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If your hands and wrists are not bare, if your nails aren't short and tidy, you can't wash your hands properly. We all learn this when we first go to the operating room and are introduced to the ritual of "scrubbing".

Well, it is time to bring the scrub to the wards. It's simple. We'll all take off our dirty white coats, roll up our sleeves, leave our rings and watches at home and scrub. Nothing fancy, no complicated rules about who has MRSA or VRE or C. difficile or ESBL, just good clean hands.

Here is a bit of foreshadowing of messaging for an upcoming campaign to encourage attention to simple measures to prevent infections.

and

An excellent television ad produced by the UK Department of Health encouraging good hygiene in an effort to limit H1N1 influenza transmission.

I gave a talk at the Canadian Society for Laboratory Science annual general meeting today concerning antibiotic resistance. In it I suggested that everyone has a role in the solution to the problem. Afterward someone asked me if they should question their physician more thoroughly when they are given a prescription. It is something I have been asked before and have generally been reluctant to suggest that questioning their doctor's prescription decision was appropriate. I have been very conscious of the need for a cooperative, blameless approach.

I have changed my mind.

Everyone should demand very specific information about all antibiotic prescriptions. You should be aware of the exact diagnosis, the expected course of illness and symptoms that would suggest need for further medical assessment. Discussions of alternatives are completely appropriate. If your doctor can't or won't give you the information you want consider another opinion.

Taking antibiotics is serious business and deserves serious personal consideration. The more questions asked the better.

A recent phase 2 trial reported in the New England Journal of Medicine was stopped before completion because of efficacy of a CMV glycoprotein B vaccine. Despite long standing concerns that a single antigen glycoprotein vaccine was unlikely to be the answer for the prevention of CMV congenital infection, it looks like it may. I am sure a larger scale trial will follow and hopefully another horrible congenital infection will become much less frequent. Check out the abstract here.

A paper in the most recent Nature Structural Molecular Biology by Dr. Wayne Marasco's group at Harvard describes the potential for monoclonal antibodies directed against the very conserved "stem" region of Influenza hemagglutinin being active in neutralizing all strains of Influenza including avian H5:N1. This is an exciting finding that I am sure will prompt intensive further work. Read about it here.

We physicians have an obligation to be ecologists. Our collective actions are having measurable effects on the evolution of the microorganisms that live with us and occasionally infect us. Have a read of this paper I wrote with Dr. David Patrick of the BC CDC to see how you can be part of the solution to this ever-escalating problem.

Click here to check it out.

Its been reported that Safeway is now advertising bottled water that's free from antibiotics, growth hormones, pesticides and genetic modification.

I don't know about you, but I've been quite happy (till now) to assume that my water was already free from antibiotics. Does the non-organic water contain antibiotics? Or pesticides??

This story has an upside, a downside, and perhaps an unsettling-side:

Unsettling-side The image reminds us of the enormous quantity of food we eat that has been genetically modified, and pumped full of pesticides, growth hormone and antibiotics.

Downside Even our water may have higher levels of antibiotics than we may think.

Upside The fact that antibiotics is on this label - and is first on the label - says a lot about general awareness and shifting priorities. This list would likely have looked much different 5 or 10 years ago.

via Treehugger

An excellent paper and accompanying editorial in today's Canadian Medical Association Journal describes huge increases in fluoroquinolone antibiotic resistance in Ontario from 2002 to 2006. Similar changes have been described in many other parts of the world.

Fluoroquinolones have only been in existence since the 1980s and first licensed for sale in Canada in 1988. They were the first new class of antibiotic introduced for many years and were received with extreme expectations. They were widely touted as the solution to antibiotic resistance to penicillins, tetracyclines, sulfa antibiotics and others.

Everybody pees. Urinals are poorly designed. Pee ends up on shoes and pants and floors.

Someone in the Netherlands tackled this problem and designed a urinal that efficiently catches pee and uses a clever bit of psychology to help the boys leave the maximum amount of pee in the urinal. A fake fly is etched on the porcelain in precisely the right spot.

By the time it is realized that the fly doesn't move the pee is collected - simply brilliant.

The blogs have been full in recent weeks with musings and articulations of what the incoming president would mean to them and their industry. Would business be brisker? Creative efforts be more creative? Would there be any noticeable change to daily life? The answer that most bloggers came to was, at best - yes and no.

No

For most 'average', Americans with 2.3 kids, a regular house, a regular car, and a regular job, the consensus is that little will change. Most of these people will not make or lose their life's fortunes, will not find themselves out of work, and will generally not fall upon hard times as the economy hibernates over the next few years.

Yes

It seems, at least at this early juncture, that the embarrassments of domestic and foreign policy might be in the past. Gone too, it appears, is the blundering, the plundering, the lying, the cheating, the misleading, and hopefully, the pillaging. It certainly appears as though the removal of these things will make things different.

But what has changed in the 'average' American's daily life? My suspicion is, for better or worse, very little. I'd venture to say that most Americans (like most Canadians), don't feel any better or worse off today than they did 3 weeks, 3 months, or even 3 years ago - despite the current economic hiccup we're experiencing.

For sure they (and we) feel much less secure now than we did then, but for the most part...?

So what changed?

As an outsider looking in, it appeared that change occurred not in the realm of personal finance, nor in GDP increase, nor in job creation, nor in any other tangible metric. The only real, perceptible change seemed to occur in people's heads and in their attitudes - in how they feel about the way things are.

As Canada weather's its own financial storm, and on this, the eve of Budget Day 2009, its not a bad time to think about how a rapid influx of positive attitude (as opposed to the unlikely influx of cash) might affect our health care system. A more positive outlook might be the perfect complement to any money that this budget throws our way.

A positive attitude is a powerful force - as we saw last week when almost 2 million Americans gathered all day in the freezing cold to watch a man swear on a bible and read a ten minute speech.