VAP: Do you know it when you see it?

Ask any infection control nurse, infectious diseases physician, or intensivist and they will tell you of the difficulty in trying to define and diagnose ventilator-associated pneumonia (VAP). This is because there are a number of other conditions that can mimic VAP. A new study in the Journal of Critical Care compares three VAP definitions to autopsy findings in 253 patients to determine the utility of the definitions. The CDC definition was not used, but is similar to one of the definitions applied in the study. None of the definitions performed well. The most sensitive definition (65%) had a specificity of 36%. On the other hand, one definition had a nearly perfect specificity (99%), but its sensitivity was dismal at 5%. The results of this study coupled with conventional wisdom should be taken as a warning that public reporting of VAP rates may mislead consumers, and other metrics for reporting should take precedence.

Sorry to be Debbie Downer but....

A new study in the American Journal of Epidemiology has found that going to the beach may be more risky than you think. Investigators at UNC-Chapel Hill found that digging in the sand or being buried in the sand was significantly associated with the development of gastroenteritis symptoms in the subsequent two-week period. The risk for illness was overall approximately 20% higher in those with sand exposure, though it varied with the specific beach (at one beach the risk was 90% higher). The study was performed at seven beaches that had sewage treatment plant discharges within seven miles.

Scary....

Does the name Betsy McCaughey ring a bell? She's the former Lt. Governor of New York and self-proclaimed expert on healthcare-associated infections, who heads the Committee to Reduce Infection Deaths. Looks like she has a new schtick according to a posting in Andrew Sullivan's blog.

Institute of Medicine to weigh in on PPE for influenza

We’ve blogged extensively about the discordance between CDC and WHO guidance on the use of personal protective equipment (PPE) while caring for H1N1 patients in healthcare settings. You can read our posts on this here, here, here and here.

Looks like IOM is now going to weigh in. You can find their project scope (or “charge”) here, along with links to the committee membership. The project specifies “novel H1N1”, but that seems very silly to me. No robust data exist to suggest that transmission of the novel H1N1 differs in any substantive way from that of seasonal influenza. So any conclusions or recommendations that come from this committee should be applicable to all influenza viruses, not just the “novel H1N1”.

The ad hoc committee has to report its findings to CDC by September 1st. So what do you think the likelihood is that we’ll be using N95s for care of all patients with seasonal influenza, every year?

Don't Get Sick (if you want to stay insured)

Another piece, in Slate, on the odious practice of rescission.

It's not just for chickens, cattle and pigs anymore...

The New York Times today has an article about Chile's salmon production industry, which is the second largest in the world. What does this have to do with infections you might ask? Well, it's about the abuse of antibiotics by the salmon industry, just like that which is occurring in other types of food animal production. And it occurs for the same reason as it does in nonaquatic agribusiness--the animals are kept in extremely crowded conditions, which increases the transmission of infectious diseases, and so antibiotics are added to the food (in this case poured directly into the water in which the fish swim) in an attempt to keep them healthy. In this way, antibiotics enter the human food supply and eventually lead to antibiotic-resistant infections in humans. For example, in Europe vancomycin-resistant enterococci (VRE) in humans can be traced to the use of the antibiotic avoparcin in animal feed. Avoparcin is a glycopeptide antibiotic, the same family of antibiotics to which vancomycin belongs. So when the bacteria colonizing the animals who ate the antibiotic-treated food became avoparcin-resistant they were likewise vancomycin-resistant. Back to the salmon--Chile dumped 718,000 pounds of antibiotics in the salmon's water last year. To put that into perspective, by my calculations, that's equivalent to the amount of antibiotics that could treat 23 million adults each for 10 days.

Restrictions May Apply

I enjoy This American Life, and have been listening to each weekly podcast while I walk to work. This week’s show was entitled “Fine Print”, and covered several unrelated topics wherein reading the fine print turned out to be crucial.

One segment of the show hits pretty hard, and is directly relevant to health care reform—it covers, in a very moving way, the health insurance industry practice of “rescission”. For those of you who live in a developed nation with a sane health care system, “rescission” is a practice whereby an insurer can revoke your health care insurance policy after you become ill, based upon a careful review of your application for any evidence (even minor, technical evidence) that you incorrectly or inaccurately completed your application.

A must-listen for any of you who think our health care system isn’t in desperate need of reform. Click on this link, then “full episode”, and go to 35:22 in the broadcast to listen.