Public Health in Action: Dr. Demetre Daskalakis

There's an excellent article in The Atlantic on Demetre Daskalakis, MD, MPH. He's an infectious diseases doctor, former ID fellowship director at NYU, former faculty member at Mt. Sinai, and now the Assistant Commissioner of the New York City Department of Public Health. He describes himself as an activist clinician providing cutting edge care and prevention to a very marginalized population of HIV positive and negative men who have sex with men. He's become well known for his creative interventions utilizing social media, as well as old fashioned public health in the trenches. It's worth a read.

Finally, the outbreak of meetings!

We’ve done a lot of blogging about the insidious M. chimaera outbreak linked to heater-cooler units (HCUs). Still, the general awareness of this problem lags, despite the fact that an untold number of HCUs are affected, and an unknown number of people are suffering with an undiagnosed granulomatous inflammatory process that has a crude mortality rate in excess of 50%. We heard excellent talks about the issue at SHEA 2016 from Emily Cooper at Wellspan (10 cases, 6 deaths), from Dr. Ray Chinn in the “Challenging Cases in Infection Prevention” session, and I gave a late-breaker on Friday evening (slides to follow in an upcoming post). By the way, SHEA 2016 was EXCELLENT, and the slide image above is from Bob Weinstein’s talk in the SHEA/CDC Training Course. 

Well, the FDA is hosting a meeting on this problem, details of which can be found here. I will be presenting about our experience at Iowa, but others with more expertise will be there as well, from US and Europe. I’m hoping to come away with a better sense of the way forward, which in my view must address (1) better case finding: improved clinician awareness via national patient and provider notifications, so that clinicians everywhere recognize exposure to cardiopulmonary bypass as a risk factor for disseminated MAC infection among patients with implants (valves, grafts), and creative approaches to identify potential cases who currently carry other diagnoses (e.g. sarcoidosis); (2) improved management of existing cases: we desperately need more clinical information about management approaches and outcomes, to help guide decision making for patients and their physicians; and (3) prevention of additional cases: the HCU has been revealed to be a bioaerosol generator that is too risky to share air with an open chest—the make/model implicated in this particular outbreak must obviously be removed from ORs, and other devices that include fans and water sources should also be scrutinized for the risk they may pose.

VA Funds Two New Antimicrobial Resistance and HAI Prevention Programs

Dr. Nasia Safdar

It wasn't long ago, that many of us were concerned about the lack of attention that antimicrobial resistance was receiving, particularly in regard to funding for research and also infection prevention programs. Yet over the last few years, there has been increased attention throughout the US including the release of the National Action Plan to Combat Antibiotic-Resistant Bacteria and increased funding for CDC, NIH and AHRQ. Besides the lack of novel interventions that extra research funding will help tackle, another huge barrier to preventing MDRO and HAI is lack of information on how to successfully implement the few interventions we have within hospitals and healthcare systems.

It is this gap between efficacy and effectiveness that VA's Quality Enhancement Research Initiative (QUERI) seeks to fill. QUERI's mission is to "improve the health of Veterans by supporting the more rapid implementation of effective clinical practices into routine care." And it is the goal of QUERI investigators to "ask crucial questions regarding the intended and unintended impacts of implementing new treatments or programs – and the best strategies for speeding their adoption into practice."

Dr. Charlesnika Evans

With that background it is incredibly exciting to announce that VA has funded two new QUERI programs that target MDRO and HAI.

The first program titled "Building Implementation Science for VA Healthcare-Associated Infection Prevention" is led by Dr. Nasia Safdar in Madison. Dr. Safdar and her team partnered with VA's National Center for Patient Safety to achieve two broad aims. First, they will implement and evaluate an evidence-based intervention - daily chlorhexidine bathing of hospitalized Veterans for prevention of HAI. Second, they will establish a VHIN (VA Healthcare-Associated Infection Prevention Network) and assess current practices and needs related to HAI prevention. The long-term goal is to utilize the VHIN as a platform for VA facilities seeking to undertake pragmatic implementation science initiatives related to HAI prevention. You can read much more about her program that began in October 2015, here.

Dr. Michael Rubin

The second program titled "Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence" or CARRIAGE is set to begin in October 2016 and aims to address the growing concern of antimicrobial resistance through strategies implemented across VA patient care settings. The three projects will evaluate hand hygiene surveillance methods, enhance the implementation of new CRE prevention guidelines and promote judicious use of antibiotics through a multi-hospital antibiotic timeout program. The program directors are Michael Rubin, MD PhD (Salt Lake City) Charlesnika Evans, PhD, MPH (Hines, IL); and Eli Perencevich, MD MS (COI alert)

The next few years promise to be an exciting time for MDRO and HAI prevention in VA and throughout the US as we develop, test and implement new methods to enhance patient safety.

At first he was only prescribed for me, now he's messing around with EVERYBODY !

Watch this video! It will change your life and the future of the world!

The overselling of science can be pretty hilarious when described by John Oliver, yet it infects not just the media but also scientific journals and professional conferences. One of the aims of this blog has always been to question the latest fad sweeping infection prevention nation; see Dan's recent post on ADI for CDI or my talk on public reporting of HAIs. In addition to highlighting the bit at the end of the video that notes the 70% increase in authority that descends upon those wearing a white coat, I've pulled out these quotes for you to ponder:

"Just because a study is industry funded or its sample size was small or it was done on mice doesn't mean it's automatically flawed, but it is something the media reporting on it should probably tell you about." - John Oliver

"I think the way to live your life is to find the study that sounds best to you and you go with that" - Al Roker

Training Course in Healthcare Epidemiology and Infection Control (Bochum Germany)

Happy 2015 ESCMID-SHEA Training Course Students and Faculty

The ESCMID-SHEA Training Course in Healthcare Epidemiology and Infection Control has been redesigned. Instead of predominately lectures, the new course model now includes three distinct tracks. The first track is an interactive and practical exercise on how to analyze and respond to a high-rate of surgical site infections in your hospital. The second track covers data analysis of a possible outbreak of C. difficile infections. The third track includes 4 interactive masterclasses led by highly experienced hospital epidemiologists covering topics such as outbreaks, responding to high endemic rates of HAIs, infections in surgical populations and other topics. 

The course was pilot tested last year in Cairns, Australia with great success (see above) and the instructors can't wait to build on that success this fall in Europe. We hope you can join us 4-7 October 2016 in Bochum, Germany. Registration is via the Aesculap Akademie website.

May The 5th Be With You - #SafeSurgicalHands

There are so many commemorative days, that I sometimes get them confused. We just missed Star Wars Day and today (May 5th) is even International Day of the Midwife, which seems appropriate if you understand the Semmelweis story - his control group was a maternity ward staffed by female midwives with one-fifth the mortality compared to the doctor/medical student ward.

Which brings us to a very important day in infection prevention - 5th of May - WHO Hand Hygiene Day! I can't do better than Professor Didier Pittet when talking about hand hygiene, so I've added his video above and provided his letter with important links for #SafeSurgicalHands below.  Thank you all for what you're doing to create a safer healthcare environment starting with clean hands.

Dear All,

I am pleased to invite you to celebrate the WHO Hand Hygiene Day in Healthcare on 5 May 2016.

The 2016 year campaign promotes #SafeSurgicalHands on Twitter and Instagram.

All WHO tools to participate are available at: www.tinyurl.com/WHOtool5May16

Post your photos/selfies at : www.cleanhandssavelives.org/safesurgicalhands/

Safe Hands in Surgery-WHO 2016 message together with colleagues surgeons: www.tinyurl.com/WHOadd2016

#SafeSurgicalHands Pictures' Wall (updated in real time): https://walls.io/SafeSurgicalHands

Additional educative videos are accessible at:

• Your WHO 5 moments for Hand Hygiene along the patient journey in surgery www.tinyurl.com/5momentsSurgery
• WHO surgical hand preparation technique www.tinyurl.com/SurgScrubTech
• For those who want to conduct a Hand Sanitizing Relay: http://tinyurl.com/HHRelay
• Any information at handhygienerelay@cleanhandssavelives.org
• Or see the best relays in 2015 : http://tinyurl.com/GlobalHandSanitizingRelay2015
• Or simply look at 10 years of Clean Care is Safer Care http://tinyurl.com/CleanHands10

I am looking forward to seeing you all participating.
Let’s improve hand hygiene, reduce infections, limit resistance and save lives.

With best wishes,
Professor Didier Pittet