Sunday, November 23, 2014

Antimicrobial Scrubs- Still Looking for the Magic Bullet

This article, a randomized trial to decrease bacterial contamination of scrubs in a hospital setting, caught my eye over the weekend.

The investigators employed a prospective, randomized, cross-over study design to assess the impact of antimicrobial scrubs (Chitosan-Sanogiene) in 110 healthcare workers. At study conclusion, 30% of scrubs were contaminated with pathogenic bacteria, including S.aureus. There was no difference in bacterial contamination between standard and study scrub.

The science of antimicrobial scrubs is imperfect. We published a study of antimicrobial scrubs demonstrating a reduction in some bacterial counts (MRSA) but not VRE and gram negative rods. The hands of the HCWs were equally colonized regardless of the attire type.

To date, we do not know the proportionate impact of apparel on hospital acquired infections. Healthcare worker hands are colonized with pathogenic bacteria regardless of attire choice. Cross transmission of pathogens in the hospital is still most likely via the hands of the healthcare worker.

We are still searching for the infection prevention magic bullet.

Monday, November 17, 2014

12th and Marshall: What Not to Wear

The Virginia Commonwealth University School of Medicine has a new Alumni magazine titled 12th and Marshall.

I was recently featured in an article titled What Not to Wear.

The genesis of the VCU bare below the elbows infection prevention recommendation is from Mike Edmond, as neatly summarize in My New White Coat is a Cool Black Vest.

Change is afoot.

Tuesday, November 11, 2014

Fear, Ethics and Ebola

It seems that Ebola preparedness continues to occupy much of my time. My blogging has been very ''light'' as of the last month or so.

I came across some interesting articles this past weekend. Here is a thought provoking article in the New York Times on the ethics of infection. In particular, the author explores the ethical obligation of a potentially infected person, such as a healthcare worker who has cared for an Ebola patient,  to personally limit contact with others. This is an important concept as the notion of the collective good is frequently counter cultural in the USA, where individual rights prevail.  

The NY Times Magazine article on fear and Ebola by Abraham Verghese is a worthy read. Dr. Verghese likens much of the current Ebola fear to that of the panic in the early 1980's with the appearance of AIDS. Public fear can lead to concerning negative consequences such as punishing healthcare workers rather than rewarding them after they put themselves at risk by caring for patients with Ebola. We do not need fewer volunteers in this crisis.

Misguided and misinformed notions can significantly stifle the dangerous and laudable work that is required to limit the current Ebola epidemic.