• Sepsis and Hypotension: start broad-spectrum abx NOW.

• Persistent pna despite empiric rx and neg cx, think TB and blastomycoses.

• Fatigue, low-grade fever, and anemia- r/o infective endocarditis.

• Single+blood cx is not always a contaminant; is IS a source of prolonged hospitalization and further testing, so choose wisely when ordering blood cx.

Implementing Socio-Adaptive Change: The role of leaders, followers and bundles in preventing infection

Sanjay Saint, MD MPH Prof. of Int. Medicine University of Michigan, Dir. of the VA/Univeristy of Michigan Patient Safety Enhancement Program, Assoc. Chief of Medicine Ann Arbor VAMC

• Successful implementation of change requires recognition of both the technical and socio-adaptive barriers.

• The key to good leadership is good followership—very little written on subject of followership.

Infective Endocarditis and Intravascular Device Infections

Thomas Fraser, MD FACP FSHEA

• Management Highlights: If patient is sick, pull the line out. If patient has a bad bug, pull the line out. Most people with lines are health care experienced—start broad-spectrum abx and tailor rx once cx available. If you do not pull the line, follow very closely, have low threshold to call ID consult, S. aureus is in a class all its own.

• When can line be replaced? Timing depends on clinical need ultimately, clinically well with resolving syndrome, receiving effective rx, blood cx neg for 72 hrs; maybe longer for Candida species.

• Who should get a TEE for HCA S. aureus bacteremia? Patients with prolonged bacteremia; >4 days; presence of an intracardiac device (valve, icd, ppm); metastatic complication; vertebral or other osteomyelitis, etc. TH

Dr. Lindsey is a COO at Strategist Synergy Surgicalists, lead consultant at Asynd Consulting, and a Team Hospitalist member.