Tuesday, June 30, 2009
Sunday, June 28, 2009
Thursday, June 25, 2009
Tuesday, June 23, 2009
Monday, June 22, 2009
Friday, June 19, 2009
Wednesday, June 17, 2009
When I return, I may address the brewing political overreaction to the VA colonoscopy mess. I have some personal experience here, being the epidemiologist at one of the VA’s that underwent surprise site visits by the Office of Inspector General (here is the report). In the meantime, I’ll just highlight what I think is the best quote I’ve read on this so far, from Philip Alcabes, associate professor of urban public health at Hunter College in New York City:
“To claim that an extra threat of transmitting blood-borne viruses pertains to the VA's colonoscopy clinics seems like showmanship. Since it isn't clear that any patients were actually infected by this equipment, the situation doesn't seem to warrant special rhetoric. It would be better to try to separate the political controversy from the actual health problem here."
Tuesday, June 16, 2009
Monday, June 15, 2009
Friday, June 12, 2009
As with many things in medicine, just because we can’t prove it doesn’t mean it’s not true. It’s hard to do randomized double-blind controlled trials with something like this. But I’m a med student and I can look down at my sleeve and see it’s dirty, I can look down at my tie and see it’s dirty.
Thursday, June 11, 2009
On a related front, SHEA has drafted a position statement on control of the novel H1N1 in healthcare facilities, calling for the CDC to adopt guidance similar to that now adopted by WHO and by many state public health departments (we’ve touched in this before). A letter was sent today, along with the position statement, to the directors of CDC and OSHA.
Wednesday, June 10, 2009
Isoniazid (INH), the standard drug used to treat latent tuberculosis given daily for nine months, is not an innocuous drug. In just the past few years, I have seen two deaths (both persons in their early 40s) and another healthy man who required a liver transplant due to the liver toxicity caused by the drug. Thus, I believe the drug is too toxic to require latently infected healthcare workers to be treated. Like the vast majority of healthcare workers, I have a TB skin test placed yearly. But I have decided that should my skin test convert to positive, I would not take INH because I believe it is too dangerous. We sorely need safer drugs for this condition. And we need better tests to detect latent tuberculosis--those currently available have many false positives and false negatives.
Tuesday, June 9, 2009
Importantly, 41% of those surveyed reported reductions in staffing of infection prevention programs. This has resulted in reduction of infection surveillance by 24% of programs, reduction of process auditing by 20%, decreased environmental and walking rounds by 42%, and decreased educational programs by 38%.
Over half of those surveyed reported that regulatory requirements and reporting mandates make it harder for them to focus on infection prevention. Perhaps The Joint Commission and other regulatory bodies should think more about the adverse unintended consequences of their ever increasing mandates.
Sunday, June 7, 2009
A military physician describes Lance Cpl. Belken as a victim of bad timing. Actually the young marine is a victim of bad policy. The last naturally occurring case of smallpox occurred over 30 years ago, and smallpox is the only infectious disease to have been eradicated. Because of fears that the virus could be used as an agent of bioterror, vaccination resumed in 2002 in the military. A campaign to vaccinate 400,000 civilians failed miserably, achieving 10% of its target. Our hospital was the first to refuse to vaccinate healthcare workers because we felt the live virus vaccine was too dangerous for our healthcare workers and because of the concern that a healthcare worker could potentially transmit the vaccine infection to a patient.
As of October 30, 2004, 822 adverse events associated with smallpox vaccination were reported. This resulted in 85 hospitalizations, 2 permanent disabilities, 10 life threatening illnesses and 3 deaths. And as the LA Times article demonstrates, the adverse events continue to occur.
Smallpox vaccine is the most dangerous vaccine in use today. Given the lack of any cases of smallpox anywhere in the world for the last 3 decades, the risks of this vaccine simply can't be justified.
Friday, June 5, 2009
1. Investments in pandemic planning and stockpiling antiviral medications paid off;Unfortunately, it will be difficult to make necessary investments in public health infrastructure during this economic downturn (the recovery act funding is time-limited, so it’s difficult for public health departments to expand infrastructure and add personnel when they don’t know if future funding will be available).
2. Public health departments did not have enough resources to carry out plans;
3. Response plans must be adaptable and science-driven;
4. Providing clear, straightforward information to the public was essential for allaying fears and building trust;
5. School closings have major ramifications for students, parents and employers;
6. Sick leave and policies for limiting mass gatherings were also problematic;
7. Even with a mild outbreak, the health care delivery system was overwhelmed;
8. Communication between the public health system and health providers was not well coordinated;
9. WHO pandemic alert phases caused confusion; and
10. International coordination was more complicated than expected.
The third bullet point, about “science-driven” response plans, is particularly applicable to the transmission route and mask issues we’ve blogged about before. I’m not sure if public health officials fully understand the impact on local hospitals and clinics of assuming airborne rather than droplet spread for influenza.
Wednesday, June 3, 2009
Despite an expressed desire to incorporate a severity measure into their pandemic alert system, WHO might soon move to phase 6 (out of 6). Meanwhile, the C.D.C. reports that pneumonia and influenza mortality in their 122 city surveillance remains below the epidemic threshold.
Maybe the new WHO pandemic alert system should keep the 6 phases, applied regardless of disease severity, and then when phase 6 is reached and the disease is very severe, they could jump right to eleven.
Tuesday, June 2, 2009
Monday, June 1, 2009
AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution: 720 (A-09)
Introduced by: Medical Student Section
Subject: Hospital Dress Codes for the Reduction of Nosocomial Transmission of Disease
Referred to: Reference Committee G
Whereas, Nosocomial infection is a significant cause of morbidity and mortality in the US; and
Whereas, According to the Centers for Disease Control and Prevention, approximately 1.7 million hospital patients contracted nosocomial infections in 2002, resulting in nearly 100,000 deaths; and
Whereas, Patients in critical or intensive care units are most susceptible to nosocomial infection, accounting for nearly 25 percent of all cases; and
Whereas, Neckties, long sleeves, and other clothing items and accessories have been implicated in the spread of nosocomial infection; and
Whereas, In 2007, the British National Health System implemented a “bare below the elbow” hospital dress code, banning neckties, long sleeves, hand and wrist jewelry, and traditional physician white coats; therefore be it
RESOLVED, That our American Medical Association advocate for the adoption of hospital guidelines for dress codes that minimize transmission of nosocomial infections, particularly in critical and intensive care units. (Directive to Take Action)