Sepsis Editorial:Thank You For A More Comprehensive (and Concise) Perspective

Source: American Nurse Today

This article on sepsis published in Clinical Infectious Diseases provides a much needed public health perspective on a serious issue.

We focus on the early diagnosis and management of sepsis through protocolized mechanisms in acute care settings.  I have nothing against standardizing care for severe conditions. However, sepsis is a greater problem than just timely diagnosis and management.

In this editorial a more comprehensive view of sepsis is considered, this includes a focus on surveillance, antimicrobial stewardship, pathogens (vaccines), health behaviors (smoking), management of chronic conditions (preferable prior to hospitalization), demographics, microbiome, infection prevention and minimizing invasive devices. 

Comprehensive and concise. Thank you!

Instead of stopping the leaks in the dam, build a better dam.

Infection Prevention Shortcomings: A Betrayal of Trust?

All serious endeavors must begin with answering the question 'why?'  

We have a paper currently in press titled Infection Prevention in the Hospital: How Much Can We Prevent and How Hard Should We Try? The paper will be published in January 2019, Current Infectious Diseases Reports.

We estimate that 50%-70% of hospital-acquired infections are potentially preventable.

So how hard should we try and why?

In the book Betrayal of Trust: The Collapse of Global Public Health, Laurie Garrett writes that “public health is an essential trust, between government and its people, in a pursuit of health for all…” This includes “...a healthcare system that follows the primary maxim of medicine- do no harm.”

In my opinion, healthcare systems that fail to prioritize and relentlessly pursue infection prevention betray the maxim of medicine, primum non nocere.  This is a betrayal of the public's trust. 

Our safety mandate is clear.

Spoiler! Thanksgiving Dinner, Salmonellosis and Other Infections of Leisure

If you are germaphobe read no further.

This MMWR report gingerly reminds us of the dangers of salmonellosis from poultry, specifically a salmonella outbreak from a Thanksgiving dinner.  

In truth, the biggest risk at Thanksgiving is overeating and not salmonella.

But why stop there? 

Check out the book titled Infections of Leisure. 

I just blew the dust off of it when removing it from my bookshelf.  The book beautifully highlights the microbes that await us during our most carefree moments-at the shore, in fresh water, with our pets, during sporting activities and with our exotic trendy cuisine. Riveting.

Happy Turkey Day.

2018 New Jersey APIC / ID Society Lecture: What an Amazing Line-Up!

Dr. Michael Osterholm

Thank you to the New Jersey APIC (Association of Professionals in Infection Control) Chapter and to the NJ ID Society for inviting me to speak at their annual infectious diseases conference. The meeting theme was The Changing Paradigm of Infectious Disease Prevention.

It was a particular honor to share the podium with Professor Michael Osterholm of the University of Minnesota and author of Deadliest Enemy, Our War Against Killer Germs. Other esteemed colleagues included Drs. David Calfee (Cornell University), Bill Rutala (UNC Chapel Hill) and Thomas Kirn (Rutgers Robert Wood Johnson Medical School).

I was both humbled and honored to be a part of the conference.

The turnout was superb.

As always, I learn more than I teach at these events.

Here We Go Again, The Doctor's White Coat, But Wait, This is (Slightly) Nuanced.

Thomas Eakins- The Agnew Clinic, 1889

Here is an  article published in Pharos on the doctor's white coat.  The article explores the white coat as a symbol of the U.S. medical profession.  The historical context is neatly summarized.

But here is the most striking part:  In 1976 patient approval (Gallup Poll) of physicians (high or very high reported approval) was 56%.  In 2016, the reported approval was 65%, a modest gain.

In my opinion, public approval of the medical profession is less than optimal.  The white coat as a symbol of humanism and professionalism falls short.  Perhaps we would be better perceived if we relentlessly advocated for universal access to safe and reliable care.

As for my opinion on the white coat, it can be found in this comprehensive summary.

IMED 2018: Workshop on the Guide to Infection Prevention in Healthcare Settings- Making Expert Content in Infection Prevention Available to All

Thank you the conference organizers and to the generous turnout for today's work shop on Guide to Infection Control in the Healthcare Setting.  The book is now in its 6th edition and transformed into a full content website.

In 2019, along with my co-editors and the support of the International Society for Infectious Diseases, we will transform the website into a WebApp- with interactive content, updates etc. 

The project will also be translated into Spanish.

The overarching goal is to make practical, hands on infection prevention expert knowledge available to all, for free.

The feedback from the audience was superb.

IMED 2018- Vienna, Austria: Opening Plenary of to a Strong Start

I am currently in Vienna, Austria, Attending the IMED 2018 (International Meeting on Emerging Diseases). 

The scientific program thus far has been superb with an engaging opening ceremony on the recent outbreaks including Ebola, Nipah Virus, Rift Valley fever, MERS CoV, Listeria and other pathogens, all by world experts.

Every outbreak is a wise teacher.

Tomorrow I have the honor of directing an IMED workshop on The Guide to Infection Control in the Healthcare Setting, on new directions and enhancements in our book turned open access website, accessible here.

Stay tuned.

We Are Not As Good As We Think! Prevalence of Hospital Acquired Infections in the USA Remains High

Soource: Royal College of Nursing.org

We are not as good as we think.

The prevalence of hospital-acquired infections has decreased to 3.2% from 4% of hospitalized patients, as just reported here in the New England Journal of Medicine. No significant improvement in C. difficile infection was reported. 

This is a modest safety gain in my opinion. 

C difficile reduction has lagged because of ongoing antibiotic overuse, overly sensitive testing mechanisms (PCR) and less than optimal environmental disinfection. Probable diverse reservoirs for transmission, including the community, are also contributing factors.

To further improve the prevalence of hospital-acquired infections healthcare systems must vigorously focus on implementation science, with the specific use of pragmatic, real world interventions that reliably decrease risk.  This includes consistent mechanisms to ensure hand hygiene, patient chlorhexidene bathing, the use of safety checklists/safety time-outs and heighten environmental disinfection.  In addition, more strategies are needed to improve antibiotic use so as to minimize over treatment and selective pressure for drug resistant bacteria.

We can do better for the safety of our patients.