Newest horizontal intervention: iPad stand + toilet roll holder

From hand hygiene to reducing presenteeism there are many horizontal interventions that are effective in preventing infections in hospital settings. However, there are risks in your own home that are calling out for community-based horizontal interventions. For example, have you ever read a magazine, newspaper or iPad while sitting on the toilet? Me neither. Now, you no longer have to worry about transmitting fecal-oral pathogens via literary fomites thanks to a newly available product: the CTA Digital Pedestal Stand for iPad 2/3/4 with Roll Holder.

This 4-star rated product is currently available for $40 and scrolling through the customer reviews you can see why. Below, I've pasted some comments from reviewer ohjodi for your enjoyment.

Brilliant! Replaces my clumsy tv tray, which didn't match my bathroom decor. I can now Skype (hands-free!) instead of trying to juggle a cell phone. Eliminates the need for a stack of magazines (unsanitary!)... I do wish it had a cup holder, and maybe a basket or tray of sorts to hold a bag of popcorn, chicken nuggets, french fries, bowl of soup, etc. I watch a lot of streaming tv and movies, and I had to knock off one star because after 30 minutes or so my legs start to fall asleep and I have to stand and shake my legs for a few minutes to get the circulation going... My toddler son LOVES THIS for potty-training with Angry Birds!

I love me some anaerobes!

The first case-control study I performed early in my hospital epidemiology fellowship at the University of Iowa was an examination of risk factors for VRE (vancomycin-resistant enterococcal) bloodstream infection in an outbreak among oncology and bone marrow transplant patients at a community hospital. Little was known about VRE at the time. One very strong risk factor emerged from my data: receiving an antibiotic that had significant activity against anaerobes. This 20-year old observation has since been replicated and subsequently proven in experimental animal models. In mice treated with anti-anaerobic drugs, VRE burden can rise to the point that these organisms constitute 99% of the bacteria in the gut. Although VRE are relatively nonvirulent organisms, in neutropenic hosts they can cause bloodstream infection following gut colonization and translocation across the intestinal mucosa.

Now comes a very interesting study from Memorial Sloan Kettering Cancer Center in this month's Infection and Immunity. The investigators induced VRE colonization in mice, then performed fecal transplantation using stool from untreated, noncolonized mice. Within 15 days VRE could not be recovered from the feces of the treated mice. They next determined that the presence of the obligate anaerobe Barnesiella in donor stool was most closely associated with the therapeutic effect. They then evaluated stool cultures of patients who had undergone allogeneic stem cell transplants and found that those patients harboring Barnesiella in their GI tracts were protected from having VRE domination of their fecal flora.

The authors put their findings into an interesting evolutionary perspective in the paper's discussion:

"Oxygen-intolerant bacteria have limited options on the earth’s surface, and the metazoan colon represents an essential, and for many anaerobic species, sole, sanctuary. Despite their density in the colon and their proximity to the bloodstream, obligate anaerobes rarely cause human disease and their survival depends on their host’s survival. Obligate anaerobes of the gut promote their host’s survival by limiting the expansion of oxygen-tolerant bacteria, which, by and large, are the subset containing most of the intestinal pathogens. Our results suggest that Barnesiella spp., by restricting the growth of VRE, regulate the composition of the microbiota and optimize host survival."

I always teach the medical students that after they read a paper they should ask themselves to identify the implications of the paper for their practice. In this case, I suspect the implication is that my future is filled with performing many, many more fecal transplants. Although the yuk factor is very high, reimbursement is bad, and the time input is significant, the powerful results and grateful patients make doing it truly worthwhile.

Photo:  Dr. Ella Barnes, British intestinal bacteriologist and namesake of the VRE conquistador.

Friday feces blogging (part 5)

A year or so ago, I bought a new external hard drive for my computer (see photo). I marveled at its storage capacity--1 terabyte! That just seemed to be a huge amount of information. So I almost fell off the exercise bike today when I read a statistic in this month's issue of The Atlantic (free full text here) on the data capacity of human feces. According to Larry Smarr, a computer scientist who views the human body as a ginormous database:

"There are about 100 billion bacteria per gram (of stool). Each bacterium has DNA whose length is typically one to 10 megabases--call it 1 million bytes of information. This means human stool has a data capacity of 100,000 terabytes of information stored per gram."

Now to bring all of this home, you should know that I use 30 gm of stool for the fecal transplant procedure. So if my math is correct, I am instilling 3 million terabytes (or 3 exabytes) of information.That is nothing short of amazing!

Dog Days of Winter?

The Dawg Pound in Cleveland Browns Stadium

As the 'Dog Days' of summer come to an end and Cub's fans everywhere enter into their official waiting 'til next year period, it's time to look forward to those crisp winter days with clean cool breezes and the cheers from college and NFL football fans filling the air. Well, that is, unless you live in Cleveland and Detroit. These cities share so much in common  - the devastating destruction of their industrial core and their long-suffering NFL fans (the Browns and Lions play each other tonight). Now they share something else in common and it isn't pretty - airborne dog feces.  Seriously.

A new study in Applied Environmental Microbiology by a group at University of Colorado, Boulder, aimed to characterize the microbes circulating in urban environments, which could trigger asthma and allergies, by analyzing the air in the summer and winter at four locations in the Great Lakes region: Chicago, Cleveland, Detroit and... Mayville, Wisconsin. I guess Milwaukee took a pass? Smart thinking. Their primary finding was that two cities, Detroit and Cleveland, had significant quantities of fecal bacteria in their atmosphere with dog feces being the most likely source, particularly in the winter. Good news!

In an an accompany CU press release, first author Robert Bowers said that "in the summer, airborne bacteria come from many sources including soil, dust, leaf surfaces, lakes and oceans, but in the winter, as leaves drop and snow covers the ground, the influence that these environments have as sources also goes down. It is during this season that the airborne communities appeared to be more influenced by dog feces than the other sources tested in the experiment." Well, now we know the real reason why the Cleveland NFL team is called the Browns. If you've ever been in the Dawg Pound, you wouldn't be surprised that there was a lot of fecal bacteria floating around. I'm just surprised it's from dogs and not Dawgs.