MRSA
Steve Shelov MD FAAP
www.DrMDK.com
Step 1: Introduction
Unfortunately, M-R-S-A, MRSA, as we call it has actually been around for quite awhile. There are a number of communitees, actually, a number of communitees in Texas, where the portion of resistant organisma or MRSA, in the community are over 60%. So this is not a new phenomenon. Not only is it not a new phenomenon, but we also know, yes, it is in hospitals, but more importantly, it is in the community. So that many of the staph that comes into the hospitals, actually come in from the community, not as a result of it being developed in the hospitals itself. So it is a mixture.
Step 2: Multiple Resistant
Interviewer: But the word, multiple resistant, what does that mean? Resistance? Dr.: Well, normally in the very beginning staph was very sensitive to penicillin. It then became resitant to penicillin. We developed a more sophisitcated type of penicillin that would be effective against it. Now, we're finding that even those more sophisticated penicillins are not effective, as effective as they were against this particular staph. So it's very serious. We do have antibiotics to treat it. They are just not the usual kind, we sort of have to step it up to a more sophisticated type of antibiotic. The concern is that the next step of resitance could be resistance to everything we have. Then, we are in very deep trouble. So it is a very important worry on the horizan for all of us. But it has been here for awhile. It is, unfortunately, not new.
Step 3: Prevention
Interviewer: So a way to prevent it would be good cleanliness. Washing of the hands, don't share wet towels in gyms, things like that? Dr.: Absolutely. The timing of this report is actually an important one, even though the organism has been around for awhile. It reenforces the need to be absolutely 100%, excellent technique in the hospitals where the professionals are. Hand-washing, hand-washing, hand-washing. Anything less than hand-washing before and after contact with patients is not acceptable. If we really do stick to careful hygiene control, keeping surfaces clean and hand-washing, we can prevent the transmission of this organism which is out there. But it needs to be vigorous, it needs to be multi-leveled reenforeced. Everyone has to say that. We now wear a badge here at the Children's Hospital. The badge says, 'Please ask me if I have cleaned my hands.' So everyone is empowered because of this particular badge to say, 'Did you clean your hands? Did you wash your hands?' It just reminds everyone that that has to be everybody's vigilance, to clean your hands.
Step 4: Alcohol Hand Wash
Interviewer: Those alcohol hand wash things, are they OK? Dr.: They are absolutely OK and they are very convenient. They can have dispensers all over the place. You don't need very much and they actually make your hands feel pretty good. Many of them come with things that soften your hands a little bit. They are very effective as a cleaner. But washing your hands with soap and water is also good. So, whatever you have just be compulsive about sticking to the routine. Wash your hands before and after every patient contact.
Step 5: Antibiotics
Interviewer: A good practice by a competant physician should be, you shouldn't use antibiotics just because someone came in the front door. If we become more selective, less resistancy will be in the community too. Is that true? Dr.: Absolutely. Obviously, what has probably prompted a lot of the antibiotic resistance is the overuse of the antibiotics, both in the communities and even in the hospitals. Too many antibiotics, broad-spectrum especially, those are the kind that will kill lots of different organisms, creates resistance. That's just what happens. The bug will adapt. It will change it's DNA, appropriately. And become resistant next time it sees that antibiotic. So, the more appropriate we use antibiotics, the less likely the difused resistance will occur. That shoul be our over-arching message. Don't overuse antibiotics. Parents, don't demand antibiotics when it looks like a simple viral illness and they will get better. Don't put your pediatrician or your adult physician if you are an adult in a bind. They will use antibiotics appropirately and insist that they use them appropriately. That makes you as responsible as they.
Step 6: Flu
Interviewer: And the flu doesn't respond to antibiotics. So if you have the flu, the best thing you can do is a lot of fluids, bedrest. But not antibiotics Is that true? :Dr.: That is absolutely right. Influenza is a viral infection. It is best treated by prevention. So get your flu shots. And children should get thier flu shots. They are just coming out now. But should you not get your flu shot or get the flu, then, in fact, antibiotics are not effective because it is a virus. Antibiotic means anti bacterial. Therefore, you just need lots of fluids and rest and medicine for your fever if you are having it and it will go its course. It will take 5 to 7 days and you won't feel good nor will your child, but it will eventually get better.
