Infection Control Today - 08/2003: Microbe Hunter Shares His Perspectives on Life With Germs

Microbe Hunter Shares His Perspectives on Life With Germs

By Kelly M. Pyrek

When you discuss bacteria, emerging infectious diseases and the rise of the superbugs, you must include the thoughts of Philip M. Tierno Jr., PhD, director of clinical microbiology and diagnostic immunology at New York University Medical Center. He is the author of The Secret Life of Germs: Observations of a Microbe Hunter and is the scientist who solved the mystery behind toxic shock syndrome. Here, he shares his views on life among the microorganisms.

Q: The Secret Life of Germs was written before Sept. 11, 2001. Did that tragedy and the subsequent anthrax scare make you feel prophetic somehow?

A: At the time the anthrax chapter was written, about two years before 9/11, then-mayor Rudy Guiliani read it and said it was far-fetched. He was going to be one of the books reviewers. After 9/11, he told me he reread it and the chapter gave him the chills. My beliefs are the same after 9/11 but it helped me get my message across better. The anthrax attack, and especially SARS, emphasizes the importance of not only washing your hands, but also taking care of contact surfaces.

Q: You have a strong opinion about comparing the number of deaths from nosocomial infections as opposed to agents of bioterrorism, dont you?

A: The nosocomial infection rate in many institutions is a problem and many nurses who read my book say theyre glad I emphasize the fact people take the number of deaths associated with nosocomial infections for granted;

100,000 people dead from hospital infections is a large number. But re-evaluate that in light of the handful of people who died from anthrax. Look at the stir anthrax deaths created, yet thousands of deaths from hospital-acquired infections didnt create as much of an issue. Sept. 11 woke everyone up with regard to germ warfare.

Q: Who are the interlopers man or microbes?

A: Microbes were here at the very beginning of the formation of the earth; we are the interlopers, the ones who arrived late on this planet. We should not think we are the superior entity. Microbes have the chemical ability to learn processes that are useful to circumvent their demise by even the smartest of all beings man. Even though microbes continue to evolve, we are uncovering germs deepest biochemical and genetic workings. In so doing we are gaining the capacity to use that knowledge for the benefit of humanity. Its interesting that the smallest of creatures, these invisible agents, will allow us to resolve the most pressing problems we as humans face, such as disease, hunger and pollution. We must continue to explore the gargantuan potential of germs so we can harness their power for the good of man.

The future of man is dependent upon an intimate cooperation with germs a profound circumstance. We are now coming full circle from believing ourselves to be at the mercy of nature (mankinds lot since the beginning of time) through entertaining the hope that we could conquer nature with our scientific ingenuity, to recognizing that nature, the magnificent architect, has already devised the remedies for even our most grievous afflictions if only we would throw ourselves upon its mercy. The young science of microbiology is now only beginning to scratch the surface of the mysteries that govern the most powerful life source on Earth germs. If man recognizes that he must work with microorganisms rather than against them, trying to defeat them with all of these chemicals, which they cant, I think we would be better off.

Q: As an expert on germs, do you share the belief we may be too clean for our own good?

A: There are no black-and-white answers. As I mention in the chapter Too Clean for Our Own Good, that situation can never be. No matter what kind of sanitizer you use, you cannot eradicate germs. You interface with them every day, no matter how clean the environment is kept. With a plethora of antimicrobial products, you are only cutting down on pathogenic forms and reducing your likelihood of experiencing unnecessary diarrheal episodes, foodborne illnesses, colds and flus. In a hurried world, many people cant wash their hands according to Elaine Larsons dictates 30 seconds of getting between digits, knuckles and under nails, rinsing and repeating, which can take several minutes. You are lucky if people dip their hands under running water. People may benefit from a handrub that contains a longacting germicidal. You can never be too clean, and you cant literally get too clean by using any sanitizer. Thats not going to prevent you from being sneezed upon, not prevent your hands from being shaken, not prevent you from kissing someone or other ways you pick up germs the sandwich you eat, the counter you touch, the computer, the phone you have germs everywhere and there is no way any product is going to eradicate germs.

Obviously you need the germs for your health.

Q: Have the CDCs new hand-hygiene guidelines clarified or complicated the issue?

A: There is a great deal of ignorance about the whole hand-hygiene concept and common sense is going down the drain. No guidelines nothing really change the advocacy of washing of your hands with soap and water, especially in the hospital setting. You might want to add a germicide to this hand-hygiene protocol, but the use of alcohol products is to be used at the bedside to wash your stethoscope, to wash your hands between patients when water is not readily available or when it is inconvenient for that situation.

Thats when you best use the product, and it doesnt replace sinks.

Q: Do you embrace contact precautions as a routine measure?

A: Contact precautions and active surveillance. And dont forget education, re-education and then re-education one more time, because as healthcare workers come and go, you have to re-emphasize the basics that people should know but take for granted or ignore. It is sad that handwashing seems to be the most difficult thing we can get people to do. When we get an outbreak of a nosocomial infection at our facility, our infection control group meets and goes over the same grind. Some of the environmental organisms we face are superbugs in the environment that may require extensive cleaning for eradication. We had a case where Klebsiella was resistant to the germicide we were using; I tested it and it would require three times the concentration that was recommended by the manufacturer. So, active surveillance and continuous education are very important to help back up environmental cleaning.

Q: You peaceably co-exists with germs; how can people become less afraid of them in an era of SARS?

A: I dont have a germ phobia and I work with germs everyday. I dont carry a mask, I dont have any duct tape, I dont have any suits for protection, but I have knowledge and knowledge is the only empowerment you need. Knowledge is what eliminates fear, and fear is merely the result of ignorance.

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