Watch this video! It will change your life and the future of the world!

The overselling of science can be pretty hilarious when described by John Oliver, yet it infects not just the media but also scientific journals and professional conferences. One of the aims of this blog has always been to question the latest fad sweeping infection prevention nation; see Dan's recent post on ADI for CDI or my talk on public reporting of HAIs. In addition to highlighting the bit at the end of the video that notes the 70% increase in authority that descends upon those wearing a white coat, I've pulled out these quotes for you to ponder:

"Just because a study is industry funded or its sample size was small or it was done on mice doesn't mean it's automatically flawed, but it is something the media reporting on it should probably tell you about." - John Oliver

"I think the way to live your life is to find the study that sounds best to you and you go with that" - Al Roker

Ebola: Bloggers in the News

UPDATED October 19

Last night, Dan, Mike and I sat around a table and drafted an op-ed at the suggestion of several colleagues. We would eventually like to include it here, but that will have to wait pending editorial reviews and rejections. Media requests have been frequent and we are doing our best to speak with as many reporters as we can. Dan has been very busy with SHEA duties, as he is currently the Society President. SHEA has just released a statement on infection prevention funding needs where Dan is quoted. He spoke (audio below) this morning on NPR-KPCC in Southern California and also appeared on NBC Nightly News. He also was quoted in USA Today.

Mike spoke to Iowa Public radio about what we've learned from the transmission of Ebola to healthcare workers in Iowa and what we can do to prepare. He also appeared on MSNBC.

I've done several interviews, including one with Bloomberg News yesterday (I didn't write the headline) and a few more that are scheduled to appear. I've also posted an MP3 below of an interview I did with CBS radio out in LA (KNX 1070) yesterday. I tried to emphasize the importance of PPE protocols, particularly doffing and the need for a buddy to monitor every step. Buddy is my new favorite word.

Perencevich Interview on CBS KNX - LA

Diekema Interview of NPR KPCC - So Cal

IDWeek 2013: Media, Social Media, and Open Access

One of the great things about sitting on the planning committee of a national meeting is the ability to put together sessions that are a bit "outside the box" if you will.  During the planning of IDWeek 2013, I had the opportunity to attend the ScienceOnline2013 Conference in Raleigh where I reconnected with Maryn McKenna and met Jonathan Eisen. I thought that many of the concepts that the science journalists (McKenna) and scientists (Eisen and Smith) discussed at ScienceOnline were directly applicable and perhaps urgently needed by the public health community that attends IDWeek. Specifically, I felt that public health was a little too heavy on the "health" and a little too light on the "public." So I worked with my colleagues on the planning committee, including Scott Fridkin and Dan Diekema, to craft a session that focused on three major methods for selling public health science to the public.

The first important topic was open-access publication. If the public and journalists don't have access to your science because it's buried behind a paywall, then it doesn't even exist.  The second topic was social media, which is a method by which scientists and public health practitioners can communicate their science or policies directly to the public including science journalists. Finally, we needed a speaker to help explain how best to interact with journalists to communicate our science and messages. So, we were very lucky to have Jonathan Eisen, Tara Smith and Maryn McKenna speak at our session at IDWeek earlier this month in San Francisco.

There are several sources available for those of you interested in the session's content:

Jonathan Eisen wrote a nice post describing the entire session and also created a Storify (a collection of live tweets associated with the session) covering all three talks, both of which you can read here at one of his blogs. He's also posted his slides on slideshare.

Tara Smith posted her slides on social media at Figshare. She also posted the slides from her excellent S. aureus in animals talk, which you can access through her blog.

NIH KPC Outbreak - The Final Word?

We've covered CRE extensively over the past couple of years.  Never so extensively as we did when the 2011 NIH KPC outbreak was first publicized last August following the whole-genome sequencing report in Science Translational Medicine. Almost a year has past since that report and kerfuffle, so it is nice to see that Tara Palmore and David Henderson have found the time to share their experiences controlling the outbreak and the media storm that followed the publication of the original manuscript. They decided to label the section on the public reaction the "Unintended Consequences of Publication." This title is very disturbing, as it highlights why many outbreaks like these are never reported - publication bias. I'm glad they weren't afraid to publish again, so that we can all learn for this difficult outbreak. The report is freely available in PDF over at CID. I'll stop writing and let you get on with your required reading.

Montgomery County is now in the loop!

The next time a contagion sweeps through the NIH Clinical Center, Montgomery County officials will be on it, thanks to a new agreement between NIH, Maryland and Montgomery County. The back-story is that Montgomery County officials were unhappy that they weren’t informed promptly about the deadly KPC outbreak at NIH.

This raises the question of when a hospital should communicate with public health officials (and the public generally) about fairly common SNAFUs. At any given time, 5-10% of hospitals are dealing with clusters or outbreaks of multiple-drug resistant gram negative bacteria (KPCs, ESBLs, MDR-Acinetobacter, etc.), and even more are in the midst of MRSA, VRE, fungal or other outbreaks. The population at risk during these outbreaks is pretty clearly defined, and doesn’t include the general public. General notification can generate media frenzy, free-floating panic and anxiety, and waste precious time and resources for the personnel trying to contain the outbreak (responding to media, doing damage control of various types, etc.). Furthermore, most states don’t include common healthcare associated bacterial pathogens among their legally reportable diseases.

However, as state and local public health officials become increasingly involved in HAI issues, it would be wise to establish explicit criteria for when healthcare facilities should report clusters and outbreaks. Provided they have sufficient funding (which they currently do not!), public health departments should play a critical role in coordinating responses to HAI outbreaks, which often involve multiple healthcare facilities in a region (across the spectrum of acute, long-term, and long-term acute care).

So when do you think a hospital should notify their state and/or local public health department? Two cases of MRSA infection in the NICU? A single serious post-operative Group A strep infection? New introduction of a carbapenemase into the ICU?

Oh, and Happy Thanksgiving!

A new MEGA SUPERBUG

As if on cue, the media is abuzz with a new dire threat. This time there is a mega superbug called MDR-acinetobacter. The good news is that David Paterson of the University of Queensland, has a new Australian government grant to assist in the development of new antimicrobials. He has received $2 million over 5 years to study this Mega Superbug. That's a new term for me. Perhaps if we have antibiotics to treat the infection they are just superbugs but if there are no effective antibiotics it becomes a mega superbug. I think someone should write a guideline to clarify this - but that would also take a $2 million grant, I suspect. There is a nice picture of David here for those of you, like me, who miss seeing him since he left Pittsburgh. I hope there is funding at NIH that can assist in drug discovery for MDR-Gram negative rods, since we don't have many options currently.

Media and MRSA

I find it interesting to read media accounts of MRSA infections. I'm not sure if it's denialism of science, trying to stir up ratings or just plain ignorance, but it's surprising the way the media portrays certain types of infections, especially MRSA. Take for example the sad story of singer Etta James and her battle with Alzheimers and now apparently MRSA. CNN said she was "diagnosed with MRSA -- a bacterial infection resistant to many antibiotics." So far, so good. The Guardian says she is "suffering from a blood infection and the MRSA superbug" while the CBC says "She is fighting the superbug known as MRSA — a bacterial infection resistant to many antibiotics." My favorite is the music website that said that she "has contracted the potentially-deadly MRSA virus since first undergoing treatment."

So we have a bacteria, a suberbug and a virus. Which sounds scarier? I would say superbug, then virus then bacteria. In any case, these representations or social representations of MRSA have been used by the media since at least the 1990's to spread fear and assign blame. This topic will become a recurring theme of my posts surrounding a talk I'll give at the 5th Decennial in Atlanta at the end of March.

By the way - how is this information getting out about Ms. James? HIPAA?

Media and the Public Health Response

Recently, I have become interested in how the media influences the public health response and watched with fascination as the H1N1 saga unfolded. As Mike pointed out earlier, the New York Times has written about the recent transplant-related transmission of Balamuthia mandrillaris and whether this one-off event should change overall transplantation guidelines nationwide. I hope the NY Times' assertion that patients with undiagnosed neurological conditions should be barred from donating organs is analyzed and public health officials don't make a knee-jerk decision based on immediate/transitory media attention or political pressure.

Decisions like these are quite complicated and proper analysis can turn-up unexpected findings. Two years ago, I co-authored an article in the American Journal of Transplantation with Eugene Schweizer and others at the University of Maryland that analyzed what would happen if kidneys were transplanted from donors considered high-risk for HIV or Hepatitis C, yet had tested negative. The current practice is to discard these valuable organs. Our most surprising finding was that the total number of viral infections in recipients was actually LOWER with the policy of transplanting these organs. The reason? It turns out that discarding kidneys from high-risk donors led to more time on hemodialysis which resulted in a higher Hepatitis C incidence in recipients. The transplant policy also resulted in higher quality of life and lower cost of care.

Now, the NY Times article is quite balanced, but this won't necessarily stop public health officials from making decisions before a proper analysis is completed. Let's hope cooler heads prevail before a "national policy on whether to bar people with poorly defined neurological disorders as donors" is decided by officials and not scientists. The one thing that is certain is that there is nothing harder to define than a neurological condition.

Infection prevention: The media backlash!

A couple news articles today are designed to generate annoying e-mails to tired infection preventionists….

The first story, from CNN, is really a non-story that takes the fact that influenza is a respiratory virus (that spreads, you know, from respiratory droplets) to insinuate that hand hygiene is not an effective flu prevention measure. Numerous experts are cited, not all of them say the same thing.

The second is a bigger deal, because it appears to already be affecting vaccine policy in at least one Canadian province. Apparently some Canadian studies have linked prior receipt of seasonal flu vaccine to an increased risk for H1N1 infection. The news account is here and I wish I could link to the study data—but it isn’t published and won’t be released by the investigators until it is peer-reviewed (then why leak it to the media, is my question…..). Tom Frieden had little to say about this issue at the CDC press conference, except that data from the U.S. and Australia have not shown such an association.

Breaking News

Media blames media for overreaction to H1N1.