Dirty scrubs

[Ted Reesor <reesor_t@yahoo.co.uk>]

Its difficult to comment on this as there is actually
precious little empirical information presented here. 
First of all, "disease causing organisms" occur
everywhere.  I mean everywhere.  The limiting factor
is how each individual is affected by the organism. 
For instance, immunosuppressed patients can succumb to
"diseases" that we encounter everyday.  One day we may
also pass away from bugs that we valiantly fought off
in our younger day.  Actually, many disease causing
organisms are harboured in our bodies and only create
a problem when they find themselves in a different
part of the body (E. coli).  The "superbugs" of today
are everyday common place bacteria that are not
affected by today's (or really yesterday's)
antibiotics.  Staph aureus (MRSA) can be found on any
table or coffee cup.  Its has not become stronger, it
just has developed its own flak jacket and can now
carry on doing what it normally does.

Also, (and this happens in every hospital) there is a
vast difference between colonization of an organism
and infection.  We can take swabs of supposedly
sterile environments (for instance, the lung) and find
several bugs down there that normally aren't there. 
One of reasons we now have drug resistant organisms is
because well intentioned doctors feel that they have
to pre-emptively treat problems that do not exist. 
Retrospection has shown us that this form of
treatment, although well intentioned, has caused a
HUGE amount of problems today.

As a scientific piece, 20 samples is a pretty poor
sample size.  I have read supposedly good articles
that state that wearing a surgical mask has no effect
on the contamination rate of patients and therefore
may not be needed.  Other articles state that washing
your hands may remove only the surface bugs, but then
reveal that more bugs are laying in wait underneath. 
There are articles that state that the tape one
carries around the stethoscope is just brimming with
nasty beasties and should be discared every 24 hours.

Finally, lets look at the society we live in.  If you
try to maintain a completely sterile environment, you
cannot do it.  Although their standards are far
stricter than ours, even the space agency states that
a completely sterile environment is not possible.  The
introduction of these new bactericidal kitchen soaps
have led to concerns that complete annilation of
99.99% of these bugs will lead to a super-bug that has
grown out of that .01%  Whether that's true or not, I
don't know.

The solution??  We should try to practice aseptic
technique as much as possible and although its not
sexy or chic, handwashing is still the best method of
avoiding spread of most germs.  Even the gloves we
normally wear are not sterile, but should be used to
prevent SPREAD of germs.  I have seen articles that
state that scrubs brought in from the home are no less
effective than hospital scrubs (this was part of an
attempt to decrease the use of hospital scrubs as part
of a cost savings campaign).  I don't claim to have a
solution, but I know that people tend to overreact to
poor science that really doesn't say anything.  Did
the doctor performing the test do a double blind test
(i.e. did he swab workers not wearing the scrubs to
determine whether there are more or less bugs being
transferred?).  He should really prolong his study
comparing the two groups and see if there was a
difference in hospital aquired infections.

Ya want to stop bugs from being spread??   How many of
us have wiped down our keyboards lately??  How 'bout
that door leading out of the washroom??  Anyone recall
Paulie Walnuts (Sopranos) diatribe on shoelaces?  Its
enough to turn us all into Howard Hughes and have us
carry boxes of Kleenex around with us...

Other than those concerns, it was rather
interesting...

Cheers,

=====
Ted Reesor, RRT/RRCP
Joseph Brant Memorial Hospital
Burlington, Ontario

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