Zero Infections in Healthcare- Revisited

I spent much of the weekend updating a lecture of infection prevention. The theme of 'zero' healthcare infections is one of the themes covered in the lecture.

Can all healthcare associated infections be prevented? This is a controversial subject and the current data suggest that the goal of zero infections is illusory. Here is a an important paper published in Infection Control and Hospital Epidemiology on estimating the proportion of healthcare associated infections that are reasonably preventable. As many as 65%-70% of cases of CABSI and CAUTI and 55% of cases of VAP and SSI may be preventable with current evidence-based strategies.

In my opinion the state of infection prevention science is not robust enough to prevent all infections. The goal should be to fully and consistently implement evidence based infection prevention best practices to maximally reduce infection risk. 

For a scholarly perspective on 'Getting to Zero,' I refer you to this publication by my friend and colleague Dr. Michael Edmond.

Hospital Bed Alarms- What is the Benefit?

There is much discussion in my line of work on improving patient safety, particularly related to hospital acquired infections. But patient safety is not limited to infectious diseases.

Patient falls are a major safety issue and hospitals are required to implement and evaluate a falls reduction program for ongoing accreditation by the Joint Commission. Decreased patient falls are associated with hospital Magnet status and quality of nursing.

It seems like we are always searching for new technologies to enhance patient safety in healthcare. One such related technology are bed alarms.

Are bed alarms useful for the actual prevention of patient falls? Here is a single center, cluster-randomized trial on the effectiveness of bed alarms on patient falls published in the Annals of Internal Medicine.  Although the intervention was successful in increasing the use of bed alarms, there was no significant impact on fall-related events or the use of patient restraints.

This paper may serve as a warning on technology over reliance and reminds us that minimizing patient fall risk is multifactorial, requiring a coordinated effort, as outlined here by the Veterans Affairs National Center for Patient Safety.  

No one said it would be easy.

UN Global Aids Report 2012

World AIDS Day 2012 is around the corner so please pay attention to the related events in your area.

Source: UNAIDS.org

Here is a link to the the UN AIDS Global AIDS report 2012.

Here are my comments at the VCU School of Medicine 2009 World AIDS Day Luncheon-Lecture.

Isolation of HIV Positive Inmates: Not based on Science

Source: CBSnews.com

The Alabama Department of Corrections has a policy to isolate all HIV positive prisoners. HIV positive inmates are housed in special dorms with air conditioning and a private cell. However, there are restrictions. Inmates eat alone, not in the cafeteria and must  wear white plastic armbands identifying them as H.I.V. positive. Also, inmates are not allowed to work around food. Read about it here in this NY Times Article.

I suspect  that any infectious diseases specialist will tell you that this isolation policy of HIV positive inmates is misguided. HIV is not spread by casual contact or by airborne transmission. Prison officials fear that HIV will spread through consensual sex, through rape or through blood when inmates give one another tattoos.

For a data driven approach to limit the spread of HIV, either in prison or elsewhere, diagnose the disease early by offering voluntary, accessible testing and treat to prevent disease transmission and disease progression.

Going Truly Organic: Unpasteurized Milk and Infectious Diseases

Source: CDC.gov

Like many, I prefer the organic foods section of the grocery store, however, I do have my limits. 

Here is an interesting article, published in Clinical Infectious Diseases, that reminds us of the perils of consuming unpasteurized, straight from the farm, organic milk.  In this case, an outbreak of Q fever was reported from a Michigan dairy.

Raw milk consumption has increased in popularity with many people purchasing milk directly collected from a dairy milking parlor. Although direct purchase of raw milk is illegal, purchase through a cow share arrangement is not. Such dairies are not inspected by regulatory authorities and are not expected to meet minimum safety standards.

Consuming raw, unpasteurized milk is associated with infectious diseases health risks. But, don't just take my word for it, read about it here from the CDC.

Congratulations Jackie Arquiette: American Society of Tropical Medicine and Hygiene Annual Meeting 2012

Jackie Arquiette at ASTMH 2012

Congratulations to VCU 2nd year medical student Jackie Arquiette for presenting her work at the American Society of Tropical Medicine and Hygiene Annual Meeting  on November 14, 2012. 

Jackie's  work focused on measuring clinical and microbiological efficacy of water filtration systems in rural, mountainous Honduras. 

Her research is referenced in our most recent Internal Medicine Grand Rounds presentation.

Kudos!

Congratulations Audrey Le: American Society of Tropical Medicine and Hygiene Annual Meeting 2012

Audrey Le at ASTMH 2012

Congratulations to VCU 2nd year medical student Audrey Le for presenting her work at American Society of Tropical Medicine and Hygiene Annual Meeting  on November 12, 2012. 

Audrey's work focused on indoor air pollution in rural Honduran homes, as part of our ongoing medical relief work. Her research is referenced in our most recent Internal Medicine Grand Rounds presentation.

Kudos!