Final thoughts

This is my last post on Controversies. I’ve been writing online since 2000, first with residency and fellowship friends on qfever.com and then on various medical sites to pay off school debt and buy some non-futon furniture. In 2009, Dan and Mike were kind enough to invite me to join this blog and I’ve greatly enjoyed the camaraderie and experience. I could write a book about what I’ve learned and unlearned and the tremendous colleagues and science journalists that I’ve met.

Back in 2009, Mike, Dan and I were all at different institutions. For me, this blog was a place to try out ideas. I didn’t have any expectation to be perfect – only our families were reading. In fact, the blog name Dan/Mike selected was great – they acknowledged the imperfection of infection control science and that we needed a place to work through ideas, to be wrong - to fail. And I greatly appreciated the feedback on my posts. Failure is how we learn.

But in 2018, we three are all at Iowa and even though we’ve added tremendous new talent to the blog, we are still seen as an Iowa blog. Now, when I write deeply questioning posts about hand hygiene, I’m seen as writing with an institution behind me and I have to be more careful or safer. And it’s not just Iowa. As SHEA treasurer, I had to worry about how my posts would be viewed. I direct a VA HSR&D Center of Innovation and sometimes I worried about how my posts would reflect on the 70 people in our Center. I now have positions with ICPIC, the Decennial, and as ID Editor for JAMA Network Open. Too many filters, too much noise. 

Finally, it needs to be acknowledged that our readers and our field are amazingly generous. You have been incredibly forgiving when I’ve tried and failed. I'm incredibly grateful for your generosity.

I will miss this blog and our readers. Thank you. The title of my first post in 2009 was “The end of the beginning.” I think that’s right.

How does a study become an internet meme?

According to the internet the steps to starting an internet meme are: (1) have an idea, (2) find a picture that reflects what you want to imply and (3) "now this is where the skill comes in."  The first two steps are pretty easy to understand, but I'm currently trying to sort out what step 3 actually means.

For an example of a study becoming a meme witness Maggie Carrel's (geography professor at Iowa) recent ICHE study where she geocoded Iowa Veterans and found that those living near a large pig CAFO where at greater risk for MRSA nasal colonization on admission to an acute care hospital. You can read a bit more about her study in Maryn McKenna's Wired blog post.  I suspect Maryn's writing is where the skill comes in because Maggie's study is now a meme (image below) from PEW's health initiative - Supermoms Against Superbugs. Super.

h/t to co-author Tara Smith for finding the meme.

Infectious Art

The University of Iowa College of Public Health has a fascinating new fund raising event - Infectious Art.  The College collaborated with a local design group to create jeweled representations of a wide variety of human pathogens and vectors. The aim was "to present the dichotomy between the aesthetic beauty of pathogens and the havoc they wreak on humanity." Ever wanted a Borrelia ring (one ring to bring them all and in the darkness bind them), Influenza A cufflinks, or HIV earrings? Me too. All proceeds will go to support the College of Public Health. Items may be viewed and purchased online or at American Public Health Association Annual Meeting Nov. 2-6 in Boston, Mass., at the University of Iowa College of Public Health's booth (#1331).

Aspergillus Pin

h/t Cassie Cunningham

57 Days of Diarrhea: Iowa and Nebraska Cyclospora Outbreak

As if living out here in the heartland wasn't exciting enough, news is quickly spreading (although not as quickly as the disease and ensuing panic) of a cyclospora outbreak in Iowa and Nebraska. Recent reports suggest that there have been at least 18 cases in Nebraska and perhaps 25 in Iowa. The Iowa Department of Public Health reports that as of Monday there were 22 cases and that the outbreak seems to have begun in mid-June. No source has been identified. What's a bit interesting is the focus in the IDPH brief and subsequent media reports on a 57-days duration (if untreated).  Many folks I've talked to are focusing solely on 57 days, as the news reports make it sound like if you get cyclospora, you might as well camp out in your bathroom for a couple months.  Perhaps the IDPH and media reports could mention that trimethoprim/sulfamethoxazole (bactrim) is a readily available and effective therapy? This might reduce the panic.

Dan made a radio appearance a few days ago to discuss the outbreak - you can read the transcript here. Interestingly, the segment mentioned that prior to this outbreak there were only 10 reported cases of cyclospora over past 20 years in Iowa.

Q: What are Iowans doing to prevent hospital-acquired infections?

A: Quite a bit, actually. Thanks for asking!

Just last week, University of Iowa researchers Tara Smith, Marin Schweizer, and Phil Polgreen all sat down with Iowa Public Radio's Ben Kieffer (picture to the left) to discuss the latest science in HAI prevention including the epidemiology of MRSA in animal populations, the importance of environmental control in hospital settings and the latest hand-hygiene surveillance technologies.

Click on over to have a listen!

What happens when an anthropologist studies hand hygiene?

Heather Reisinger is a medical anthropologist at the University of Iowa and the Iowa City VA.  Her research and service efforts have involved hand-hygiene improvement efforts in VA, including leading a system-wide hand-hygiene practice survey and interacting with operations partners to improve hand hygiene.  She recently discussed her efforts to balance research with process improvement in the latest issue of Anthropology News.  Her questions focus on discrepancies between reported hand-hygiene compliance rates (e.g. 90%) and the lower rates observed during research funded compliance monitoring (e.g. 40%) and other important but unanswered questions.  Worth a read.

Reference: Reisinger H et al. "Improving Hand Hygiene: The Intriguing Space Between Health Services Research and Clinical Operations" Anthropology News, August 2012

Image source: Ethnography Museum, Budapest

Happy New Year from #Iowa #Nice

I think infection control was also invented in Iowa...

Novel H3N2 Influenza in Iowa: More bad news from pig country

PIGS: Portugal, Italy, Greece and Spain

When it rains, it pours.  Dr. Patricia Quinlisk, medical director for the Iowa Department of Public Health, announced today that a novel H3N2 influenza A strain had infected three Iowa children.  Evidence points to one child transmitting the virus to the other two. There have been seven prior cases of this strain, all in the US (Maine, Indiana and Pennsylvania) and all apparently linked to animal exposure, which makes the Iowa cases unique. All but one case has been in children under 10 years old, suggesting prior year exposure to H3N2 might be protective. Perhaps it's ironic that this novel swine strain was first transmitted from human-to-human right here in pig country.

Sources: Des Moines Register 11/22/2011 and Winnipeg Free Press 11/22/2011

Addendum: Iowa just added 2,300 jobs, which I think is about double our human population.  I think two job seekers family members (update:  actually just in for Thanksgiving) from other states even moved in with Dan this past weekend.  Getting crowded here, which might be increasing the flu transmission.

Actual update on the virus: "In these ten most recently reported cases, the virus has been a swine H3N2 virus with the M segment gene borrowed from the 2009 H1N1 virus. Essentially a hybrid – a new reassortant virus - that until this summer had not been seen before." source: Avian Flu Diary

7 Miles? No problem!

Congrats to star Iowa infection control runners Loreen Herwaldt, Martha Freeman and Marin Schweizer for completing the annual Bix 7 road race in Davenport, Iowa yesterday. Bix for Bix Beiderbecke and 7, well, for 7 miles. 

Influenza not taking year off, again! - 3 flu strains in Iowa

Iowa is below Minnesota, to the left of Illinois with a large nose
and small mouth; most consider it the most handsome state.

I thought after last year, influenza would finally take a year off and not cause any problems.  It seems that influenza's streak is getting into Cal Ripken territory.

I also thought that moving to Iowa would limit my exposure to these sorts of transmissible pathogens.  It's not like I see people most days; ain't nobody here but us chickens.  I even thought Dan was joking about measles and mumps.  We have vaccines, we can't possibly have measles and mumps around here!  Apart from what people say, I really do think wishful thinking can prevent influenza if we wish REALLY really hard. If even one of us gives up hope - bam, pandemic.

So I was surprised (not really) to learn that we currently have 3 influenza strains circulating in Iowa (H3N2, H1N1 and Influenza B). From what I gather, there is a good match with the vaccine. So perhaps now would be a good time to get vaccinated.  As Dan said, we are doing well at UIHC with a 93% vaccination rate. Not sure what the vaccine uptake is in the community, but I guess we are about to find out.

Chicago Tribune article