Stress at Work? It May Not All Be Bad.

Source: Harvard Business Review

I appreciate that wellness is the goal. In this day and age of increasing  physician burnout, to experience (or cause) stress is a taboo.

However, a stress fee existence is not always feasible and may not result in the best outcomes.  If optimal performance is the goal, then a reasonable (optimal) amount of stress is required, as reflected in the Yerkes-Dodson Law, summarized here in the Harvard Business Review.

Anxiety affects performance both positively and negatively,  the goal is to find the middle way- for optimal impact.

Antibiotics in the Pipeline for Gram Negative Organisms. Interested? Read On.

Congratulations to Dr. Nicole Vissichelli, VCU infectious diseases clinical fellow, on this first author, hot off the press, comprehensive review article published in Current Treatment Options in Infections Diseases.  The manuscript was ca-authored by Dr. Mike Stevens.

The publication covers recently FDA approved treatments for gram-negative infections in addition to antibiotics currently in development.

The article is available online here.

Kudos.

The Big Bang Theory Comedy Show, Satisfice and Infection Prevention

Professor and Nobel Laureate Herbert Simon's satisfice concept has hit pop culture. 

This season's Big Bang Theory episode titled Decision Reverberation explored satisfice, or opting for a solution that is both satisfactory and sufficient. A summary of the episode can be found here.

Those who know me well are well aware of my near obsession for satisfice in infection prevention, as explored here.

Satisfice, a portmanteau for all things reasonable and pragmatic. 

You Tube Healthcare Triage: Our Work on Bare Below The Elbows and Doctors' White Coat- Front and Center

Very nice to see our work on bare below the elbows and our SHEA Expert Guidance on Healthcare Worker Apparel highlighted in this YouTube video.

Also, as discussed in the video, the risk of hand sanitizer causing fires in the hospital is negligible.  

We should allow healthcare providers to carry personal use hand sanitizer bottles!  It may just improve hand hygiene.

Imagine that!

Resistance to Immunity: Summary of the Anti-Vaccine Movement

Jenner and the Cow Pox Vaccine Source:NYRB

For those looking for a very scholarly book review and summary of the anti-vaccine movement I refer you to this article in the New York Review of Books.

The review is expansive and covers historical figures from Edward Jenner to the discredited Andrew Wakefield (vaccines and autism).

The article also delves into the importance of marketing vaccines not only for individual benefit, but for the common good. Sometimes we give up personal liberty to benefit the community (no indoor smoking, speed limits, paying school taxes even if you do not have children etc). 

Last, for those obsessed with going 'natural,' the materials used in vaccines are much more natural than the treatments (antibiotics, antivirals) used to treat infectious diseases!

Infection Prevention: Buy In Versus Responsibility

For some, this may be disagreeable.

I have been giving the concept of 'buy in' some thought lately. I came across this article on shared governance  and the roll of buy in in bringing about change.

Let's define buy in as engagement and ownership in a system, process or issue. This connotes an option to participate (or not) in a change process. 

Shared governance in theory promotes buy in as it allows healthcare workers greater autonomy over their practice. This is preferable to a top down approach.

However, buy in of infection prevention best practices (hand hygiene, safety checklists, surgical time outs, perioperative antibiotic use, chlorhexidine patient bathing of ICU patients etc) falls short of the ethical responsibility of primum non nocere. Our ethical duty to maximize risk reduction in healthcare is explored here. 

Buy in and shared governance allows for optionalism, lack of standardization, scant accountability and overall poor risk reduction. If everyone is in charge, no one is.

So beware, for matters of patient safety, where published, evidence based interventions exist, opting for a slow and cumbersome buy in process through shared governance leads to slow and variable change. Accountability and standardization are commonly lacking. 

Sadly, patients are harmed. 

Whither the White Coat? Oh Yeah....

Photo credit: Mike Edmond

Oh yeah, the iconic white coat is once again questioned as a fomite in this New York Times article. The SHEA expert guidance on healthcare worker apparel is referenced therein along with other quality publications from my colleagues in hospital epidemiology.

Health systems can effectively minimize patient contact with infrequently laundered white coats by way of a bare below the elbows approach to inpatient care. This can be done as an infection recommendation with nudges and role modeling. 

Without a mandate we have achieved >80% compliance with bare below the elbows at VCU Health, as reported in our latest publication on the topic.

Whither the white coat? To the back of the door hook.