Tuesday, March 29, 2016

Curtailing Unnecessary antibiotic Use and the Peer to Peer Comparison

It is estimated that nearly 50% of all outpatient antibiotics are unnecessarily prescribed. This recent article in the Sunday New York Times Sunday Review explores mechanisms in which antibiotic prescription can be curtailed. One study highlighted in the article employed a peer-to-peer comparison of antibiotic prescribing practices across primary care providers.

When compared to peers, physicians categorized as 'poor performers' tend to improve their practice, in this case with respect to antibiotic prescribing.

I have learned that the peer-to-peer comparison is a powerful tool for driving behavior change an improving best practices in infection prevention. Surgeon-to-surgeon comparison of surgical site infection outcomes heightens attention to risk reduction interventions. Comparisons between units and wards are also powerful, particularly when it comes to adherence with best practices such as hand hygiene, head of bed elevation, chlorhexidine bathing, central line insertion checklist completion and daily review with documentation of ongoing urinary catheter need.

Physicians and nurses, particularly those in leadership, tend to be high achievers. Use it as an advantage. No one provider or hospital unit wants to be the outlier in poor performance.

Thursday, March 24, 2016

American College of Physicians (ACP) Interveiw

Several months back I did an interview for the American College of Physicians. The interview was geared toward medical students and was published online recently. 

I am certain that the content is not the least inspirational, nevertheless, I am am honored that the ACP reached out to me.

Tuesday, March 22, 2016

Going Analog, Sort of...

Source: The American Scholar
I am going way off topic here so please forgive me. 

I read with much interest an article in The American Scholar titled Saving the Self in the Age of the Selfie. The article, written by James McWilliams,  delves into our seemingly incessant need to be connected, typically via smartphones, to emails, text messages, Facebook and other social media. The immediacy of data not only informs but also distracts and stresses us out. For some, this manifests as FOMO, Fear of Missing Out. For many, we seem to be losing the ability to concentrate, focus and carry on meaningful interactions and relationships in a face to face, in person manner.

I  frequently witness distracted behavior at work, both in committee meetings and on clinical rounds. Has paying attention really become this difficult?

The solution does not seem easy. Some need to learn how to be alone and in silence, no small feat in this day and age of virtual connectedness. Digital disarmament will take willpower and discipline, much like what is needed for smoking cessation and weight loss. 

Power down, go analog, lay low, talk face to face, read a book (or something without pop-up adds and hyperlinks) and learn to be bored, this is the next challenge. 

Saturday, March 19, 2016

VCU Celebration of Excellence 2016: Infectious Diseases Service

The VCU Department of Medicine hosted a Celebration of Excellence event last evening at the Jefferson Hotel in Richmond, Virginia.

Drs. Michael Stevens and Julie Reznicek were recognized. Kudos.

A photo op with some of the VCU Infectious Diseases Faculty is below and includes Drs. Stevens, Reznicek, De la Cruz and Sastry. 

Left to Right: Drs. De La Cruz, Sastry, Stevens, Reznicek and the blogger

Friday, March 18, 2016

Whole Genome Sequencing and Clostridium difficile: New Insights

Like all US hospitals, we report C.difficile infection rates and compare ourselves to other institutions. Clostridium difficile infections are treated as healthcare associated infections but how are these best prevented? We still are not sure but new evidence is suggesting that the environment may play an increasingly important role.

By using whole genome sequencing, as reported in this paper, we have some new insights. In this study, the authors report that the majority (60%) of cases within an institution were circulated by ward-based contamination. Remarkable.

I believe in antibiotic stewardship programs to limit the unnecessary use antibiotics. This will help to decrease C.difficle risk hospital-wide. However, the environmental component must be aggressively tackled, this includes consistent hand hygiene with soap and water, rapid contact isolation of confirmed or suspected cases, meticulous bleach disinfection of rooms, and even (consider) using new technologies such as UVC robots (previously discussed here). 

Ongoing mechanisms must be in place to assess and feedback the completion of these infection prevention process measures otherwise best practices will falter.

Hospital not tackling the environmental component of C.difficile and other hospital acquired infections do so at their own peril. 

Tuesday, March 15, 2016

Finally! Device Utilization Ratios and Catheter Associated Urinary Tract Infections

Finally a publication that argues for the use of urinary catheter device utilization ratios as a an outcome and not a mere process measure. 

Fact: urinary catheters are overused and cause harm.

Over the last 18 months we have begun to aggressively assess, track and feedback urinary catheter device utilization ratios. Through education and feedback of urinary catheter daily need documentation in the electronic medical record, we have seen a persistent downward trend in catheter use. Like catheter associated urinary tract infections (CAUTIs), documentation of daily catheter need along with device utilization is a standing report at the hospitals's infection control committee and is fed back to unit and hospital leadership. The outcomes of interest are both catheter use and CAUTIs.

The result? Increasing review of daily catheter need, decreased catheter use and decreased CAUTIs.

Today our automated, electronic discontinuation orders for urinary catheter discontinuation goes live. This mechanism will require a formal override of catheter discontinuation if ongoing use is desired, further minimizing unnecessary catheter use. The evidence to support this is neatly summarized here.


Wednesday, March 9, 2016

International Congress on Infectious Diseases- Hyderabad, India: Photo Gallery Now on Website

For those of you interested in an overdose of photos from my recent trip to India, please click here for the photo gallery on my website.

Buddha Statue, Lumbini Park, Hyderabad, India

Sunday, March 6, 2016

International Congress on Infectious Diseases- Hyderabad, India: Parting Shots

Today was a day exclusively for sightseeing.

I spent the day with Dr. Daniel Morgan of the University of Maryland and Nadia Masroor of VCU. We explored the 800 year old Golconda Fort and the Quli Qutab Shahi Tombs then enjoyed a fine meal of spicy paneer and vegetable biryani. A last supper of sorts.

The trip has been a professional and cultural event with an intense pace.

In the last 8 weeks I have been to Wales, England, Honduras, Charleston and India.

Time to decelerate for a while.

Saturday, March 5, 2016

International Congress on Infectious Diseases- Hyderabad, India: Day 4

Today's full day conference agenda began with some excellent lectures including one on antibiotic resistance by Dr. Daniel Morgan of the University of Maryland.

During the noon break, I caught up with Drs. Morgan and Silvia Munoz-Price to discuss updates on our book, titled New Perspectives and Controversies in Infection Prevention, due to be published in late 2016/early 2017. We are making progress.

My last conference stop was the closing scientific session where I gave my lecture titled Technologies for Hospital Disinfection and Textiles for Bioburden Reduction. Kudos to the crowd for a reasonable turnout on the last session of the last conference day. 

With the stimulating lectures, the international attendance, and discussions with peers from all over the globe, I come away with new perspectives and renewed energy, making it all worthwhile. 

ICID 2016 was a professional success.

Tomorrow, tourism only.

Friday, March 4, 2016

International Congress on Infectious Diseases- Hyderabad, India: Day 3

The 3rd day of ICID started off with some excellent lectures. 

One of particular interest was on the evolving promise of rapid diagnostic testing in resource poor settings, by Dr. Vanya Gant of University College of London Hospitals. The lecture emphasized, among other things, the difference between point of care vs. point of decision testing, where the latter potentially has a more meaningful impact on clinical care.

The afternoon was spent sightseeing in Hyderabad with visits to the 400 year old Charminar Monument, the Mecca Masjid (mosque) completed in 1694, and the Ghanzi Bazaar. 

The long day was capped off with the ICID Presidential dinner.

My lecture is tomorrow afternoon. 

I am looking forward to it.

With VCU Colleagues at ICID 2016: (L) Dr. Sangeeta Sastry and (R) Nadia Masroor