The surgical mask for the non-surgeon



Photo: LesterHo

My favorite section of GQ magazine is the column, The Style Guy, in which Glenn O'Brien solves sartorial conundrums. The June issue has a question from a reader asking whether it's ok to wear a surgical mask with a suit when you're recovering from the flu and want to get back to work. Here's his response:

In Japan the surgical mask is more normal than a hat. Ths is sometimes because of Japanese courtesy, keeping their germs to themselves; sometimes because of their fear of germs; and sometimes in homage to Michael Jackson. In America you can't pull the mask off with anything but scrubs. My position is, if you're sick enough to be contagious, stay the hell home.

There you have it. Even the Style Guy is down on presenteeism.

Rethinking the System: Atul Gawande's HMS commencement address

JR Hildebrand and his pit crew

"A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care...We don’t have to look far for evidence. Two million patients pick up infections in American hospitals, most because someone didn’t follow basic antiseptic precautions."

You can read the full speech in the New Yorker (here)

New C. difficile drug approved

Fidaxomicin, the new drug we discussed here, was just approved by the FDA for treatment of Clostridium difficile disease. Price is still not available, but I agree that it is likely to cost at least as much as brand-name oral vancomycin (the parenteral formulation of vancomycin can be formulated for oral use much more cheaply, a practice that is now common). If it is that expensive, fidaxomicin probably will be reserved for recurrent disease (the clinical trial demonstrated equivalence for treatment response, the benefit of fidaxomicin was in reduced recurrence rates among patients with non-NAP1/BI strains).

Photo: Dr. Sherwood Gorbach, Chief Scientific Officer at Optimer Pharmaceuticals. Sandy Huffaker/New York Times

Twisted logic



Graphic: WeirdSpace


There's a piece in this week's American Medical News on the New York bill to mandate bare below the elbows. It includes this quote from Dr. P.J. Brennan, former President of SHEA:

It's not as though, by eliminating sleeves, you eliminate germs. The key thing to understand is that these environments are not sterile and are never going to be sterile. That goal is unattainable in a clinical setting. The real goal is to adhere to good hand hygiene, isolation practices, gloving, barrier precautions -- that's where we'd put our money.

I think Dr. Brennan's argument represents the conventional wisdom among hospital epidemiologists, but it doesn't make sense to me. He supports contact precautions, but doesn't support bare below the elbows, both of which are based on the same evidence and assumptions. So I think his logic is twisted. It seems to me that you either believe that clothing has the potential to transmit pathogens or you don't.

Is a graduation handshake a risk factor for bacterial pathogens?

University of Maryland dean, Dr. E. Albert Reece,
shakes hands during a graduation

In all likelihood, many of us have just suffered through enjoyed sitting through a recent preschool, high school, college or medical school graduation. The astute readers of this blog probably noticed the alcohol hand rub dispensers on stage for use by the graduates prior to shaking their dean's hand. You also noticed how few graduates actually used the dispensers.  Maybe they were nervous or rushed or were already wearing gloves to go with their graduation gowns...cool contact precautions.

So, should a dean worry about catching bad bugs from their students?  According to a new study published in the Journal of School Nursing, there is very little risk of acquiring a bacterial pathogen during a brief hand shake. In the study, cultures were collected from school officials' hands before and immediately following graduation. From a sample of 5,209 hands, Staphylococcus aureus was separately detected on one pregraduation right hand, one postgraduation right hand (different strain), and one postgraduation left hand, while nonpathogenic bacteria were found on 93% of the hands. They estimate the acquisition risk as 0.019 pathogens acquired per handshake. Of course, the study didn't test for viral transmission, which to me is a bigger worry.

Bishai D et al. Journal of School Nursing, May 11, 2011

New York Times LA Times May 23, 2011 (Dr. Reece from U. Maryland School of Medicine is quoted in this article)

Off to ASM

I'm off to New Orleans today, to attend the ASM General Meeting. I'm scheduled to give a talk Monday morning as part of a "pro-con" session on rapid diagnostic testing. Even though the world might end today, I prepared a talk in advance. My task is to argue that culture is just as good (or in some ways even better) than rapid PCR-based techniques for MRSA screening. Fun! Next week I'm giving another talk at our local library. I'll be explaining why a typewriter is just as good as a computer if you're writing something that is expected to have little impact.

CDC finally addresses zombie threat

The CDC is getting a lot of media attention for finally turning their attention to zombie preparedness. As regular readers of this blog know, we called for decisive action (and the development of a rapid screening test) almost two years ago. I’m not sure what took the CDC so long to address this threat head-on. Rest assured, dear readers, that we’ll stay on the zombie beat and alert you immediately to their emergence. Our goal? Zero zombies.