Re: MRSA after a c/section-scary
From: art fougner, md (evsono@pipeline.com)
Tue Oct 30 09:40:22 2007
Your skin infections ... in pictures.
http://www.visualdxhealth.com/
Art
At Tue, 30 Oct 2007, art fougner, md wrote:
>
>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
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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