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.
Monday, May 23, 2016
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.
Thursday, May 12, 2016
|Dr. Nasia Safdar|
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|
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 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.
Wednesday, May 11, 2016
Tuesday, May 10, 2016
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
Friday, May 6, 2016
|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.
Thursday, May 5, 2016
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.
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 email@example.com
- 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
Let’s improve hand hygiene, reduce infections, limit resistance and save lives.
With best wishes,
Professor Didier Pittet
Tuesday, May 3, 2016
The following is a guest post from Dr. Daniel McQuillen, IDSA Chair for the IDWeek 2016 Program Committee, and President of the Massachusetts Infectious Diseases Society.
IDSA representatives to the AMA CPT/RUC committees have been involved in development and valuation of codes for physician supervision of OPAT infusion, RVU revaluation (upwards) of Evaluation & Management codes and transitional/continuing care codes. In addition, the IDSA Board approved a partnership between the Valuation Workgroup that I lead and The Advisory Board, a consulting group with a healthcare focus, to formally develop the concept of an ID Hospital Efficiency Improvement Program. Such a program will contain ID service lines that are threads throughout healthcare systems, and can serve as templates for members to use when they are proposing new or expanded ASP, IP and OPAT programs to their hospitals or systems. The IDSA Board of Directors previously funded our work with an external expert valuation firm to establish that the benchmarks for “fair market value (FMV)” for ID executive compensation should be higher than the FMV numbers usually thrown out by hospital executives at ID docs. The compensation survey just published by the IDSA Clinical Affairs Committee (CAC) complements this and represents an effort to generate accurate data to counter the inaccurate data promulgated by MGMA and Medscape, not a ‘spin’ that everything is fine. It is just one piece of a broad effort to bolster the value of ID specialists to the systems they work in and support. I note that SHEA has recently surveyed its membership on compensation and await a report on the findings in hopes that it serves as another more accurate benchmark reference. The FMV data along with examples of medical executive co-management agreements for non-clinical activities with sample contracts can be found in the “Value of ID Specialists Toolkit” on the IDSA website (membership login required).
A major thrust of what the IDSA Clinical Affairs Committee, Value Task Force, and Valuation Workgroup have been doing for several years is to establish a robust set of tools with supporting evidence that will serve to increase the benchmarks for what we get paid for our non-patient care activities. New trainees coming out of fellowship have little idea how to establish the value of and negotiate for fair compensation for those activities (I know I had no clue). Success in these efforts will go a long way to increasing overall compensation and have potential to yield far more reward than increasing payments for E&M services would. Our specialty’s inherent altruistic nature, especially in academic settings but still in many clinical practice settings, gives our expertise away with too much ease. We have to change that.
Finally, two IDWeek plugs: the IDSA CAC has organized a session for several years that explores the issues of Health Care Reform as they affect our specialty. This year will feature talks on Health Care Reform trends by a speaker from The Advisory Board, ID-led ASP, and how ID specialists fit in a bundled payment environment. Second, in lieu of their annual Business Meetings, the Presidents of IDSA and HIVMA will be hosting an ID “State of the Specialty” Town Hall Meeting Friday evening at IDWeek. Please attend with suggestions in hand.