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Summertime. And the living is easy. Janice Joplin has to be the best singer. Ever. There may be those in the comments who disagree, but remember, within the context of the blog, what I write is canon. Which is not the same as being true. Canon.

Any-who.

I spend summer on the front porch and rarely venture inside. Outside has had the most empty summer nights I can remember. No insects buzzing the street light, the porch light or bouncing on the window trying to go to the light. If bugs have taught us anything, it is do not go towards the light.

Just a few depressed mosquitoes, going though the motions before being swatted into oblivion, now remastered. If you are going to die, at least die with better graphics.

Nothing for the birds and bats to eat, which perhaps explains why the predominant birds of late are crows. Lots of crows. A murder if you will. It has been ages since I saw a robin or a jay. At least the crows are sentinel chickens for West Nile virus. Don’t you love language? A crow as chicken:

Some infected birds, especially crows and jays, are known to get sick and die from the infection.

Crows start dying off, I’ll worry more about those desultory mosquitoes. And perhaps bird flu if the crows start acting out:

Crows exhibited nervous symptoms following ingestion of HPAI H5N1 infected carcasses.

Although, who can tell with crows?

Good news in hard times, at least not all the bugs are vanishing. As an aside, I was colloquially called the bug doctor, although that was the Orkin man. And I was called the I and D doctor, which is actually the surgeon. For those not in the biz, I and D is short for incision and drainage. I was the ID (infectious diseases, not intelligent design) doc. Geeze, language can get convoluted.

Some bugs are thriving. Rubeola? Pertussis? COVID? It’s a good time to be a pathogen. All you can eat buffets across the US. And even more opportunities for growth are opening up for the discerning pathogen. Not cryptocoins. Nope. Hospitals.

For the current administration, in its ongoing effort to make sure infectious disease doctors have enough work, has disbanded The CDC Infection Control committee, the Healthcare Infection Control Practices Advisory Committee (HICPAC).

HICPAC has made 540 recommendations for infectious disease control, and 90 percent of its suggested measures were fully implemented by the CDC, NBC found.

The committee provided best practices for preventing and controlling health care-associated infections. It shared guidelines on disinfection and sterilization, environmental infection control and hand hygiene in health care settings, among other areas of concern.

Why should you care? Because someday you are going to end up in a hospital, and hospitals are dangerous places, rife with infection, and other, risks. It takes tremendous effort to minimize these risks. Today, if you go to one of my hospitals at least, the risk of infection is remarkably small. All thanks to the infection control committee.

What does infection control, now infection prevention, do? Three main goals.

  1. Insure that patients with infectious diseases -measles, COVID, influenza, MRSA, etc.- are placed in proper isolation so that staff and other patients are protected from the infection. Isolation is expensive, may not be good for the patient and a pain to do. But I was always of the opinion that if your day as a health care provider is not an inconvenient pain in the ass, you are not doing your job correctly.
  2. Investigate potential infection outbreaks. These happen at least once a year. New technology, new techniques, and new organisms can lead to new infections. Generally, 2 to 3 unexpected infections of the same, often unusual, organism triggered an investigation. Sometime we found a reason; sometimes we didn’t and the problem just went away. We were the FEMA of the hospital, and we know where FEMA is going.
  3. Infection prevention: applying interventions to prevent hospital-acquired infections: surgical wound infections, catheter infections, etc. No good deed ever goes unpunished and I learned early that any patient intervention can have a fatal infectious complication. My first month as an intern, a patient had a cardiac arrest at home and successfully revived. The peripheral iv placed during the resuscitation became infected, the S. aureus seeded her stenotic aortic valve, which blew out and killed her all in 72 hours. The worst kind of a Little Bug Went Ka-Choo.

For most of my career, I was the ostensible chair (although I sometimes thought I was the stool) of infection control for multiple hospitals. The infection control practitioner did most of the real work, it was my job to back them up. I will admit for the first 15 or so years I thought healthcare acquired infections were the price paid for the treatments we gave our patients. How could you not have the occasional infection from a ventilator, open heart surgery, or a dialysis catheter?

Well, turns out almost every hospital/healthcare acquired infection need not occur. If you follow the CDC/HICPAC guidelines, derived from too numerous to count clinical studies, you can drive these infections to almost zero. It is, as mentioned, a pain. And expensive. And you need a hospital administration committed to doing the right thing, which I always had. Not everyone does, as in private equity owned hospitals:

patients had a substantial increase in infections, falls, and other adverse events.

Over the last decade or so of my career, health care infections went from common to vanishingly rare, around one each a year.

And what was the origin of these studies and guidelines that lead to such a dramatic decrease in iinfections?

CDC/HICPAC. Their infection control committee. Applying their guidelines has prevented a tremendous amount of morbidity and mortality.

And now? So long, farewell.

Why? HICPAC was “unnecessary.”

Great. It is nice to know that going forward there will be no hospitalizations, surgery, central lines, or infectious diseases in the hospital. Looks like MAHA is a success. Of course, we all know the results of removing infection prevention provided by “unnecessary” telephone sanitizers.

It was ever so nice to have experts pondering a complex literature and helping guide care. Busy clinicians don’t have the time, or the expertise, that CDC often provides. Provided. It is important to have science-based standards. Well, it used to be anyway. While I understand the rationale for the name of this blog, I think what separates SBM from the current Lysenco-ists is reality, not science. I received reality based guidelines from the CDC. Moving forward? Fictions, fantasy, lies and delusions. Ah well.

I suppose we can add more hospital acquired infections and the occasional outbreak in the hospital to the list of future infectious disasters.

And more infections will mean more antibiotic use, accelerating the evolution of antibiotic resistant bacteria.

Glad I am retired. Not so glad I am of an age where hospitalizations seem to occur too frequently.

Yep. May not be bugs in my yard, but it is going to be hog heaven for bugs in the hospitals.


Moth Trails by dbgg1979 https://www.flickr.com/photos/dbgg1979/3421345648/

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  • Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at edgydoc.com.

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Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at edgydoc.com.