January 14th, 2009 by Dr. Val Jones in Expert Interviews, News
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Photo Credit: Dr. Crippen
I recently listened in to a Webinar related to infectious disease prevention strategies in elementary schools. The lead speaker (Dr. Thomas Sandora) was the principal investigator of a research study that was sponsored by Clorox and published in the Journal, Pediatrics a few months ago. I thought the results were interesting.
Study Design
This study was a randomized, controlled trial of 285 third to fifth graders in a school in Avon, Ohio. The study took place over a two-month period: from March to May, 2006. Half of the classrooms were randomized to the intervention group (which included having the kids apply hand sanitizer before and after lunch, and the teachers perform a sanitary wipe down of all their desks once/day), the other half were observed during their “business as usual” daily routine without sanitizers. The primary outcome measure was “days of school missed due to illness – either upper respiratory or gastrointestinal.” Swabs of surfaces in both the intervention and control groups were taken.
Results
Interestingly, there was no difference in the groups in terms of days of school missed due to upper respiratory type illnesses. There was a small but significant (9%) reduction in gastrointestinal-related illnesses absenteeism in the intervention group. Surface swabs picked up norovirus with higher frequency in the control group classrooms. No MRSA was detected during the study.
Discussion
Upper respiratory tract infections (URIs) are highly contagious, and are commonly spread by droplets in the air as well as surface contact (some viruses and bacteria can survive for 2 hours or more outside the body). Due to an infected child’s continuous contact with their own nasal secretions (sorry for the graphic photo), it is difficult to reduce the spread of URIs through the occasional hand washing or sanitizing. One would have to wash a child’s hands after each time they touched their mouth or nose.
On the other hand, gastrointestinal infections like norovirus are spread via the fecal-oral route, and are therefore not dripped and sneezed all over the place the way URI-causing viruses tend to be. Instead, GI infections are spread when hands are not washed thoroughly after a trip to the bathroom – and then food is touched and ingested.
So it’s not all that surprising that the transmission of GI-related infections were particularly susceptible to this study’s intervention: hand sanitizing before and after lunch, and a daily desk surface wipe.
An interesting point that Dr. Sandora made was that alcohol-based hand sanitizers don’t contribute to antibiotic resistance, because their killing mechanism is not related to antibiotics. I guess it’s like saying that humans don’t become resistant to knife injuries when exposed to attacks with greater frequency.
Conclusions
Hand sanitizer and surface disinfectant strategies may be more effective in reducing the transmission of gastrointestinal illnesses than respiratory tract illnesses in elementary school children. But since compliance is challenging – the total reduction in GI illness transmission remains modest though probably worth the hygiene effort. One glance at the photo above tells you all you need to know.
December 1st, 2008 by Dr. Val Jones in Announcements, Medblogger Shout Outs
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This is one awareness day where your coffee habit can make a difference. Starbucks is donating 5¢ to the Global Fund for every Starbucks beverage sold on December 1, 2008 at participating US and Canada locations.
h/t Emergiblog
And Dr. Anonymous has a nice post about World AIDS Day, citing this letter from a survivor:
(This is an excerpt from a letter to the editor from the Cleveland Plain Dealer from November 30, 2008):
I am a 20-year survivor living with AIDS, and another World AIDS Day (Monday) is fast approaching. Food trays once left at hospital room doors of those dying from AIDS are now being served. The preventative measure of “gown ing-up” has come and gone. However, the stigma of AIDS has stayed unchanged. Sadly, there are conflicting AIDS transmission fears and infection rates spiraling out of control.
I am blessed in that I am still here, with thinning hair, bifocals and my AARP card in hand. I am living proof of the incredible medical strides made in managing HIV/AIDS. I am blessed in living to see nieces and nephews come into my world and bring forth great-nieces and great-nephews. I am blessed in that I continue to continue. I still grieve for the many friends I’ve lost to AIDS.
This year, another 56,000-plus Americans will become needlessly infected with HIV/AIDS. We know how to prevent HIV infection. We need to wage a War on AIDS in America. We know how to win it.
Robert W. Toth — Cleveland, OH
November 9th, 2008 by Dr. Val Jones in Medblogger Shout Outs, Opinion
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As many of you know, I’ve been pretty upset about the “never events” policy put forward by CMS. That’s because they took a theoretically reasonable punitive rule (Medicare will not pay hospitals for patient care related to gross medical errors, aka “never events,” like wrong-side surgery) and made it far too general (never events include delirium, falls, and any infection – even a cold). It is absolutely impossible to prevent these sorts of things 100% of the time. So how should “never events” be defined?
The Happy Hospitalist nails it:
Can the never event happen at home? If the answer is yes, it cannot be a never event. It is a natural event. Even the criminal events that nobody can foresee are considered never events. Tell me how a hospital can prevent a random crazy family member or hospital guest from going berserk and assaulting an employee or patient. It’s impossible to predict or prevent.
November 5th, 2008 by Dr. Val Jones in Medblogger Shout Outs, News
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This news from Gary Schwitzer’s excellent blog:
Dr. Nancy Snyderman of NBC News appeared on the Today Show with Matt Lauer last week, profiling a physician-author who has written that the best science does not establish a causal link between childhood vaccines and autism. 
Lauer, in a followup question, mis-spoke and called it a “casual” link – not causal. One wonders whether he truly knows what the words mean.
Snyderman talked about how the physician-author, Dr. Paul Offit (author of “Autism’s False Prophets”), has received death threats. Snyderman herself said she had been physically ambushed by those who contend that vaccines cause autism.
As Snyderman was wrapping up the segment, Lauer said – in typical anchor throwaway language:
“Controversial subject …”
Snyderman immediately shot back, “Not controversial subject , Matt. …It’s time for kids to get vaccinated. The science is the science. It’s not controversial.”
You can see the video here or here.
Kudos to Snyderman for educating her big-bucks anchor colleague live on-the-air.
For a full review of Offit’s book, please check out this link.
November 4th, 2008 by Dr. Val Jones in Opinion, True Stories
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Election anxiety has America on the edge of its seat. I anticipated long lines and a lot of drama, so I voted early to avoid the rush. That left me with nothing election-related to do today, so I decided to head over to my local pharmacy and get a flu shot instead.
Last year the flu vaccine was only 50% effective because experts did not correctly predict which viral strains would victimize Americans. This year I have my fingers crossed that the Brisbane and Florida strains included in the vaccine will do the trick. After all, Influenza is the single leading cause of vaccine-preventable disease in the U.S., with estimates between 15 million and 60 million cases in the US a year among all age groups. Influenza leads to 200,000 hospitalizations and about 36,000 deaths a year in the U.S., mostly in infants and the elderly. I’ll never forget the touching story of how one family lost their three and-a-half year-old daughter to the flu.
So I arrived at the pharmacy only to find a disorderly group of flu-shot seekers, pacing near the entrance to the retail clinic. About 20 minutes later a young woman with a clipboard and sign up sheets came out and started asking people what kind of insurance they had. When my turn came she informed me that my insurance plan was not participating, and suggested that I leave. I asked if I could pay out-of-pocket for the shot and she said that I could and gave me a consent form. More people arrived without any movement in the line, and I overheard one person commenting that the nearby polling booth wasn’t moving as slowly. Another customer decided to leave to go vote and then come back later for the shot.
Forty minutes later my name was called and I entered a small room littered with papers and syringe caps. I rolled up my right sleeve and asked the technician about his injection technique. I watched him carefully draw up half a cc of vaccine from a multiple-use bottle.
He then asked me how I was going to pay. I presented my credit card and he said that he only accepted cash or check. I said that I had no idea that credit cards weren’t accepted and he seemed surprised that I wasn’t aware of the retail clinic policy. A large envelope was leaning against his chair leg, full of $30 cash deposits for the shot. Read more »
