Infection Control Today - 08/2003: Are We Winning or Losing the WarAgainst Bacteria?

August 1, 2003

Are We Winning or Losing the War AgainstBacteria?

Thats the question we posed to InfectionControl Todayreaders this summer. Heres their take on the battle against thesuperbugs.

We are winning, in the sense that we continueto develop more specific technologies to identify, contain and confine, andprevent the preventable invaders. Innovative advances in every aspect of thehealth industry involve practices, protocols, processes, and products. We arelosing, in respect to compliance due to fiscal constraints, regulatory mandates,practice restrictions and critical shortages of competent healthcareprofessionals.

Nancy Bjerke, RN, MPH, CIC Independentinfection control consultant San Antonio, Texas As long as practitionerscontinue to believe that healthcare-acquired infections dont happen in theirfacility and depend totally on infection control rates, the bacterial war willcontinue to be waged with bacteria having the edge. We do not seem to havelearned lessons from the past; as soon as we think we have controlled one typeof microorganism, we get back to our old habits and then, wham! When leastexpecting it, we get dealt another wake-up call (e.g., SARS). The only way toeffectively deal with infectious agents is to make sure all practitioners, inall healthcare settings, follow all recommended practices each and every time,with no exceptions.

Nancy Chobin, RN, CSPDM CS/SPDeducator Saint Barnabas Health Care System Livingston, N.J.

We are losing more than winning. I live in aU.S. Mexico border city and I still see several cases of people self-medicatingthemselves and their children. With prescription medicines available over thecounter in Mexico, many people prefer medicating themselves and their kids tosave the cost of a doctors visit. Many times the pharmacist acts as thedoctor, recommending or prescribing medications to these people. The majority ofthe people who practice this self-medication routine every time they get sick donot follow the instructions given to them as far as finishing all theirmedication because they feel better after a day or two. The increase ofdrugresistant diseases is the direct result of this widespread practice alongborder cities, and with Third-World conditions being the norm along the U.S.-Mexico border, we are fighting a losing battle.

David Reyes, CEH Superintendentof custodial operations Texas Tech University Health Sciences Center El Paso,Texas For more than 20 years I have been reporting to infection controlcommittees (about) the community-acquired and nosocomial organisms in acute-carehospitals and we have not won the battle thus far. I believe this is due to anumber of challenges including the over-usage of antibiotics and the under-usageof aseptic practices. I shudder to think how Dr. Semmelweiss would feel aboutour lack of handwashing. When are we, as a professional group, whether clinicalor non-clinical, going to accept the fact that handwashing has saved lives? Andwhat in the world has happened to the aseptic practices we know are right butfor some unknown reason refuse to use? And yes, how about keeping our sterileproducts sterile to the point of use? Why do we question that artificial nailsare not appropriate in direct patient care? And how about the issue of homelaundering scrubs for SPD and OR? Holy buckets, if we truly believe this, thenwhy not just wear our blue jeans into the OR suite? After all, we will have asterile gown put over them. We will never win the battle over microorganismsuntil we learn that aseptic practice, handwashing and good old common sense arewhere it all begins!

Nyla Skee Japp, RN, PhD, ACSP Nursemanager, Banner Desert Medical Center Mesa, Ariz.

At this time I believe we are still ahead ofthe microorganisms, although they do seem to be gaining. Part of the issue isthe ability to recognize and publicize the illnesses more rapidly than in thepast. And as weve seen, the ease of international travel brings more peopleinto contact with (infectious) agents their immune systems have never seen. Agood sign is that in our area, physicians are more reluctant to orderantibiotics for patients who want them called in to their pharmacy without beingseen by the doctor. But in the long haul, and I mean the really long haul, Ithink the bugs will win.

Linda Scherer, RN, BSN, CIC InfectionControl/Employee Health Nurse Hospice and Palliative Care of LouisvilleLouisville, Ky.

I have to admit Im not convinced we arewinning the war against superbugs. I think the bugs are doing what they aremeant to do. They are learning and evolving. We develop new ways of fightingthem, they invent new ways of defending themselves. This is life. I dontthink well change that. But when it comes down to protecting our patients, wecan still do a lot with appropriate hand hygiene and coming up with newinnovative ways to encourage proper hand washing among all health careproviders, no matter what their titles, physician, nurse or technician. It is,as they say, in our hands and we are the only ones who can take it from there.

Carol Shenold, RN, CIC Infectioncontrol Deaconess Hospital One only has to have a cold to know we arelosing the war against superbugs. The first words out of most peoples mouthsare usually, you ought to be on antibiotics. This is especially true ifthey happen to be medical professionals. There is still the perception thattaking antibiotics will help keep it from getting any worse. Rest, fluidsand symptomatic treatment with over-the-counter drugs is still thought of as notgood enough. One would think that education would prevent this kind of thinkingbut I havent seen it happening. At the rate we are going, I fear that moresuper bugs will be created and antibiotics will become less effective inmanaging disease.

This is an important issue, and since I seepatients with MRSA, and VRE coming to the operating room more often than I wouldlike to, I think there should be some ongoing active dialog among nursing andother healthcare workers to help resolve these problems if at all possible.

Karol K. Santovin, RN CNOR Chargenurse, operating room North Florida/South Georgia Veterans Health SystemGainesville, Fla.