What Can Fourteenth Century Venice Teach Us About Ebola?

Plague Doctor's Mask

What can fourteenth century Venice teach us about Ebola? 

Here is an interesting perspective published in Environment Systems and Decisions. Venetian authorities focused on managing physical movement, social interactions, and data collection for the city as a system. This included the creation of lazarettos (quarantine stations) on nearby islands, quarantine periods, and wearing protective clothing (plague doctor's mask).

With the present Ebola outbreak, we are reminded of the importance of emergency preparedness, patient isolation for infection prevention, the use of personal protective equipment and the need for cultural/practice changes in African countries (limiting both contact with sick individuals and post-mortem contact) so as to further limit person to person cross transmission.

Plague and Ebola, different illnesses, different pathogens, some historical parallels.

Flashing Lights and Alcohol-Gel Dispensers- Improving Hand Hygiene Compliance

I am always looking to new approaches for increasing hand hygiene compliance. Here is an article published in the American Journal of Infection Control that caught my eye.

The investigators used a simple red light flashing at 2-3 Hz affixed to the alcohol gel dispensers, within the main hospital entrance.. Baseline and intervention observations were completed over five 60-minute periods (Monday-Friday) from 7:30 to 8:30 AM using a covert observation method.

Baseline hand hygiene compliance was 12.4%. The intervention increased compliance to 23.5% during cold weather and 27.1% during warm weather.

Really? Do we think that this will have a significant and lasting impact of hand hygiene compliance and infection prevention outcomes? 

I doubt it.

In my opinion, hand hygiene programs should preferentially focus on staff, use education, prompts, maximize accessibility of hand sanitizers, employ observation and feedback, and if feasible, employ automated hand hygiene monitoring technologies.

The blink red light is not sufficient.

Ebola Virus Preparedness in US Hospitals- An Emerging Disconnect

As the Ebola outbreak continues to evolve and as US hospitals prepare for the imminent arrival of additional cases stateside, a disconnect is emerging between recommendation and practice. 

For example, the Centers for Diseases Control recommends that health care workers treating Ebola patients need only wear gloves, a fluid-resistant gown, eye protection and a face mask to prevent becoming infected with the virus. Patients should also be placed on contact and droplet precautions.

Where I work, and elsewhere, the fear of Ebola infection by HCWs is driving more aggressive infection prevention measures. The phenomenon is nicely summarized in the NY Times article. In addition to the isolation of patients in airborne and contact precautions, we have dedicated personal protective equipment for the care of Ebola infected patients, this includes Tychem suits, double gloves, PAPRs and fluid resistant booties over the Tychem suit.

Although the minimal standards for isolation and personal protective equipment set by the CDC for the care of Ebola infected patients is likely sufficient, the cross transmission of Ebola from a patient to a HCW in a US hospital would, in my opinion, result in near mass hysteria.

A heightened infection prevention strategy for the care of Ebola infected patients may not be unreasonable.

Ebola Preparedness- VCU Interview

I have been asked by some about where to find my recent Channel 12 interview on Ebola preparedness.

The interview may be found here.

What Not to Wear (In the Hospital)!

What not to wear (in the hospital)! The VCU School of Medicine will launch a new glossy publication (print and web) this Fall. One of the featured articles will be on healthcare worker attire.  

This piece is partly motivated by the SHEA Expert Guidance Paper of Healthcare Personnel Attire in Non-Operating Room Settings which I co-authored with various colleagues from the Society for Healthcare Epidemiology of America.

In the photo shoot, we captured images of traditional physician attire and that of bare below the elbows approach for inpatient care.  At VCU Medical Center, the Infection Control Committee recommends bare below the elbows for inpatient care. The aim is to promote hand hygiene to the level of the wrists and to prevent infrequently laundered items, such as lab coat sleeves, from coming into contact with patients and the patient care environment.

For many, the white coat has a utilitarian function with its pockets. We have learned, from a study in our institution, that the need for carrying capacity is an ongoing motivator for wearing a white coat. The black vest, with its pockets, serves as a reasonable substitute to the white coat and allows for a bare below the elbows approach to inpatient care.

The concept of the black vest as the new white coat was originally conceived by my friend and colleague Dr. Michael Edmond, and is neatly summarized here.  

Stay tuned.