Friday, October 30, 2009
It's a party! Bring your own alcohol (gel).
I learned about a new holiday today at IDSA. The WHO has declared May 5 to be hand-hygiene day. I'd suggest that we all celebrate by washing our hands, but apparently the point is that health care workers should be cleaning their hands all the time--specifically at 5 moments in the patient encounter. (See, 5 moments for the cinco de Mayo.)
This international effort is trying to make hand hygiene "easy, convenient and even sexy," according to Didier Pittet, MD. The project is very country-specific--in some developing countries, they're teaching how to make your own hand gel, while in others the focus is on humorous education to improve compliance. The importance of localizing humor was made clear by a French cartoon of a germ on a couch that Dr. Pittet presented. "Dr. Freud, in this hospital, it's become impossible to cause infections anymore," the germ said. It sure wouldn't win the ACP Internist/Hospitalist cartoon caption contest.
Labels: infectious diseases
posted by Stacey Butterfield at
1:11 PM
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Infectious tidbits
More hot stuff in infectious disease, this time from Bennett Lorber, MD. Dr. Lorber reviewed an array of recent research yesterday at IDSA. Here's the super-condensed version of his conclusions:
It's pretty clear that acid-suppressive medications are increasing the risk of pneumonia, and thereby causing excess hospital deaths, so they should not be prescribed so broadly. "We need to tell our medicine and hospital colleagues that acid-suppression should be a carefully considered decision," Dr. Lorber told the infectious disease docs.
Prescribing prophylactic antibiotics before catheter removal, on the other hand, is supported by new evidence. A recent trial found a NNT of 6 to prevent symptomatic infection. "We don't like this idea, but it's a pretty good study," Dr. Lorber said.
However, if you're trying to prevent infections after cardiac surgery, there's not enough evidence to justify putting patients on a statin before the procedure. A recent cohort study found that statins weren't associated with reduced post-op infections.
And finally, if you suspect a prosthetic joint infection, tell the lab to hold on to the specimen for at least 2 weeks, because a recent study showed that about a quarter of bacteria grown in cultures didn't show up until after a week had passed.
Labels: infectious diseases
posted by Stacey Butterfield at
1:11 PM
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Thursday, October 29, 2009
Get your darn flu shot!
The press conference I attended today at the Infectious Disease Society of America's annual meeting had a clear message and it was pretty much a more polite version of this post's title.
Researchers presented data showing that flu vaccination of pregnant women (seasonal, not pandemic, by the way) makes their babies less likely to be premature, small or admitted to the hospital for flu early in their lives. So, such vaccinations would solve the problem of not having a vaccination for newborns and achieve the cost-effectiveness of protecting two people with one shot. The scientists expressed hope that their findings would increase the currently "dismal" rates of expectant-mother vaccination. "If they're not doing it for themselves, maybe they'll do it for their babies," said Marietta Vasquez, MD.
I wouldn't count on it, based on the results presented about vaccination attitudes among hospital workers. The one-hospital survey found that plenty of health care workers, and even some physicians, believe that flu vaccines aren't safe and could give you the flu. In addition, many of them were not aware that one can transmit the flu without having symptoms. Depressing.
On the bright side, even though vaccine expert Paul Offit, MD, termed his part of the press conference a "mini-rant," he actually had some positive news to offer. "The pendulum is starting to swing the other way," he said. Concerns from parents of immunocompromised kids and the refusal by some docs to see unvaccinated children, among other factors, are putting the anti-vaccine troops on the defense, he thinks.
Labels: infectious diseases, influenza
posted by Stacey Butterfield at
6:53 PM
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Saturday, April 25, 2009
Highlights from Internal Medicine 2009
At a Thursday afternoon session, Jason Persoff, MD, reminded his audience of the high stakes involved when dealing with cardiac resuscitation. Even when CPR is done perfectly, he noted during "Shocking Developments in Resuscitation: Cold Compressions and Clinical Updates," it yields only one-third of the normal cardiac output, 10% to 15% of normal cerebral blood flow, and 1% to 5% of normal cardiac blood flow. And perfect CPR is rare: Dr. Persoff cited a study showing that chest compressions are too shallow about 63% of the time and too slow about 72% of the time. As for defibrillation, it's often not done quickly enough, Dr. Persoff said. He advised attendees to shock first, ask questions about rhythm later.
On Friday, Dennis G. Maki, MACP, delivered a lecture on "Emerging Infectious Diseases" that focused in part on C. difficile-associated disease (CDAD). Rates of CDAD are increasing "precipitously," he noted, because of more variable strains and an older, more susceptible population. He also pointed to another possible culprit: alcohol-based handrubs. Because spores can't be killed by alcohol gels, Dr. Maki recommends good old-fashioned handwashing instead.
Finally, at a Saturday afternoon session on "Pain Management in the Hospitalized Patient," Eva H. Chittenden, FACP, offered attendees a thorough review of best practices, including appropriate use of opioids and other medications. Although completely relieving pain isn't always possible, Dr. Chittenden said, clinicians can focus on reducing it to a level that's tolerable for the patient. "We have to believe our patients when they say they have pain," she said, "because they're the only ones who can tell us."
For more in-depth coverage of Internal Medicine 2009 sessions, check out the June issue of ACP Hospitalist.
Labels: cardiology, infectious diseases, Internal Medicine 2009, pain management, palliative care
posted by Jennifer Kearney-Strouse at
12:23 PM
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