Friday, August 31, 2018

Prague, Czech Republic: Literature, Libraries and Football Grounds

I am currently in Prague, Czech Republic, and not at a medical conference (finally)!

No European jaunt is complete (for me) without visiting cool bookstores, libraries and football grounds.  

I visited The Klementinum, the most beautiful library in the world (no photos allowed in the barroque library), the Franz Kafka Society Bookstore, and the AC Sparta Prague football ground (Generali Arena) for a match vs Dukla FC.

Images below.

Monday, August 27, 2018

Working While Sick: Growing Interest in Reducing Presenteeism?

I enjoyed reading this recent commentary on presenteeism (working while sick) in infection control and hospital epidemiology, available here.

Just recently was invited to give a SHEA 2019 lecture on presenteeism and the need for a culture change in the hospital.  Could interest in reducing presenteeism be on the rise?

A major risk of presenteeism is the transmission of viral respiratory infections to hospitalized patients, particularly those with compromised immune systems.  Reasons for working while sick include not wanting to let colleagues and patients down, logistical reasons (no cross coverage) and a strong cultural norm to work through sickness.  In addition, HR policies commonly do not uncouple sick leave from paid time off. This is shortsighted and discourages healthcare worker to call out sick.

Some have advocated universal mask use in high risk units as a means of reducing the transmission of viral pathogens from healthcare workers to patients. This may not be practical.

As with nearly all complicated healthcare matters, addressing presenteeism will require a multi-modal approach.  We should raise awareness of the risks of presenteeism. This should be coupled with definitions and guidance on symptoms that preclude care in the patient environment. A 'jeopardy' on call system should be in place for cross coverage of ill physicians and nurses. HR policies should uncouple sick leave from paid time off. Last, mechanisms should exist to minimize abuse of sick leave. 

So, if any of you have achieved the above changes to minimize presenteeism, please forward me your practices and processes.  

We could learn from you.

Thursday, August 23, 2018

If You Value Safety, Learn to Love Criticism!

Yesterday I had a less than pleasant encounter with a nurse who was not wearing gown and gloves in a C difficile isolation room.  In addition, she chose to wash her hands with alcohol hand rub instead of soap and water.  When this violation of policy was brought to her attention, privately and not in front of the patient, she became very defensive and argumentative.

Now, one could argue that the relative impact of contact precautions and even hand hygiene with soap and water on C difficile prevention is small.  However, if policies are flexible and optional and if feedback is deemed threatening, we have a problem.

This morning, by chance, I came across this TED podcast by Adam Grant on How to Love Criticism, available hereThe podcast highlights the value of criticism for personal and professional improvement.  We need not embrace a policy of radical transparency and brutal honesty with all colleagues, however, by exploring extremes in modes of criticism we can gain new insights on how to foster improvement.

In a hypersensitive environment, where change must be accomplished in a non-threatening manner, frequently under the theme of shared governance, criticism can seem counter cultural. It need not be so.

If a top healthcare goal is patient safety, under the primacy of first do no harm, critical assessment of all processes and practices is needed. Standardized reports that highlight processes, outcomes and missed opportunities, with peer-to-peer or unit-to-unit comparison are a good start. However, a culture of constructive criticism really starts from the top, with executives setting an expectation and requesting criticism and feedback on their performance. The same would be expected of mid-level managers, physician directors and nurse managers. Regular staff meetings and daily unit/ward safety huddles are excellent venues to actively seek criticism and feedback on leadership, practice and processes. These would drive accountability and heighten the performance of both individuals and groups.

If we value patient safety, we need to critically seek our reflection in the mirror, no matter the result.  

Tuesday, August 21, 2018

Think on These Things: Santiago Ramón y Cajal

I was just back in my native Córdoba, Argentina, at my home on Calle Santiago Ramon y Cajal, named after the 1906 Nobel Prize winning Spanish physician and neuroscientist. The Nobel biography page on Dr. Ramón y Cajal can be found here.

My visit home made me reflect on his book Reglas y Consejos Sobre Investigación Científica, published in 1898, wherein he summarizes his observations and perspectives on medicine and scientific investigation. 

"Discovery is not necessarily a function of special talent, but a function of hard work, which creates talent, and, low achievement is less commonly from a lack of time and resources, it is more from a lack of willpower."

From what I have observed in colleagues, including excuses, bad time management, poor choices and lack of discipline, these observations fully ring true today.

Thursday, August 16, 2018

Visita al Hospital Rawson, Córdoba, Argentina

Gracias a la Dra. Miriam Maldonado y al Dr. Sergion Arselán por una visita memorable al Hospital Rawson de Córdoba, Argentina.

Fue tanto un placer como un honor visitar al hospital y dar dos seminarios a los estudiantes de medicina cursando infectología. 

Una experiencia única.

Images below are from my visit to the Rawson Hospital, Córdoba, Argentina, where I was the guest of Drs. Miriam Maldonado and Sergio Arselán. I also had the pleasure of giving two lectures on infection prevention to the medical students in the infectious diseases course.  


Con Dra. Miriam Maldonoado y Dr. Sergio Arselán

Wednesday, August 15, 2018

VCU Antimicrobial Stewardship Program Receives IDSA Antimicrobial Stewardship Centers of Excellence Designation

Congratulations to Dr. Mike Stevens and the rest of the VCU Antimicrobial Stewardship Program (ASP) team! 

The VCU ASP Team was just recognized as one of the 25 Antimicrobial Stewardship Centers of Excellence by the Infectious Diseases Society of America (IDSA). 

The IDSA announcement can be accessed here.

Thank you VCU ASP team, you make the Hospital Infection Prevention Program very proud!

Tuesday, August 14, 2018

Día de Invierno Soñado / Wonderful Winter Day: Córdoba, Argentina

Fue un día idóneo para deambular por el centro de Córdoba, sin destino, sacando fotos, tomando cafe, visitando museos y comprando libros.

It was a perfect day to wander through the city center of Córdoba, with no specific destination in mind, to drink coffee, visit museums and buy books.

Museo Caraffa

Palacio Ferreyra

Palacio Ferreyra

Palacio Ferreyra

Palacio Ferreyra

Palacio Ferreyra

Palacio Ferreyra

Paisaje urbano / Cityscape

Paseo del Buen Pastor

Paseo del Buen Pastor

Paseo del Buen Pastor


Confitería El Ruedo

Catedral de Córdoba

Saturday, August 11, 2018

Tercer Día: Congreso Jornadas Infectológicos de Invierno, Córdoba, Argentina

Gracias a todos por una conferencia de altísimo nivel. Fue tanto un gusto como un honor compartir estas jornadas con los infectólogos destacados de Córdoba.

Mis dos charlas de hoy fueron muy bien atendidas y recibidas con una interacción dinámica.

Espero volver a participar en el congreso de 2019.

Vista panorámica desde el centro de convenciones, Hotel Sheraton, Córdoba, Argentina

Centro, Córdoba, Argentina

Auditorio, Congreso Jornadas Infectológicos de Invierno, Córdoba, Argentina 2018

Friday, August 10, 2018

Segundo Día: Congreso Jornadas Infectológicos de Invierno, Córdoba, Argentina

Gracias a los organizadores por un día completo y exitoso en el Congreso Jornadas Infectológicos de Invierno, Córdoba, Argentina.

Las presentaciones por mis colegas fueron de altísimo nivel. Muy dinámicas e informativas.

Me quedan dos charlas para mañana, el ultimo día del congreso.

Sigo entusiasmado.

Thursday, August 9, 2018

Primer Día: Congreso Jornadas Infectológicos de Invierno, Córdoba, Argentina

Primer día del congreso Jornadas Infectológicos de Invierno, Córdoba, Argentina.

Los seminarios han sido de muy alto nivel.

Mañana tengo mi primer discurso: Infecciones Intrahospitalarias- Cuanto se pueden prevenir y cuanto debemos tratar?