Top Priorities in Infection Prevention- From A European Perspective

What are the top priorities in infection prevention?  

From a survey of European infection prevention experts, published here, the rank (top to bottom) includes microbial epidemiology/resistance, surveillance and decolonization/disinfection/antiseptics.  In fourth place was organizational and behavioral change.

The list would likely be similar for North America.

I personally feel that organizational and behavioral change should be at the top of the list, under the gamut of infection prevention implementation. Although infection prevention is not a perfect science, if known, data driven risk reduction strategies are implemented reliably, consistently and to scale, this would result in a massive patient safety boon.

We need to prioritize implementation of best practices, as I have previously explored. 

Anything less will fall short of our patient safety goals.

At the Existentialist Cafe

Although I am at work this holiday week, the clinic and administrative schedules are relatively light. I have been delving into books with enthusiasm (and with time to spare).

At the Existentialist Cafe by Susan Bakewell is no boring read on the history and characters of existentialism, in fact, it reads like a novel.

Thank you Jean-Paul Sarte for reminding us that existence and 'being' comes with options, that our day to day tasks need not be pre-ordained, overly encumbered and rigid.

Food for thought.

Good read. 

Fall / Winter 2016 Medical Literary Messenger Published!

I am exceedingly proud to announce that we have just published the Fall/Winter 2016 edition of the Medical Literary Messenger (MLM).

The project website is : www.med-lit.vcu.edu. The MLM can be downloaded in PDF or e-book format via the website. The PDF can be found here.

As always, thank you to my Associate Editors, Dr. Megan Lemay, Dr. Michael Stevens, Patricia Dodson and Celeste Lipkes. Additional heartfelt thanks to Brie Dubinsky (Managing Editor/Web Designer) and Rachel Van Hart (Design and Copy Editor), without them this project would come to a grinding halt. I also owe a huge debt of gratitude to all of the reviewers. Last, It goes without saying that without the contributors, the MLM would simply not exist.

Happy Holidays.

Cell Phone Text Message Reminders for Enhanced Hand Hygiene Performance

It is a well known fact that hand hygiene practice in the hospital is nearly always suboptimal.The literature on hand hygiene is replete with strategies to improve practice.

In this article published in American Journal of Infection Control, a hand hygiene reminder with either a congratulatory message or an encouragement message (for those with less than optimal hand hygiene compliance) was sent once weekly to staff in a 15 room infectious diseases ward in a French hospital.The unit employed an RFID automated hand hygiene monitoring system. Hand hygiene rose from a baseline of 15% to 23% following the alert notification.  

In my opinion the hand hygiene adherence pre/post intervention is concerning and low, especially in an infectious diseases ward! This was possibly secondary to poor capture from the RFID automated adherence technology.  What I found most interesting was the acceptability of the once weekly text message reminders by the frontline healthcare workers. There was little to no alert fatigue reported! This is promising.

If we can deploy a hand hygiene technology that accurately captures hand hygiene compliance (foam in/foam out), is coupled to targets with feedback and accountability, and, if that feedback can be automated (via text message once weekly) and tied to performance and encouragement, we may be on to a game changing strategy.

The quest for optimal hand hygiene enhancement continues...

Grit: Passion and Perseverance

I have been reflecting on the concept of grit as explored in a scholarly fashion in this book by Angela Duckworth. Her TED video on grit is available here.

Simply put, grit is the cultivation of passion with purpose and perseverance. The concept really resonated with me, particularly in my career as a physician and university professor.

Although grit is in part innate, it can be cultivated and developed. If you want to be grittier, join a group with a culture of grit. Also, leadership can breed a culture of grit through setting standards and providing motivation and support.

The theme is clear. High achievers are not necessarily the smartest or most connected, they are the grittiest of the lot.

Science Museum of Virginia Lunch Break Science Presentation on Infection Prevention and Safety

Thank you to the Science Museum of Virginia for hosting me today for a public-oriented lecture on infection prevention and safety at the Lunch Break Science series.

The event was well attended and the lecture was seemingly well received. I truly enjoyed the Q+A. Thank you to Mr. David Olli of the Science Museum of Virginia for the generous invitation and kind introduction.

Pictures from the event are below.

In February 2017 there will a Lunch Break Science lecture by a local distillery on the art and science of whisky. 

I definitely will attend that one.

Hand Hygiene: What happens Next?

WHO 5 Moments for Hand Hygiene

I have been thinking about hand hygiene a lot. Despite all of our efforts, we never seem to reach the highest level of compliance,

This recently published, high quality, cluster, randomized trial of hand hygiene with different levels of assessment and performance feedback underscores, in my opinion, an important point: that direct observation with assessment and feedback, even with patient participation as hand hygiene reminders, has limited impact. Overall, only modest improvements in hand hygiene were observed with enhanced feedback and patient participation.

Hand hygiene compliance monitoring via standardized observers remains the gold standard, as summarized here. This is our strategy at VCU Health.  We have observed significant improvements in hand hygiene, however, we are not yet at the desired level. If we continue to do the same things we will get the same results.      

Enter hand hygiene automated monitoring technologies.

Much like hand hygiene compliance assessment by direct observation, automated hand hygiene monitoring technologies capture the foam in/ foam out hand hygiene events. If these technologies can be deployed to scale, with consistency, reliability, goal setting and accountability, we may have a game changer on our hands, pardon the pun.
        
We are in the 2nd wave of hand hygiene technology pilot testing at VCU Health. The goal is to go 'house-wide.'

Exciting.

                                              

Overuse! Dr. Daniel Morgan at VCU Internal Medicine Grand Rounds

Today we had the pleasure and honor to host Dr. Daniel Morgan of the University Maryland for internal medicine grand rounds.

The topic was overuse-the endemic over diagnosis and over treatment in the U.S. Healthcare System. The results are increasing risk, patient harm and elevated costs. The presentation was masterful, scholarly and well received by the audience.

Here is an editorial article written by Dr. Morgan on the myth of more medicine and better health, published in the Baltimore Sun.

Below are some images from the event.

                          

Shakespearean Syphilis, The Libertine and the Ravages of a New World Disease on European Society

Here is an article that highlights the astute observations on syphilis in the many works of William Shakespeare. The article was published in Pharos, by the Alpha Omega Alpha society.

The Libertine, starring Johnny Depp, is about a 16th Century English nobleman (John Wilmot, The 2nd Earl of Rochester) who was notably afflicted by syphilis, among other ailments of debauchery.   

Both the works of Shakespeare and The Libertine document syphilitic manifestations in Europeans following the disease's introduction from the New World. These included gummas, alopecia, extremely painful osteitis, neuropathy and dementia.

Although we still see a lot of syphilis the cases are much less severe.  This is likely due to more rapid diagnosis and early, effective treatment.  Regardless, I have to suspect that reinfection (particularly in the brothels) and general poor health and nutrition likely played a significant role in disease progression. How could it not?      

History of medicine via literature and film! 

Cool.                      

The Digital Doctor Is In!

I am not a luddite! I believe in medical technology but as with many things, there is a force and counterforce, a yin and yang of sorts.

There is no doubt that the electronic medical record (EMR)has led us to new heights, such as immediacy of access and retrievability of data, images etc.  

There is a dark side, however. We spend more time tapping on our PCs, minimizing contact with our patients, the so called iPatient phenomenon, as explored in this New England Journal of Medicine article by Dr. Anthony Verghese. Also, the EMR minimizes the need for doctor-doctor in person consultations. Who makes radiology rounds anymore? This may not be a good thing.

Much of this is summarized in the Digital Doctor, by Dr. David Wachter, a book which I found quite enlightening.

I am back on the VCU Wenzel Academic ID Consult Service this weekend, will attempt to focus on the patients...and not the EMR.