"Infection Control" By Allen Weiss, MD, MBA, President and CEO

Dr. ALlen Weiss, MD, MBA, FACP, FACR

November 1, 2008 - Controlling infections in hospitals has been a concern since Viennese obstetrician Dr. Ignaz Semmelweis delivered babies in 1847. At first, this physician was ridiculed for advocating hand washing before delivering a baby. After Dr. Semmelweis died, the germ theory was proven correct. Clearly, control of infections has saved more lives that anything except a good sanitation system.

What can we do to prevent infection both outside and inside the hospital? First, recognize we have a problem. Second, use safe methods to prevent infection. And third, use the correct treatment to control infection if prevention has failed.

Two-and-a-half years ago I conveyed, in this column, the benefits of hand washing—the best method of prevention. This included the indisputable fact that frequent hand washing with soap for about twenty seconds, is very effective. If sinks and running water are not available then instant hand sanitizers work well and may even be more convenient in certain situations. The problem remains that many public restrooms necessitate touching potentially dirty surfaces, such as faucet handles, paper towel dispensers and doors, after hands have been washed. By just being careful, without being too obsessive, one can avoid most of these problems. Modern, state-of-the-art restrooms, such as those at the new Southwest Florida International Airport, have electric sensors and physical layouts that facilitate avoidance of post hand washing contact.

At NCH, we now have many public bathrooms with electric sensors. We also have waterless hand cleaners in the lobby for everyone to use. Similar dispensers are located in every patient room as well as in the hallways, where appropriate.

We can also look for and confirm the presence of Methicillin resistant Staph Aureus (MRSA) with a test that takes about four hours to complete. Previously, the test results came back in 24 hours and by that time, the patient had encountered many caregivers. When we confirm the presence of MRSA we isolate the patient to avoid spreading the infection. MRSA is a common infection in hospitals and nursing homes in the United States today. Years ago this type of infection was relatively rare. The infection does not bother people who are well but when a person's resistance drops, as with an operation or hospitalization, this MRSA infection can cause serious problems to a patient.

What can you do to assist in infection prevention? Try to avoid touching someone when you or they are sick. 43% of people forget about washing their hands. 31% say they are too busy and have insufficient time. Begin the improvement by just covering your mouth and nose when sneezing or coughing. However, instead of using your hands—that will then contain transferable bacteria—use a tissue whenever possible. Don't ask or pressure your physician to prescribe antibiotics unless you really have a proven bacterial infection. The overuse of antibiotics is second only to the lack of potable water as a World Health Organization (WHO) top focus for improvement. The new “superbugs” can resist most common antibiotics and have been strengthened by the overuse and inappropriate use of antibiotics.

The Centers for Disease Control and Prevention (CDC) in Atlanta reported that more than 100,000 cases of infections are resistant to the common antibiotics previously used to treat them. The five billion dollar expense to control these infections is only surpassed by the cost in loss of human life.

We have the best science and the most effective medicines in this country, but if we don't follow the basic practices of good hygiene and prudent use of antibiotics we will all be risking our health. Thanks for being careful.

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.