The Perils of Hospital Borne Infection
Much in the news about methicillin-resistant Staphylococcus aureus, or MRSA. Seems this dangerous bug - which can cause fatal infections, and which loves the highly conducive atmosphere of a hospital - is 10 times more prevalent in hospitals than previously thought. The risk here is that these bacteria are hovering all over the place in hospitals, and have taken advantage of the highly sterilized environment to evolve ever more formidable strains. Meanwhile, hospitals are filled with people with compromised immune systems and open wounds who are particularly vulnerable to infection. If you’re healthy, you could be exposed to these bacteria without any problem; our immune systems keep the bacteria in check. Indeed, many of us may have already been colonized with the bacteria - they’re just sitting on our arms, and no Irish Spring will get rid of them. But they’re no real threat, unless our immune systems somehow fall off guard or unless they somehow find a way in to more vulnerable tissue.
Two thoughts:
First, it reminds me of what’s called The Necktie Problem. The best way to avoid staph is to get doctors and other providers to wash their hands. But there’s one refuge for bacteria always dangling around, that gets very little cleaning - neckties. This became evident a couple years ago, after a study showed that half of doctors’ neckties carried dangerous pathogens, including MRSA. Given the infrequent dry-cleaning of neckties, this has started a small movement among some (forward thinking? Sartorially lazy?) doctors to get rid of neckties altogether in hospitals. The lesson being that no matter how sterile an environment you may institutionalize, there are always little things that you’ll overlook. (Another reason to favor a female doctor, too.)
Second, an anecdote that puts the problem into some relief. I happen to know this doctor who specializes in infectious diseases - in particular, he’s an expert in MRSA. He recently had to have a pretty simple surgical procedure. But it required general anesthesia. His wife happens to be a surgeon at the hospital where he was getting his surgery. So given that he has expert knowledge in the risk of hospital-borne infections, and given that he was likely to have been colonized by MRSA because of his work, and given that he had special understanding of his hospital’s surgical procedures, he was particularly concerned about his likely high risk for developing an infection following his surgery. His solution: a total body scrub with antibiotics. This is not routine procedure - to wipe down your entire body before going in for surgery. It’s something most folks wouldn’t even consider as a precaution. But like neckties, dangling there, once you think about it, it makes total sense. If you ask me, next time me or mine have to get a scheduled surgical procedure, we’re definitely getting a cleansing rubdown ahead of time.
June 26th, 2007 at 12:33 pm
A surgeon emails:
MRSA is now, unfortunately, not restricted to hospitals and the immune compromised. We’re seeing much more of it in the general population. I saw plenty of otherwise healthy young people coming in with nasty abscesses from MRSA. So, basically, we’re all susceptible, no matter what.
Second, the pre-op scrub is only effective if it is done immediately before incision. If it’s done the night before, the bacterial counts resume their pre-scrub level by the time the patient gets the operation.
June 28th, 2007 at 10:53 am
I don’t think bowties would have the same issue!