7 Miles? No problem!

Congrats to star Iowa infection control runners Loreen Herwaldt, Martha Freeman and Marin Schweizer for completing the annual Bix 7 road race in Davenport, Iowa yesterday. Bix for Bix Beiderbecke and 7, well, for 7 miles. 

Contagion

For those of you who didn't get worked over enough by the H1N1 pandemic, there's a movie entitled Contagion that will be released in September. It's about an epidemic of deadly avian influenza and the cast includes some major Hollywood stars. You can see the trailer here. Looks scary--maybe it will increase influenza vaccine compliance!

Hat tip:  Rebekah Moehring

ICHE Special Issue: Antimicrobial Stewardship

Infection Control and Hospital Epidemiology has just announced that it will publish a special issue devoted to antimicrobial stewardship in conjunction with the SHEA spring meeting in Jacksonville, Florida, April 13-16, 2012. 

Topics of interest include:

• Antimicrobial stewardship for special populations, including pediatrics, oncology, hemodialysis, and critical care
• Health outcome and cost effectiveness impact of antimicrobial stewardship
• Use of diagnostic tools and role of microbiology in antimicrobial stewardship
• Effective implementation of programs in community hospitals, long-term care acute care facilities, outpatient settings and non-acute healthcare settings (e.g., dialysis, ambulatory care and ambulatory surgery centers)

Due date: October 1, 2011.

Get writing and submit your paper here.

Call for manuscripts PDF available here.

Good luck!

Oxa-48 KP wreaking havoc

Photo: Wikipedia

According to press releases (here and here), the Maasstad Hospital in Rotterdam, Netherlands, has had 27 deaths due to oxa-48 producing Klebsiella pneumoniae infections over the last 11 months.

Now I am not saying this to be flippant or mean, but here's an example of how having the best MRSA control program in the world doesn't protect patients from other important pathogens. It's one of the most compelling arguments for focusing on practices that impact all organisms transmitted via contact--what we call a horizontal approach to infection prevention. Dan Diekema once said (on NPR, no less), "MRSA's not the only bad bug out there. It's just the most famous."

See you at Starbucks!

There is a very interesting study in the July/August issue of the Annals of Family Medicine from the Medical University of South Carolina (free full text here). Investigators there analyzed data from the 2003-2004 NHANES study, a survey designed to assess the health and nutritional status of the US populace, using an interview and physical examination on approximately 5,000 persons selected as a representative sample of the population. This study also included a nasal swab done on each participant, which found that 1.4% of persons in the sample were colonized with MRSA.

Using the NHANES dataset, the South Carolina  investigators found that persons who drank coffee or hot tea were half as likely to be colonized with MRSA, even when controlling for age, race, socioeconomic status, health status, hospitalization in the last year and antibiotic use in the last month.

Now it's important to remember that this is an observational study, which doesn't allow us to determine causation, as we know that these studies can be plagued by bias and confounding. Nonetheless, the authors do elaborate on the biologic plausibility for their tantalizing finding.

I'm just saying it sure beats squirting mupirocin up your nose!

Trouble in Pittsburgh

The behemoth healthcare system, University of Pittsburgh Medical Center, had its living donor transplant program temporarily shut down after a patient was transplanted with a kidney from a hepatitis C infected donor. The details of the fateful transplant can be found in two well-written articles in the Pittsburgh Post-Gazette (here and here). It's a classic example of the swiss cheese model of complex system failure, where all the holes lined up (in this case the positive lab test was missed on 6 occasions), allowing an adverse outcome to occur. The articles note that UPMC's response was to demote the transplant surgeon and suspend the transplant nurse coordinator. A noted transplant surgeon describes that as an administrator's knee jerk reaction and another stated, "if everyone in transplants got hit for making a mistake, no one would be working." But the journalist probes to unearth how the system fostered the error, and he notes the stresses on the surgeon to increase surgical volume (as well as stressors in his personal life), problems with the electronic medical record, and alarm fatigue. 


I have been intrigued at how physicians who perform the most highly technical procedures in medicine can sometimes be uninterested in details that ultimately can unravel their programs. What infectious diseases physician hasn't been consulted to see a patient who has undergone an amazingly complex surgical procedure, who survived against all odds only due to an enormously talented surgeon, all to be undone by sloppy infection control practices down the line, such as noncompliance with hand hygiene? In the UPMC case, I have to wonder whether a simple tool, such as a checklist, could have prevented this error.

What is your name sir?...Ignaz

Loreen Herwaldt (and thanks to John Boyce) just forwarded along this cinematic depiction of Ignaz Semmelweis and his early investigations into the benefits of hand hygiene. The piece was written/directed by Jim Berry at NYU back in 2001 and funded by a Sloan Foundation grant for scripts featuring positive depictions of scientists. The film is a bit graphic/realistic. 

My favorite quote is from the mother pictured above: "You have a gentle touch sir, I want you to be my baby's namesake. What is your name, sir?"  A: "Ignaz"

Another moving section:  Semmelweis: "I believe that this practice will save lives."  Senior physician: "but this is not our way, at this hospital, doctor, we must be unbending in our practice."

The film is available for viewing on the Sloan Science and Film website (here)