Saturday, December 8, 2012

An outbreak linked to a cardiac surgeon

The LA Times reports today on an outbreak of nosocomial Staphylococcus epidermidis endocarditis in patients undergoing valve replacement surgery at Cedars-Sinai Medical Center. The outbreak involved 5 patients, 4 of whom required replacement of the prosthetic valve. All the cases were linked to a cardiac surgeon who had what sounds like an eczematous process on his hands.

The article notes:
The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation, said Rekha Murthy, medical director of the hospital's epidemiology department. She added that there were also no national standards on types of gloves used, whether to wear double gloves or how many times surgeons should change those gloves during a procedure.
Rekha's comments point out a few examples of the many unknowns in healthcare epidemiology. As hospital epidemiologists we are held accountable to fix problems, but often we're bereft of the answers to such basic questions. This has been a recurrent theme on this blog, and as Eli has stressed, we lack funding to perform the research to fill the gaps in our knowledge base. After this week's Infectious Diseases fellowship match, which demonstrated that few young doctors remain interested in our field, it appears that we may also eventually lack the human resources to address these problems.

2 comments:

  1. Just to fill in some of the details about the declining interest in ID training: almost 40% of ID programs didn't fill their training spots, and for the past few years there have far more training spots than qualified applicants. This isn't a result of an expansion in training programs, it represents a steady decline in interest. After the match this year, there were 13 unmatched applicants and almost 70 unfilled training positions. I will post some additional thoughts on this when I have more time (too much IDWeek planning to do this weekend).

    The outbreak you describe reminded me of my first outbreak investigation--when I was a fellow, Dick Wenzel sent me across the country to help investigate an outbreak of Candida parapsilosis prosthetic valve endocarditis. As I sat down to do my first interview with a member of the operative team, he said "I don't know what's going on with this, but I hope we can get new OR gloves out of it". Turns out the outbreak coincided with the hospital's decision to change to a new brand of hypoallergenic gloves for the ORs. The surgeons hated them because they kept tearing, and they didn't want to double-glove because of the "loss of fine touch" that resulted. Entire fingers would occasionally tear off the gloves, leaving bare-hands over the operative field. Combined with the fact that C. parapsilosis is among the most common subungual colonizers, it wasn't too tough to figure that one out!

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