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.

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"

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.

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.

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.

Patagonia

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

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!

18th ICID Buenos Aires: Second Day in Pictures

Exciting day at the 18th ICID Buenos Aires with Dr. Michelle Doll representing us during her scientific presentation on Clostridium difficile infections. 

Later, with my colleagues Drs. Stevens and Doll, we held a work shop on the recently launched Guide to Infection Control in the Hospital.  Really excellent turnout with valuable feedback.

Later I gave my invited lecture on infection prevention controversies and isolation precautions.

Dr. Oveimar De La Cruz will represent VCU tomorrow with a lecture on respiratory viral infections in transplant recipients.

More to come.

6th Edition of Guide to Infection Control in the Hospital. Launched! Free and Open Access

The 6th edition of Guide to Infection Control in the hospital has launched. The book, where I serve as editor in chief, is now accessible here (free and open access).

The project's next step is for a mobile, point of care application. Stay tuned.

Thank you to the Society and to the co-editors. A very special thank you to all of the contributors. 

We could not have done it without you!

18th ICID Buenos Aires: First Day In Pictures

Really great representation by VCU ID Team at the 18th International Congress on Infectious Diseases.

Dr. Michelle Doll moderated a session on antimicrobial resistance. Dr. Michael Stevens presented an e-abstract on a metric for relative carbapenem consumption and moderated a session whole genomic sequencing and infection prevention.

Tomorrow Dr. Doll will present an oral abstract on Clostridium difficile diagnosis and I will give a lecture at the infection prevention controversies session.

Full day of conference focused attention.

More to come, tomorrow.

VCU ID Team at the International Congress on Infectious Diseases 2018: Buenos Aires, Argentina

L-R: Drs. Stevens, De La Cruz, Doll, Bearman

It is a distinct pleasure to be with my VCU ID colleagues in Buenos Aires, Argentina, for the 18th International Conference in Infectious Diseases.

We have several oral presentations, posters and a committee meeting to further edit the 6th Guide to Infection Control in the Hospital.

Stay tuned for updates.