Diogenec Blog

By Donald A. Donahue, Jr., DHEd, FACHE

By Donald A. Donahue, Jr., DHEd, FACHE

At least 36 percent of healthcare workers are not taking flu vaccinations, according to a Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention. 84 percent of doctors have been vaccinated compared to only 70 percent of nurses. The authors say that healthcare workers need to get vaccinated, not only to protect themselves but also family members and patients. Vaccinating HCPs against the flu has been demonstrated to minimize absenteeism and illness and well as reducing influenza transmission to other health care professionals, family members, and patients.

See: http://www.medicalnewstoday.com/articles/233122.php

The lower prevalence of influenza immunizations – more than a third of healthcare workers opting to go unprotected – is a reflection of a general downturn in vaccination compliance.  This trend has resulted in an increase in otherwise preventable diseases, including measles, whooping cough, and influenza, often with deadly consequences.  The flu is particularly challenging, as the disease is contagious before symptoms emerge.  This means that someone might be infected and infecting others before they know they are ill.  This poses a particular danger to the very young, the elderly, and those with compromised immune systems.  During the 2009 H1N1 outbreak, it was estimated that as many as one third of those infected exhibited no symptoms.  Unwitting exposures can increase absenteeism, drive up healthcare costs, and threaten lives.  The CDC has estimated as many as 49,000 people have died in some years due to flu-related causes, roughly the population of Joplin, Missouri or Santa Cruz, California.  What role do those who forgo immunization play in this toll?  A simple shot can prevent a deadly transmission, whereas being unprotected can make you a carrier.  Which side of this equation do you want to be on? 

By Donald A. Donahue, Jr., DHEd, FACHE

By Donald A. Donahue, Jr., DHEd, FACHE

Japan failed to act on its warning system for radiation threats following the tsunami-induced nuclear crisis this spring.  The system predicted Karino Elementary School would be directly in the path of the plume emerging from the tsunami-hit Fukushima Dai-Ichi nuclear plant, but instead of evacuating the area, the school was turned into a temporary evacuation center.  Reports from the forecast system were sent to Japan's nuclear safety agency, but the flow of data stopped there.  Prime Minister Naoto Kan and others involved in declaring evacuation areas never saw the reports, and neither did local authorities.  So thousands of people stayed for days in areas that the system had identified as high-risk, an Associated Press investigation has found.

See: http://www.google.com/hostednews/ap/article/ALeqM5i7E9XVq0Bdxm46U5k2ht0KiAEVNA?docId=23ebbb28add7428dba55f97db16f3d43

The apparent communication breakdown that led to the designation of a high risk location as an emergency shelter is an example of the disconnects that often complicate disaster scenarios – akin to what military planners call the “fog of war.”  That term, attributed to Prussian military analyst Carl von Clausewitz, reflects the confusion and sometime dysfunction that accompanies an unusual situation with rapidly changing circumstances and uncertain information.  Many factors can contribute to such failures.  Emergency operations centers can be taken out by the disaster [as happening in New York City on 9/11], planning factors can be proven incorrect, or the disaster can overwhelm existing capabilities.  There is a delicate balance in disaster planning between overwrought, “doomsday” scenarios and underestimating the risk for economic, political, public relations, or other considerations (no mayor wants to be depicted as leading “SARS City”).

By definition, a catastrophic disaster is overwhelming.  The inevitable shortfalls can be reduced by prior coordination (know what to expect and from whom), redundancies in systems and processes, and simplified checklists to guide emergency procedures.  These all start with an honest risk assessment, devoid of self interest, ownership, or ego.  A pre-acknowledged report requirement – in this case the projected danger zones from a radioactive plume – sets the standard for comprehensive response.  As the disaster unfolds is not the time to assess needs.  There will be inevitable gaps, but these can be minimized via rigorous projection, planning, and practice.

A salmonella outbreak blamed for scores of illnesses and at least one death may be linked to eating ground turkey. The Centers for Disease Control and Prevention said that since March 1 a total of 77 cases in 26 states had been reported as being infected with the bacteria. The outbreak strain is resistant to many antibiotics, a fact that can increase the risk that patients will be hospitalized and that treatment will fail. Evidence points to ground turkey as the likely source of the outbreak, the CDC said.

See: http://www.cnn.com/2011/HEALTH/08/02/california.salmonella/index.html?hpt=hp_bn6

The outbreak of Salmonella Heidelberg offers some insights into how disease travels and ways to avoid falling victim.  Consider the numbers:  77 cases over a five month period; spread across 26 states in every region of the nation.  This would indicate the contamination has not been a significant adulteration of a single batch of meat, but rather an ongoing problem only now producing enough evidence to detect a pattern.  In many ways, this situation resembles that faced in developing parts of the world where endemic strains of bacteria sicken travelers.  As public health and agricultural officials have stressed, proper food handling and cooking of meat and poultry – reaching a temperature of 165 degrees Fahrenheit (74 Celsius) – reduce the chance of acquiring food-borne illness.  The U.S. food safety system is the best in the world, but no human endeavor is perfect.  You are your own first line of protection.

In Joplin, Missouri, five deaths from the Joplin tornado linked to fungal infection. Injuries sustained from splintered wood or other materials triggered a rare fungal infection that may have contributed to the deaths of five people following the Joplin, tornado, the Centers for Disease Control and Prevention said. In all, 13 people contracted the illness, and the CDC also said it had seen multiple fungal infections of that type after other natural disasters such as hurricanes but never after a tornado. The fungi in question are typically found in soil, decaying wood or other organic matter.

See: http://www.reuters.com/article/2011/07/30/us-tornado-deaths-idUSTRE76T1DT20110730

The aftermath of the Joplin tornado -- like many disasters – continues to reveal tragic characteristics.  The incidents of mucormycosis are notable, as discussed, because this infection has not been previously diagnosed related to a tornado.  This does not mean, however, that this have never before occurred.  A normally rare infection, mucormycosis should be considered following any event where wounds and environmental fungi could be a potential cause of necrotizing soft-tissue infections.  This is particularly true for individuals with conditions that impact the immune system, including AIDS, diabetes, malignancies (e.g., lymphomas), renal failure, organ transplant, long term corticosteroid and immunosuppressive therapy, cirrhosis energy malnutrition, and Deferoxamine therapy.

Japanese agricultural officials say meat from more than 500 cattle that were likely to have been contaminated with radioactive cesium has made its way to supermarkets and restaurants across Japan in recent weeks. Officials say the cattle ate hay that had been stored outside and exposed to radiation from the ongoing Fukushima nuclear disaster. The revelations have intensified food safety concerns in Japan, underscoring the government’s inability to control the spread of radioactive material into the nation’s food. Radioactive material has been detected in a range of produce, including spinach, tea leaves, milk and fish.

See: http://www.nytimes.com/2011/07/19/world/asia/19beef.html

While this particular news item addresses the ongoing nuclear plant crisis in Japan, it is indicative of a more far reaching vulnerability in agricultural security and food safety.  Absent a hermetically sealed building, any contamination will spread throughout the environment and appear elsewhere, potentially presenting a threat of exposure.  This is true not only of leaked radioactive materials, but of antibiotics, pesticides, heavy metals, and a host of other substances.  The degree of actual danger varies by the material, the concentration, the length of exposure, and the health of the individual exposed.  Unfortunately, it is virtually impossible to avoid all exposure given the web of commerce and the extended food supply chain.  Minimizing risk can be viewed from two perspectives:  that of the producer and from the viewpoint of the consumer.  Farmers, processors, transportation, wholesalers, and retail outlets can minimize risk -- and potential liability – by reinforcing security and safe handling practices. Consumers should try to stay informed of identified dangers in food supplies.  Unfortunately, few Americans regularly check into this aspect of personal safety.  Several agencies responsible for food and drug safety maintain a single web site resource for recalls:  www.recalls.gov.  Periodic review of that information can be a lifesaver.

By Donald A. Donahue, Jr., DHEd, FACHE