VCU-UVA Infectious Diseases Case Conference Fall 2017: The Tradition Continues

Yesterday we hosted the Fall session of the Virginia Commonwealth University - University of Virginia Clinical Case Conference. The twice yearly event was resuscitated after a nearly 20 year hiatus. Images from the event, hosted at the VCU Alumni House, are below.

Why do it? 

Because rarely does one person, group or organization 'have it all.' We learn through collaboration, dialogue and the sharing of expertise. Plus, collegiality leads to an output which is greater than the sum of the parts.

Thank you to UVA ID Division Chair Dr. Bill Petri for his ongoing collaboration. A special thanks to Dr. Jane Cecil for running the event.

Last, a very special thanks to my two assistants Peggy Andrews and Krystle Shaw. Without them much of my professional agenda would be chaotic and unfulfilled.

The 3rd Annual Gordon Archer Research Day, a VCU ID Division function, is around the corner. 

Stay tuned.

L-R: Dr. Jane Celic, Peggy Andrews and Krystle Shaw

Drr. Jane Cecil

Case Conference

Writers, Poets, Artists and Collectors: The Chester Beatty Library, Dublin, Ireland

Dublin is a city of writers, poets and artists. 

Some, like writer Oscar Wilde, add to culture by creating, others, such as Sir Chester Beatty, add by collecting- so that the rest of us may have a chance to marvel at rare books and manuscripts.

The Chester Beatty Library, quite possibly the largest private collection of manuscripts and books from antiquity to the present, is on display as a public museum.For those who are captivated by books and reading this is the place to be.

Back to the USA and back to the consult service tomorrow.

Statue of Oscar Wilde in Merrion Square

Bram Stoker Festival 2017: Dublin, Ireland- Royal College of Surgeons Lecture

By happenstance I learned of the annual Bram Stoker Festival celebrating one of Dublin's many famed writers and obtained tickets to attend a lecture titled 'Slayers and their Vampires' at the Royal College of Surgeons, Ireland. The lecture was held in the Aula Magna, the Albert Lecture Theatre.

The academic panel included Bruce McClelland, Maura McHugh and David Skal, a Bram Stoker biographer.The discussion covered the the historical, folkloric and metaphorical aspects of the Dracula story. It was unlike any other academic lecture I have ever attended at a medical college.

Images are below.

Perhaps Virginia Commonwealth University should host an annual Edgar Alan Poe festival.

Albert Lecture Theatre, Royal College of Surgeons, Ireland

Royal College of Surgeons, Ireland

Thank You University of Nebraska Infectious Diseases Blog!

Thank you to Dr. Jasmine Marcelin for her kind blog post regarding my medical grand rounds lecture last week at the University of Nebraska Medical Center.

I thoroughly enjoyed the event, summarized here.

I am still in Ireland, blogging light.

Literary Fascination! Dublin, Ireland

I like books, as previously posted, so forgive me this aside. 

I am currently in Dublin, Ireland, where I visited the famed Trinity College, viewed the Book of Kells exhibit and strolled along The Long Room, of the institution's vaunted library. Later, a stroll to the pubs frequented by Samuel Beckett, James Joyce and Oscar Wilde.

Images below.

Grand Rounds at University of Nebraska Medical Center: Infection Prevention: Processes, Pragmatism and Controversies

University of Nebraska Medical Center Campus

Arriving early at the Durham Research Center auditorium, prior to loading the slides

Thank you to Dr. Mark Rupp and the rest of the infectious diseases, infection prevention and healthcare quality team at the University of Nebraska Medical Center for graciously hosting me as the invited grand rounds speaker on October 20, 2017.

My lecture, titled Infection Prevention: Processes, Pragmatism and Controversies, covered much of what is interesting to me in infection prevention. Of course, the presentation heavily referenced pragmatism, bias in hospital  epidemiology and a satisfice approach to infection prevention. So as not to disappoint, the use of gowns and gloves and the  de-escalation of contact precautions was explored along with physician apparel, bare below the elbows and accountability. 

Thank you to the audience for listening.

Discontinuation of Contact Precautions: Back in the Literature

Like a recurrent bad dream for some, the discontinuation of contact precautions for the control of endemic MRSA and VRE is back in the medical literature.  

A meta-anlysis, published here, by Alex Marra, once again suggests that the cessation of contact precautions for the control of endemic MRSA and VRE is without adverse consequences.

My colleague Mark Rupp also published this manuscript in ICHE summarizing the University of Nebraska's positive experience with the discontinuation of contact precautions for the control of endemic MRSA and VRE.

I am off to the University of Nebraska Medical Center tomorrow, to give an invited medical grand rounds lecture on infection prevention- policies, pragmatism and controversies.

I might just talk about the discontinuation of contact precautions too.

Are We Serious About Limiting Presenteeism?If So HR Policy Changes Are Needed

Presenteeism, or working while sick, is a cross transmission risk. With the looming respiratory virus season this is increasingly relevant. Not all risks related to presenteeism are ascribed to respiratory viruses. Here is a reported cluster of Group A streptococcal skin infections in a skilled nursing facility, likely related to a 'present' healthcare worker with Group A streptococcal pharyngitis. It has also been argued that reducing presenteeism is more effective than mandatory influenza vaccination in reducing hospital acquired influenza.

But how can we effectively reduce presenteeism? 

I have found no published reports of successful strategies for presenteeism reduction in healthcare settings. 

Staff education of the dangers of presenteeism is a good start but likely insufficient. A change in human resources (HR) policy is likely needed such that sick leave is different than paid time off, as summarized in this pro/con article. Healthcare workers would thus not feel 'penalized' by losing vacation time when out sick. Of course, sick leave could easily be abused, thus requiring policies and mechanisms to better manage absenteeism.

Bottom line, we can talk about limiting presenteeism but this commitment will ring hollow without changes in HR policy. This has been done, as neatly summarized in this blog post by Mike Edmond.

I get a sense that for many healthcare systems the policy of mandatory influenza vaccination is easier and more expedient than making substantive changes in HR policies.

Eminence Front! Eminence Based Medicine and Other Options to Evidence Based Medicine

What to do when high quality evidence is not available to guide decision medical making?

I dug this one out of the archives of the British Medical Journal after hearing a reference to 'eminence based medicine' at ID Week 2017.

Strategies include 'eminence based medicine"- where experience is worth any amount of evidence, and may actually trump evidence in many cases.It's an eminence front! Other strategies include 'eloquence based medicine' and ' providence based medicine" where decisions are best left in the hands of the Almighty.

In the absence of evidence all may not be lost. Weigh the risks, benefits, consider the opportunity costs and be pragmatic.

ID Week 2017: Parting Shot- Pay Us More Than Minimum Wage!

In a moment I will en route to Virginia.

Here is a parting shot from ID Week 2017, from the IDeas Wall. Note the comment at the bottom. In the USA, where procedures are lucrative, cognitive specialties suffer and have the lowest reimbursement.

"Pay us more than minimum wage." 

Infectious diseases is a very exciting, low paying job.

ID Week 2017: Congratulations to Drs. Nicole Vissichelli and Oveimar De La Cruz

Dr. Nicole Vissichelli at ID Week 2017

ID Week 2017 is coming to an end. really great week with high quality presentations and posters.

Congratulations to Drs. Nicole Vissichelli and Oveimar De La Cruz on their bone marrow transplant and infectious diseases related abstract.

Dr. Visichelli will present her work next month at VCU's Gordon Archer Annual Research Day. 

Stay tuned.

ID Week 2017: With the Agent Provacateur- Mike Edmond

'Jane, you ignorant Slut!' From Saturday Night Live Skit to ID Week pro/con debate theme.

Learning with Levity.

With friend and former VCU colleague Mike Edmond, the Agent Provocateur of hospital infection prevention, prior to his arguing against universal influenza vaccination of HCWs.

Lively and spirited.

ID Week 2017: Guide to Infection Control In the Hospital with the International Society of Infectious Diseases

Drs. Doll, Stevens and I caught up with Chris Trimmer and Laurence Mialot of the International Society of Infectious Diseases, where we continued to plot the next steps for the 6th edition of The Guide for Infection Control in the Hospital.

The new edition will be launched at the International Congress on Infectious Diseases, Buenos Aires, 2018. Expect new content and new web-based format, with e-pub and portable app, all in the making.

Exciting.

New Perspectives and Controversies in Infection Prevention. Published!

L-R: Drs. Morgan, Murthy, Munoz-Price and the blogger.

Thank you to my co-editors Drs. Dan Morgan (University of Maryland), Silvia Munoz-Price (Medical College of Wisconsin) and Rekha Murthy (Cedars-Sinai/ UCLA) for their invaluable collaboration on this newly published book, New Perspectives and Controversies in Infection Prevention (Springer).  More importantly, thank you to the many contributors for their high quality submissions.

As the name suggests, we did not shy away from controversy, which is how we like it!

We caught up at ID Week 2017 (San Diego) for a group photo.

Portable Bedside Equipment: An Infection Prevention Nuisance

I generally enjoy reading small articles that probe commonplace infection preventions issues. 

This recent article underscores the potential and likely under-recognized threat of portable equipment (bedside ultrasounds, EKGs etc) in the transmission of pathogens in the hospital. After inoculating portable equipment with a DNA marker, a substantial proportion (about 20%) of areas sampled, including common areas, patient rooms and portable equipment, were positive for the DNA marker, suggesting that both transmission across inanimate surfaces is possible (likely via HCW hands) and that disinfection is unreliable.

The solution is not simple. Hand hygiene is variable, most commonly at foam in and foam out of patient rooms, thus missing other opportunities for hand decontamination. More importantly, disinfection of portable devices is not standardized. Assigning this task to busy nurses simply will not work in the real world.

We need better processes for disinfection of environmental bioburden. Dedicated environmental teams or technologies are needed to regularly and consistently clean portable equipment.

I am en route to San Diego for ID Week 2017. 

Stay tuned.

The Bad-Ass Librarians of Timbuktu! A Real Life Revenge of the Nerds.

The librarians of Timbuktu are bad-ass! No joke.

My penchant for seeking books (old and new alike) and hanging out in libraries was previously highlighted here . Naturally, a book chronicling the heroic rescue of ancient manuscripts (on medicine, religion, astronomy etc) in Timbuktu from imminent destruction by Al-Qaeda peeked my interest.

The  Bad-Ass Librarians of Timbuktu, a bookish and intellectual lot, organized a covert heist of over 350,000 manuscripts and smuggled them to safety in southern Mali. A real world thriller with a 'revenge of the nerds' flavor.

I will be spending much of the upcoming week at ID Week 2017. 

Expect pictorial updates on the blog.