Early Goal Directed Therapy of Sepsis- Congratulations to Ravi Gupta- VCU School of Medicine Graduate- May 2015

Congratulations to Ravi Gupta, MD, a recent graduate of the VCU School of Medicine (May 2015).

Ravi was the 1st author of a review on early goal directed therapy for septic shock, written when he was a medical student and published in Critical Care. 

The manuscript can be accessed here, open access and free to all.

Dangers of Vaccine Refusal- Illness Onset at Later Age and with Greater Severity

With the move toward mandatory influenza vaccination in my place of employment, this article seemed timely, published in The Lancet Infectious Diseases. 

What are some of the potential dangers of vaccine refusal? In this modeling study, the impact of modern vaccination practices on infection risk is explored.

Although vaccination makes preventable diseases rarer, it also increases the expected severity of the disease, particularly at an older age, in the unvaccinated.This is particularly true for illnesses such as rubella, mumps and varicella.

We should understand that remaining unvaccinated in a predominantly vaccine-protected world exposes children to the most severe possible outcomes for many preventable diseases. 

Risky.

Hospital Room Disinfection: We Have Serious Knowledge Gaps

We have focused recently on enhancing our cleaning methods at VCU Medical Center. This includes terminal hospital room disinfection assessment reports of high touch surfaces and reports related to the use of the Tru-D UVC robot, both presented monthly at the infection control committee. As a result, I read this paper with great interest.

The review is an excellent summary of the current state of hospital room disinfection and the results are less than encouraging and raise more questions than answers.

• There is a lack of rigorous, patient centered outcome studies on the effectiveness of disinfection. 
• What is the comparative effectiveness of different cleaning methods?
• We do not have a best way of assessing 'cleanliness.'
• What surfaces should be disinfected and how often?

We may be more interested in hospital room disinfection, however, the body of evidence to support and guide our efforts is weak.

In them meantime, we will press on with what we have and trust that our disinfection efforts will at the very least, do no harm. 

Walk in the Woods- Appalachian Trail, Break from the Hospital

I took a break from the hospital to hike the Appalachian Trail, with my brother, in the Shenandoah National Park. Over the course of six days we had some tough climbs, wet nights, foggy days, spectacular views and close encounters with bears! We also met a wide variety of day hikers, backpackers and furry animals. 

A few images are found below.

Personal Protective Equipment- Donning and Doffing : Training Required

Here is an article that caught my eye, published in the American Journal of Infection Control. The authors assessed critical errors in the doffing of personal protective equipment during viral hemorrhagic fever preparedness. Training and practice are necessary to get in and out of the protective apparel.

We are learning that errors with donning/doffing of personal protective equipment abound, not only in a unique pathogens setting but also with the more mundane use of contact precautions. 

In a forthcoming publication that assesses healthcare worker self-contamination when doffing gowns and gloves, soon to appear in JAMA Internal Medicine, we have written the corresponding commentary. In brief, healthcare worker contamination is common and we have yet to devise achievable, sustainable training with ongoing assessments of appropriate donning and doffing of personal protective equipment. 

As we move toward using contact precautions more judiciously and selectively, as suggested here,  we must strive to ensure appropriate and consistently correct use of gowns and gloves. 

Stay tuned. More to come.