Cowboy hats always win? FDA nudges towards limiting antibiotics in animal feed

According to an article in today's NY Times, the FDA has just released a new policy limiting agricultural antibiotic uses to settings protecting animal health, and stating that veterinarians should be involved in the drugs’ uses. Various estimates suggest that between 13% and 70% of total antibiotic use occurs in agricultural settings solely to promote animal growth. These new changes may reduce slightly the amount of penicillins and tetracyclines used in animals. However, it is not clear that limiting "old" antibiotics such as these will have a large impact on MDR-bacteria in humans since it represents marginal use of antibiotics with resistance genes/mechanisms already circulating.

This quote from the article seems accurate: "In the battle between public health and agriculture, the guys with the cowboy hats generally win."

NY Times article (here)

Empowering patients to ask providers to wash their hands

"2000 miles

Is very far through the snow

I'll think of you

Wherever you go"
- Chrissie Hynde

We moved our family to Iowa City last week. There is something about being back in the Middle West that gets me singing old Pretenders' songs. I can't really explain it. One thing I've immediately noticed is that people say "hand washing" here and not "hand warshing" like I heard often back east.

Enough of that. There is a qualitative study out in the June issue of the Journal of Patient Safety by Amanda Garcia-Williams and colleagues from the CDC's DHQP that assessed the CDC video "Hand Hygiene Saves Lives" as a tool of patient empowerment. They conducted four focus groups using laypersons without hospital exposure in the past year, laypersons with hospital exposure, nurses and physicians. There are a lot of interesting findings within the study and many should be subject to further analysis.

The primary finding was that laypersons were much more likely to ask a nurse to wash his/her hands after watching the video, however, those with recent hospital exposure stated that they would still be "nervous" or "scared" to do so. Interestingly, laypersons with hospital exposure were more likely to ask physicians to wash their hands after watching the video but those without hospital exposure were not influenced by the video to ask physicians to wash their hands.

A very interesting finding was that laypersons with hospital exposure had lower levels of perceived risk for HAIs than persons who hadn't been in the hospital recently. Perhaps fear of the unknown is playing a role here. I suspect this fear could be used positively to get them to monitor compliance among their healthcare providers. Overall, I found the results of this study promising. Hopefully they will continue to analyze the impact of this video through quasi-experimental study or using other methods to see if this video intervention actually results in changed patient behavior, improved hand hygiene compliance, and dare I dream, reduced HAIs.

Article in the Journal of Patient Safety (here)

IV bactrim is gone

Hospitals across the country are facing a shortage of IV trimethoprim/sulfamethoxazole (bactrim). This is a severe shortage with hospitals reporting that they have completely exhausted all supplies. It is manufactured by a single company, Teva Pharmaceuticals, which is currently not able to project a date when it will be available. Moreover, the company has no supply to release for emergency use. Click here to view a nice table on therapeutic alternatives created by the American Society of Health System Pharmacists.

More than you'll ever want to know.....

For those of you interested in public reporting of healthcare associated infections, Pennsylvania has just released its 2009 report on HAIs. You can view it here. Since every HAI in every hospital is reported by mandate, this report represents the closest thing to a registry of HAIs that has ever been produced, and this report represents the first full year of reporting. There are 128 pages of slicing and dicing the data. In the 250 hospitals there were 26,000 HAIs across 11 million patient-days for an overall crude rate of 2.4 HAIs per 1,000 patient days. Surgical site infections accounted for 24%, UTIs accounted for 23%, BSIs accounted for 13%, and pneumonia cases accounted for 11% of the HAIs. Note that PA requires non-device related infections to be reported as well. Rates of infections were highest in academic medical centers and long-term acute care hospitals, as would be expected considering the patient populations served. Of note, MSRA accounted for 8% of all HAIs. Of the CLABSIs reported, 16% were due to Staph. aureus, 16% were due to coag-negative staph, and 14% were due to enterococci. One caveat: there has been no true validation of the surveillance at the hospitals though on-site audits are reported to begin this summer.

We're good enough, we're smart enough, and doggone it, people like us!

Today's daily affirmation for infectious diseases doctors comes to us from Dave Warren's group at Washington University and is published in this month's American Journal of Medicine. In this study, the authors evaluated 341 cases of Staph. aureus bacteremia and compared outcomes between those patients who had an infectious diseases consult and those who didn't. Not at all surprising to any of us was that in multivariable analysis, patients who had ID consults had a 56% reduction in 28-day all-cause mortality, even though by most metrics the patients who had the consults were sicker. So when you start your rounds tomorrow consider yourself an independent predictor of good outcomes!

New CDC proposed guidance for influenza control

CDC recently posted proposed guidance on prevention of seasonal influenza in the healthcare setting. Written comments on the proposed standards will be accepted through July 22, 2010. The intent of these guidelines is to replace prior CDC infection control recommendations for seasonal and H1N1 influenza. In a nutshell, CDC is proposing droplet precautions, except when aerosol generating procedures are being performed, in which case airborne precautions should be followed. To see the document click here.

Pertussis outbreak

The LA Times reports today that pertussis activity in California has reached epidemic levels. To date this year, there have been over 900 confirmed cases with an additional 600 cases under investigation. Five deaths in infants have been reported.