Hospital Terrorist
There is yet another Super Bug amongst the growing list of nosocomial pathogens that are notorious for being resistant to antibiotics. This lad’s name is Pseudomonas Aeruginosa, and although PA is not as popular as his co-conspirator Mrs. A (Methicillan-Resistant Staphylococcus Aureus) he is making up for the lack of press coverage by being a very artful dodger.
This lad is everywhere, in water, soil, on plants and even on some animals. He isn’t fussy about his eating habits as he can survive on 75 different substances, thrives in up to 37′C (98.6′F) weather and doesn’t mind when it gets to 42′C (107.6F’), and he doesn’t even need oxygen to breathe if he has nitrates, and guess where those are? Among many other places they can be found in septic systems and field runoffs that find their way into the waterways. Hmmm, that couldn’t happen anywhere near you could it?
Pseudomonas aeruginosa is the fourth most common pathogen and accounts for 10% of all hospital acquired infections, it is the most common pathogen isolated from patients hospitilized for longer than seven days. He has minimal nutritional needs and this bacterium produces a biofilm that colonizes indwelling devices such as catheters and mechanical breathing apparatae. Case ratio fatalities in patients that are infected with PA who have cancer, cystic fibrosis, or burns is 50%. He can cause septicemia, urinary tract infections, pneumonia, endocarditis, dermatitis, and osteochondritis to mention but a few. He is a most versatile beastie!
P. aeruginosa can be identified by his gram morphology (gram-negative), inability to ferment (lactose or sucrose), a positive oxidose reaction, fruity odour, and flourescence under ultra-violet light in early sightings of colonies and their presence in wounds. He can live in the sinks, on the mops, and in hard to clean instruments, PA can be brought into the hospital by plants and flower arrangements, and especially unwashed hands! While all the scientists are trying to find a cure with chemicals and macrophages, you can eliminate this bio-bad boy with 10 seconds of washing up with soap and water!
He is a common enough creature and does little or no harm to healthy individuals but he is always on the look out for an opportunity to get busy. He can be transmitted around the wards from patient to patient on stethoscopes carelessly utilized and not sterilized by the doctors, personal contact between patients by the staff, he can be picked up from keyboards, phones, and instrument panels, and also from contaminated food and water consumed by an immunocompromised patient. The gift of clean hands may be a more important present to bring to patients than a bouquet of flowers!
The DNA face of PA.
Warning: unverifiable anecdote. A nurse who told me she had responsibility for management of the infectious disease ward of a largish hospital - no names, no packdrill - also told me that the main challenge they had in preventing the spread of infection was getting doctors and nurses to wash their hands. Who woulda thought?
Comment by Des Walsh — July 30, 2007 @ 12:39 am
Yeah Des, it must be frustrating to fight an invisible demon with no one willing to co-operate by simply washing hands!
Comment by Administrator — July 30, 2007 @ 7:02 pm
Yes, Des, it’s all to do with doctors and nurses and handwashing. You’ve neglected the minor issues of overcrowding, antibiotic overuse, and visitors’ lack of handwashing, not to mention a raft of other factors. You’ve also no mentioned the audit carried out by the HSE recently (can’t remember what it’s called, but it’s on the web) which concluded that healthcare workers are pretty good at hand washing. It’s all very well for a nurse to make comments like that, but tracing the source of outbreaks is a complex science. Docs and nurses take enough flak as it is, without being blamed for MRSA too!!!
Dr. Thunder
www.twoweeksonatrolley.blogspot.com
great blog, by the way mate. I’m new to the blogosphere, but I’ll be a regular visitor from now. Keep up the good work
Comment by Dr. Thunder — August 2, 2007 @ 11:58 pm
Thanks for stopping by Doc Thunder and appreciate the comments. There is indeed an audit in the process of being conducted by the HSE and a full report should be published sometime in September. We all need to be more aware of the way these Super Bugs get around!
Comment by Administrator — August 3, 2007 @ 6:46 pm