Tuesday, October 16, 2007

MRSA - It's preventable

Everywhere I turned today, I was engaged in discussions about methicillin resistant staph aureus (MRSA) and tonight I read a new article in JAMA that says it is twice as prevalent as we thought.

MRSA is a common skin bacteria-Staphylococcus aureus-that has become a "bug on steroids" and is resistant to penicillin, methicillin and other drugs that used to kill it flat. It has developed over time and 85% of infections are associated with hospitals and long term care centers. When it enters the skin barrier through incisions or IV lines, it can cause serious internal infections and is a leading cause of death.

Staph aureus is found in the nose and respiratory tract and healthy people can be carriers. It can live on clothing and curtains and (I've heard but not verified) that in England they are prohibiting physicians from wearing ties because of possible contamination.

MRSA infections are preventable and the bacteria is killed by topical alcohol.We've known that hand washing saves lives since Philip Ignaz Simmelweis discovered clean hands save lives in Vienna in 1847. He was fired, by the way, for such an outlandish idea that physicians should wash before they deliver babies or do surgery!

Topical alcohol based hand rubs, hand washing between patients, using infection control protocols for IV and line placement and screening for and isolating carriers of MRSA are all ways to drop this infection rate to zero. Paul Levy, the blogging CEO at Beth Israel Boston has been openly revealing his hospitals efforts to reduce MSRA and all hospital acquired infections. This is something that we should openly discuss, tackle as health providers and each of us help our colleagues remember to wash so we can drop these infection rates pronto.


K said...

Transparency for something like this is essential. So much of what doctors do is for all intents and purposes magic to a lot of people (myself included sometimes) in part because no one ever explains what is going on, and even basic biology (and physiology, for that matter) doesn't get taught nearly well enough in public schools to educate people either. If a person doesn't know why, for instance, they shouldn't smoke in an intensive care wing (hello, oxygen saturation all over the place), then they're more likely to shrug it off as something not terribly important.

Of course, on the flip side, you get people who know a little about things, and allow themselves to get swept up in stuff like antibacterial everything, wiping down counters and toys and hands with those wipes-in-a-tube, when it probably isn't necessary to be nearly so germophobic (especially given what we know about triclosan and its effect on sealife, for starters). It's a trade-off, as there will always be people who don't necessarily think too much about what they do when given a small bit of information, and no amount of "no, really, Windex is not meant to be sprayed there" is going to stop them. Such is the nature of the beast (of humanity).

But yeah, I'm all for insanely clean hospitals, there are exposed innards there! Geez!

Hana Solomon, MD said...

I have been preaching and teaching patients for more than 2 decades about the importance of nasal irrigation with hypertonic buffered saline.

We know this daily practice removes debris, thins secretions,reduces symptoms and can reduce illneses. we should learn from eastern culteres and begin this daily hygiene practice. I am confident it will redcue medication use (antibiotics) and even perhaps reduce the MSRA in the nasal cavity. Finally, it can do no harm and it feels so good.

Toni Brayer MD said...

K and Dr. S, Thanks for your comments. Dr. S, I have found nasal irrigation to be so effective for patients with allergies, congestion and "sinusitis". I agree with the health benefits and it makes sense it would decrease staph bacteria.

Rich said...

My mom just had a bad staph pneumonia that caused her to hospitalized in ICU for a week.

I have heard that people who enter the country illegally are major carriers of this virus because they are not screened and are not getting vaccinations. Nobody seems to want to talk about this though.

Toni Brayer MD said...
This comment has been removed by the author.
Toni Brayer MD said...

Rich, the staphylococcus bacteria is the most common and is found on everyone's skin. There is no evidence that immigrants have more colonization of staph. There is no current vaccine for staph.

Rich said...

Toni, I do realize that there is no current vaccination for staph but you have to admit that anyone that enters the country illegally are NOT getting the usual vacines that all of us are suppose to get. This puts health care workers and the public at large at great risk. I deliver direct patient care and I see with my own eyes what's going on here.

You have to look at why staph has become so prevelent in our society over the last ten years.

Yes, for one it's related to over use of antibiotics but some epidemeologists have made claims it is also related to the sharp rise in undocumented immigrants. I can only bet in San Fransisco it's worse. It's predictable - why has TB and even polio starting to appear again?

Anonymous said...

My mother died in July of cancer. She was screened toward the end and was said to have the MRSA virus. I am guessing she was exposed in the rest homes and the hospitals she was in the last 8 months of her life.

The doctor told all of us who were helping with the care for her that it would be best if we were tested after she passed. I was the only one who turned up positive for the MRSA virus.

I took rounds of some antibiotics and a salve applied to my nasal cavities and was tested 60 days later and was found to still have the virus.

I am not too happy about this and want to find something I can rinse my sinuses with to eradicate this germ for good. Can you help me?

Please reply to nsauceman@yahoo.com


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