Friday, April 20, 2018

SHEA 2018- Portland, Oregon: In Pictures

Thank you to the Society for Healthcare Epidemiology of America for organizing a very high quality conference- SHEA Spring 2018.

Kudos to my VCU Team for their excellent work and scientific presentations. You make me very proud!

Images from the last several days are below.

laura Pedersen

Heather Albert, RN

Jacob Pierce, MD

Pamela Bailey, DO

Ginger Van Hoozer, RN

Barry Rittmann, MD

Salma Abbas, MD

With Drs. Mike Stevens and Michelle Doll

Dr. Michelle Doll

Dr. Michelle Doll

Dr. Mike Stevens moderates a session on infection prevention in low and middle income countries

Tuesday, April 17, 2018

The Hospital Epidemiologist. What's in a Name?

What's in a name, or in this case, a title? How does one define a hospital epidemiologist? We discussed this today at the SHEA Board meeting.

The following is my interpretation and does not reflect the official view of SHEA.

Hospital Epidemiologist are Doctors who Prevent Infection! This is done through:

  • Leadership
  • Policy
  • Science and research
  • Preparedness
  • Antibiotic stewardship
SHEA 2018 starts tomorrow, looking forward to it.

Stay tuned.

Friday, April 13, 2018

Enhanced Recovery After Surgery (ERAS): The Way To Go

Dr. Michael Scott

My experience with surgical site infection (SSI) risk reduction is a mixed bag. Perhaps our interventions were seen as too infectious disease oriented and not in line with a global surgical quality approach.

What was desperately needed was a comprehensive, bundled approach to surgical safety with ownership by anesthesiologists and surgeons, where reduced surgical site infections are a secondary yet important collateral benefit.

Enter Enhanced Recovery After Surgery (ERAS) protocol!

I refer you to this excellent review article on ERAS published in JAMA Surgery by my VCU colleague, Dr. Michael Scott. The topic was presented at VCU Department of Medicine Grand Rounds on 4/12/18 by Dr. Scott. 

Enhanced (early) recovery after surgery results in fewer complications and fewer infections.

More information at the ERAS site

I am off to SHEA 2018 next week, stay tuned.

Monday, April 9, 2018

HAI Surveillance: Still Searching for the Sweet Spot with Goodhart's Law in Mind

Professor Charles Goodhart
It seems with much of what we do in infection prevention, we are searching for the sweet spot, whether it is a in how we isolate patients with contact precautions or how we order diagnostic tests (test stewardship).

I read with great interest this article in Clinical Infectious Diseases on partially automated vs. fully automated surveillance systems for hospital acquired infections. No system is perfect and both approaches have some value.

My personal bias: we should standardize and automate as much as possible but only for clinically relevant outcomes with agreed upon infection prevention risk reduction processes.  Why aggressively monitor what we are unable to change (with the current state of science)? An ongoing element of manual review seems inevitable for now.

Last, beware of gaming. As referenced in the article, any surveillance system is subject to Goodhart's Law, named after British economist Professor Charles Goodhart (London School of Economics)

‘ Any observed statistical regularity will tend to collapse once pressure is placed on it for control purposes because actors will change their conduct when they know that the data they produce will be used to control them.'

We are still searching for the HAI surveillance sweet spot.

Wednesday, April 4, 2018

Take a Dump, Save a Life! The VCU Stall Street Journal Makes Fecal Microbiome Talk Mainstream

You know that the fecal microbiome has gone mainstream when you see posters such as these on the campus bathrooms.  

Published in the VCU Stall Street Journal, and hanging in VCU bathrooms, all you ever wanted to know about fecal microbiome diversity and the benefits of fecal microbiota transplantation for C. difficile infections. 

Take a dump, save a life.

Infectious diseases goes pop culture (sort of)!

Wednesday, March 28, 2018

De-Escalation of Contact Precautions- An Interrupted Time Series Analysis: Now Published!

Our article assessing the de-escalation of contact precautions with an interrupted time series analysis is now published electronically, print copy to follow in Infection Control and Hospital Epidemiology.

We continue to observe decreasing trends of all hospital-acquired infections (including MRSA and VRE)  with a broad based horizontal infection control program. The de-escalation of contact precautions has not negatively impacted this trend.

Special thank you to all of the collaborators, particularly Mike Edmond from the University of Iowa.

Tuesday, March 27, 2018

Toilet: A Love Story (and a Reflection on Open Defecation)

Yes, this film is named Toilet, and, yes, it is a love story (and about open defecation).  

The film explores the social and cultural values that are associated with indoor toilets, the ongoing problem of open defecation in India and a husband's quest to build a toilet for his wife.

To borrow a quote from the film: "If you change nothing, nothing will change"

Wednesday, March 21, 2018

Occupational TB Exposure Risk: Time to Question the Current Screening Paradigm

Source: Hasting Prince Edward Public Health, Ontario, Canada
I really love it when a new study challenges current practice.

We screen US healthcare workers at regular intervals for tuberculosis (at least once yearly).  

This article, recently published in Clinical Infectious Diseases questions that practice.  After following over 40,000 healthcare workers for over 16 years, only 123 positive TB skin tests were reported of which only 7% had a suspected TB exposure in the workplace.  None developed active tuberculosis.

Do we need to screen so often?  Perhaps we could screen employees on initial hire and then only after a documented exposure to a tuberculosis case?  This would be easier, less costly and likely result in no harm.

Time to rethink the current healthcare worker tuberculosis screening paradigm.

Monday, March 19, 2018

Doxycycline for Post Exposure Prophylaxis- Decreasing Syphilis and Chlamydia Infections but not Ready for Prime Time

Source: Web MD
Doxycycline may have a potential new niche, this time for STI post exposure prophylaxis. 

This recent article in Lancet Infectious Diseases reports significant reductions in chlamydia and syphilis infections in men who have sex with men on HIV PrEP when taking a 200 mg dose of doxycyline post sexual activity.

To have a population based impact, per this previous publication, doxycycline would have to 70% effective at preventing syphilis and taken by 50% of sexually active gay men for syphilis rates to decrease by 50%.

All of this is tantalizing but concerns are aplenty. Condom use continues to decrease with patients on post-exposure prophylaxis. The impact of doxycycline use on antimicrobial stewardship efforts and emergence of antibiotic resistance in chlamydia and syphilis isolates are real. Study results must be replicated for greater validity.

Doxycycline as post exposure prophylaxis for the prevention of sexually transmitted infections  is not yet ready for prime time.

Friday, March 16, 2018

Argentina 2018- 18th International Congress of Infectious Diseases and Beyond: Parting Shots

I am back stateside after attending the 18th International Congress on Infectious Diseases in Buenos Aires, Argentina (see prior blog posts).

In addition to popping home to Cordoba, Argentina, I had the opportunity to visit Patagonia (El Calafate) and Tierra del Fuego (Ushuaia).

Parting images are below.


Perito Moreno Glaciar, Patagonia

Tierra del Fuego

Ushuaia, Tierra del Fuego

Beagle Channel, Tierra del Fuego

Beagle Channel, Tierra del Fuego

Beagle Channel, Tierra del Fuego

End of the World, Tierra del Fuego

Sunday, March 4, 2018

18th ICID Buenos Aires: Last (3rd) Day In Pictures

L to R: Drs. Bearman, De la Cruz and Stevens

Sadly, the 18th International Congress on Infectious Diseases comes to an end today. The program has been superb thus far. Naturally, as an Argentine, attending the conference in Buenos Aires has been a thrill.

Dr. Oveimar De La Cruz (VCU Transplant Infectious Diseases) gave a masterful presentation today on viral respiratory infections in transplant recipients.

Thank you to the International Society of Infectious Disease (ISID) for inviting both me and my team to present our work on hospital infection prevention (Dr. Michelle Doll), antimicrobial stewardship (Dr. Michael Stevens) and transplant infections (Dr. Oveimar De La Cruz). The ongoing ISID support of our book (with co-editors Michelle Doll, Mike Stevens, Shaheen Mehtar, Ziad Memesh and Victor Rosenthal), Guide To Infection Control in the Hospital, is exciting and timely.

Last, a special and personal thank you to Drs. Doll, Stevens and De La Cruz for their exceptional representation of Virginia Commonwealth University Infectious Diseases. More importantly, thank you for the ongoing collegiality and friendship.

What an exceptional 3 days!