Hemolytic Uremic Syndrome- Not Just from Undercooked Meat

E.coli: not just from hamburger meat

Breaking news from Germany: 10 people killed from an infection by Shiga toxin producing E.coli. The infections came from eating raw tomatoes, cucumbers and lettuce that were bought in northern Germany. The cucumbers were imported from Spain and were sold in supermarkets in Hamburg.

Shiga toxin producing E. coli outbreaks are typically linked to unpasteurized milk and cheese and undercooked beef. Symptoms include high fever, bloody diarrhea, kidney failure and even death (Hemolytic-Uremic Syndrome). Jack in the Box restaurant made E.coli a household word in 1993 with a famous outbreak of serious food borne illness.

Consumption of fruits and vegetables are part of a healthy diet, except when contaminated by bacteria such as Shiga toxin-producing E. coli. Vegetables are typically contaminated by manure fertilizer or by farm water run off. Not thoroughly washing vegetables can be hazardous.

I am off to Honduras for our yearly medical relief trip tomorrow morning, where, among other things, I hope to avoid traveler's diarrhea and dysentery.

Ditch the Labcoat, Please.

Photo: Mike Edmond

Okay, we are now sounding like a broken record, but please ditch the labcoat during inpatient care.


I refer you to Dr. Michael Edmond's latest blog entry.


If you feel that clothing CAN TRANSMIT pathogens, and are in favor of gowns and gloves for contact precautions, then you should support not wearing long sleeved lab coats during inpatient care. Like other apparel, the sleeves will become contaminated during patient care. The contaminated sleeves come into contact with patient skin, invasive devices and can transmit pathogens. Short sleeves will limit contaminated apparel patient contact and will not hinder hand hygiene to the level of the wrists.


This infection intervention is biologically plausible, simple, inexpensive and not likely to cause harm.


So why the resistance? I suspect that many are still wedded to the symbolism of the labcoat.


Get over it.

Congratulations Ellen Gerszten- VCUHS Employee of the Month

Congratulations Ellen Gerstzen-VCUHS Employee of the Month! 


The most dedicated and effective social worker I have ever met. 


Thank you for all you do for our patients. Your work is invaluable to all of us.

With Ellen Gerszten- VCUHS Empoyee of the Month at her Award Reception 5/25/2011 

Public Health Implications of Same Sex Marriage

I came across this intriguing title in the American Journal of Public Health.

Of course, there is much controversy about the legalization of same sex marriages. Many argue that same sex marriages are an extension of human rights. This perspective looks at same sex marriage for a medical standpoint.

Reports in the medical and social science literature suggest that legal and social recognition of same-sex marriage has had positive effects on gay and lesbian couples. The health benefits of legalized marriage are significant regardless of sexual orientation.  These include significantly less depression and anxiety, better psychological well-being, better access to health insurance and quality health care as well as more consistent family support. Improved access to health care is conferred by marriage benefits under federal or state law and by the decreased effects of institutionalized stigma on gays and lesbians.

Of course, those opposed to same sex marriage are likely not to be swayed by arguments in favor of human rights or improved medical outcomes.

Physicians on Strike?

I refer you to a commentary in Academic Medicine on professionalism, unionization and physicians on strike.


Professionalism is a basis of medicine's social contract with society. In countries where national healthcare exists (obviously, not in the USA), physician unionization and strikes have occurred as part of the negotiation process.
As the USA heads forward with health care reform, these measures of negotiation may come into play.


The authors point out that physicians provide an essential service whose withdrawal is capable of causing great hardship to those they serve (patients), including potential loss of life. Physician strikes could lead to significant erosion of public trust and professionalism. Physician strikes are usually to better their own situation, and not for the sake of better patient care.


Physician strikes should be avoided. To do so, the medical profession must be represented and must influence negotiations at early stages. Discussions on the principles and controversies in physician negotiation should be a part of medical training, to better prepare physicians on these matters. 


In the end, physician strikes conflict with medicine's professional values.

Contaminated Blood Cultures: Pesky Practice

It has been a busy week on the internal medicine service but not so busy that I can fully ignore both playing a game of football (soccer) and blogging.


Although we have had a lot of success in my medical center in significantly reducing the rate of blood culture contamination, unfortunately, blood culture contamination continues to occur here and elsewhere. Contaminated blood cultures are not without consequence. 


A recent publication in Infection Control and Hospital Epidemiology reminds us that contaminated blood cultures result in unnecessary antibiotic administration, additional laboratory tests and procedures, and hospital readmissions.


Apart from proper phlebotomy and blood culture collection technique, the first step in reducing this wasteful and potentially harmful result is to order blood cultures only when clinically necessary.


This last point seems self evident, however, this principle is violated over and over.

Never Learn Your Medicine From a Pharmaceutical Representative

Source: Time

Here is an insightful article on how the prescribing patterns of physicians are monitored and used by pharmaceutical companies to direct 'detailing', essentially drug promotion and sales calls by slick sales people.

The article underscores how doctors may have to be more proactive about keeping their prescription histories from marketers. Also, physicians must be proactive, much like the VCU Division of Infectious Diseases, in prohibiting pharmaceutical sales in clinical areas and teaching conferences.

As a former mentor of mine from the University at Buffalo School of Medicine once sagaciously taught me: 'never learn your medicine from a pharmaceutical representative.'