What do patients in their hospitals have in their hands and do companies in their rooms?



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What do patients have at their hands in hospitals and businesses in their rooms?

Lona Mody, a professor at the University of Michigan and head of the research team. She specializes in persistent infections in homes and the elderly. Credit: ONE.

Lona Mody, a professor at the University of Michigan and head of the research team. She specializes in persistent infections in homes and the elderly. Credit: ONE.

English words have many meanings, often unrelated and sometimes contradictory. Depends on the context. The term "bugs" translates as insects. In the context of pubic punches, and for sniper lovers, bug or supernatural is a skilled, intelligent and respectful adversary who can get rid of one life after another. In the hospital sense, the use of the term bugs can be traced back to 1945. Since then, medicine has progressed and for some time the correct description of "drug-resistant microbes" has been used. The situation has recently increased and many of the microbes have nothing to do with medicines. Probably because of the most revolting rebels, the specialists return to the original term and its meaning at the time. The superbugs, indeed the supercomputer, sit perfectly in them. They have lost all respect for the antibiotics in the "last choice" drawer.

Along with the growing number of superstars, there are also losers who went to the hospital with some banality to never come back from there. Fourteen authors from the United States and Switzerland also tried to contribute to the quest for a way out of this embarrassment. A few days ago, the results of his study were published by Clinical Infectious Diseases. Multiple drug resistant organisms in hospitals did not attract any interest. Wrong Although this is not a very fun read, we should all know the facts. In fact, there are some recommendations, but how serious is the current finding: "Of the 100 hospitalized patients, more than a third (39%) have their hands contaminated with life-threatening pathogens within 48 hours of hospitalization." Or: "One in four inpatients have one or more multiresistant bacteria in their hands." If we shorten, the authors make it clear at the beginning of the article that contaminated patients are common practice in hospitals.


Of course it burns those who are more, but we may also be interested in health. First, because you never know when he will be a patient, and even if he is not, the complications of treating others have an impact on the length of stay, and that is what the company is costing and health should deserve it. Team leader and first author, Lona Mody, devoted the cost to a previous separate study. This time she took a different look – the ways in which the disease spreads in health facilities. She discovered this with blemishes from everything the patients come in contact with. Subsequent genetic analysis gave a response to what the microbes they had eliminated.

Critical points have come from testing over time, if you want reservoirs of disease. The bottom line is: The most risky issues are the touches with a bed positioning controller, nursing call buttons and a contact table. But even the curtains that separated the individual patients did not glorify. They provide not only a certain privacy, but also something extra. The authors caution, "The increased risk of spreading the disease comes from things that affect both the hands of patients as well as staff and visitors."

Even the skin in the hands of patients was not left behind by scientists. In other words, what patients are coming into their rooms. Researchers continued to wonder how hand contamination changes within the first 24 hours of arrival. In all cases, the test was performed on newly admitted, randomly selected patients at two general hospitals in Michigan. There were no inferior devices and therefore the results are taken as a mirror for all other hospitals.

The results of the analysis are extremely worrying. In fourteen percent (399 patients), antibiotic-resistant superbugs were present in the hand or nasal mucosa after a very short hospital stay. The fact that they were infected upon their arrival is evidenced by the fact that the same bacterium was present in a third of the things that patients at the hospital have taken. For example, the help call buttons mentioned above.

Another six percent of the patients (those who at the start of the hospital had multiple drug-resistant organisms in their hands) bought them somewhere during hospitalization, and then put them in their hands. Other knowledge is also shocking. Murderous microbes had patients as "undesirable roommates" in one-fifth of the rooms.

So far, the main risk of potential contamination causing serious complications to people treated has been seen by health professionals. But they have long focused all the attention and control. It is correct and primordial, but this study points to the origin of the infections so far neglected. The fact that it is not just wild words that must end up somewhere in the wind is evidenced by specific cases: Six patients who at the time of admission had a serious infection with one of the families MRSA rejects smear tests showed that all had positive tests of MRSA in their hands and that their rooms were also contaminated by the strain that caused serious complications after surgery.

The general public, patients, survivors, … generally does not matter what subgroup specific nullity to their problems, and therefore the concept of superbugs applies to all the dangers that the treatment does not. Logic has it. For example, because all the microbes mentioned here deserve such a nickname. One like the other, in our weakness, is "afflicting our throats" with equal intensity, and we are always worried about life. Perhaps this is why we have recently come across the broader semantic notions (whether original or lay) of the word "superbugs" in professional clinical studies. We also support this concept. To complete, we added that, in the case of Moda and its team, the hospital superbugs were MRSA and VRES.

No one ever saw us in the hospital to wash our hands at the front desk. Having discussed the facts about the management of US medical facilities, handwashing has introduced several hospitals as their standard. Other institutions should follow soon. Australia has also taken a similar route. Some time ago, driven by efforts to improve health facilities there, a national campaign to improve hygiene in the workplace and hospital staff was held. This is followed by a second campaign, which is already targeted at patients.

Ignác Filip Semmelweis, a Viennese physician (1818-1865). First, he noted that the maternal mortality rate was higher in the infirmary where medical students studied to go to the autopsy. His suspicion that the infection was spreading in the hospital was increasing after the death of his colleague Jakub Koleček. He died of an infection after being cut by a scalpel at an autopsy. He formulated the principles of antisepsis, which were effective and became a general hospital standard. Credit: Freelance.

Ignác Filip Semmelweis, a Viennese physician (1818-1865). First, he noted that the maternal mortality rate was higher in the infirmary where medical students studied to go to the autopsy. His suspicion that the infection was spreading in the hospital was booming after the death of his colleague Jakub Koleček. He died of an infection after being cut by a scalpel at an autopsy. He formulated the principles of antiseptic, which were effective and became a general hospital standard valid today. Credit: Freelance.

Of course, there is no time to wash your hands with a sharp lace and there will be no time. Bathrooms and examination rooms are also long under the watchful eye of institutions. A recent test showed that bathrooms are less risky for us than our cell phone. The present study shows that the devil's hull of the hospital is hidden in neglected details. It does not have to be just about the things and equipment of the patients' rooms but also about the cars we rent in the lounge so we can bring our beloved from the parking lot to the reception, or to the waiting room for a specialized examination, .. .

Conclusion

Everything reminds us of the rediscovery of something that Ignác Semmelweis coined in 1851. He introduced a careful washing of the hands, which was made with limestone. Without Semmelweis knowing the causative agent of the disease, he selected his measures for the mortality of the mothers on the youngest fever. He earned the nickname "Protective Mother."

Handwashing and frequent disinfection of everything that patients in the hospital should, in all likelihood, improve the desperate situation in hospitals as well as in modern super-aprons. It will take some time for proper EU machinery to start. But there is no need to rave. To improve the current situation (if similar to the US), it is possible to contribute without guidelines. Not just those who are on the waiting list for surgery and who are fundamentally involved. We can also help improve the situation when we visit someone there. Until now, it was natural to wash our hands after visiting the hospital to get nothing. The latest study suggests that visits, in addition to pleasure, bring more space to patients than flowers and oranges. Virtually every tenth visitor had hands on the MRSA family. Therefore, washing your hands before entering the hospital room should become a natural matter for pure consideration. Regardless of the terms we washed at home. Maybe we pressed a button on the elevator, or the banister was inadvertently stuck up the stairs, a coffee machine down the hall, or a cell phone.

Literature

Lona Mody et al., Multiple drug resistant organisms in hospitals: What are the hands of patients and their rooms ?, Clinical infectious diseases (2019). DOI: 10.1093 / cid / alien092


Glossary

AMR (sometimes only AR) is an abbreviation commonly used for the expression of antimicrobial resistance. It is used in the sense of antibiotic medication that is lost and may be related to both traumas and fungi induced by bacteria, as well as to protozoa.

ABR is a more restricted term – it means antibacterial resistance and therefore is a subset of RAM.

MDR stands for multiresistant and means that the microbe resists not only antibiotics, but also other drugs, such as sulfonamides. Some authors, in addition to the MDR, use another XDR.

XDR refers to a higher form of resistance, not only in the spectrum of antibiotics and other drugs, but also in terms of their doses. In some publications, instead of XDR, the authors use total drug resistant (TDR), but basically the same as XDR. These XDR, respectively TDR, are increasingly dubbed "superbugs".

Not only are microbiologists making new terms. No clinical bacteriologist lagged behind his jargon. In their listings, the most common abbreviations include: MRSA, which means "hospital" Staphylococcus aureus antibiotic resistant to methicillin.

VRE is an expression of enterococci mocking vancomycin. CRE presents microbes resistant to carbapenemia – one of the "last resort" antibiotics in bacterial infections E. coli one Klebsiella pneumoniae. In our bad luck, even in coliform bacteria, cases of "NDM-1 gene" have been described. This gives them the ability to produce the enzyme carbapenemase and allows the user to laugh at this recently effective treatment. And because bacteria like to deal with genes with each other, many infectologists see tomorrow in black. This is because there are currently no new antibiotics in the development process that could counteract a possible epidemic.

RGNB is another term we can find in medical records. It is not intended for a specific disease or a specific bacterium. In the clinic, it is used to obscure some ignorance when the result is related to an entire group of unspecified Gram-negative bacteria resistant to treatment.

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