Wednesday, October 18, 2017

Discontinuation of Contact Precautions: Back in the Literature

Like a recurrent bad dream for some, the discontinuation of contact precautions for the control of endemic MRSA and VRE is back in the medical literature.  

A meta-anlysis, published here, by Alex Marra, once again suggests that the cessation of contact precautions for the control of endemic MRSA and VRE is without adverse consequences.

My colleague Mark Rupp also published this manuscript in ICHE summarizing the University of Nebraska's positive experience with the discontinuation of contact precautions for the control of endemic MRSA and VRE.

I am off to the University of Nebraska Medical Center tomorrow, to give an invited medical grand rounds lecture on infection prevention- policies, pragmatism and controversies.

I might just talk about the discontinuation of contact precautions too.


Friday, October 13, 2017

Are We Serious About Limiting Presenteeism?If So HR Policy Changes Are Needed

Presenteeism, or working while sick, is a cross transmission risk. With the looming respiratory virus season this is increasingly relevant. Not all risks related to presenteeism are ascribed to respiratory viruses. Here is a reported cluster of Group A streptococcal skin infections in a skilled nursing facility, likely related to a 'present' healthcare worker with Group A streptococcal pharyngitis. It has also been argued that reducing presenteeism is more effective than mandatory influenza vaccination in reducing hospital acquired influenza.

But how can we effectively reduce presenteeism? 

I have found no published reports of successful strategies for presenteeism reduction in healthcare settings. 

Staff education of the dangers of presenteeism is a good start but likely insufficient. A change in human resources (HR) policy is likely needed such that sick leave is different than paid time off, as summarized in this pro/con article. Healthcare workers would thus not feel 'penalized' by losing vacation time when out sick. Of course, sick leave could easily be abused, thus requiring policies and mechanisms to better manage absenteeism.

Bottom line, we can talk about limiting presenteeism but this commitment will ring hollow without changes in HR policy. This has been done, as neatly summarized in this blog post by Mike Edmond.

I get a sense that for many healthcare systems the policy of mandatory influenza vaccination is easier and more expedient than making substantive changes in HR policies.

Tuesday, October 10, 2017

Eminence Front! Eminence Based Medicine and Other Options to Evidence Based Medicine


What to do when high quality evidence is not available to guide decision medical making?

I dug this one out of the archives of the British Medical Journal after hearing a reference to 'eminence based medicine' at ID Week 2017.

Strategies include 'eminence based medicine"- where experience is worth any amount of evidence, and may actually trump evidence in many cases.It's an eminence front! Other strategies include 'eloquence based medicine' and ' providence based medicine" where decisions are best left in the hands of the Almighty.

In the absence of evidence all may not be lost. Weigh the risks, benefits, consider the opportunity costs and be pragmatic.



Sunday, October 8, 2017

ID Week 2017: Parting Shot- Pay Us More Than Minimum Wage!


In a moment I will en route to Virginia.

Here is a parting shot from ID Week 2017, from the IDeas Wall. Note the comment at the bottom. In the USA, where procedures are lucrative, cognitive specialties suffer and have the lowest reimbursement.

"Pay us more than minimum wage." 

Infectious diseases is a very exciting, low paying job.

Saturday, October 7, 2017

ID Week 2017: Congratulations to Drs. Nicole Vissichelli and Oveimar De La Cruz

Dr. Nicole Vissichelli at ID Week 2017

ID Week 2017 is coming to an end. really great week with high quality presentations and posters.

Congratulations to Drs. Nicole Vissichelli and Oveimar De La Cruz on their bone marrow transplant and infectious diseases related abstract.

Dr. Visichelli will present her work next month at VCU's Gordon Archer Annual Research Day

Stay tuned.

Friday, October 6, 2017

ID Week 2017: With the Agent Provacateur- Mike Edmond



'Jane, you ignorant Slut!' From Saturday Night Live Skit to ID Week pro/con debate theme.
Learning with Levity.

With friend and former VCU colleague Mike Edmond, the Agent Provocateur of hospital infection prevention, prior to his arguing against universal influenza vaccination of HCWs.

Lively and spirited.

ID Week 2017: Guide to Infection Control In the Hospital with the International Society of Infectious Diseases



Drs. Doll, Stevens and I caught up with Chris Trimmer and Laurence Mialot of the International Society of Infectious Diseases, where we continued to plot the next steps for the 6th edition of The Guide for Infection Control in the Hospital.

The new edition will be launched at the International Congress on Infectious Diseases, Buenos Aires, 2018. Expect new content and new web-based format, with e-pub and portable app, all in the making.

Exciting.