More on the vaccine maldistribution problem

The Chicago Tribune reports that Wall Street banks have received H1N1 vaccine for their high-risk employees. Now we can all breathe a sigh of relief!

"Not a retraction"....the pushback

Not surprisingly, the lead author of the now-infamous mask study is defending her findings and claiming her data still demonstrate superiority of N95s over surgical masks for protection against influenza. She also claims (as does another IOM member) that this study didn't influence the IOM report.

Really? Dr. McIntyre was a member of the IOM committee, and her recent comments make it quite clear that she long ago decided which mask should be used during influenza epidemics.....to claim that the work her group presented to IOM did not influence the final report is laughable. Us infection control types might not be sharp enough to detect critical flaws in a cluster randomized trial analysis......but we're not stupid.

Mask study FAIL

This is the audio of the IDSA presentation I referred to here.

I'm pretty sure someone has presented data from the same study at ICAAC and IDSA before....but I'm not sure if anyone has ever done so and also changed their conclusion 180 degrees....and in the process influenced a major IOM report that led to a misguided national recommendation for infection prevention that resulted in nationwide shortages of personal protective equipment.

How can a single study do so much damage before undergoing peer review? Yikes.

Intermountain Healthcare

Here's a preview of this Sunday's NY Times magazine piece on the Intermountain Healthcare approach to improving health care quality, which relies upon standardization and protocol-driven approaches to care.

Posted without comment, both because I haven't finished the article myself, and because I'm on the ID consult service right now--keeping busy seeing patients who for the most part do not fit easily into any diagnostic or treatment protocol.

H1N1 infects cat

The American Veterinary Association announced today that a cat in Iowa was diagnosed with H1N1. The virus is believed to have been transmitted from an infected human in the household. The cat has now recovered.

SuperFreakonomics and the hospital epidemiologist

In their new book, SuperFreakonomics, Steven Levitt and Stephen Dubner give us their analysis of why hand hygiene compliance is poor among doctors. They cite the following reasons: the large number of patients that may be seen in a day and how busy doctors are; inaccessibility of sinks, though they note that conveniently placed alcohol-product dispensers are often ignored; perception deficit, that is, doctors believe their compliance is much better than it actually is; and arrogance. Then they put on their economist hats and talk about negative externalities. By this they mean that the doctor bears little risk personally when he or she is noncompliant with hand hygiene and thus the doctor has little incentive to comply. So far, so good. But then they downplay trying to change behavior in favor of solutions that bypass the need for change in behavior (e.g., antimicrobial impregnated products). I think the answer is both behavior change and non-behavioral solutions are required since there aren't enough of the latter to overcome dirty hands. I was particularly happy that they advised doctors to stop wearing neckties to improve infection control (though my happiness is not just infection control related). Also of note, they profile our colleague, Dr. Rekha Murthy, hospital epidemiologist at Cedars-Sinai Medical Center, and her successful program on hand hygiene.

So what's the importance of this? The economists haven't really added any new insights or solutions to the problem of healthcare associated infections. But they clearly will have impact by offering their analysis to the general public. Their previous book, Freakonomics, has sold over 4 million copies, and led to the launching of a blog with a full time editor, and a movie is in the works. How did I learn about their interest in infection control? I saw Stephen Dubner on CNN talking about why doctors shouldn't wear neckties. Interestingly, if you do a Google image search of him, you'll note that he rarely wears a tie.

Never mind!

The same authors who claimed their study results were so convincing that it was no longer ethical to recommend surgical masks for the care of patients with influenza have now admitted that their analysis was flawed, and that their study (when analyzed correctly) shows no difference between N95s and surgical masks for protection of health care workers from influenza transmission (a conclusion now consistent with the JAMA study by Loeb, et. al.).

These data were cited as being of major import in the IOM report, which of course was a major determinant in the CDC decision to stick with N95s for all care of those with ILI during the H1N1 influenza pandemic.

I wasn't at the IDSA presentation where this retraction occurred, but I imagine it involved one of the authors going up to the microphone, meekly stating, "never mind", and rushing off to catch a flight back to Australia.