is low, from the study above, the authors estimate that as many as 20,000 cases of herpes zoster are associated with statin use. Not insignificant.

If these results can be replicated, the findings will be of public health importance.  Physicians will need to be aware of statin use, particularly in the elderly, and should advocate for herpes zoster vaccination of these patients.

Hand Hygiene Bundle

Is there an optimal hand hygiene bundle? This paper reviews the literature on the most effective hand hygiene approaches.

Education, reminders, feedback and access to hand sanitizer help drive compliance.

There is no single best method or magic bullet for solving our hand hygiene compliance dilemma.

Improving hand hygiene requires a behavioral science approach and is still  in need of high quality, effective strategies to heighten practice. 

The Key to Success? Grit

There are many qualities for success. Those who know me have heard me talk about grit.
My experience in medicine suggests that the highest achievers are the grittiest. 

Here is an excellent TED Talk on grit by Angela Lee Duckworth. 

"Talent does not make you gritty."

Worth watching.

Click here or on the image below.