Thanks Teresa!

There is a collective sadness in the world of infection prevention. Teresa Horan, one of the true gems in our field, is retiring. Teresa has spent 28 years in the CDC's Division of Healthcare Quality Promotion, joining the Hospital Infections Program in 1984. She started out as the Coordinator of the National Nosocomial Infections Surveillance (NNIS) System and over the past decade has led the transition from NNIS to the National Healthcare Safety Network (NHSN). She is also an Adjunct Instructor in the Department of Epidemiology at Emory University’s Rollins School of Public Health and a Captain in the U.S. Public Health Service Commissioned Corps. Among other individual and team awards, she has received the Carole DeMille Achievement Award and the Elaine Larson Lectureship from the Association for Professionals in Infection Control and Epidemiology (APIC). 


Quoting from a CDC email, we agree that "her superb contributions to surveillance and prevention of healthcare-associated infection are singularly important to the field and an inspiration to her CDC colleagues, frontline infection preventionists, and other professionals working to improve patient safety throughout the United States and internationally." We will really miss working with Teresa and wish her a healthy and happy retirement!

Beware of dishes!

As of this week, germophobes have one more thing to worry about. A new paper in PLoS One (full text here) describes the results of a series of experiments in which dishes and forks were contaminated with a mouse norovirus and then subjected to the usual cleaning protocols used in restaurants (both machine and hand washing of the items). The results were disturbing. The various cleaning methods all left residual norovirus on the dinnerware. This is especially important since the infecting dose of norovirus may be as low as 10 viral particles.

So what to do with this information? Here are your options (from most to least risk averse):
(1)  Never eat in a restaurant again
(2)  Carry your own dinnerware with you wherever you go
(3)  Eat only at McDonald's where all dinnerware is disposable (though you could still be at a small risk from the reusable plastic tray your food items are placed on)
(4)  Eat at all your favorite places and stockpile compazine and immodium
(5)  Just cast your fate to the wind

An outbreak linked to a cardiac surgeon

The LA Times reports today on an outbreak of nosocomial Staphylococcus epidermidis endocarditis in patients undergoing valve replacement surgery at Cedars-Sinai Medical Center. The outbreak involved 5 patients, 4 of whom required replacement of the prosthetic valve. All the cases were linked to a cardiac surgeon who had what sounds like an eczematous process on his hands.

The article notes:

The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation, said Rekha Murthy, medical director of the hospital's epidemiology department. She added that there were also no national standards on types of gloves used, whether to wear double gloves or how many times surgeons should change those gloves during a procedure.

Rekha's comments point out a few examples of the many unknowns in healthcare epidemiology. As hospital epidemiologists we are held accountable to fix problems, but often we're bereft of the answers to such basic questions. This has been a recurrent theme on this blog, and as Eli has stressed, we lack funding to perform the research to fill the gaps in our knowledge base. After this week's Infectious Diseases fellowship match, which demonstrated that few young doctors remain interested in our field, it appears that we may also eventually lack the human resources to address these problems.

Don't be one, get one...

Rick Mercer is a Canadian comedian and political satirist - his "Talking to Americans" bits were pure genius. Recently, he was kind enough to offer up two minutes of his valuable time to convince Canadians to get the flu vaccine. I agree - this could be the best public service announcement ever.

(Updated!) What you missed in Infection Prevention: December 6, 2012

1) Today's NEJM has lot's of interesting stuff.  First up, they have a review of the first cases of fungal infections associated with contaminated methylprednisolone injections in Tennessee. The report covers 66 case patients with 21 having confirmed Exserohilum rostratum infection and 1 having confirmed Aspergillus fumigatus infection.

2) Next up, NEJM has a perspective piece from the FDA that highlights infections secondary to contaminated antiseptic products including iodophors, alcohol products, CHG and quaternary-ammonium compounds.

3) And finally from the NEJM, Thomas Sandora and Donald Goldmann have a perspective piece outlining their suggestions for preventing hospital outbreaks of antibiotic-resistant bacteria. Most of what they offer is standard infection control dogma from the  - it's the healthcare worker's fault for not washing his/her hands diatribe - to the suggestion that a "parsimonious set of interventions aimed at reducing exposure to antibiotics may have the greatest effect on resistance." They even included a table of the suggested parsimonious stewardship interventions (below). I don't believe that any are backed by more than uncontrolled quasi-experimental studies or expert opinion. (Please correct me if I'm wrong!) Might they have recommended funding studies of these interventions instead?  It's hard enough to be a hospital epidemiologist in 2012 marketing the few evidence-based interventions at our disposal without laying the burden of making us defend interventions based on pure speculation on our backs.  Oh well.

4) There is a report in today's Ottawa Citizen by Helen Branswell that nicely outlines two NDM-1 outbreaks that occurred (October 2011 and January 2012) in Toronto. The article covers an study published in ICHE and another in CID. The latter described the transmission of the NDM-1 between E. coli and Klebsiella species in the same patient.

5) Last-but-not-least, check out this story in NPR that highlighted an innovative research study out of Michigan State University. Researchers modeled the spread of murders in Newark, NJ as an infectious disease and discovered that murder appears to be transmissible like an infectious pathogen. They are now figuring out why some neighborhoods are more resistant to homicide and how they might "vaccinate" populations to reduce murder. Pretty cool and Go Sparty!

Infection Control Image of the Day

I know, this image made the rounds on the internets last year, but the infection control risks were not highlighted. Yes, this image is real and don't try this at home.

The ghosts of the "prior room occupant"

"Well, you know, Doc, when something happens, [it] can leave a trace of itself behind. Say like, if someone burns toast. Well, maybe things that happen leave other kinds of traces behind. Not things that anyone can notice, but things that people who "shine" can see….I think a lot of things happened right here in this particular hotel over the years. And not all of 'em was good."

-From the movie The Shining, 1980 

I’m reviewing papers for a talk I’m preparing on “control of multiple drug resistant gram negative rods (MDR-GNRs)”. So I’m looking again at a set of studies that always scare me (even more than a Stephen King novel)—those that demonstrate that a variety of bad bugs (C. difficile, MRSA, VRE, and MDR-GNRs) can be “left behind” after a patient is discharged, poised to colonize or infect the next occupant of that hospital room. It is a scandalous indictment of current hospital disinfection practices that patients must be haunted by the pathogens of the previous occupant of their hospital bed! 

There are still some practical (and financial) hurdles that must be overcome before new disinfection technologies (UV light, H2O2 vapor, antimicrobial surfaces, etc.) become standard of care. In the long run, though, I think that’s where the future lies—excellence in cleaning will remain important (organic debris will always require removal), but for microbial eradication in the environment, these technologies are going to replace our existing, more rudimentary approaches.