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Dan Diekema Profile picture
@dan_diekema
May 2, 2018 • 4 tweets • 1 min read • Read on X
Twitter is fine for respectful exchange of opinions, but when we’re really mad we dust off the Selectric and write a letter...yes, to an Editor! In this case about the C. difficile LabID event: ncbi.nlm.nih.gov/m/pubmed/29708…
Adjustment by lab method still problematic, and now a new feature....last test reported wins! So if you use an algorithm that includes toxin EIA, be sure that test gets reported last. #lasttestwins
Public reporting and pay-for-performance continue to mess with HAI metrics. #GoodhartsLaw
In future posts I might discuss how to optimize C diff testing for patient care and infection prevention!

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More from @dan_diekema

Dan Diekema Profile picture
Jan 16, 2022
This tweet is misleading. The study cited is a pre-print that reports Ct values and ability to culture virus from 21 subjects. In only 3 were they able to culture virus beyond day 6, and they were unable to culture virus from any of the 6 asymptomatic subjects after day 5...
...and as I've pointed out before, there is no lab test for "infectiousness", and ability to culture a virus from a sample does not equal infectiousness (reverse also may be true!). Best data to base public health decisions on would be good contract tracing data...
...from omicron wave, assessing SAR by date from sx onset. Whatever you think about length of isolation, and whether a test should be included, I don't think this work adds much. If anything it supports 5 d from test for asymptomatic (small N)! Study here: niid.go.jp/niid/en/2019-n…
Read 7 tweets
Dan Diekema Profile picture
Oct 2, 2020
Since this is apparently the "day of a thousand hot takes" (most of which will be wrong), I'll interrupt my Twitter hiatus to highlight some things that this teachable moment should drive home. Because what's happening now reinforces several points often lost re #COVID19: 1/10
First are the timelines: INCUBATION period of up to 14 days means all the "X is negative today" stories are dumb, as X could still be incubating the virus. INFECTIVITY is likely highest prior to symptom onset, and infected persons can transmit for 2-3 days before sxs and... 2/10
...for several days after sx onset (infectivity dropping rapidly after ~days 5-7). Thus anyone can start shedding at any time (even between tests for those tested daily), so repeated daily testing does NOT reduce importance of distancing and mask use. This gets at the...3/10
Read 10 tweets
Dan Diekema Profile picture
Sep 1, 2020
Ugh. I hoped to stay out of this spat for a while, but I'm being attacked by @jljcolorado for a short video I made a few weeks ago. It was designed for our HCWs, and deliberately used the terms HCWs are familiar with when describing transmission: Droplet and Airborne. 1/8
Those are the categories we've used. They are overly simplistic, and I completely agree that this is a continuum, as I describe here: haicontroversies.blogspot.com/2020/07/a-tire…
But "aerosol" doesn't currently have a direct link in HCW minds to prevention approach, unlike Droplet and Airborne. 2/8
So in the video, when I refer to "tiny droplets" that "linger in the air", I'm of course referring to aerosols. And attempting to introduce a bit of nuance in order to thread a needle for our HCWs, to convince them transmission in indoor settings can be over longer distances, 3/8
Read 8 tweets
Dan Diekema Profile picture
Jul 6, 2020
So I wrote a blogpost yesterday to outline how I think about the airborne/droplet debate, after reading the NYT piece about a letter that is now out in CID:
academic.oup.com/cid/article/do…
And the letter is of course much more measured, less controversial than the media coverage...1/4
(which focuses on the larger debate that's making many of us weary at this point, for reasons I stated in the post). The article makes 3 recommendations that don't seem controversial to me: (1) improve ventilation in public buildings, workplaces, schools, long term care..2/4
(2) use other measures such as local exhaust, HEPA filters and UV light to supplement general ventilation, and (3) avoid overcrowding.
I think everyone is already on board with #1 & #3. #2 is more resource intensive and probably will generate more debate. They wisely avoid...3/4
Read 4 tweets
Dan Diekema Profile picture
May 11, 2020
Sigh. Was doing ID consults all weekend, off Twitter. Think I will stay off for a while. Didn’t like Idiocracy the movie, and this prequel is excruciating because it’s real. Our non-warrior leaders can go self-isolate while planning the Great Reopening...
...the rest of us will keep battening the hatches and be sure there’s enough ICU beds on short notice for all those who don’t have the luxury of self isolating, and here I’m about to lose my cool so I’m out...will focus on what’s in front of me.
And to be clear (he says on the way out the door), I’m not opposed to contact tracing. I’m opposed to cynical political leaders who have access to the testing and resources required for contact tracing making decisions to open up states where that capacity does not exist...
Read 4 tweets
Dan Diekema Profile picture
May 4, 2020
I've been presenting these contact investigation studies (repeatedly) to try to place into context the recurring drumbeats (Goldberg Drumbeats?) about airborne transmission on one hand, and about prolonged infectious periods on the other. Both concerns get raised in... (1/4)
..response to studies that detect SARS-CoV-2 using molecular methods, either in the air from patient environment (or experimental conditions), or from patient samples for weeks after infection. But we now have data from literally thousands of close contacts of COVID-19...(2/4)
...patients that can inform these questions. Answer always the same: most transmission requires prolonged close contact, attack rates highest in household contacts, much lower for healthcare contacts, and transmission occurs within 5 days of symptom onset...(3/4)
Read 4 tweets

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