Tuesday, October 16, 2018

Open Access to All: The Guide to Infection Control in the Healthcare Setting


Our book, The Guide to Infection Control in the Healthcare Setting (6th Edition) is fully updated and available, in a web-based format, open access to all, here.

The Spanish language translation is in process. 

Further plans for the Guide (development of an App and additional content) are to be discussed at IMED 2018, with the publisher, The International Society for Infectious Diseases .

Stay tuned.


Monday, October 15, 2018

Super-Book! Super-Bugs: An Arms Race Against Bacteria

The book Super-Bugs: An Arms Race Against Bacteria is a stellar read on the looming antimicrobial resistance crisis.
Kudos to the authors on this super book, the best that I have read on the topic 

The writers take a complicated subject and neatly break it down into its component parts with clear and direct writing.  

Antibiotic resistance is not seen as an immediate urgency as it is a slow moving issue that on a day-to-day basis people do not experience or see.  This poses a massive challenge for policy makers. Couple this with antibiotic overuse (both in humans and in animals) and the financial disincentives for pharmaceutical companies to developed and market new drugs and a crisis awaits.

Realistic solutions are offered and include public-private partnerships for drug development, antimicrobial stewardship (both in humans and in agriculture) and heightened infection prevention.

Complicated problems need sensible, multi-modal approaches, as expertly argued. This is no dry, academic tome.

Here is a well written commentary in The Telegraph (UK) exploring the above in greater detail.

Read on.

Wednesday, October 10, 2018

Social Media Decorum for Medical Professionals: The Crowded Elevator Rule

Source: The Writing Cooperative
Social media blurs the barriers between professional and personal lives.

How should healthcare professionals maintain a social media presence without compromising professional appearance?

This manuscript published in the Journal of the American College of Surgeons is a timely best practices guidance for social media use by surgeons, applicable to all healthcare professionals.

Some of the recommendations are both straightforward and commonsense such as not using social media as a tool for patient-physician communication and always protecting patient confidentiality.  Also, avoid posting content that may have negative or unintended consequences in the workplace. Last, the article recommends that surgeons should actively maintain a professional online profile.

I agree with all of the above.

Personally, I try to follow one inviolate rule: never post anything online that I would not be comfortable saying in a crowded elevator.  

It works for me. 


Tuesday, October 9, 2018

Personal Protective Equipment Coverall! The Way To Go?

Source: Johns Hopkins Center for Bioengineering Innovation and Design
We have previously argued (here) that healthcare workers need training in personal protective equipment (PPE) doffing, especially given the high risk of self contamination.

I read with great interest this article in American Journal of Infection Control, where a novel PPE coverall (for Ebola) was assessed in stimulated scenarios.

This new PPE suit has a rear entry and exit seem, covered zippers and over the shoulder pull tabs which simplify donning and doffing. In a simulated scenario, this new design was comfortable and well received by healthcare workers.

The next critical step, in my opinion, is formally assessing self contamination at the time of doffing. 

If the newly designed PPE coverall suit decreases self contamination (vs the traditional PPE suit), this may be the way to go.

Friday, October 5, 2018

Bowler Men And Beyond: Rene Magritte at the SF MoMA

Adjacent to the Moscone Convention Center is the San Francisco Museum of Modern Art (SF MoMA), currently housing an excellent exhibit titled Rene Magritte, The Fifth Season.

A perfect respite from long days of conferencing at ID Week 2018.

Magritte was a provocateur in a well cut suit and a notable surrealist artist.

The (iconic) man in the bowler hat! 

Belgian artist Rene Magritte



Iconic work- The Birth of Man by Rene Magritte







The Blogger within an interactive exhibit at the Magritte exhibit



Disinfection of Non-Critical Equipment: We Can Do Better

Source:WikiHow
Congratulations to our two college research students, Emmy Bowe (University of Richmond) and Tara Srivastava (University of Virginia) for their recent publication on disinfection of non-critical equipment, published in American Journal of Infection Control and accessible here.

We can learn a lot about ourselves by asking simple questions. We simply do not perform disinfection of non-critical equipment with fidelity. Barriers are several, as reported in our paper.

Simple steps to improve practice include improved point of care cleaning information, improved access to cleaning supplies and increased instrument storage space. 

Small interventions will likely pay disinfection dividends.

Thursday, October 4, 2018

VCU Infectious Diseases at ID Week 2018, San Francisco, CA. Making us Proud!

Thank you to the VCU Infectious Diseases and Infection Prevention team for their tireless work and scientific presentations at the ID Week 2018 national conference, San Francisco, California.

Thank you all for the kind feedback on my spirited debate on hand hygiene with Dr. John Boyce. 

What an honor!



Kaila Cooper, VCU Infection Prevention Nurse Director

Trina Trimmer and Kaila Cooper

L to R: Trina Trimmer, Kaila Cooper, Drs. Sann, Emberger, Bailey and Ritmann

VCU Medical Student Andrew Kirk

Drs. Jacob Pierce and Jane Cecil





Tuesday, October 2, 2018

Medical Blogging is Legit! Don't Think So? Read On...

Although not as prestigious as a peer reviewed publication in a high impact journal, medical blogging is a legitimate (academic) exercise .

This paper, recently published, in Infection Control and Hospital Epidemiology, uniquely highlights the content and quality of infectious diseases blogs. 

Blogging has its value and is a means of communicating timely issues and content.

The key is to keep the blog short (less than 1000 words), provide relevant hyperlinks, and have an 'angle', a perspective.  Make it meaningful. Wit and humor help too.

In my opinion, for an academician, medical blogging is complementary to publishing peer reviewed work.

Blog on.

Monday, October 1, 2018

Health Hazard:The Spread of False News Online and the Anti-Vaccine Movement

I came across this intriguing article in Science, a comparison of the spread of true and false news online.  Using sophisticated analytic and statistical techniques, the investigators concluded that false news spreads more quickly then true news, particularly false political news.  

The spread of false news is not much impacted by bots as previously believed. False news is propagated by humans.  The reasons are not fully clear, however, false news is generally more novel than true news, suggesting that this may serve as a driver for spread.

The spread of false news is very concerning, particularly false medical news, such as vaccine misinformation

This recent publication in Vaccine, available open access here, suggests that we should change our approach to vaccine communication.  Forget debunking false conclusions as this is rarely effective.  Focus instead on integrated messages that exploit potential social networks and promote messages with positive, emotional values on immunization. This will have greater traction with the public. Novel. 

I am off to San Francisco today, for the 2018 ID Week conference. I will be participating in a debate versus my esteemed colleague Dr. John Boyce. Details can be found here.

Stay tuned.

Friday, September 28, 2018

VCU Investure Dinner: Richard P Wenzel Endowed Professorship of Internal Medicine


VCU in 2004: With Mike Edmond (Left) and Richard Wenzel (Right)


Last night I attended the VCU Investure dinner for endowed professorships.

Although I have held the title for several years, It was an absolute honor to formally receive the Richard P. Wenzel Endowed Professorship in Internal Medicine from the Virginia Commonwealth University.

Due the massive influence, mentorship and friendship, both personally and professionally, from Drs. Richard Wenzel (now Professor Emeritus) and Michael Edmond (now at University of Iowa), I have succeeded at VCU. 

Gratus semper.

Monday, September 24, 2018

AO Trauma Clinical Priority Program Forum on Bone Infections: It's Good To Explore Beyond Your Comfort Zone



Perhaps I have been consorting too much with infectious diseases specialists and hospital epidemiologists. My academic focus may be too narrow.

I spent the weekend, as an invited participant, at the AO Trauma / AO Foundation 7th Annual Meeting-Clinical Priority Program (CPP) forum on bone infections. The meeting was held in Washington, DC.

The small, international group of participants (USA, England, Wales, Ireland, Belgium, Switzerland, Germany, and Japan) included orthopedic surgeons, basic scientists, immunologists, an electron microscopist and one infectious diseases specialist (the Blogger).

The discussions focused on leading translational research, to better understand the pathophysiology and further the diagnosis and treatment of complicated bone infections. New perspectives, deeper awareness and novel concepts are best found out of one's typical comfort zone.

Along with VCU Orthopedic Chairman and AO Trauma CPP Chair, Dr. Stephen Kates, I am a co-investigator on a multi-center, international protocol to standardize and implement a surgical site infection risk reduction bundle for open fractures. The study has launched and is collecting data.

More to come.

Friday, September 21, 2018

The Great Influenza and Author John M. Barry at The Virginia Museum of History and Culture

Last evening I had the pleasure of attending The Great Influenza event at the Virginia Museum of History and Culture. The guest of honor was celebrated writer John M. Barry, author of The Great Influenza. The near capacity crowd greeted the honored guest with enthusiasm.

Following the keynote address by Mr. Barry, where he discussed the history of the 1918 influenza pandemic, lessons learned and looming concerns, I had the honor of being a panel member participant, on a discussion of influenza, pandemics and unique pathogens. Panel members included Dr. Peter Buckley (Dean VCU School  of Medicine) and Dr. Michael Donnenberg (Infectious Diseases and Senior Associate Dean for Research VCU School of Medicine)

Images from the event are below.



Left to right: Drs. Donnenberg, Buckley, John M. Barry, the Blogger





Monday, September 17, 2018

Once Again, Untested Assumptions: Microbiota, Probiotics and Patient Harm

This article is a fresh reminder of an untested assumption, something not uncommon in medicine.

Probiotics, to restore the microflora and prevent antibiotic associated diarrhea and Clostridium difficile infections, how could these be unsafe?

Probiotics are presumed low risk but we simply don't know the potential harms because adverse events are not rigorously assessed in related clinical trials.

Now when asked about the safety of probiotics,  I am obligated to modify my answer: 

Probiotics are likely safe but we simply don't know for sure.


Friday, September 14, 2018

Hand Hygiene: How Much is Enough?

I am back in the USA, back at work, preparing slides for my ID Week 2018 pro/con debate on hand hygiene tracking and monitoring.

We hold hand hygiene sacrosanct in infection prevention.  Some would argue that hand hygiene does not prevent infections, rather, it reduces the transmission of multi-drug resistant organisms, as explored here

Regardless, it is safe to say that hand hygiene is potentially one of the most important infection prevention interventions and that compliance is generally suboptimal. A good systematic review and meta-analysis of interventions to promote hand hygiene can be accessed here.

Beyond that, things become contentious.

The proportionate impact of hand hygiene on infection prevention outcomes is debatable, there are no head to head trials comparing one multi-modal hand hygiene tracking strategy to another and certainly none comparing multi-modal strategies to the emerging hand hygiene electronic monitoring systems on the market.  

What is the optimal level of hand hygiene compliance?  At what point is there a diminishing return with improved hand hygiene and infection prevention outcomes?  Which hand hygiene interventions are most reasonable and sustainable, so that they play out in the real world?

Simply put, our science (hospital infection prevention) lacks specificity

So how much hand hygiene is enough?  No one really knows but more is probably better.

Vexing.




Monday, September 10, 2018

Budapest: Hospital in the Rock

A a less known destination in Budapest is the Hospital in the Rock.

This medical bunker built within the caves of Castle Hill served as a World War II Red Cross hospital during the siege of Budapest. During most dire times, capacity soared to 600 patients! Not unexpectedly, infections were an issue with such overcrowding.

In 1956, the facility served a similar war-time hospital purpose during 1956 Hungarian revolution.

Under the Soviets, the facility was used as a nuclear bunker.

Fascinating.














Parting Images of Budapest

I am still writing a travelblogue.

Parting images include night scenes, below, from my meanderings through Budapest.

A storied city with eclectic influences from the Ottomans, the Habsburgs and the Soviets. The Széchenyi Thermal Bath was particularly unique.

Other highlights include a visit to Castle Hill, the Hospital in the Rock (blog post here), the Hungarian Parliament Palace, the Great Market Hall, the sober Shoes on the Danube Monument (to jews executed by Nazis on the Danube riverbank) and a Barons of Budapest walk through former palaces, museums and libraries in Budapest.