Wednesday, June 24, 2015

Guide to Infection Control in the Hospital, 5th Edition- Now Available as a Free Download

Our book, the Guide to Infection Control in the Hospital, 5th Edition, co-edited by Richard Wenzel, Michael Stevens and Michael Edmond is now available as a free PDF download through the International Society for Infectious Diseases (ISID).

To download the Guide you must join ISID, which is also simple and free.

The Guide is comprised of 60 chapters offering concise summaries on essential topics in infection prevention.

Further information on downloading the 5th Edition of the Guide to Infection Control in the Hospital can be found here.

Monday, June 22, 2015

Unorthodox Treatments for Lyme Disease- What is the Evidence?

Finally, an article that summarizes many of the unorthodox treatments that I have heard about from patients seeking second or third opinions for the diagnosis and management of Lyme disease.

This recently published article in Clinical Infectious Diseases is eye opening. This study was designed to identify and characterize the range of unorthodox alternative therapies advertised to patients with a diagnosis of Lyme disease.

The authors performed internet searches using the Google search engine to identify the websites of clinics and services that marketed non-antimicrobial therapies for Lyme disease. The authors then used the PubMed search engine to identify any scientific studies evaluating such treatments.

More than 30 alternative treatments were identified, which fell into several broad categories including oxygen and reactive oxygen therapy; energy and radiation-based therapies; nutritional therapy; chelation and heavy metal therapy; and biological and pharmacological therapies ranging from certain medications without recognized therapeutic effects on Borrelia burgdorgeri to stem cell transplantation. 

As predicted, the medical literature did not support any of these treatments. 
Anecdotes and patient testimonials, neither which carry any scientific weight, are used to support many alternative Lyme disease treatments.

In my experience as an infectious diseases specialist, I have seen Lyme disease both frequently misdiagnosed and mismanaged. Many practitioners offer alternative therapies on a fee-for-service (cash, not covered by insurance) basis, frequently selling products out of their offices. 

When patients are suffering and in despair, these therapies are dangerously appealing.

Thursday, June 18, 2015

CMS HAC Reduction- Body of Evidence

Here is an article recently published in ICHE which caught my attention. The study explores the impact of the CMS HAC Reduction program on central line associated bloodstream infections (CLABSI).

A brief summary of the CMS Hospital Acquired Condition (HAC) Reduction program can be found here.

The premise is that pay for performance with hospital to hospital ranking will improve safety and infection control outcomes such as CLABSIs. 

Enhancing patient safety via performance incentives sounds logical however the data (to date) may not fully support this approach. 

In the study referenced above, the investigators did not observe changes in the slope of CLABSI infection rates in the postpolicy period compared with the prepolicy period for either safety net (post HAC Reduction policy vs pre HAC Reduction policy ratio, 0.96 [95% CI, 0.84-1.09]) or non-safety net (0.99 [0.90-1.10]) hospitals. After controlling for secular trends, no impact in CLABSI rates by the CMS HAC Reduction program was detected (either positive or negative) on already declining rates of CLABSI across the nation. 

We need need better long term data before we make these sorts of programs (with financial repercussions) permanent fixtures in the patient safety landscape.

Thursday, June 11, 2015

Skin Microbiota and Immunity- A Dialogue

I read with great interest this article titled Dialogue Between Skin Microbiota and Immunity, in Science.

The authors explore the interactions of microbes and immune cells on the skin surface with respect to disease and homeostatic states.  

For altered skin microbiota, especially when inflammatory or infectious complications ensue, there is a call for topical microbiotic therapy in the form of microbial creams that restore the balance skin's flora. 

I have previously written about chlorhexidine bathing for the prevention of hospital acquired infection. I cannot help but wonder what downstream effects may occur as we alter the cutaneous microbiome with chlorhexidine for the short term gain of preventing hospital acquired infections.

The human body has a normal microbial ecology. We alter it at our own risk.


Sunday, June 7, 2015

Parody of Ebola based on Lola by The Kinks

With no disrespect to the public health threat of Ebola, here is a video worth viewing- the Ebola parody based on the Kinks hit song Lola.

Video: zdoggMD

Friday, June 5, 2015

Biocidal Linens - Too Good to be True?

The title of this article was intriguing, particularly given my prior experience with studying textiles and healthcare personnel clothing.

The investigators assessed the impact of biocidal copper oxide impregnated linens on the rates of healthcare-associated infections (HAI) in a long-term care ward. All standard linens were replaced with 
biocidal copper oxide impregnated linens and personnel uniforms were changed to a copper oxide impregnated biocidal product.

During the trial period, in comparison to standard of care period, there was a 24% reduction in the HAI per 1000 hospitalization-days (p<0.05), a 47% reduction in the number of fever days (>38.5°C) per 1000 hospitalization-days (p<0.01), and a 32.8% reduction in total number of days of antibiotic administration per 1000 hospitalization-days (p<0.0001). 

I am skeptical. The impact of potential confounders is not addressed. Hand hygiene compliance? Chlorehidine bathing of patients? Use of central line checklists, urinary catheter checklists? Invasive devices utilization ratios? Too many unanswered questions. 

Last, one of the authors is the CEO of the study's funding source. Conflict of interest!

Textiles are no magic bullet and this sounds too good be true.

Thursday, June 4, 2015

VCU ID Fellowship Program at 12th Annual VCUHS Resident / Fellow Research Day

Our ID Fellows (trainees) made us proud today at the 12th Annual VCUHS Resident / Fellow Research Day.  All have presented posters, published papers or written book chapters with us.

The cream always rises to the top.


L-R: Drs. Claudia Jarrin and Melanie Brown

L-R: Drs. Dan Soule and Dan Markley

L-R: Program Director- Dr. Jane Cecil with group

Mrs. Hope, Relative Risks and Thank You, Mr Jackson- Reflective Video Essays

The practice of medicine, without reflection is fraught with peril for both doctor and patient. Below are a few reflective videos worth seeing.

"Medicine is not an exact science but rather an uncertain art" as stated by Dr. Frank Fulco in the reflective video, Relative Risks, accessible here.

Mrs Hope, by Dr. Christina (Nina) Vitto on burnout in medicine, accessible here.

Thank you, Mr. Jackson, by Dr. Stephanie Call, underscoring the importance of focusing and living in the present, accessible here.