Congratulations Dr. Oveimar De La Cruz for being recognized last night at the VCU Celebration of Excellence Event.
Dr. De la Cruz is a recognized expert in transplant infectious diseases consultation and has taken VCU transplant infectious diseases to new horizons.
Dr. De La Cruz will be giving an invited lecture, on respiratory viral infections in transplant recipients, at the 18th International Congress on Infectious Diseases, Buenos Aires, Argentina (March 2018).
Kudos.
We commonly get excited when new technology hits the ground. Sometimes, excitement exceeds the evidence in support of an intervention.
At VCU, we aggressively deploy UVC robots for terminal cleaning of C. difficile as published here. The impact has been modest (as expected).
This recent paper, by Alex Marra, Marin Schweizer and Mike Edmond, is the most comprehensive assessment of the impact of no-touch disinfection methods to decrease MDR pathogens. The authors beautifully estimate the impact of touchless technologies using a comprehensive literature review and pooled risk estimates.
No touch disinfection can impact C. difficile and VRE infection rates but only as an augmentation to traditional cleaning.
Beware: no touch disinfection is not infection prevention salvation, keep the expected outcomes in check with reality.
I recently recorded a radio interview on local influenza activity with broadcast journalist John Ogle of WCVE, the local Richmond NPR station.
Oh yes, there is heightened influenza, as we are all aware. Acquaintances and patients alike ask me for advice to minimize risk of infection.
Despite the concern, it is amazing how many patients are refusing influenza vaccination in the clinic.
One of my patients recently refused influenza vaccination exclaiming " I don't need any vaccines, and, I also do not wear a seat belt. I like to live dangerously!"
How do you argue with that?
Ode to Dr Wenzel!
His latest cyber terrorism medical thriller, Dreams of Troy, was reviewed in Chestnut Hill Local, a Philadelphia area newspaper. The article and review is available here.
The book is a good read.
A few images from his VCU book signing (December 2017) can be accessed here.
Diagnostic test stewardship is en vogue at the moment.
This excellent article, co-authored by my 60 miles-west-of-Richmond, University of Virginia academic- hospital-neighbor, Dr. Costi Sifri, is a nice summary of opportunities and challenges to safely reduce unnecessary diagnostic infectious diseases testing.
I mentioned this topic in a previous blog. Dr. Dan Diekema just published a nice commentary on the HAI Controversies Blog.
Many of our new diagnostic tests (PCR based) are very sensitive and cannot discern between active disease vs colonization. Coupled with pragmatic surveillance definitions set forth by the CDC, we over diagnose catheter associated urinary tract infections and bloodstream infections, hospital onset C. difficile and ventilator associated pneumonia anywhere from 15%-68% (as referenced in the article above).
I enthusiastically agree, we need to critically assess how tests are ordered so as to minimize overdiagnosis and minimize potential harms. If we do this thoughtfully, with appropriate oversight and ongoing critical assessment, this could have a huge impact (on cost and safety).
However, we want to avoid prior missteps from over enthusiasm, like MRSA active detection and isolation, which was all the rage (for some) about 10 years ago. Now we are learning that contact precautions for the control of endemic MRSA may not be infection prevention salvation, as explored here.
Times and perspectives change.
What constitutes an influenza epidemic? I am not going to get too scientific and will not delve into issues such as increasing influenza rates, antigenic shifts, and antigen drifts.
Rather I offer you this perspective published in Clinical Infectious Diseases-on the 1918 "Spanish Flu" in Spain.
Public health officials in Valladolid argued with local authorities about formally declaring an influenza epidemic in 1918. City officials feared disruption of local holiday visitors and business activities, which were then supposedly at their peak.
Per Spanish law, if if physician died of influenza infection while on duty and if there was not an epidemic situation officially declared, then the widow was not entitled to receive a pension from the government. Thus, physicians put heavy pressure on the Mayor of Valladolid to officially and finally declare the 1918 epidemic of influenza in Spain.
If we feel that political and economic pressures do not factor into public health responses in the modern era, then we are deluding ourselves.
Sometimes posterity is not kind to our opinions.
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| The Plague Doctor |
I dug into the archives to find this famous quote from Professor Robert G. Petersdorf, made during a Alpha Omega Alpha (national medical honor society) address at the University of Chicago (1978). The paper is found here (NEJM)
"Even with my great personal loyalties to infectious diseases, I cannot conceive of a need for 309 more infectious-diseases experts unless they spend their time culturing each other."
I mean no disrespect. I have tremendous admiration for Dr. Ptersdorf's accomplishments. No doubt he achieved more than I ever will.
Since the above proclamation, however, we have witnessed the emergence/re-emergence of HIV, Ebola, SARS, MERS, Zika virus, Chikungunya virus, multi-drug resistant bacteria, Clostridium difficile, Anthrax, H1N1 influenza, plague and drug resistant malaria, just to name of few as no doubt you get the point.
Infectious diseases specialist are still relevant and in demand.
