Worried about superbug? Wash your hands

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Worried about superbug? Wash your hands

By: GIG CONAUGHTON - Staff Writer
Last modified Saturday, October 20, 2007 10:39 PM PDT

SAN DIEGO ---- If you've got a cut or scrape, keep it clean and bandaged. Try not to share a towel at the gym, or shaving razors at home. Don't assume that a red spot is just a spider bite. When you're at the doctor's office, or hospital, look for that germ-killing, sanitizing hand gel.

Mostly, wash your hands ---- a lot.

That was the advice from doctors and nurses last week in the wake of a new report saying the "superbug" known as methicillin-resistant Staphylococcus aureus, or MRSA, has become a major public health problem, not just in hospitals and nursing homes where it sprang to life, but everywhere.

The report, compiled by researchers at the federal Centers for Disease Control and Prevention in Atlanta, estimated that 94,000 people in the U.S. suffered attacks from the bacteria in 2005 and nearly 19,000 died from it ---- even though the bug can be treated with certain antibiotics.

The report was issued just days after a Virginia high school student died from the germ and 21 schools there were closed for a cleansing campaign. In San Diego County, a 12-year-old Ramona boy died in February after being infected.

No surprise

The latest CDC report shows that there were three times as many infections in 2005 as the agency reported in 2000. Health officials said they were hardly surprised by the findings that the bug is more widespread, even outside of hospitals.

Joyce Agorrilla, the infection control nurse for North County's Palomar Pomerado Health, said the report was old news and that she sees about five patients every day with the bug ---- hospital patients, but often also young people with scrapes or cuts in the emergency room.

Dr. Gonzalo Ballon-landa, an infectious disease doctor with ScrippsHealth, and chairman of the San Diego County Medical Society's Group to Eradicate Resistant Microorganisms, said the group has talked about the staph infection being an increasing problem in area communities for years.

"Three years ago, we sent out an alert about the fact that spiders in San Diego County were getting a bum rap," Ballon-landa said, referring to a leaflet saying that doctors were seeing rampant increases in numbers of spider-bite victims. "They're not spider bites. They're MRSA boils."

The superbug bacteria can cause relatively minor infections, but can also grow into serious life-threatening infections affecting organs and limbs.

On the rise

The latest CDC report used a different methodology than past studies, this time extrapolating data collected from nine locations to create estimated numbers of incidents and deaths, rather than counting actual incidents. Still, health care officials said they believe the new report is more accurate.

The report appears to show an increase in the superbug ---- something that health officials have feared for decades ---- because the bacteria, now treatable with only a small number of antibiotics, could continue to evolve and become even more resistant.

In addition to the estimates of 94,000 sick and 18,600 dead in 2005, the report also suggested that roughly 32 of every 100,000 people could have serious superbug infections.

By comparison, the 2005 incident rate for HIV/AIDS in the United States was 16.6 people per every 100,000 persons.

The new study focused only on serious, "invasive" infections: those in people's blood, spinal fluid, or around hearts, livers, spleens, lymph nodes, kidneys, other organs, joints or bones.

Finally, the report said that while most of the people who got sick were still tied to the health care system ---- either they were in hospitals where they could be exposed, or they had been in hospitals in the last year ---- about 14 percent of all cases were springing up in communities on their own.

Evolving danger

When penicillin was created in 1939, it quickly became the new antidote to infections that, until then, had no defense. Either patients died, or recovered on their own.

But eventually, doctors realized that some Staphylococcus bacteria were becoming immune. In 1960, methicillin was introduced as a new antibiotic to fight infections. But, again, within a year, the first strains of methicillin-resistant Staphylococcus were discovered. The first documented outbreak in the United States was in 1968.

Until the late 1990s, invasive infections were only found in hospitals, nursing homes and other health care facilities where people routinely had invasive procedures such as dialysis and surgical procedures.

But in recent years, the bug has been increasingly springing up in communities outside hospitals ---- in gymnasiums, prisons, and elsewhere.

There have been many suggestions as to how the bug has evolved. Agorrilla, the infection control nurse from Palomar Pomerado Health, and Susan Trout, an infection control practitioner at Oceanside's Tri-City Medical Center, said many experts believe that the improper use of antibiotics has been key in allowing the germ to gain strength.

When people are prescribed antibiotics, they don't always take their entire prescribed dose, they said ---- weakening the bacteria but not killing it, allowing it to grow resistant.

Overuse

Ballon-landa from Scripps has a different view. He said the rampant, "inappropriate, injudicious use" of antibiotics ---- not whether the treatment has run its full course ---- has allowed the bacteria to grow resistant.

"Parents take their kids to the doctor with a fever," he said, "and by golly, they're demanding antibiotics, and the doctors prescribe them. Whenever there is stress on nature, it reacts in equal and opposite force. My old professor always used to say, 'We keep building bigger mousetraps and they keep building bigger mice.' "

Others have suggested that the use of antibiotics on livestock to help animals grow faster has helped spread the bug.

What health officials do agree on is that the bug is prevalent. Many healthy people carry it in their noses, or in other body cavities, without ever knowing it, or suffering a symptom. Those people can pass it on to others through contact.

It can create infection ---- and sometimes havoc ---- when it gets into an open wound, scrape or cut, or when a person's immune system is weakened.

Protection

In recent years, some hospitals across the country have started to take nasal swabs from every person entering the hospitals to try to head off problems with staph infections.

Palomar Pomerado Health and ScrippsHealth officials said they do not do that. Agorrilla said Palomar Pomerado routinely checks patients who have blood or urine cultures done. ScrippsHealth officials said they run tests on all intensive care unit patients. Tri-City officials would not comment on their measures.

In addition, the hospital officials said they've taken steps to improve hygiene in recent years. Purifying hand gel dispensers are in patient rooms and all around facilities. When a patient tests positive for the superbug, they are isolated. When doctors, nurses ---- and even visiting family members ---- go into the patients' rooms, they wear masks, gowns and gloves.

Public hygiene

Local officials said the public should also increase its hygiene, and vigilance.

Ballon-landa said one of the best things people could do was to stock up on, and use alcohol-based hand sanitizers.

"They're extremely efficient at killing the bacteria," he said. "People can carry (sanitizers) in their purse or pocket."

Experts also said that because the bug is prevalent, and can be passed so easily, people should make sure to wipe off exercise equipment when they're working out at community gyms; that they shouldn't share towels and other personal use items, even at home; and that they should wash their hands after using the restroom or touching a wound.

Ballon-landa said there was no need for the public to panic. He said if people noticed what they thought was a spider bite, or a cut or scrape that seemed to get more inflamed, rather than heal, in the first two days, they should see their doctors.

Overall good hygiene, he said, was still the best way people could protect themselves from all kinds of maladies ---- from the flu to the superbug.

"We should be much cleaner in general, from cleaning our homes to washing our hands." Ballon-landa said. "How often do we go into a bathroom and see someone rush out without washing? We have to be much cleaner."

Contact staff writer Gig Conaughton at (760) 739-6696 or gconaughton@nctimes.com.

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