Monday, December 11, 2017

Dreams of Troy by Dr. Richard Wenzel - Book Signing Today at the MCV Foundation

The Dreams of Troy book signing by our very own Dr. Richard Wenzel took place today at  the MCV Foundation.

Best wishes to Dr. Wenzel on the launch of his new book. The book is available via Barnes and Noble or

Images below.

Sunday, December 10, 2017

Futbol for a Cause: 13th Annual Richmond City FC Copa Navidad

The 13th Annual Copa Navidad was held at SCOR - our annual "futbol for a cause" indoor game brings all Richmond City FC members (past and present) together to raise money for a local charity. The Richmond City Blues played the Richmond City Whites in a charity match for bragging rights and for a good cause. The outcome was a draw!

This year's Copa Navidad benefited Richmond Street Soccer, run by Daryl Grove and Taylor Rockwell (two RCFC members). Richmond Street Soccer is the RVA arm of Street Soccer USA, a national nonprofit that uses soccer to combat homelessness and the causes of homelessness.

The Richmond team is partnered with The Healing Place, a substance abuse recovery center where 70% of the graduates remain sober for at least one year and 78% find employment within 90 days of completing the program.

The men who join the Richmond Street Soccer from The Healing Place are working hard to improve their lives. The dedication, team spirit and self-confidence that comes with playing soccer is part of that process. 

For more information visit The Healing Place website at and Street Soccer USA website at

I have been with Richmond City FC since 2003 and am proud to still mind the goal for one of their teams. More importantly, I am proud to participate in the Copa Navidad.

Images from the event are below.

Richmond Cty FC Copa Navidad 2017

Richmond City FC Old Guard: L to R: The Blogger, Frank Fulco, Andy Marr and Sean Samuel

With Richmond City FC mate- Dr. Frank Fulco

Richmond City FC Christmas Spirit

Thursday, December 7, 2017

Antimicrobial Stewardship- The Role of the Patient ?

In 1996 PubMed indexed one paper with the search term "antimicrobial stewardship.' In 2017, 630 papers are indexed under the same search term. Antimicrobial stewardship (AS) is on the rise. This cool article lends a new perspective- that of the role of the patient as an antimicrobial steward.


Patient centered care is also on the rise and is neatly summarized here in this British Medical Journal article. Patient involvement in AS does not seem so far fetched.

I personally think that rapid PCR diagnostics, particularly for viral respiratory pathogens and diarheal illnesses, should have a sizable impact on unnecessary antibiotic use. A definitive diagnosis mitigates the fear of being wrong and prescribing a 'just in case' antibiotic. This is explored in the film Resistance, as posted here.

Increased patient awareness and understanding of AS and the impact on their care is likely the first step in successfully involving patients in AS endeavors. Patient awareness and advocacy of 'no antibiotics for viruses' almost certainly cannot be a bad thing.

How much impact could this have on AS? 

Nobody knows but it is worth investigating..

Monday, December 4, 2017

Dreams of Troy- Medical Thriller By Our Very Own Richard Wenzel. Book Signing Announcement.

For those in the area,  on December 11, 2017, at the MCV Foundation, our very own Richard Wenzel will be signing his new medical thriller- Dreams of Troy.

The event will be from 3:00 p.m. to 5:00 p.m.   Copies of the book will be for sale at the event. The book may be purchased online via

Here is a link to the launch of Dr. Wenzel's previous book, Labyrinth of Terror.

Looking forward to seeing everyone there.  Expect images on the blog immediately afterwards.

Tuesday, November 28, 2017

Approaches to Hand Hygiene Monitoring: From Low to High Technology Approaches.

L-R: Michelle Doll MD, MPH and Nadia Masroor, MPH
Congratulations to my research coordinator, Nadia Masroor, MPH and VCU Associate Hospital Epidemiologist and Assistant Professor, Dr. Michelle Doll, on their recent invited article in the International Journal of Infectious Diseases on hand hygiene monitoring- a perspective covering both low and high technology approaches.

For years we have had a hand hygiene direct observation monitoring program at VCU Health -a  strategy which is common place in North America.  We have begun the deployment of a wireless, blue tooth based hand hygiene technology badge carried by individual healthcare workers (nurses, care partners, residence and attending physicians).  This technology allows us to track hand hygiene - as measured by foam in and foam out of patient rooms at the individual and group level.  As with nearly all hand hygiene monitoring there are inherent limitations-  this does not capture all 5 moments for HH as defined by WHO. So far, two hospital units are near completion of the 1st phase. The house wide deployment will roll out in a step-wedged design over the course the next 18 months.

The volume of data is extraordinary.  Whereas the the hand hygiene monitoring team captured roughly 35,000+ hand hygiene opportunities per year, our technology  has thus far captured > 90,000 in 8 weeks in two units. Dr. Doll and Nadia Masroor are leading the project.

This technology does not represent infection control salvation, and, as with everything, the decision to employ it is subject to an opportunity cost. The new technology, however, will allow us to promote and track hand hygiene more vigorously, a step towards greater reliability in safety.

More to come.

Friday, November 24, 2017

Resistance: Film on the Threat of Resistant Microbes

For any of you seeking an engaging and well done documentary on antimicrobial resistance (suitable for the lay public), check out Resistance.  The film is available on Netflix.

The film neatly summarizes the antibiotic era and the drivers of antibiotic misuse in both medicine and agribusiness. A 'tragedy of the commons' is looming in the threat of a post-antibiotic era.

In medical practice, rapid  infectious diseases (PCR based) diagnostics minimize uncertainty and can curtail the use of unnecessary just-in-case antibiotics. The next frontier is the use of computer assisted decision support- clinical decision trees to maximally guide antibiotic prescription at in real time, as explored here in this recent Clinical Infectious Diseases article.

Antibiotics must be treated as precious resources. 

Monday, November 20, 2017

Primum Non Nocere, But First Length of Stay and Patient Throughput

The central tenet of medicine is primum non nocere, first do no harm. Compelling and resounding but not sufficiently convincing (to some) when it comes to infection prevention prioritization.

All hospitals have infection prevention goals and priorities. After all, preventing hospital acquired infections is primum non nocere on a population level. When coupled with evidence based risk mitigation strategies and an understanding of significant harms, this should be sufficient to drive infection prevention priorities.

Impact on length of stay and patient throughput  (as I previously discussed in a blog) is a critical driver for many decision makers in the hospital. Decreasing length of stay and maximizing throughput is the new Holy Grail of hospital administration, disregard this angle at your own peril if you seek to persuade and prioritize infection prevention strategies across your institution.