HCW Attire- A Source of Pathogens?

Well, this is a topic that has interested us for quite some time. Uniforms and attire worn by many HCWs are really nothing more than street wear as they are not sterile and frequently laundered at home. We have a submitted manuscript in review, on this topic, which I hope to be able to share with you in the near future. 

A paper recently published in the American Journal of Infection Control investigated the rate of potentially pathogenic bacteria present on uniforms worn by hospital staff, as well as the bacterial load of these microorganisms. Cultures were obtained from uniforms of nurses and physicians at the abdominal zone, sleeve ends, and pockets. 

A total of 238 samples were collected.  Potentially pathogenic bacteria were isolated from at least one site of the uniforms from 63% of participants. Not surprisingly, 58% of participants claimed to change their uniform every day, and 77% defined the level of hygiene of their attire as fair to excellent. 

Once again, we have evidence that uniforms are colonized with potentially pathogenic bacteria. It remains unclear, however, what impact this may have in cross transmission of pathogens to patients. 

Clearly, more studies are needed to assess this last point.

Outbreak.com- Digital Epidemiology

HealthMap: image source- The Guardian (UK)

I have been incommunicado now for nearly 9 days, relaxing in Cape Cod and tuning out from the world, until, of course, Hurricane Irene hit the Eastern coast of the USA.


Now back in Richmond and attempting to pick up where I left off.


Social media and the web are useful beyond the obvious. They can also be potent sources of epidemiologic data providing clues and leads on emerging diseases and outbreaks.  


Here is an interesting article in Time Magazine titled Outbreak.com -using the web to track infectious diseases in real time.


Highlighted is the HealthMap project. HealthMap automatically trolls news sites, eyewitness reports, government data, even wildlife-disease cases to identify new patterns in outbreaks, presenting the results on a clickable map.

Owing to internet and cell phones, a new level of interconnectedness has arisen, allowing for instantaneous digital data mining of every corner of the globe.

Global, digital epidemiology is born, so, go ahead and tweet, post and upload your malady into the the cloud....it may be of significance.

Cigarette Companies File Suit Over Warnings

The US Government has released new images that will cover the upper half of the front and back of cigarette packages produced after September 2012. I have previously blogged about this before.


Predictably, tobacco manufacturers are up in arms and have made a legal motion to stop it, as reported in an article in the New York Times. Lawyers for the tobacco companies are arguing that the labels and pictures violate the First Amendment protections for commercial speech.


Protection of commercial speech should not safeguard the sale of product of significant public health (negative) impact.  When you produce and sell a product that remains the leading cause of preventable death, killing 443,000 Americans a year according to the Centers for Disease Control and Prevention, and costs us (through increasing insurance premiums, Medicare and Medicaid) untold millions, then the Government does indeed have the right to use cigarette packages as mini-billboards for the government’s antismoking campaign.


I will be on vacation next week and hence will be blogging 'lightly'. I also plan to do some napping, to enhance my sense of well being during the break.

Norovirus on a Commercial Airline- Not Just for Cruise Ships

Flying has become troublesome enough already with security checks, having to remove your shoes, pat downs, etc. Now, one can add norovirus (diarrheal infection) to the list of potential inconveniences. Recurring norovirus infection on an airplane was recently reported in Clinical Infectious Diseases.


During October 2009, an outbreak of diarrhea and vomiting occurred among different groups of flight attendants who had worked on separate flights on the same airplane. 


The investigation identified a passenger who vomited on a Boeing 777-200 airplane.  Sixty-three (82%) of 77 flight attendants who worked on the airplane during 13-18 October provided information, and 27 (43%) met the case definition for norovirus infection. The attack rate among flight attendants decreased significantly over successive flights from 13 October onward (P < .001). Working as a supervisor was independently associated with development of illness (adjusted odds ratio, 5.8; 95% confidence interval, 1.3-25.6).  

The investigation suggested that the vomiting incident was the inciting step. Transmission to flight attendants may have occurred through direct contact with vomit or virus aerosolized by vomiting or indirectly by contact with the contaminated environment.


Passengers were not investigated. Nevertheless, the potential for foodservice contamination with norovirus, by flight attendants, is real and could lead to disease in passengers. That could make for an uncomfortable situation, especially on a long flight.


One has to wonder what sort of disinfection practices are in place in the event of a vomiting episode(s) on a commercial airline....

Reinventing the Toilet- A Public Health Mission

Having spent a fair amount of time in rural Honduras, I have seen the impact of poor sanitation and have gained a greater appreciation for functional plumbing. Much of the world is without proper sanitation and forced to use makeshift holes in the ground or latrines. This has an impact on the incidence of diarrheal infections, particularly in children.


The modern toilet requires massive infrastructure and water. Both are scarce commodities in resource poor settings.


The Bill and Melinda Gates Foundation is sponsoring a "Reinvent the Toilet" competition. See video below.

For an informative article on "Reinventing the Toilet" click here. 


For a video on the  on the solar powered toilet, click here.


It is time to get our S#@! together for a just public health cause.

Loss of Empathy- Disturbing Trend

Over the last year, I have heard much about the decline of empathy during medical training. A recent meta-analysis, published in Academic Medicine, is a systematic review of studies dealing with the decline of empathy among medical students and residents.


Three longitudinal and six cross-sectional studies of medical students demonstrated a significant decrease in empathy during medical school; one cross-sectional study found a tendency toward a decrease, and another suggested stable scores. The five longitudinal and two cross-sectional studies of residents showed a decrease in empathy during residency. 


Assuming that the empathy self-assessment tools employed in this type of research are valid, then the decline appears real. 

The authors propose a model to account for a decline in empathy. Factors attributed include individual personality types, inappropriate learning environment, inappropriate role models, excessive duty hours, mistreatment of trainees, high workload, and loss of peer support.  All contribute to burnout, lower quality of life and depression. The result is a decline in empathy.


The loss in empathy may be a coping mechanism. Could a decline in empathy be a normal reaction to distressing aspects of the human condition? If so, is the current decline in empathy any different than that experienced by our medical predecessors?


If, in fact, we are becoming globally less empathetic as a profession, then the quality of medical care may be at stake. 


We have much still to learn about ourselves as healthcare providers.

Alarming Trend in Syphilis Rates Across the USA- Racial Disparities Abound

Treponema pallidum- the agent of syphilis: Source BMJ.com

As an infectious diseases physician in an urban, tertiary care, university hospital, I am still struck by the seemingly endless cases of new HIV and syphilis diagnoses seen in young men. These  men, many of whom are gay, were born after the HIV epidemic began. Shouldn't they be practicing safe sex?

A recent publication in the Annals of Internal Medicine highlights an alarming trend in the rates of syphilis.

From 2005 to 2008, 27 states from all U.S. census regions reported data on the sex of sex partners for 70% or more of male cases of primary and secondary syphilis. Regression analysis revealed significantly different trends in rates of primary and secondary syphilis: Absolute increases in rates among black MSM and Hispanic MSM were, respectively, 8.0 times and 2.4 times the absolute increase in rate among white MSM. By region, rates among MSM increased 30% in the Midwest, 48% in the South, 73% in the Northeast, and 77% in the West. By age group, the largest absolute increase in rates occurred among MSM aged 20 to 29 years.

Rates of primary and secondary syphilis disproportionately increased among young, black and Hispanic MSM.

Sure, these findings have implications for point of care safe sex counseling by healthcare providers. But, they also reflect, in my opinion, a public health failure, the result of inconsistent education (by schools, health departments and parents) on sexual risks and safe sex counseling, including an under promotion of condom use. 

Until this is addressed, we are destined for more of the same.