Bram Stoker Festival 2017: Dublin, Ireland- Royal College of Surgeons Lecture

By happenstance I learned of the annual Bram Stoker Festival celebrating one of Dublin's many famed writers and obtained tickets to attend a lecture titled 'Slayers and their Vampires' at the Royal College of Surgeons, Ireland. The lecture was held in the Aula Magna, the Albert Lecture Theatre.

The academic panel included Bruce McClelland, Maura McHugh and David Skal, a Bram Stoker biographer.The discussion covered the the historical, folkloric and metaphorical aspects of the Dracula story. It was unlike any other academic lecture I have ever attended at a medical college.

Images are below.

Perhaps Virginia Commonwealth University should host an annual Edgar Alan Poe festival.

Albert Lecture Theatre, Royal College of Surgeons, Ireland

Royal College of Surgeons, Ireland

Thank You University of Nebraska Infectious Diseases Blog!

Thank you to Dr. Jasmine Marcelin for her kind blog post regarding my medical grand rounds lecture last week at the University of Nebraska Medical Center.

I thoroughly enjoyed the event, summarized here.

I am still in Ireland, blogging light.

Literary Fascination! Dublin, Ireland

I like books, as previously posted, so forgive me this aside. 

I am currently in Dublin, Ireland, where I visited the famed Trinity College, viewed the Book of Kells exhibit and strolled along The Long Room, of the institution's vaunted library. Later, a stroll to the pubs frequented by Samuel Beckett, James Joyce and Oscar Wilde.

Images below.

Grand Rounds at University of Nebraska Medical Center: Infection Prevention: Processes, Pragmatism and Controversies

University of Nebraska Medical Center Campus

Arriving early at the Durham Research Center auditorium, prior to loading the slides

Thank you to Dr. Mark Rupp and the rest of the infectious diseases, infection prevention and healthcare quality team at the University of Nebraska Medical Center for graciously hosting me as the invited grand rounds speaker on October 20, 2017.

My lecture, titled Infection Prevention: Processes, Pragmatism and Controversies, covered much of what is interesting to me in infection prevention. Of course, the presentation heavily referenced pragmatism, bias in hospital  epidemiology and a satisfice approach to infection prevention. So as not to disappoint, the use of gowns and gloves and the  de-escalation of contact precautions was explored along with physician apparel, bare below the elbows and accountability. 

Thank you to the audience for listening.

Discontinuation of Contact Precautions: Back in the Literature

Like a recurrent bad dream for some, the discontinuation of contact precautions for the control of endemic MRSA and VRE is back in the medical literature.  

A meta-anlysis, published here, by Alex Marra, once again suggests that the cessation of contact precautions for the control of endemic MRSA and VRE is without adverse consequences.

My colleague Mark Rupp also published this manuscript in ICHE summarizing the University of Nebraska's positive experience with the discontinuation of contact precautions for the control of endemic MRSA and VRE.

I am off to the University of Nebraska Medical Center tomorrow, to give an invited medical grand rounds lecture on infection prevention- policies, pragmatism and controversies.

I might just talk about the discontinuation of contact precautions too.

Are We Serious About Limiting Presenteeism?If So HR Policy Changes Are Needed

Presenteeism, or working while sick, is a cross transmission risk. With the looming respiratory virus season this is increasingly relevant. Not all risks related to presenteeism are ascribed to respiratory viruses. Here is a reported cluster of Group A streptococcal skin infections in a skilled nursing facility, likely related to a 'present' healthcare worker with Group A streptococcal pharyngitis. It has also been argued that reducing presenteeism is more effective than mandatory influenza vaccination in reducing hospital acquired influenza.

But how can we effectively reduce presenteeism? 

I have found no published reports of successful strategies for presenteeism reduction in healthcare settings. 

Staff education of the dangers of presenteeism is a good start but likely insufficient. A change in human resources (HR) policy is likely needed such that sick leave is different than paid time off, as summarized in this pro/con article. Healthcare workers would thus not feel 'penalized' by losing vacation time when out sick. Of course, sick leave could easily be abused, thus requiring policies and mechanisms to better manage absenteeism.

Bottom line, we can talk about limiting presenteeism but this commitment will ring hollow without changes in HR policy. This has been done, as neatly summarized in this blog post by Mike Edmond.

I get a sense that for many healthcare systems the policy of mandatory influenza vaccination is easier and more expedient than making substantive changes in HR policies.

Eminence Front! Eminence Based Medicine and Other Options to Evidence Based Medicine

What to do when high quality evidence is not available to guide decision medical making?

I dug this one out of the archives of the British Medical Journal after hearing a reference to 'eminence based medicine' at ID Week 2017.

Strategies include 'eminence based medicine"- where experience is worth any amount of evidence, and may actually trump evidence in many cases.It's an eminence front! Other strategies include 'eloquence based medicine' and ' providence based medicine" where decisions are best left in the hands of the Almighty.

In the absence of evidence all may not be lost. Weigh the risks, benefits, consider the opportunity costs and be pragmatic.