I published a video recording in Medica 2005 explaining about this threatening "war with bugs". Not many cared, because its easy to swollow lies than accept the truth.
Most politicians, primary care workers, health officials are still saying that the people affected with MRSA "tend to be elderly and frail and suffering from a range of serious conditions". This is the thing of the past; we are still bombarded with message from the media who got frenzy and still pointing their finger at “Dirty hospitals”. These papers are also hyping up information about clay, honey, garlic, and natural products that may cure infections. We know various drug companies have suddenly started investing in Antibiotic research and some are prematurely publishing information that they have identified a cure.
People acquiring a dangerous bacterial infection were hyped up driven by compensation claims. All patients, whatever their age, require care and are not subjected to an extra hazard and we know that most of these infections are preventable provided the doctors and nurses take care of themselves. I don't know how the schools, prisons, army barracks, and Gym are going to cope once they hear of some one getting infected.
Many people (3 out of 10) are colonized with MRSA and bring it into the hospital with them is also frequently heard and, indeed has been proved to be true. However, a simple method of establishing this, and one of the most potent methods of preventing the spread of infection within a hospital, is screening before a patient is admitted, or on admission, and isolated until a negative result has been ignored. The government is pressing on and going ahead creating the so called "Polyclinic" (I call this "The Bug Chambers") where we can all share our colonies and in-fact get some new breeds too.
The rapid test available and approved in the US and the Netherlands which facilitate this process of identifying carriers. This testing is said to cost £25m every year, the bad news about this is that you get to know you may die in 2 years (23% are likely to die in 2 years) and has been proved not to reduce the spread of infection unless they are strictly isolated. The insurance companies will refuse to pay and doctors will not operate on you. This is likely to be a death sentence worse that HIV.
Prevention, rather than treatment, is the only option available and more effective as far as patient and staff safety is concerned, and also it is much more cost effective in the long run or until some one comes out with a miracle cure.
Why on earth, is the BMA talking about smoking, alcohol, and teenage pregnancy when we must all concentrate and invest in educating people how they could save their families and their lives by simply taking adequate care of their hands and nose.
Medifix
Sunday 6 July 2008
Superbug: MRSA colonization - the long-term risk
Superbug: MRSA colonization - the long-term risk: "MRSA colonization - the long-term risk
One of the ongoing puzzles of MRSA's behavior is the significance of colonization, that situation of MRSA living on the skin — or in the nostrils or other locations close to the body's external surface — without causing illness. It's not known how frequently MRSA colonization occurs, for one thing: The long-standing estimate of 1% of the population has been challenged by a number of recent studies."
One of the ongoing puzzles of MRSA's behavior is the significance of colonization, that situation of MRSA living on the skin — or in the nostrils or other locations close to the body's external surface — without causing illness. It's not known how frequently MRSA colonization occurs, for one thing: The long-standing estimate of 1% of the population has been challenged by a number of recent studies."
Sunday 1 June 2008
Cannula, Catheters And Spreading MRSA Scare Is All Too Real
Various antibiotics are used to treat a number of what are now common diseases and to prevent the onset of infections when our skin, our first barrier to fight off disease, is somehow broken through a simple cut, bruise, puncture, or a more serious wound. It is something that we all take for granted, today. However, many diseases and simple wounds that are so easily treated today because of the availability of antibiotics have not always been available. Now things are about to change because we as doctors forgot our role and responsibility in the community.
Harmless bacteria that people carry on their skin, has now suddenly becomes a dangerous predator immune to antibiotics, chemical wash and antiseptic is threatening us all. Community-Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) entering blood with helpless white blood cells unable to stop them. HA-MRSA occurs most frequently among people with weakened immune systems-possibly 1 in 20 patients may have MRSA, according to a study conducted by the Association for Professionals in Infection and Epidemiology (APIC). HA-MRSA is often responsible for surgical wound infections, urinary tract infections, and pneumonia in hospitals. CA-MRSA, on the other hand, strikes in otherwise healthy people and children in the community. They manifests itself in soft-tissue infections, also in such skin conditions as boils, pimples or an abscess, whose initial appearance mirrors a insect bite and is often dismissed as trivial.
It’s occurred to us yet again that microbes just might be more determined to survive than we are. And that they were here before we were, and that maybe our hard-hitting pre-emptive war on bugs—with the many vaccines and antibiotics routinely used—is only making things worse.
This may sounds like a B-movie on the Sci-Fi Channel, but the CA-MRSA scare is all too real - one of several health alerts this year that proved just how vulnerable we are despite all our scientific know-how and advances in medicine. Invasive procedures, operations, plastic surgery, transplant surgery, hip or knee replacement, open heart surgery, bypass and minor surgical procedures will come to a grinding halt. This is the year we learn that the very technology we’ve created to help us live more comfortable and, yes, often healthier lives will turn around and bite us-hard.
IV Cannula, Catheters, and MRSA Infections
The number of both community acquired and hospital acquired staphylococcal infection has increased in the past twenty years and this trend parallels the increased use of peripheral intravascular catheters (cannula). A primary cause of Staph infection in hospitals is the use of IV cannula. Majority of septicemia begin with colonization of the cannula-insertion tract by bacteria from patients own skin-flora.
Peripheral venous cannulae are the devices most frequently used for vascular access. Although the proportion of cannulation leading to infections was said to be low, the frequency of the procedure means that resultant infections do lead to considerable annual morbidity. Certain cannulae (e.g., peripheral arterial cannulae) are accessed several times a day to check arterial blood gas or obtain samples for laboratory analysis. This increases the potential for contamination and subsequent clinical infection.
In modern medical practice, up to 80 percent of hospitalized patients receive intravenous therapy at some point during their stay. Since Dr. Crile used it to manage shock in 1915, cannulation has become the most commonly performed invasive medical procedure, contributed to various advances in medicine and has increased the incidence of spreading infections in the hospitals.
Cannula manufacturers have associated this device with increased incidence of needlestick injuries and are aggressively marketing their product “Safety Cannula”. They do not accept multiple attempts required to introduce cannulae can result in spreading infections.
Antibiotic resistant staphylococcal infections kills more people every day and is now proved to be associated with IV Cannula. Our hypothesis has been proved by specialist working in Winchester and Eastleigh Healthcare NHS Trust, UK. Since they started prescribing and monitering IV Cannula insertion, there has been no new cases of MRSA reported since last November. In 2007-08 the Trust had 11 MRSA bloodstream infections.
Cannula insertion is particularly difficult in certain cases, including in intravenous drug users, patients having repeated courses of chemotherapy, infants and children, and dark-skinned or obese patients.
It is often complicated in patients who are afraid, as fear activates the sympathetic nervous system, provoking peripheral vasoconstriction. Once an initial attempt at cannulation has failed, nearly all patients experience a degree of sympathetic activation that makes subsequent attempts increasingly difficult.
Multiple attempts to introduce cannula are traumatic and increase the incidence of introducing infections because adequate skin preparation is not often good in subsequent attempts. Vascular access development and the frequency of using this technique in neonatal and pediatrics units are now threatening mankind. Failed attempts are also embarrassing for the provider, causing a degree of nervousness that also hampers further attempts. It is therefore important that a cannula is inserted quickly the first time. Many doctors claim a high success rate for inserting cannulae, but may still require several attempts to get it right in certain cases. Cannulation can prove problematic and time consuming, which causes difficulties in urgent situations.
In emergencies optimal attention to aseptic technique is not always feasible and multiple punctures are more likely to result in infection, including septic thrombophlebitis, endocarditis, and other metastatic infections (e.g., lung and brain abscesses, osteomyelitis, and endophthalmitis).
Department of Health (UK) published their finding why the MRSA is increasing in NHS hospitals (Hospital organization speciality mix and MRSA). They did not find any association of higher incidence of MRSA in dirty hospitals, temporary staff, and high bed occupancy. They are now beginning to point their finger at practical procedure that healthcare worker routinely practice.
There is a growing awareness in the medical community that the cannulation technique needs to be reviewed.
What Have We Done?
We have been advising various cannulae manufacturers and the health department about the problem (since 1989) we as doctors encounter using these device. Unfortunately they have not been supportive and claim there is no problem. We have identified various papers and information to substantiate our claim. This is now rapidly becoming an ethical issue and we as doctors must think twice before inflicting pain and harm to patients by introducing infections. Increased contaminated plastic disposable products also give opportunity for bacteria to multiply and spread.
We have also developed a new technique to help doctors and nurses introduce IV Cannula with ease and reduce the number of attempts. Cannula manufacturers think our technique will de-skill doctors and have refused to help bring in changes that matter. Our work was published in medical journals, (video in You Tube)and appriciated by doctors but have failed to impress the manufaturers.
How Can You Prevent Getting Infected?
It is important that you as a patient must take care and observe what the doctors and nurses do when they are managing a patient in emergency situation. In one study, nearly 40% of doctors failed to wash their hands properly prior to and after performing a practical procedure. 60% of doctors were found to be colonized with enterococci after they handled a patient with infection. One in 20 doctors are said to carry MRSA in their hands.
This is very important point we need to be aware of and so take adequate care not to let the bacteria enter the bloodstream. Once introduced this may become a life long chronic problem or acute systemic infection that can kill.
As patients, please refuse to be touched or treated by any doctor, nurse or medical student who refuse to wash their hands adequately (below elbow using soap and water for 30 seconds). They must use sterile gloves when introducing an IV cannula and should not touch other unsterile parts of your body searching to find a vein using a sterile glove. If they fail to introduce a cannula in the first attempt, they must start the procedure without observing adequate drying time and good skin preparation.
Multiple attempts taken to introduce IV Cannula will increase the risk of introducing infections which can result in dire consequence to the patient and our community.
Harmless bacteria that people carry on their skin, has now suddenly becomes a dangerous predator immune to antibiotics, chemical wash and antiseptic is threatening us all. Community-Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) entering blood with helpless white blood cells unable to stop them. HA-MRSA occurs most frequently among people with weakened immune systems-possibly 1 in 20 patients may have MRSA, according to a study conducted by the Association for Professionals in Infection and Epidemiology (APIC). HA-MRSA is often responsible for surgical wound infections, urinary tract infections, and pneumonia in hospitals. CA-MRSA, on the other hand, strikes in otherwise healthy people and children in the community. They manifests itself in soft-tissue infections, also in such skin conditions as boils, pimples or an abscess, whose initial appearance mirrors a insect bite and is often dismissed as trivial.
It’s occurred to us yet again that microbes just might be more determined to survive than we are. And that they were here before we were, and that maybe our hard-hitting pre-emptive war on bugs—with the many vaccines and antibiotics routinely used—is only making things worse.
This may sounds like a B-movie on the Sci-Fi Channel, but the CA-MRSA scare is all too real - one of several health alerts this year that proved just how vulnerable we are despite all our scientific know-how and advances in medicine. Invasive procedures, operations, plastic surgery, transplant surgery, hip or knee replacement, open heart surgery, bypass and minor surgical procedures will come to a grinding halt. This is the year we learn that the very technology we’ve created to help us live more comfortable and, yes, often healthier lives will turn around and bite us-hard.
IV Cannula, Catheters, and MRSA Infections
The number of both community acquired and hospital acquired staphylococcal infection has increased in the past twenty years and this trend parallels the increased use of peripheral intravascular catheters (cannula). A primary cause of Staph infection in hospitals is the use of IV cannula. Majority of septicemia begin with colonization of the cannula-insertion tract by bacteria from patients own skin-flora.
Peripheral venous cannulae are the devices most frequently used for vascular access. Although the proportion of cannulation leading to infections was said to be low, the frequency of the procedure means that resultant infections do lead to considerable annual morbidity. Certain cannulae (e.g., peripheral arterial cannulae) are accessed several times a day to check arterial blood gas or obtain samples for laboratory analysis. This increases the potential for contamination and subsequent clinical infection.
In modern medical practice, up to 80 percent of hospitalized patients receive intravenous therapy at some point during their stay. Since Dr. Crile used it to manage shock in 1915, cannulation has become the most commonly performed invasive medical procedure, contributed to various advances in medicine and has increased the incidence of spreading infections in the hospitals.
Cannula manufacturers have associated this device with increased incidence of needlestick injuries and are aggressively marketing their product “Safety Cannula”. They do not accept multiple attempts required to introduce cannulae can result in spreading infections.
Antibiotic resistant staphylococcal infections kills more people every day and is now proved to be associated with IV Cannula. Our hypothesis has been proved by specialist working in Winchester and Eastleigh Healthcare NHS Trust, UK. Since they started prescribing and monitering IV Cannula insertion, there has been no new cases of MRSA reported since last November. In 2007-08 the Trust had 11 MRSA bloodstream infections.
Cannula insertion is particularly difficult in certain cases, including in intravenous drug users, patients having repeated courses of chemotherapy, infants and children, and dark-skinned or obese patients.
It is often complicated in patients who are afraid, as fear activates the sympathetic nervous system, provoking peripheral vasoconstriction. Once an initial attempt at cannulation has failed, nearly all patients experience a degree of sympathetic activation that makes subsequent attempts increasingly difficult.
Multiple attempts to introduce cannula are traumatic and increase the incidence of introducing infections because adequate skin preparation is not often good in subsequent attempts. Vascular access development and the frequency of using this technique in neonatal and pediatrics units are now threatening mankind. Failed attempts are also embarrassing for the provider, causing a degree of nervousness that also hampers further attempts. It is therefore important that a cannula is inserted quickly the first time. Many doctors claim a high success rate for inserting cannulae, but may still require several attempts to get it right in certain cases. Cannulation can prove problematic and time consuming, which causes difficulties in urgent situations.
In emergencies optimal attention to aseptic technique is not always feasible and multiple punctures are more likely to result in infection, including septic thrombophlebitis, endocarditis, and other metastatic infections (e.g., lung and brain abscesses, osteomyelitis, and endophthalmitis).
Department of Health (UK) published their finding why the MRSA is increasing in NHS hospitals (Hospital organization speciality mix and MRSA). They did not find any association of higher incidence of MRSA in dirty hospitals, temporary staff, and high bed occupancy. They are now beginning to point their finger at practical procedure that healthcare worker routinely practice.
There is a growing awareness in the medical community that the cannulation technique needs to be reviewed.
What Have We Done?
We have been advising various cannulae manufacturers and the health department about the problem (since 1989) we as doctors encounter using these device. Unfortunately they have not been supportive and claim there is no problem. We have identified various papers and information to substantiate our claim. This is now rapidly becoming an ethical issue and we as doctors must think twice before inflicting pain and harm to patients by introducing infections. Increased contaminated plastic disposable products also give opportunity for bacteria to multiply and spread.
We have also developed a new technique to help doctors and nurses introduce IV Cannula with ease and reduce the number of attempts. Cannula manufacturers think our technique will de-skill doctors and have refused to help bring in changes that matter. Our work was published in medical journals, (video in You Tube)and appriciated by doctors but have failed to impress the manufaturers.
How Can You Prevent Getting Infected?
It is important that you as a patient must take care and observe what the doctors and nurses do when they are managing a patient in emergency situation. In one study, nearly 40% of doctors failed to wash their hands properly prior to and after performing a practical procedure. 60% of doctors were found to be colonized with enterococci after they handled a patient with infection. One in 20 doctors are said to carry MRSA in their hands.
This is very important point we need to be aware of and so take adequate care not to let the bacteria enter the bloodstream. Once introduced this may become a life long chronic problem or acute systemic infection that can kill.
As patients, please refuse to be touched or treated by any doctor, nurse or medical student who refuse to wash their hands adequately (below elbow using soap and water for 30 seconds). They must use sterile gloves when introducing an IV cannula and should not touch other unsterile parts of your body searching to find a vein using a sterile glove. If they fail to introduce a cannula in the first attempt, they must start the procedure without observing adequate drying time and good skin preparation.
Multiple attempts taken to introduce IV Cannula will increase the risk of introducing infections which can result in dire consequence to the patient and our community.
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