|David Livermore and NDM-1|
h/t Mark Vander Weg
|David Livermore and NDM-1|
|CNN's advice for KPCs? - Eat Yogurt|
So there is another measles outbreak, this time in Minnesota. Unlike recent experience with mumps, in which outbreaks are associated with vaccine failure (over 60% of cases occurring among recipients of two mumps vaccines), measles outbreaks occur primarily among the unvaccinated, and are sustained by those who reject or avoid the MMR (see prior posts here and here). Of the 13 confirmed Minnesota cases, 5 were too young to be vaccinated, 6 should have been vaccinated but were not, and 2 so far are of unknown vaccine status. Regular updates can be found on the Minnesota Department of Health website. There’s also an interesting article in the Star-Tribune about resistance in the local Somali community to receipt of MMR, out of fears of….you guessed it, autism.
We’ve covered this ground before—go here for our prior posts on the anti-vaccine movement. We recently had some local news coverage of a pediatrician who was declining patients if the parents refused vaccinations. I believe this is a perfectly reasonable position for a pediatrician to take. In fact, if a pediatrician does accept anti-vaccine families, he or she has a duty to warn all the other patients in the practice of the increased risk to infants or immunocompromised children from being in that office waiting room.
|Michael Edmond and Richard Wenzel|
|Scott Weese, DVM, DVSc|
Photo: U. of Guelph
Mike and Eli can comment on what drives them to blog, but I know my initial motivation (one that Mike shared) was that there was no other venue in which to express timely and unvarnished opinion about the hottest topics in infection prevention. Publication turnaround times are slow, and even opinion pieces are often peer-reviewed and edited to the nth degree of blandness. One formative experience for me was having a letter to the editor of one of our major infection control journals rejected—not because it contained erroneous information or was poorly reasoned, but because it would give “aid and comfort” to those who didn’t share the dogmatic views on MRSA control held by the editor-in-chief.
Many of my early posts, then, involved me getting some things off my chest. For example, my day one post, entitled “Why I hate contact precautions, Vol. 1” (because I fully intended, and did, proceed with follow up posts containing additional reasons that I hated them!). Once some of those things were covered, including some memorable exchanges around the MRSA active surveillance debate, I found that the blog served many other important functions. Over time it has become a kind of “online catalogue” to which I refer frequently when writing proposals and manuscripts. It also keeps me on the lookout for interesting and useful items in our literature, and forces me to assess papers a tad more carefully than I used to—not just to see if they are “bloggable”, but to determine when there are flaws that ought to be pointed out to our readership.
I hope to spend time at SHEA next week talking with Eli and Mike about where to go with this blog over the next year. Feel free to make suggestions in our comments section or by e-mailing one of us directly. Most of all, thanks for your interest in this blog, and in preventing HAIs.
If only one could replicate the stool microbiome using culture techniques, this barrier would exist no longer. However, early studies of the gut microbiome revealed that the majority of species are not cultivatable in the laboratory.
So I found this report from Washington University to be very interesting—these researchers were able to preserve gut microbiome functions in germ-free mice using strict anaerobic culture techniques. If indeed a person’s “readily cultured bacterial community” could exhibit in vivo behavior that mirrors the complete microbiome, then there is the potential for complex microbial communities to be developed and passaged that could replenish the microbiome in patients with CDAD.
|The original Washington Monument|
The CDC just announced ongoing funding of the Prevention Epicenters (PE) program. You can read John Jernigan’s post at Safe Healthcare for the details. We have been involved in this program in the past (the University of Iowa participated during the first two rounds, and both Sloan-Kettering and Maryland were Epicenters while Eli was in those locations). Loreen Herwaldt worked with our Iowa group to put together a great application for this round. Alas, we fell short—but to a group of sites with real depth in the science and practice of healthcare epidemiology.
Collaborating within a multicenter research consortium has its challenges, and progress often seems painfully slow. It’s impressive, then, to look at the body of work that has come out of the PE program, especially given the shoestring budget from which it has been funded. Ten million dollars sounds like an awful lot of money, but spread over 5 centers (each of which represents a healthcare system) and 5 years, minus the institutional overhead, it doesn’t leave much to do studies that might lead to new insights in prevention. Too often this means scaling down prospective interventional trials into less-definitive-but-still-valuable observational studies, simply for want of funds.
Stacked against the morbidity, mortality and cost of health care associated infections, HAI prevention research is massively underfunded. The PE program is a great example, but should be scaled up 10-100 fold.
Regarding the industry conflict-of-interest (COI) issue, the report takes WHO to task for poor handling of COI and lack of transparency, but concludes that there is "no evidence of attempted or actual influence by commercial interests on advice given to or decisions made by WHO." I’m not sure what such evidence would be required…direct cash payments to members of the WHO advisory committee? Anyway, given that the panel felt that WHO waited too long to call the pandemic, it is unlikely they’d conclude that this decision was driven by industry COI.
Read the report yourself—now that Iowa has thawed out and the sun has appeared, I have no time to detail all 15 of the recommendations the panel made.
|"Am I not destroying my enemies when I make friends of them?"|
|Modern Torture Devices|
My hospital system plans to do blood cultures on all patients who are admitted with a central line in place (decision not yet final, but momentum is great). Such cultures would prevent mis-labeling of community-acquired infections as hospital-acquired, if infection actually happened to be present on admission and was not clinically suspected. This would allow upgrade of DRGs, to increase reimbursement, and would prevent a CLABSI from being labeled wrongly as hospital acquired. Our state has mandatory reporting and comparison of CLABSI for all hospitals and there is great pressure to reduce rates. I have great reservations about this practice, having seen this done before when blood contaminants stalled the entire purpose of the admission, adding to antibiotic use and length of stay. Does anyone else have opinions or experience with this practice?So just to be clear: as a result of pressure to get their publicly reported rates of CLABSI to zero (and to maximize reimbursement), this hospital plans to obtain admission blood cultures on every patient with a central venous catheter. Not only will these non-indicated cultures drive up healthcare costs, they will result in untold days of unnecessary antibiotic use (for the blood culture contaminants that will greatly outnumber true pathogens), increase pressure for antimicrobial resistance, prolong hospital stays, and could result in potentially lethal adverse effects (drug reactions, C. difficile, etc.).
Looks like Don Berwick’s tenure at CMS will be a short one, since the votes to confirm him are not there. We commented here on his initial recess appointment. I can’t comment much more without making this a political blog, which has never been our intent. I will only say that it is a sad commentary on the state of our divided government, and yet another setback for efforts to improve the
The average person harbors at least 10-fold more bacterial than human cells. So I smile whenever I read articles like this one. I guess we're supposed to be shocked, just shocked, to find that densely populated human environments are, well…..not sterile.
Given the range of behavior displayed in public transit systems (245 complaints of urinating and defecating in one year? really??), it makes sense to design the environment with surfaces that are easily cleaned and disinfected. Routine efforts to document microbial contamination in such environments are mostly a waste of time and money. Call me if you’re planning such an effort in your municipal transit system. For half the cost, I’ll predict with uncanny accuracy what you’ll find…..