ID Week 2016: Parting Shots and Comment

Reflecting on the many memorable moments of ID Week 2016, Dr. Dan Sexton's SHEA Lectureship stands out.  His call for more data driven decisions in infection prevention resonated with me.

To quote Dr. Sexton: ' Too many healthcare workers rely on confidently held misinformation.' This misinformation is one of the greatest threats to infection prevention and safety. I could not agree more.

Although I did very little tourism in New Orleans, I did come across a gem of an independent bookstore, in the French Quarter. Packed with books and owned by a knowledgeable bookseller.

For a bibliophile, Livres D'Arcadie was the icing on the ID Week cake.

ID Week 2016: Dr. Doll Interview, ID Bug Bowl

The ID Week 2016 program has been superb thus far and is coming to an end soon.

Dr. Michelle Doll- VCU Health

Congratulations to our own Dr. Michelle Doll on a video interview of her recent study linking regular dental care to decreased risk of pneumonia. The video can be viewed here.

This morning was the inaugural ID Bug Bowl. The competition was stellar, the participants (residents, students, ID fellows) were impressive. 

The future of ID is bright with trainees such as these.

Inaugural ID Bug Bowl

ID Week 2016: Pressing On

Nadia Masroor and Dr. Michelle Doll

ID Week 2016 is pressing on and proving to be both educational and memorable. The scientific program has been superb thus far. As always, it great to catch up with friends and colleagues from across the world.

In addition to my pro/con debate on contact precautions, the VCU ID team has been well represented with posters on surgical site reduction and antimicrobial stewardship.

Tonight is the VCU Infectious Diseases Alumni dinner. 

Looking forward to it.

Dr. Shaina Bernard

Contact Precautions for control of Endemic Pathogens- Pro/Con Debate, ID Week 2016

I had the great pleasure and honor to debate Dr. Daniel Morgan (University of Maryland) today at ID Week 2016 on the pro/con of contact precautions for controlling endemic pathogens. Dr. Morgan was masterful.

I argued the 'con' perspective, specifically for not isolating patients with MRSA or VRE infection/colonization. This is what we practice at VCU Health. The VCU experience is summarized here and here.  A collaborative perspective on the topic is summarized here.

The winner of today's debate? You will have to ask the members of the audience.

I enjoyed it thoroughly.

The Human Microbiome, Koch's Postulates, Infection Prevention

This week our own Dr. Wenzel presented an update on the dynamic human microbiome, exploring the interaction of bacterial diversity, homeostasis and infection prevention. Masterful.  He will be giving this lecture at the 2016 ID Week conference in New Orleans, next week.

For hospital infection prevention, much of the current thought is on both preserving the current microbiome and restoration of bacterial normalcy in select situations (fecal microbiota transplants), as summarized in this scholarly review.

Our knowledge of the human microbiome is rapidly expanding, as witnessed by the number of publication cited over the last several years in PubMed (over 5,500 articless last year alone vs. 245 in 2005).

Our understanding of bacteria, disease and wellness is evolving such that Koch's Postulates are not so neatly applicable anymore. Some bacteria are important components of the normal microbiota, preserving homeostasis, yet pathogenic at other times (Staphylococcal species on the nose and skin, fermicutes, bacteriodetes and Clostiridium in the gut).

As we bathe patients with chlorhexidine and decolonize with mupirocin, decreasing the burden of potentially dangerous pathogens to prevent hospital acquired infection, we alter the normal microbiome, possibly disrupting our protective microbial balance. 

We are in a constant evolution with the microbes and we have much to learn.

C. difficile Reduction in the Hospital- It's the Environment!

Like many hospitals we have struggled to control the rise of hospital acquired C. difficile infections. 

We have finally turned the corner and have decreased the rate of infection with a broad platform that includes enhanced hand hygiene (soap and water), early detection and isolation of patients, heightened bleach daily and terminal room disinfection (with audits and feedback) and the aggressive deployment of UV-C light robots (again, with audits and feedback) for the terminal cleaning of rooms previously inhabited by a C.difficile patient. The focus is on isolation and bioburden (spore) reduction. 

As with many similar multi-pronged strategies, the proportionate impact of each component is hard to measure.

Note this important paper, recently published, that underscores the importance and impact (25% reduction) on C.difficile incidence of strategically deploying a UV-C irradiating robot for terminal room disinfection.

The environment is an important driver of hospital acquired C.difficile infections. 

Why Physicians in Healthcare Leadership Should Talk the Talk and Walk the Walk

I firmly believe that physicians in healthcare leadership should continue to see patients, and so do the authors of this recent opinion article in the Annals of Internal Medicine.       

The reasons are multiple. Being truly informed about the 'state of things' on the ground is critical. Front line healthcare workers have a perspective and awareness that simply cannot be learned any other way. To understand how a medical organization functions one needs to be present, seeing patients in the clinic or in the hospital. Relying on 'memory' from prior clinical practice does not work, much like expecting a fine athletic performance while no longer engaging in physical training.

Clinical credibility is also huge and can only be obtained through direct patient care. Last, seeing patients is personally fulfilling. Isn't that why we went into medicine after all? Now, all this takes effort and makes for long days but few worthwhile things come easy.

Physician leaders in healthcare should talk the talk and walk the walk. 

On Bullshit

This is not a new publication, simply new to me: On Bullshit, by Princeton UniversityProfessor Harry Frankfurt. The full text is available here.

Do not let the jocular nature of the title fool you, this is a serious short book (essay, really) written in 1985. 

Bullshitting is not lying, which is a willful act and implies a knowledge of the truth. A bullshitter doesn't care about the truth. He is engaged in the enterprise of manipulating and selling an opinion. Bullshit is likely more pervasive than lying and certainly more insidious.

For an entertaining and informative interview of Professor Frankfurt on the Daily Show, click here.

On Bullshit should be required reading during election time.