Here we go again: Active detection and isolation, C. difficile edition

An interesting study in JAMA Internal Medicine, likely to generate a lot of discussion, addresses the use of “active detection and isolation” (ADI) for control of C. difficile disease. This quasi-experimental, single-center study employed PCR screening (tcdB detection) of all patients admitted through the emergency department (patients admitted from other locations were excluded, as were “short stay” patients), and those that were found to carry toxigenic C. difficile were admitted into a kind of “quasi-isolation”—gloves were used, but not gowns or private rooms. So all-in-all, a very pragmatic (and somewhat idiosyncratic) intervention. Healthcare-associated C. difficile disease rates declined after the intervention, which students of prior quasi-experimental studies of ADI for MRSA and VRE will find unsurprising. 

At this point, I will outsource my blog post to Jon Otter and Martin Kiernan at the Reflections IPC blog. Go on, head over there for an excellent pro-con post about this study, and vote on the question posed at the end of the post. Then come back here to read my only additional observation…..I can wait (spoiler alert: I agreed with Jon).

OK, you’re back: the only thing I have to add to Jon and Martin’s excellent post is this: we’ve been here before. Recall the persuasive quasi-experimental studies (many single-center, some multicenter) of MRSA and/or VRE ADI published over the course of a couple decades. When better designed studies were eventually performed and published (e.g. STAR*ICU, REDUCE-MRSA, MOSAR, this one by Harbarth and colleagues that doesn't have a catchy acronym)—you know, studies that included concurrent control groups (control groups are for losers!), it became evident that ADI wasn’t the key to MRSA or VRE control. I think we’re headed down that road again, this time with C. difficile. Who’s going to step up and organize the multicenter, cluster-randomized trial we need to do now? Or perhaps better to ask: who is going to pay for it?

Guest Post: Social Media Survey

This is a guest post from Dr. Jon Otter, an epidemiologist focused on Infection Prevention and Control at Imperial College Healthcare NHS Trust in London. Jon has a degree in Microbiology and a PhD in epidemiology. His research interests include the epidemiology of MRSA, CDI and MDR-GNR, the role of contaminated surfaces in transmission, and molecular typing methods including whole genome sequencing. If you're interested in reading more of Jon's excellent musings, he's a blogger at the Reflections on Infection Prevention and Control blog.

Social media (in all its guises) is being used increasingly in our personal and professional lives. The advent of social media brings with it a number of challenges (time-consuming, unhelpful interactions, new liabilities) but also some important potential benefits for healthcare professionals and patients (principally unique opportunities for reaching colleagues and patients). I've been asked to do a talk at ECCMID in Amsterdam next month on the use of social media among healthcare professionals. I was able to find some reasonable data on the use of social media among scientists, but I could find very little data on the use of social media among healthcare professionals in general, and IPC/micro/ID folks in particular. So, I've produced a simple survey to fill this gap, and ask that you share the link (https://www.surveymonkey.co.uk/r/KWYMDPM) with your colleagues so that they can complete it too. It is important that the survey is circulated outside of social media channels, for obvious reasons! I’ll be including the results of the survey in my ECCMID talk, and will make the slides available afterwards here. Many thanks to the Controversies bloggers for the opportunity to tell you about this survey.

(Editor's note: Survey takes 30 seconds so please help Jon out if you can, Thanks!)