The Learning Hospital: From Theory to Practice

As described by the Institute of Medicine, the learning hospital is distinguished by ceaseless evolution of erudition, enhancement, and implementation. A learning hospital, where “science, informatics, incentives and culture are aligned for continuous improvement and innovation,” need not be supported by additional funding from the healthcare system.

No published examples of the learning hospital exist, until now. Kudos to Colgate University student Olivia Hess and the rest of the VCU Hospital infection Prevention Program on this publication titled The learning hospital: from theory to practice in a hospital infection prevention program. The manuscript is PubMed indexed here.

To quote Dr. Santiago Ramón y Cajal, Nobel Prize winning Spanish Physician:"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."

Dr. Enrique Gerszten: VCU Physician, Teacher, Icon and Compatriota Argentino

Icon: Dr. Enrique Gerszten (Source: VCU News)

It is a great honor for me to post this blog about my close friend, VCU colleague and Argentine compatriot, Dr. Enrique Gerszten. 

I refer you to this wonderful VCU News article celebrating his 6 decades of inspiring 
physicians in training. The article speaks for itself.

Dr. Gerstzen, now in his 90s, is still going strong and still working.

Icon.

Moxifloxacin: In Verse

I came across this poem, titled Moxifloxacin, in the New York Review of Books, on my Amtrak train ride back to Richmond, Virginia.

I leave the interpretation of it to you.

2019 Southern New Jersey APIC / ID Society Lecture: What an Honor!

Thank you to the Southern New Jersey APIC (Association of Professionals in Infection Control) and Infectious Diseases New Jersey for their invitation to speak at the 2019 November conference. I discussed the SHEA Expert Guidance on infection prevention in the operating room anesthesia work area, available here.

From the Q+A it seems like we are experiencing the same issues such as what to do with those surgical skull caps that are infrequently (if ever) laundered. Vexing.

It was an honor to share the stage with such prestigious colleagues, including my friend and colleague, Dr. Arjun Srinivasan of the CDC.

As always, I learn more that I contribute.

Urgent, Serious and Concerning: CDC Antibiotic Resistance Threats in the USA 2019

Urgent, Serious and Concerning, the CDC threat classification of select resistant bacteria and fungi. For those who have not read this report, recently published by the CDC, the full text PDF is available here.

I applaud the CDC not only for their comprehensive summary, but for their meaningful call to action.The aesthetics of the document is also noteworthy. High quality.

Antibiotic resistance is not a looming threat, its presence is real, the time to act is now.

Psychological safety and Infection Prevention: Are You Comfortable Speaking up?

Psychological safety, AKA a culture of safety, represents one's comfort in speaking up in the name of safety.

This article in the American Journal of Infection Prevention neatly explores a snapshot  of psychological safety, as assessed by questionnaire, across multiple U.S. hospitals and correlates that with hospital self reported infection prevention processes.  Nearly 60% of 900 hospitals responded to the survey, which is no small matter.

A couple of things of note: Only 41% of hospitals reported the presence of a hospital epidemiologist in the facility! This is not surprising as most community hospitals do not have a formal hospital epidemiologist on staff.  Only 38% of respondents reported a "high psychological safety"  environment within the workplace.  High psychological safety was associated with more successful use of urinary catheter discontinuation orders and nurse driven urinary catheter discontinuation.  Most likely,  these healthcare workers feel more empowered to act in the name of safety.

So here is my take-  a true culture of safety starts with relentless messaging from the senior leaders that safety is first and foremost.  This is followed by a reporting mechanism with action oriented responses to hold systems and individuals accountable. Anything less is suboptimal.

Patient safety trumps patient throughput.

IRIS: Comparing Infection Control in a Dutch vs US Hospital

I read with great interest this article published in the American Journal of Infection Control on comparing infection control practices between a Dutch and U.S. hospital using the IRIS (Infection Risk Scan) method.

IRIS is a mechanism to measure the quality of infection prevention and antimicrobial use in a standardized way.  Sounds too good to be true.  

I encourage you to read the methods carefully to get a sense of how these processes were measured. In brief, IRIS  consists of cross-sectional measurements of appropriateness of medical device use, antimicrobial use, environmental contamination and hand hygiene compliance, along with other variables.

The data are summarized as improvement plots. This is where the study is most relevant.

The primary infection prevention goal to focus on improvement of modifiable risk factors to minimize all potentially preventable infections, as explored here.  Clear identification of areas for improvement is the 1st step towards greater patient safety.

Oral Vancomycin for the Prevention of Healthcare Onset Clostridium difficile: Choose Wisely

I read with interest this recent publication on the use of oral vancomycin for the prevention of healthcare facility onset Clostridium difficile infection during systemic antibiotic exposure.

Indeed, patients with a prior history of Clostridium difficile who require systemic antibiotic treatment for other infections are at high risk for recurrence.  The use of oral vancomycin prophylaxis is effective in reducing the risk of recurrent Clostridium difficile, however, this should be chosen wisely, preferably under formal infectious diseases consultation.

As always, the focus should be on minimizing the overuse of antimicrobials.  We argue for  limiting antibiotic overuse as the principal strategy for preventing Clostridium difficile infection, published here in BMJ Quality and Safety.

I am in the hospital this weekend,  attending the Infectious diseases consults, living the dream.