I would like to bring attention to something that you all may be aware of. That is the frequent occurence of infection by the resistant bacteria, MRSA. This stands for Methicillin Resistant Staphylococcus Aureus. These infections are divided into Hospital acquired and community acquired. Years ago, perhaps traced back to 1999 these infections were only found in the hospital where frequent use of antibiotics and the closeness of sick patients selected this group from the rest of the usual Staph species. These were also that were susceptible to the usually effective antibiotics. Now we are seeing a host of infections acquired in the community and it is clear that this bug is everywhere. Now when persons are admitted to the hospital they are all screened by nasal swab in order to detect possible carriers of this bacterium. These swabs are frequently positive. Hospitals now have policies that are mandated that separate persons who carry S. aureus from persons other patients. Nurses and doctors have to use gloves and gowns. In the office I am seeing many skin abscesses that arise for no specific reason as a red surface, painful boil on the skin. The treatment is to open and drain these. The risk for infections such as these is much greater in immunocompromised persons. Most clearly person with diabetes whose control is not as good as it could be are in that category.. In persons with diabetes, the skin barrier may not be healthy. High blood sugars affect white blood cells that fight these bacteria. Bacteria are everywhere and the likelihood of a bacterial infection is opposed by how intact and effective a persons immune system works. This is helped by hand washing, daily bathing, flu vaccinations, foot care and diabetes control. Many of our Type 1 patients use insulin pumps and even continuous glucose monitors and therefore have these tiny subcutaneous catheters in their skin for a prolonged period of time. With pumps the site is supposed to be changed every three days. I personally have found how important it is to changed these sites and have experienced infections due to prolonged use myself. It is remarkable how important this is for pump infusion sites while with the continuous glucose sensor, the site for that shows so little reactivity and chance of infection even while in for a considerably longer period. The recommended change time is weekly. Insulin injections are very unlikely to get infected due to the brief time for injection in a person who has good hygiene. The same applies to fingerstick capillary blood sugars that we do at home.
The MRSA carrier state is very common and one can carry the bacteria in the nose or on the skin and not have an infection. Carriers may also have increased risk of these infections if they have surgery. MRSA is a common causer of surgical wound infections. There are treatments that can reduce the chance of these causing infection. A type of antibiotic ointment can be applied high up in the nose for 5 days to try to eliminate the carrier state. Hibiclens is a type of antiseptic soap that can be used for bathing and that can reduce the amount of bacteria on the skin. MRSA as well as other resistant bacteria are major problem in hospitals and now in the community and bringing these infections to the attention of the doctor is very important. These bacteria can get into the bloodstream, can cause recurrent skin abscesses and can be transmitted to other persons. There is a lot more to know. You may notice that your doctor does not wear a tie or does not let it fall onto you when he examins you. These ties have be cultured and shown to have bacteria on them . So no tie is not a sign of disrespect. More later