Saturday, March 24, 2012

Side Note: 165 Years After Semmelweis

I am deeply disturbed by the fact, that so many years after Semmelweis discovered the cause and methods of prevention of puerperal fever and worked out the basics of modern asepsis, modern healthcare institutions and professionals are still having trouble grabbing the concept.

Nosocomial infections kill approximately 100,000 ( one hundred thousand ) people in the USA alone every year! 

MRSA microphotograph
 So what?! one might say. Life is a risky business, let's move on!

 Back in Semmelweiss' time, in the mid 19th century ( 1841-1847 ) ONE in every FIVE -TEN mothers (range 5-30%), that gave birth under the guidance of doctors, died of puerperal fever. At the same time, only about ONE in FIFTY ( ~2%)  mothers, that delivered with help of midwives, suffered the same fate.

Are we much better off today?

MRSA - Methycillin Resistent Staphylococcus Aureus, one of the many killers.
Estimates ( since there is no  systematic  collection of data ) say, that about ONE in every TEN persons (10%) admitted to a hospital contracts nosocomial infection in the USA. Number are similar in many developed countries.

Of these, 100, 000 a year dies due to this infection, again in the USA alone. Sorry, I have no better data. The numbers are staggering, since we know the cause of these infections and we have an arsenal of antibiotics, disinfectants, regulations and best practice recommendations in place, none of which were available back in Semmelweiss' time. He had no idea about bacteria, let alone the availability of antibiotics, which came about 80 years after his discovery (see Alexander Flemming, 1928).

Wonder why?

Take a visit to one of the nearby healthcare institutions, and chances are that you will observe many, if not all of the following:

-Nurses and doctors with long nails and rings ( the original reason this post is written) .
-Plants potted in soil
-Personnel  commuting in work uniform ( meaning they take everything home and it is their responsibility to clean the clothes!!)

Come on! What would you choose if presented a choice: Life or a few days of homely comfort while in the hospital?

None of the above objects can be properly sanitized and regarded as safe in a health care facility!
-You can wash your hands every minute, the bacteria under your nails and rings will be just fine.
-No amount of vacuuming and steaming  can make a carpet free of germs. 
-Soil in pots are the best reservoirs for one of the deadliest killers: anaerobe bacteria.
-Uniforms DO come in contact with patients and nosocomial strains and need aggressive cleaning, sterilization to prevent the spreading of these! You can't just walk in these clothes for day, then throw them into the perm press cycle with your kids shirts!

All of these objects facilitate the hiding and recirculation of these bacterial strains from patients to nurses and doctors back to patients. Every time they have a chance to contact some new antibiotic and develop resistance against it.

165 years after Semmelweis, we still do not understand the concept of asepsis!

No amount of hand washing ( which, I sadly observed myself on many occasions, is err... not always done properly at the right time) and Mom's best friend sanitizers can fight off the legions of killers that hide and attack from these places!

Let me just relate a story, that I observed at one of my previous workplaces, a cardiothoracic surgery.
MRSA in bacterial culture
The Institution had just completed the construction of a new, cutting edge operating unit. When they performed a few dozen of open heart surgeries at the new place, they noticed, that patients suffered more ten times more often nosocomial wound infections, than in the old operating rooms. After long months and many deaths resulting from these infections, they finally figured out the hiding place of the killer bacteria ( Klebsiella strain in this case). They were hiding in the insulation inside the roof structure and  walls. They had to tear the building to bones and re-do the whole insulation and stucco work.

One could be wondering if bacteria hiding under the wall was enough to kill dozens of people, what can those germs do that freely circulate between the rings, carpet, clothing, soil, recirculated A/C air  and weakened patients!

What does it look like when somebody gets infected with MRSA, these really pretty little creatures? ( Warning! Disturbing images!)

"Some patient advocacy groups say hospitals need to take better steps to prevent such infections, like making sure that health care workers frequently wash their hands and that surfaces and instruments are disinfected. And antibiotics should not be overused, they say, because that contributes to the evolution of resistance."

Let me add this: all the above are not enough if we cannot eliminate the hiding places of these bacteria from health care institutions.

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