Seeking a Review on Cyclospora? Well, Look No Further.

In my home state of Virginia the health department is investigating an increase in cyclospora cases. The investigation is summarized here.  Beware of unwashed fruits and vegetables.

Coincidentally,  an informative review on human cyclosporiasis was published this month in The Lancet.

So, if you seek a  timely review on cyclospora, access it here.

3rd Annual OHS Alumni Soccer Classic: July 27, 2019

3rd Annual OHS Soccer Classic: Blue vs Orange

This one again goes out to all who value lifelong friendships and football.

Today I partook in the 3rd Annual Oneida High School (OHS) Alumni Soccer Classic with a handful of my teammates from our 1989 graduating class. It was a diverse event with several generations of footballers including current OHS varsity soccer players and the sons of OHS soccer alumni. 

Fond memories from my 4 years as the OHS varsity goalkeeper on the very pitch where today's match was played. Although I was fortunate to play NCAA soccer for Colgate University, the high school team, particularly the friendships, holds a very special place in my heart. 

The day was beautiful.

This year, finally, I was on the winning team. But, to quote the late, great Tom Petty- even the losers get lucky sometimes.

How Much is Enough? Strategies for Fluorescent Gel Monitoring of Patient Room Cleaning

Source: Reflection on Infection Prevention and Control Blog

I love pragmatic studies especially when they provide real-world practical solutions for common problems.

Kudos to Clare Rock and her team on this publication that guides us on the frequency and method of a fluorescent gel evaluation (FGE) of terminal room cleaning. A random selection of of three high touch surfaces in two separate rooms should accurately predict the cleaning practices on a given unit. The evaluation should be repeated, randomly, every 2 weeks.

This is a reasonable, effective and sustainable strategy for FGE of patient room cleaning.

I am off to Syracuse, NY for  the rest of the week, for the 3rd annual Oneida High School Soccer Classic (previous event here) and my 30th high school reunion.

Infectious Diseases Specialists Improve and Protect The Common Good. Fund It!

Kudos to Mathew Zahn et al on this viewpoint in published in Clinical Infectious Diseases. 

Infectious diseases specialists add value, improving and protecting the public's health.  I could not agree more. However, low compensation in infectious diseases is a significant recruitment disincentive.  

Zahn et al do not simply describe a problem, they propose solutions  

Theses include loan repayment opportunities for physicians working in public health,  improved financial compensation for infection control and antimicrobial stewardship, changes in CMS coding and reimbursement to reflect the complex level of care provided by cognitive specialties (such as ID) and full funding of local, state and federal public health agencies.

Protecting the common good requires resources. 

Fund it!

Being Decisive and the Hierarchy of Intervention Effectiveness

Source:PatientSafe

I read with great interest the argument for a reflective rather than reflexive approach to ordering urine cultures in this Infection Control and Hospital Epidemiology letter to the editor by Mohamed Fakih et at. I agree, we need to be much more thoughtful and deliberate with the tests that we order, including urine cultures.

But, let's be straight. Provider education is necessary but far from sufficient for substantive practice change. Checklists,  standardization, electronic medical record prompts and forcing functions tend to work best in this respect.

Which brings me to the next point. Our decision making should rarely be dichotomous, as beautifully explored in the book Decisive by Chip and Dan Heath. Instead of either/or we should consider this and that.

Thus, to minimize urine over testing and catheter associated urinary tract infections, educate providers and utilize test stewardship interventions modeled after the hierarchy of  intervention effectiveness.

Change takes effort.

Universal Gloving for Inpatient Care: It May Work!

I was pleased to see this metanalysis and literature review on universal gloving (UG) for inpatient care recently published in Infection Control and Hospital Epidemiology. Kudos to the authors. The abstract is available here.

We are honored that our two previous publications on universal gloving were included in the analysis.

Universal gloving may have a small protective impact on hospital-acquired infections.  

We have always felt that UG should be an adjunct to a horizontal infection prevention strategy.  Of course, hand hygiene practice must not be negatively impacted by the use of UG.

Although not a mandate at VCU, I perform UG prior to all physical examinations. It is both simple and easy.

Play it Safe! Fake Kiss the Pope's Ring

Now this article is intriguing. 

Should the Pope continue to allow his followers to kiss the Piscatory ring? The practice, albeit ritualized, is far from hygienic, as summarized in this brief manuscript.

But how real is the risk of infection? Probably small and the risk of an outbreak from the Pope's ring is even smaller.

The practical solution, if so sought: adopt a fake kiss of the ring.

As for rings at the bedside in healthcare, they should be banned as the bacterial burden is significant. Rings also cannot be effectively cleaned in between patients.

Time for a practice change.

Checklist for Anthrax Mass Exposure Event: Hopefully We Will Never Need to Use It

I was pleased to see this paper on a checklist for anthrax mass exposure published in the Annals of Internal Medicine. The paper was written by my Cornell University colleague, Dr. Nathaniel Hupert.

Dr. Hupert and I previously published a protocol for anthrax screening in 2003, also in Annals of Internal Medicine. That paper is available here.

In the unlikely case of an anthrax mass exposure event, in the face of fear and chaos, a sensitive and reliable checklist to distinguish anthrax signs and symptoms from other conditions would be a hugely valuable triage tool.

Let's hope we never have to use it.

The Catalogue of Shipwrecked Books: The Amazing Quest for All Books in All Languages

Source: The Vintage News

Everyone knows of Christopher Columbus but what about his youngest son Hernando Columbus? After accompanying his explorer father to the New World (on the 3rd and 4th voyages) Hernando become a different sort of conquistador back in Europe. A conqueror of books.

Hernando  amassed on of the largest private libraries ever known, with the deliberate goal  of collecting widely (all books in all languages), beyond what was considered acceptable or of value by the Catholic church. His collection spanned between 15,000-20,000 books. Hernando was obsessed with collecting, mapping, and cataloging a wide view of then contemporary affairs. 

His ambition and stamina in this singular quest was amazing.

The collection, known as the Colombine Library, is housed in Seville, Spain.

Herando's bibiomaniacal quest is deftly recounted in The Catalogue of Shipwrecked Books, by Edward Wilson-Lee, which is, incidentally, a book worth collecting.