Who’s to Blame for MRSA?
Brady Pregerson, MD & Rebekah Child | Scrubs Magazine
RN: Over the years, we’ve seen MRSA grow from a hospital problem into a community problem. This nasty mutant bug can very easily be picked up from the gym (sweaty bottom + tiny, dirty seat + open pores = trip to the ED for serious antibiotics). Average, ordinary people are contracting this insolent bacteria and just can’t shake it.
MD: Although Staph aureus infections have been around since before the dark ages, and even yours truly had to go to the emergency department as a teenager for the type of cure only a gleaming 11-blade can offer, we’re definitely in the midst of an MRSA epidemic. And unlike some of the other current epidemics such as HIV and hepatitis C, which primarily target those who share needles or don’t protect themselves during sex, MRSA targets everyone.
Athletes are definitely at risk, but so are we.
In fact, as healthcare workers, we’re probably at higher risk than most. A friend of mine who’s a nurse developed an MRSA infection after a minor hand surgery. We’re around it every day. So if we don’t take the proper precautions, it means trouble.
I’m almost tired of all the articles on the subject. I get it. I should wash my hands frequently at work, and when I get home, wash everything else. And of course, taking precautionary measures during patient care, including using the correct barriers when dealing with open lesions and putting patients with a history of MRSA infection on isolation to protect patients and staff.
RN: I can’t help but wonder what part we played in this growing problem. I always try to emphasize to my patients on discharge that they MUST TAKE ALL OF THEIR ANTIBIOTICS. Don’t stop taking them when you feel better, don’t save them for another sick day, don’t give up if you miss a dose. Keep going until the bottle is empty! I try to explain to them about these mutant bugs and how serious they are. I also wonder what doctors have done, or haven’t done, to prevent this. Sometimes, people just demand an antibiotic even when everyone from the ED volunteers to the cafeteria staff knows that this person has a virus and, thus, antibiotics are useless. But some docs give in, most likely to win the battle, even though in the long run they may lose the war.
MD: Not me! I know the data. Ninety-five percent of respiratory infections are caused by viruses, and 75 percent of the inappropriate antibiotics in this country are written for URIs. I find that most patients will trust me that they don’t need antibiotics if I take the time to explain why. It takes a few extra minutes of my time, something that is precious at work, but I think it’s worth it. I have a whole shpiel I give, which I won’t reproduce here, and it usually works. I want to win both the battle and the war. I want to be part of the solution and the cure. Of course, it doesn’t always work, but I’m batting around 900 these days. For abscesses, there’s a bit more controversy. According to most experts, simple abscesses actually don’t require antibiotics after an I&D. However, there is data to suggest that antibiotics may help eradicate the carrier state that exists between acute infections. Sounds worth it to me.
RN: One thing nurses and doctors can always do better is wash their hands. I’m going to go out on an anecdotal limb here and say that nurses are better at being hygienic than doctors are. Actually, that’s not really a limb—it has been shown in quite a few studies—but we’ll have to save that for a future installment of MD/RN! Have a great day, people, and remember: Stay safe, stay sanitized.
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