OB-GYN-L Messages for October, 2007: Re: MRSA after a c/section-scary

Re: MRSA after a c/section-scary

From: ainsron

ainsron@sbcglobal.net

Mon Oct 29 16:01:23 2007

If I use the sanitizer as I am entering a room, I am rubbing as I enter and approach the patient. If I use it after leaving a room, I am done rubbing by the time I enter the next patient's room.

Ronald E. Ainsworth, MD, FACOG

-----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Meenan, Anna Sent: Monday, October 29, 2007 1:36 PM To: Multiple recipients of list OB-GYN-L Subject: Re: MRSA after a c/section-scary

Well, she has asked some, and some have actually said "oops" and gone back out to do it. I use the hand sanitizer as I enter the room also, and it usually takes about 30 seconds of rubbing to distribute it and get it to dry, which I do as I am approaching the patient and beginning my history. This saves me 30 seconds several times a day and reassures the patient that I have indeed washed my hands. Do you really stand outside the room rubbing your hands waiting for them to dry? My niece reports she never sees anyone come in rubbing their hands.

Re: The handwashing initiative: Given the terrible statistics you get when you actually study the matter at most hospitals, why would your med exec committee vote down something like that? It would be one thing to be annoyed at the idea if it was clear that all physicians were washing their hands all the time, but we KNOW that is not the case. At our hospital we're getting better, but we haven't hit 100% yet, or even close to it.

Anna Meenan, MD

>How does she know they aren't washing their hands? We have waterless soap
>dispensers outside each room, I use it on my hands every time I enter/leave
>a room. The patients have no idea that I am doing that, how could they?
>
>There was a proposal last year for a hand-washing initiative from our
>infection control nurse. Part of it was to empower patients to ask their
>nurse, CNA, physician, etc. to wash their hands when they entered their
>room. It passed surgery committee, which I was chair of, but was voted
down >by the medical executive committee. Other physicians were annoyed at the
>idea.
>
>Ronald E. Ainsworth, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Meenan,
>Anna
>Sent: Monday, October 29, 2007 10:38 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: MRSA after a c/section-scary
>
>Interesting, Art. Oh, and can we please wash our hands more? My
>niece is a patient at a very prestigious hospital in LA-LA land, with
>PPROM at 25 weeks, and NO ONE is washing their hands when they come
>into her room to do patient care activities. I told her to put up a
>sign that says "My paranoid aunt in Illinois wants to know: Did you
>wash your hands?"
>
>Anna Meenan, MD
>
>>Man's best friend?
>>http://www.azcentral.com/news/articles/1028staphinpets.html
>>
>>Art
>>
>>At Sun, 28 Oct 2007, Meenan, Anna wrote:
>>>
>>>I'm pretty sure it's increased incidence, Betsy. I NEVER saw MRSA
>>>outside the hospital or nursing home until 2 or 3 years ago and have
>>>seen LOTS of it since then. A small pimple or folliculitis I would
>>>say observe, maybe put polysporin or bactroban on it, but anything
>>>that reaches a size that could be I&D'd should be I&D'd. I believe
>>>the recommendation is not to use antibiotics once it's been drained,
>>>as that is usually curative, but if there is any significant
>>>surrounding cellulitis, I usually start Bactim. If the patient is
>>>near term and Bactrim is contra-indicated, vanco or gent can be used,
>>>though they will have to be admitted for IV treatment.
>>>
>>>I agree with Steve, the swelling in the incision should have been
>>>I&D'd the first time it was noted, and with temps of 103, the pt.
>>>should have been in the hospital.
>>>
>>>Anna Meenan, MD
>>>
>>>>On Oct 28, 2007, at 12:31 PM, Meenan, Anna wrote:
>>>>
>>>>> If a boil on a healthy 12-year-old kid can be MRSA, why not a
>>>>>swelling in a post-op wound?
>>>>>
>>>>I don't know if the increased reporting on community-acquired MRSA
>>>>represents increased incidence or just increased
>>>>recognition/reporting.
>>>>
>>>>I know that I frequently have patients who complain of a pimple or
>>>>folliculitis. If there is not a large area of induration, I just
>>>>tell them to use warm soaks and otherwise leave it alone. If
>>>>community aquisition of MRSA is increasing, should there be greater
>>>>investigation of these lesions?
>>>>
>>>>What are others doing?
>>>>
>>>>Betsy Hyde CNM
>>>>Branford, CT
> >
>>--
>>art fougner, md
>>"May The Wings of Liberty Never Lose a Feather." - Jack Burton

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