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One of the most exciting developments in recent years is our progress in eliminating post oeprative surgical wound infections . We know have data for over 2 years working with our Neurosurgical Group. The operative patients had many of the predisposing factors commonly seen in postoperative infections -obesity BMI> 30 in 45% and  current tobacco use 45%.The program includes the following:

1.Risk assessment of infection at the time of surgery

2.Nasal screening for MSSA and MRSA. Effective decolonization proved by repeat culture.

3.Very high risk patients referred to ID for clearance pre surgery.

4.Tobacco Cessation for 1 month pre and post procedure

5.Pre-operative bathing  daily with Hibiclens for the 72 hours pre surgery + Hand washing.

6.Sage Cloths the night before  and the morning of surgery.

7.Surgical prophylaxis guided by patient history and nasal and hand cultures.Either vancomycin or cefazolin

8.Chlorhexidine used in preparation of the surgical site. Other compounds may be used in addition to chlorhexidine

9.Strong attention to peri-operative gluscose control.

10.Use of Hibiclens for bathing and hand washing for 1 week post surgery

If you would like to implement these programs at your center-contacnt Dr. Smith thru the Website or by phone at 601-936-0706

Influenza activity appears  big time in our state. The CDC Flu View for the week ending November 24,2012-categorizes Mississippi’s flu activity as widespread.Only 3 other states –South Carolina, New York and Alaska join us in this categorization.The current Mississippi listing through the  MississippiDept of Health lists only 29 cases thru that same time period. This is not a true reflection of the total number of cases but rather  a report from a selected number of sites which reflects distribution. For example in our Emergency Room –we have had 25 + rapid Influenza tests in November and 10 tests + in December through only the first 4 days–35 total with 2 admissions.The State data reflects zero + cases in Hinds county and only 2 in Rankin.

Take home message:

1.Get your flu shots right away if you have not already one–if you are 6 months of age or over.

2.If you experience a febrile respiratory illness–make sure your doctor checks you for the  flu and consider empiric

administration of Tamiflu.

3,Go to the cdc.gov web site for much more info.

Happy Holidays to all. Dr. Smith and staff

1.TATTOO INK RELATED INFECTIONS.-NEJM aug 22, 2012 Reports an outbreak of contamination of gray inks used in tattooing.The ink was contaminated during manufacture.The organism was Mycobacterium chelonae.Points out the danger of tattooing even in parlors which have reasonable infection control.The supply inks are apparently not really well regulated as regards to sterility. Take home pay–Another reason to avoid tattoos.

2. A NEW PHLEBOVIRUS ASSOCIATED WITH SEVERE VIRAL ILLNESS IN MISSOURI.–NEJM-aug 30,2012.Interesing review of 2 patients who developed a febrile illness post tick bite with leukopenia,thrombocytopenia,fever,fatigue,diarrhea.All studies for the usual tick related pathogens were negative.

Subsequently—electron microscopy revealed a member of the Bunyaviridae group–a phelebovirus.   Designated as the “heartland” virus. Kochs postulates have not been fulfilled but it appears highly likely that this is a new tick associated pathogen.

3.MRSA AND MSSA IN HEMODIALYSIS—JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY –AUGUST 16.

Nice article pointing out the importance of MSSA and MRSA in the Hemodialysis population.Also stresses that Vancomycin is inferior to the Penicillin -cephalosporin grpup of antibiotics in the treatment of MSSA sepsis.

Still working with my Renal colleagues to get a more consistent approach to identifying carriage of MSSA/MRSA and the increased likelihood of sepsis if the patient is carrying these organisms. A work in progress.

Hopefully Fall is just around the corner. Best Dr. Smith

The total West Nile Cases in our state have exceeded 100 now at about 110 reported. Texas is the leader with about 700 cases .Accounting for the differences in population the attack rates are similar in the 2 states.Rankin and Hinds counties constitute the largest number of cases -39 or approximately 37% of the total cases. The recent heavy rains may continue to exacerbate the problem.

Hanta Virus.The news this week pointed to a second fatal case of Hanta Virus infection in a Yosemite visitor. There have been 587 cases of this infection since  1993 with about 1/3 fatal.There is no known treatment.Have a safe Labor Day   Dr. Smith

The Mississippi State Department of Health thru the State Epidemiologist’s office issued an advisory on West Nile Infections in our state as of Aug 3,2012. In 2011 there were 52 cases with 5 deaths for an approximate 10% case fatality rate.We are now in the peak months of activity  as 89% of reported cases occur in July,August and September.65-88% of cases occur after July 31.As of Aug 2, 33 reported cases have occurred in 2012.64% were neuroinvasive.This is the largest number of cases that has occurred in a single year at this time since 2006 when there was a total of 184 cases at the end of the year..

The above information is taken directly from the Advisory sent out on August 3, by the State Epidemiologist Thomas E. Dobbs MD.  Number to call for further information in clude the Office of Epidemiology 601-576-7725 or 1-800-556-0003.You may also call or e mail the Center of Infectious Disease Excellence with any Questions. stock up on your insect repellent.  Dr Smith

Apologize that things have been busy and no recent posts.There is an excellent article about bacteria on and in man in the New York Times June 13,2012 by Gina Kolata. She is one of the best of the science writers. Recommend to all.

Hope everyone’s having a good summer . Dr Smith

I am delighted to announce that we have Zostavax.This is one of the most

exciting new vaccines for adults. The vaccine was approved several years ago

but Merck has been unable to produce enough vacccine to supple both the pediatric

and adult markets. Within the past year 2 exciting develop ments have occurred:

1.The age range for the vaccine has been extended to ages 50 and above down from

60.

2.The vaccine availability problem has been apparently solved.Please call the Center

and arrange to have us vaccinate you if you are above age 50 and meet the other

eligibility criteria.The vaccine is the same as the one given to all children but is

more concentrated.It is very well tolerated and offers excellent protection.

Please call us at 601-936-0706 to schedule. Dr. Smith

The Center of Infectious Disease Excellence strongly supports Health care Reform

which has been passed by the Obama Administration with gradual implementation.

we support this for several reasons:

1.Most importantly it is better for patients.they will get better and more cost

efficient care

2.Requiring everyone to have health insurance is the humane , progressive

way .It is analogous to Car Insurance .It is the conservative posture.These individuals will be getting health care anyway and if they are not paying into insurance then the restof

us bear all the costs.This  is also very important for illegal immigrants–to bring them into the system in some fashion.I have never encountered a Mexican- American in my

consultative practice who has health insurance.

3.Already the improvements have allowed children to stay on their parents policies until age 26.

4.The doughnut hole costs to the patient are being reduced

5.Robert Brook said in the Journal of the American Medical Association”That with the passage

of theis act and its subsequent implementation the United States enters the

body of civilized nations”.

6.Stupid comments about “socialized medicine” are both ignorant and

untrue.Approximately 50% of all medical care is provided through Medicare /

Medicaid, VA,Public Health Service,Indian Health Service, and the various branches of the US Armed Services.We never hear a word from Tea Party types complaining about Medicare,

VA,or the US Armed services Medical Care.

7.The current US Health Care Non System is expensive and disorganized.We rank about 37

in the world on most outcome measures and are by far the most costly

health care system in the world.

8.The Health Care Reforms will be a great boon for most hospitals and for the Insurance Industry by bringing large numbers of new patients into the system.Medicaid will also increase

and we will need to find creative new ways to hold down the costs there.

9.I have yet to hear a single argument that makes any medical sense as to why

we do not need comprehensive Health Care Reform.Access is both a right and a

privilige.The terms are not mutually exclusive.Government should always be about

securing the greatest good for the greatest numbers of its citizens.

Dr. Smith

First—Thanks to everyone-individual travelers, churches, government,

businesses,colleges for making 2011 a most outstanding year. We are deeply grateful to be able to serve you.

Our Clinic the -Travel and Immunization Clinic of Mississippi is the

only medically directed Travel Clinic with the following outstanding

features.

1.Medical Director with 30 years Travel Medicine Experience-

Board Certified in Internal Medicine and Infectious Disease

A Fellow of the American College of Internal Medicine and the

Infectious Disease Society of American and a Member of the

International Society of Travel Medicine.

2.We are the only Travel Clinic open 40 hours per week and

able to rapidly get our travelers in and out.

3.We stock all needed vaccines and are able to provide

prescription medications–not available at the Health Department

4.Travel Medicine changes daily–individuals who do not do this full time

may not be alert to the rapidly changing world conditions. We monitor

CDC and WHO on a daily basis to bring you the most up-to-date information.

.

5.We have recently joined Shoreland Travel–the leading vendor of

computer generated Travel Medicine information. They integrate both

CDC and WHO and provide State Dept and advisories regarding

social unrest, natural disasters–that might not be available through

CDC WHO booklets.

6.We can work with both individuals or groups and can come to your site and make presentations for larger groups.

7.We are conveniently located at 1040 River Oaks Drive Suite 303 in the river Oaks Professional Building–between Marty’s Pharmacy and River Oaks Hospital.

This is a very safe -well lighted physicians office building with ample parking

and excellent security.

Let us have the opportunity to serve your travel medicine needs.

Call Connie Brinson at 601-936-0706

Dr. Smith

The epidemic continue to stongly rage throughout the country. There are some

encouraging signs of decreasing frequency of these infections within hospitals due

to enhanced infection control measures in hospitals.For 2012.

1.Pregnant women especially those who might have to have a C-Section or at

enhanced risk for serious invasive MRSA infections.These can be entirely prevented

by screening all pregnant women at 36 weeks–at the same time we screen for

Group B. Streptococccus.

2.All patients with any types of risk factors for MRSA who are planning to have

elective surgery shoudl be screened for MRSA.Increased risk factors would include-

Diabetes,Health Care Exposure,Day care exposure,Previous history of staph

disease or colonization in patient or family,extreme obesity- BMI of 40 or greater.

3.Individuals who develop MRSA in a community setting should be rapidly

referred to our clinic or to a clinic with comparable experience. This is especially

true if the indvidual has had more than 1 MRSA infection or there is a second

member of the family with an infection. These infections rapidly spread within

families and all family members need to be checked and decolonized if MRSA + to

STOP the micro-epidemic.The boils are a nuisance but in rare occasions the staph can spread

to bone, lung or blood.                            Dr. Smith