Are Antibacterial Soaps Effective?

The FDA is asking manufacturers to prove the effectiveness of their antibacterial products that use triclosan or triclocarban as the active ingredient. (See the press release here.) This comes on the heels of last week’s announcement of their plan to help phase out the use of medically important antibiotics in food animals.

When I became a microbiologist I stopped using products with triclosan in an effort to curb antibiotic resistance. While I like to see the FDA’s efforts, I wonder if they’re doing too little, too late, and I’m not the only one.

Some additional reading on the topic:

1. Mechanism of triclosan resistance study, published 1999.

2. Another triclosan resistance study, published 2006.

Edited to add: Maryn McKenna’s excellent write-up on the topic.

Swails

-Kelly Swails is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

Resolutions

Have you thought about your New Year’s resolution yet? Hopefully you haven’t thought about when you’re going to break it. In addition to personal goals, we should all think about resolutions that we can make professionally. Whether it is stick to productivity numbers or finally finish that last credit to get another certification, this is the time of year to think about how you can grow in 2014. Our personal lives can affect our professional life and it is the balance between these two that keeps us sane and able to go back to work day after day. When one takes a little too much of your time you must step back and figure out where that fulcrum needs to be placed.

Growth in any career can be small steps or can be a leap such as another degree or promotion. Every person’s career is on a different trajectory and it really is up to the individual on how far they want to go. It is the decisions we make that shape our careers. Some people will tell you to be aggressive and take what you think you deserve, and others will say be patient, put in the work, and good things will come your way. (I wrestled in high school so you can take a guess at which philosophy I follow!) Whichever one you follow the big decisions and hard work you put in will only take you as far as you want it to. I have met many people my age that are happy working on the bench and have no aspirations of being a supervisor. Whatever you choose to do you should be happy and feel engaged that the work you’re doing is helping people. We are in healthcare and even though a lot of us don’t directly see patients the work we do helps nurses and physicians help the patient.

With only a couple weeks left in 2013 this is a great time to reflect on personal and professional accomplishments while also getting ready to start a new year that is full of new challenges and also new opportunities. As I usually say, no challenge is too large to take on and no opportunity is too small to overlook. For example I wrote an article for Lab Medicine and gave a 5 year progress report on my career and it turned into an opportunity to blog for one of the most important organizations for the laboratory profession. I always wanted to take the ideas I had in my own lab and throw them out there and see what other people thought of them and how they do certain things. When we write these blogs we love to hear comments and discussions of how you the reader interact and “live” in your own laboratory. Reflecting on 2013 I’m thankful for Lab Medicine for this great opportunity and my resolution for 2014; I’m going to be moving up that ladder, one rung at a time.

 

Herasuta

Matthew Herasuta, MBA, MLS(ASCP)CM is a medical laboratory scientist who works as a generalist and serves as the Blood Bank and General Supervisor for the regional Euclid Hospital in Cleveland, OH.

On the Lab Medicine Website

We’ve got some great new content exlusive to the Lab Medicine website to share with you.

Aleksandr Ivanov discusses Barriers to the Introduction of New Medical Diagnostic Tests.

Attipoe et. al. present the unexpected finding of Diphyllobothrium nihonkaiense. This is the second documented finding of this particular parasite in the United States.

Beavers et al report a case of an albumin transfusion reaction.

 

‘Tis the Season

The holiday season is rife with celebrations. Tree Trimmings! Presents! Gatherings! And let’s not forget the food. Turkey! Dressing (with or without oysters)! Cookies and its glorious dough! An unfortunate side effect of holiday celebrations is food poisoning, specifically those caused by, Salmonella, Campylobacter, and Vibrio.

According to the CDC, Salmonella and Campylobacter are in the top five pathogens with Salmonella being the biggest culprit in hospitalization. If you want to prevent Salmonella poisoning—or think you might already have it—here’s a handy guide to causes, symptoms, and treatment.

Raw eggs and mishandled poultry aren’t the only causes of food poisoning, though. Shellfish can be a concern, as is undercooked beef and unpasteurized dairy products. The Mayo Clinic has a wonderful chart describing the major food poisoning pathogens. A noticeable omission is Bacillus cereus, which breeds quite nicely in leftover rice.

For laboratory professionals, foodborne illnesses are a common cause of laboratory-acquired hospital infections. Be vigilant when handling enteric specimens and enteric cultures. Observe basic lab safety—use personal protective equipment, don’t use personal electronics in the lab, and be obsessive about washing your hands. Don’t let Salmonella or one of his buddies ruin your holiday season.

 

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

Are Pathologists and Primary Care Physicians Ready for the Genomic Era and Personalized Medicine?

I was reading about the FDA’s recent crackdown on 23andme to stop marketing their saliva based whole genome testing and interpretation service. Rather than resist, 23andme decided to comply and is currently in “talks” with the FDA so that they can complete the process for FDA validation and again begin to market their kits and testing. For now, they can continue to provide their genealogy testing and whole genome sequencing without interpretations.

Currently, in some academic research centers, whole genome or exome sequencing via next generation sequencing (NGS) methods is utilized on a limited basis by researchers and clinicians to identify pathogenic mutations. NGS and bioinformatic analysis methods continue to steadily improve and costs have been decreasing. However, there are limitations and barriers to widespread use at this point. These include but are not limited to: 1) widely used databases such as the Human Gene Mutation Database (HGMD) and the Online Mendelian Inheritance in Man (OMIM) still only contain information that only covers a fraction of the human genome, 2) more research is still needed to identify more variants mutation-disease associations, and 3) most mutations identified fall under the category of “unknown clinical significance”.

Tools such as NGS, despite its improvement over previous technology, still cannot identify large deletions or copy number variations (CNV) and is a technology not accessible, cost-wise and support-wise, to most health care institutions. Despite all of this, primary care physicians, even now, still may be confronted with patients who bring them their genomic screening results, whether obtained from commercial services provided by companies like 23andme or through molecular testing through a health care institution. But today’s physicians, including primary care physicians and pathologists, were not trained in medical school to understand how this testing is performed or the significance of these results. But the time is coming, and maybe sooner than we realize, when we will have to deal with such testing on a daily basis.

So, it is imperative that we train our doctors and doctors-in-training now to be ready for when that time comes. But, my question this week is “How should we go about it?” Additionally, who should compose the health care team to provide guidance and counseling to patients once results are available? And who should regulate how testing should be done and what information should be included in results reporting? Leave me a comment if you have an opinion or any ideas.

Chung

Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.

Global Health Engagement Month—A Different Perspective

Those of us who work in the international health field are connected in many ways.  We come from a variety of healthcare and public health careers and so approach the needs of global health in different ways. The common thread is strengthening the quality of healthcare and increasing and improving the availability to those in need around the world.

December is designated as Global Health Engagement Month for the US Military communities. All of our branches of service participate in humanitarian assistance and disaster response, and their efforts during times of international need are often the first assistance that some countries receive. In addition to providing care for our military active duty members and their families, our military medical corps from each branch of service provides care, assistance, teaching and disaster response in many different venues. They often work with NGO partners, other countries, and the Ministries of Health and the medical communities of nations in need. It is indeed a “global health engagement” effort that makes a difference. It has been my privilege to work with ASCP laboratory capacity building as a volunteer consultant, and I’ve also had an opportunity to work with the US Navy to build their partnerships with NGOs when they send their hospital ships on humanitarian assistance missions. Seeing global health outreach from several different perspectives keeps me ever mindful of the good work we do, and how much there still is to do in the world!

If you are interested in what our military is doing in providing humanitarian assistance , read about the hospital ships USS Mercy and USS Comfort and see why “Global Health Engagement Month” is so important to our military health colleagues here and here. I’m sure you’ll be amazed and proud of our country and inspired by their stories!

 

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

 

Dirty Winds

Over at Body Horrors, Rebecca Kreston writes about public health concerns of infectious disease and parasites. In this thought-provoking post, she discussions musicians (specifically, those who play wind instruments) and lung infections. She cites several small studies that found pathogens (Mycobacterium, Stenotrophomonas, and Cryptococcus) in instruments such as saxophones and trumpets.

The moral of the story: horn musicians, clean your instruments. And don’t ignore a persistent cough.

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.