Archive for the ‘HAI’ Category

Evening Ebola Update, Sun, 1/25: Dr. Chan tells WHO her priorities re: EBOV/WHO/Vaccine trials have different designs in each West African country   Leave a comment

1/25/15

Dear Colleagues:

l.  Reuters has an article on what needs to change at WHO to make WHO more rapid and more effective in global health emergencies.  The article quotes speakers at the WHO Executive Board’s Special Meeting on Ebola today who said that regional WHO directors made the EBOV epidemic political rather than a medical emergency and WHO responded too slowly with too little power to end the EBOV epidemic while it was an outbreak.  See: http://www.reuters.com/article/2015/01/25/us-health-ebola-who-idUSKBN0KY0KA20150125

2.  WHO website has posted Dr. Chan’s opening speech to the WHO Executive Board’s Special Meeting on Ebola today.  The most important statements from Dr. Chan’s speech are:  WHO has set up 27 laboratories in West Africa; deployed 60 Ebola health care teams in West Africa; established 66 Ebola Treatment Centers in West Africa; sent a total of 2000 HCW to West Africa.  There are now WHO officials in all prefectures and districts of Liberia, Guinea, and Sierra Leone.

3.  Dr. Chan states her most important goals now re: EBOV are: restoring and upgrading health care systems in West Africa so all countries are prepared to stop a subsequent outbreak of zoonotic infectious disease in its tracks; implement new ways to get medicines and drugs to market sooner; develop a ‘rapid response teams’ for WHO to immediately respond to global health emergencies; setting up a contingency fund to cover expenses of ‘rapid response teams’.  See the entire Dr. Chan speech at: http://who.int/dg/speeches/2015/executive-board-ebola/en/

4.  Many news sites on the world-wide web have reported that several Ebola vaccine Phase 3 trials will begin in West Africa within weeks.  An article by Martin Enserink in Science 16 January on page 219-220 describes the methodology of these various trials.  The debate over randomized controlled trials versus ‘compassionate use’ distribution of vaccine has been ‘solved’ by using different trial methodology in Liberia, Guinea, and Sierra Leone.  Here is a modified chart from Enserink’s article:

1. Liberian trials:  Led by: NIH; Participants: 30,000; Design: Randomized trial with control arm in general population. Vaccines: GSK, Merck.

2.  Guinean trials:  Led by: International consortium; Participants: 9000; Design: 1. Ring vaccination, 2. Observational study in EBOV HCW; Vaccines: To be determined.

3.  Sierra Leone trials:  Led by: CDC; Participants: 6000; Design: Stepped-wedge trial in EBOV HCW; Vaccines; To be determined.

See the Enserink artlice and chart at: http://www.sciencemag.org/content/347/6219/219.full

RGL, MD

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Posted January 25, 2015 by levittrg in Ebola, HAI

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Hightlights from SHEA/Becker’s, Thurs, 10/30: Fecal Tx/MRSA precaut./EBOV waste/Clostridium strain helps   Leave a comment

10/30/14

Dear Colleagues:

SHEA Spotlight this week has the following highlights:

l.  Fecal transplants for recurrent C. difficile are excellent for these patients.  Fresh transplants (require 4 d prep) and frozen transplants have similar cure rates of >90%.  This cure rate occurs in patients with toxin and w/o toxin.  The transplants change the GI microbiotome to resemble the donor microbiotome.  Multiple transplants can be done.

2.  Fecal transplants can be used in critically ill patients with C. difficile scheduled for colectomy.  Cure rate is 88%.  Vancomycin is given concurrently.

3.  Contact precautions (gloves, gowns, masks) prevent MRSA spread in hospitals, but note that only 20% of MRSA is transmitted patient to patient in hospital.  80% of MRSA comes from the outside.  See JAMA article.

4.  Needle sticks may be prevented by sharp-protection needles, double gloving, and blunt sutures in surgery.

5.  Only 1/3 hospital patients wash their hands after using the toilet.  Remember 1/2 of hospital patients are on antibiotics at any given time.  Not hard to see why antibiotic resistance has developed in hospitals.

6.  EBOV waste should stay in the ‘hot area’; autoclaved or otherwise sterilized with DEDICATED autoclave or sterilizer; no shared autoclave or sterilizer.

See: https://col128.mail.live.com/?tid=cmOftTEDxg5BGSeQAiZMHTgA2&fid=flinbox for full stories on these highlights.

7.  Becker’s reports that a gut Clostridium strain named C. scindens produces resistance to C. difficile.  See:  http://www.nature.com/nature/journal/vaop/ncurrent/full/nature13828.html#affil-auth in Nature.

RGL, MD

Posted October 30, 2014 by levittrg in HAI

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SHEA Spotlight on HAI: Scopes must be scrubbed/Pts. don’t wash hands/1/2 inpts on antibiotics   Leave a comment

10/15/14

Dear Colleagues:

Last week’s SHEA Spotlight contains the following important take-home messages re: reducing hospital-acquired infections (HAI):

l.  From U.S. News and World Report: Endoscopes are not disinfected despite sterilization unless the scopes are manually cleaned of debris prior to sterilization.

2.  From Science Codex: Hospital patients use hand hygience after visiting their bathrooms only 30% of the time.  Not difficult to see why HCW hand hygiene hasn’t stopped multi-drug resistant bacterial infections in hospital.

3.  From CDC: One half of hospitalized patients are taking one antibiotic at any given time.  Half of these patients are on more than one antibiotic.  Again, not hard to figure out why multi-drug resistant bacteria have thrived in hospital.  In the South, the incidence of such bacteria in hospital has increased 5X between 2008 and 2012.  See: https://col128.mail.live.com/?tid=cmW0m_49BP5BGMwwAjfePkzA2&fid=flinbox for full articles.

RGL, MD

Posted October 15, 2014 by levittrg in HAI

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