One percent chlorhexidine for meatal cleaning prior to urinary catheter insertion significantly reduces(by 74%)the risk of catheter associated urinary tract infection. The study was a multi-center, stepped-wedged randomized controlled trial recently published in Lancet Infectious Diseases, available here. Wow! Now the hard part will be getting nursing staff to reliably use chlorhexidine for meatal cleaning prior to urinary catheter insertion. This will require education, human factors engineering (i.e. making chlorhexidine the default product in the catheter insertion kit), audits and feedback. Too good to be true? Perhaps not.
Here is a witty article that only the British Medical Journal would publish, straight from the archives and available to all in open access format. I actually read this paper as a 3rd year medical student at the University of Buffalo in 1995. White Coat Effects. A study of medical rank and weight of the white coat. The more senior the rank, the lighter the coat. Cool, although we no longer wear white coats (!), as published here.
Misinformation during a public health crisis is a significant threat. Check out this essay titled Civil Society's Role in a Public Health Crisis, available here. The potential impact of uncensored backchannel data, by way of Twitter, text messages, emails, blogs, photos and videos, could result in devastating and misleading information. The consequences would include panic, drug shortages, supply hording and misguided quarantine, diagnostic and treatment efforts . This threat could be as impactful as the actual pandemic itself. A misinformation containment communication strategy is urgently needed- one with truthful, purposeful information that serves as a ' communication inoculation"- which is nicely explored in the essay. The time to plan is now, post event is too late. For a previous blog post and Facebook Lie video on Pandemic Richmond, follow this link.
When I completed my infectious diseases training at New York Hospital-Cornell University the name Benjamin Kean was legendary. Unfortunately, I arrived nearly 7 years after his death. Dr. Kean's New York Times (1993) obituary is found here. I recently discovered Dr. Kean's memoir, in the form of a dusty library book titled M.D.: One Doctor's Adventures Among the Famous and Infamous
from the Jungles of Panama to a Park Avenue Practice. A damn good read!
A proper dedication to Dr. Kean was published in ID Clinics of North America, available here.
Lean is a widely used quality improvement methodology. The origins of lean are in the automotive and manufacturing industry. The primary goals of lean are to eliminate waste, specify patient value and identify all the steps in the value stream so as to improve process and outcomes. But does it really work in healthcare?
Here is a systematic review of the literature of Lean healthcare interventions. Bottom line: Lean interventions have no significant impact on patient satisfaction health outcomes. Lean interventions are associated with increased financial costs and decreased healthcare worker satisfaction. We need to learn more about how best to improve patient experience and outcomes. Lean interventions may not be salvation in patient quality.
If your looking for a high quality, updated perspective on preventing surgical site infections, check out this recently published review in Infection Control and Hospital Epidemiology by our very own Dr. Richard P. Wenzel. We traditionally focus on infection prevention from exogenous threats, with an emphasis on minimizing cross transmission. The majority of surgical site infections, and other healthcare associated infections, come from our own endogenous microbiome. To more aggressively prevent surgical site infections, in addition to proper surgical hand antisepsis, perioperative antibiotics, perioperative glucose control and perioperative normothermia, our optics should now be on maximal control of the patient's microbiome. Areas to further explore include improved patient skin antisepsis, to include both the epidermis and dermis, along with better nasal microbiome control via standardized postoperative nasal anti-septic protocols. Bold infection prevention strategies and paradigm shifts are required for impactful change in outcomes.
We are all aware of outbreaks and pandemics such as measles and H1N1 Influenza. But here is a novel perspective, corruption as an ignored pandemic. Corruption includes absenteeism, theft, embezzlement, favoritism and corruption of data. All of this results in decreased access and quality of medical care. Anticorruption measures include top-down control and accountability.
The work by Transparency International brings the global correction phenomenon to light. Information is available on their website The press release is available here. For the complete report (PDF) click here.
I am way off topic and know that I should stick to what little I know such as infectious diseases and infection prevention. Passion sometimes simply wins out.What follows will interest few of you, if any. From 5th grade to college and after a long hiatus, I returned to drumming several years ago. Drumming is a passion that is to be studied seriously. For those seeking an excellent documentary on the history of the drumset, from 1865 to the present, check out the film above. From military drum lines to ragtime, bee-bop, jazz, big band music, rocakabilly, rhythm and blues and rock and roll, the drumset is in constant evolution, with each genre building on the last. Mastery (of anything) takes time, deliberate practice and a willingness to be a perpetual student. As with any profession or trade, the more you understand the past the greater you can master and contribute to the present.
We strive for improved environmental cleaning as a strategy for
preventing healthcare associated infections. Finally, a randomized multi-center trial that assesses a pragmatic cleaning bundle on patient centered outcomes. This paper is published in Lancet Infectious Diseases. A bundled approach with training, audit and feedback for daily room disinfection resulted in improvements in cleaning processes. Healthcare associated infection outcome reduction was modest, with reductions seen only on VRE infections. No impact was observed on S.aureus bacteremia and C.difficile infection. Disappointing. Novel technologies, such as UVC disinfection, also fail to provide significant infection prevention benefits, as summarized here in this review article. I come to this conclusion: heightened disinfection in the hospital is necessary yet not sufficient for significant reductions in healthcare associated infections. There is no magic disinfection bullet. Only a comprehensive, horizontal infection prevention program will minimize infections from exogenous pathogens. The next barrier is to better understand and prevent healthcare associated infections from our own microbiome.
One percent chlorhexidine for meatal cleaning prior to urinary catheter insertion significantly reduces(by 74%) the risk of catheter associated urinary tract infection. The study was a multi-center, stepped-wedged randomized controlled trial recently published in Lancet Infectious Diseases, available here.
