Re: MRSA after a c/section-scary
From: art fougner, md (evsono@pipeline.com)
Tue Oct 30 08:59:57 2007
Anna
Apparently Lady Macbeth was right!
http://www.nypost.com/seven/10302007/entertainment/health/the_soap_dish.htm
Art
At Mon, 29 Oct 2007, Meenan, Anna wrote:
>
>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
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
