Hikers and hand hygiene

A new paper in the American Journal of Infection Control from SUNY Upstate focuses on hand contamination in wilderness hikers. Hand cultures were performed on 72 hikers and 31% were found to have fecal contamination. Now I won't belabor how this may have happened, but as an infection control expert, I would recommend packing some Purell for future treks.

Fungal meningitis outbreak still unfolding

The fungal meningitis outbreak continues to expand. At this point, there are 347 cases of central nervous system infection (meningitis or stroke) and 7 joint infections, with 25 deaths. The outbreak now involves 18 states with an estimated 14,000 patients exposed to contaminated methylprednisolone from the New England Compounding Center. Exserohilum has been recently cultured from unopened vials of the product and is the predominant pathogen in the outbreak.

Here are some recent articles on the outbreak:

• Wall Street Journal (10/28/12)
• Boston Globe (10/28/12)
• New York Times (10/28/12)

Best Hand Hygiene Signs Ever!! - This time I really mean it!

OK, back on topic. The Allegheny County Health Department developed a series of hand hygiene signs based on literary classics way back in 1999 to stop a shigellosis outbreak.  The project, called Literary Classics: A New Kind of Reading Material for Public Restrooms won the prestigious J. Howard Beard Award from the National Association of County and City Health Officials. The nine hand-hygiene signs were based on work by authors Jane Austen, Charles Dickens, Judy Bloom, Mark Twain and others. All are available here in JPG or PDF. Amazing.

h/t Melissa Ward

Presenteeism - Don't Come to Work Sick!

Mike has posted numerous times on the problem of presenteeism in healthcare workers. The Wall Street Journal has a nice article/video on "the art of calling in sick" and why it's important to stay home to protect your co-workers. The post includes sage advice from Iowa's own Loreen Herwaldt, who advises influenza and pertussis vaccines and good hand hygiene. She says that "the 24-hour rule pediatricians preach to parents—that a child with the flu should stay home from school or day care at least 24 hours after the fever and symptoms go away—usually holds true for adults too." Importantly, she also mentions that the rules would differ for healthcare workers who are sick.

Thanks Jenn!

As we alluded to previously, the inaugural IDWeek was a success.

Sadly, one of the people instrumental in making it a success is leaving the Society for Healthcare Epidemiology of America (SHEA). As Executive Director, Jennifer Bright, MPA, has led SHEA through a period of unprecedented growth. 

A partial list of SHEA milestones under her direction were outlined in the e-mail announcement of her departure, and include: (1) successful introduction of a new SHEA Spring educational and research conference, (2) the inaugural IDWeek, (3) establishment of the SHEA Education and Research Foundation, (4) establishment of the SHEA Research Network, (5) introduction of the Antimicrobial Stewardship in Practice online course, (6) development and implementation of regional HAI training courses, (7) successful ACCME reaccreditation, (8) the SHEA International Ambassador Program, (9) roll-out of the SHEA young investigator epi-project competition and awards, (10) partnership with Medscape, (11) several years of increasingly successful annual meetings, including the 5th Decennial International Conference on HAIs, and (12) a steady increase in SHEA membership. 

In our opinion, Jenn was the most successful executive director in SHEA’s history. We will miss her personally, and SHEA will miss her guidance. Good luck in the future, Jenn!

The boiling frog and antibacterial resistance

I just returned from IDWeek in San Diego (as many of you have). I will say that it wasn't the same as having a standalone SHEA meeting - fewer impromptu hotel lobby discussions and few Europeans - but it had its moments. For one, the sessions were better attended - I think many ID physicians who would normally not travel to a spring SHEA meeting, wandered into infection prevention sessions. Perhaps they direct the infection control committee at their hospital and wanted an update. It was also interesting to see the community protesters out in force; we don't get that kind of attention in infection prevention...but perhaps we should.

The Lyme disease guideline protesters did get me thinking about community action and infection control and why we don't get that kind of attention.  The early nineties saw plenty of HIV/AIDS protests and now that MRSA alone is associated with similar mortality (imagine if you add MSSA, VRE, KPC, NDM-1, ESBL, MDR-acinetobacter), I wondered if and when the public and clinicians would wake up to a world without antibiotics and get angry.  I know there are differences between the HIV and MDRO epidemics. Yes, HIV is a single virus that struck young people down in the prime of their lives, but with MDROs we're facing a world with unsafe surgery (or no surgery), death during neutropenic fever and perhaps fewer transplants. So why is there such a huge difference in our responses?

I think a major reason that MDROs attract little attention is that the emergence of resistance occurs too gradually. A useful metaphor in this case is the boiling frog.  The story goes that if you place a frog in boiling water, it will immediately jump out, but if you place it in cool water and slowly turn up the heat, it will be boiled alive. Since carbapenem-resistance Gram-negatives didn't just appear one day like HIV, we see less response to the problem. We had penicillins to protect us and when they failed we had cephalosporins and then when they failed we had the carbapenems. The problem is, we stopped investing in antibiotic discovery 30 years ago, and there is nothing after carbapenems. So now, we must wait 10-20 years for new antibiotics and we MUST invest in infection prevention research and implementation. I think MDROs are due for a protest movement, but it probably won't appear. We all love a good warm bath, now don't we.

IDWeek!

It has been a great IDWeek so far, with almost 7000 registered attendees.  I've moderated and attended several excellent sessions that we'll be blogging on next week, when we have a few minutes to absorb it all!  Susan Huang's presentation of the REDUCE MRSA trial results occurred today, so we'll no doubt be discussing how these data further support Mike's long contention that horizontal infection prevention strategies are superior for MRSA control. Yesterday we received an excellent update on the fungal meningitis outbreak from Tom Chiller, Carol Kauffman and Tom Patterson.  Carol and Tom also just coauthored (with Pete Pappas) this summary from today's NEJM, check it out!