Balancing the "yuck" factor

Periodically, we see bold headlines in the print and electronic media alerting us to a "new" infectious public health threat.

For more on this topic, go to www.dentaleconomics.com and search using the following key words: infection control, public health threat, infectious diseases, virus, Dr. John Molinari.

Periodically, we see bold headlines in the print and electronic media alerting us to a "new" infectious public health threat. The articles that follow often describe tragic cases of individuals who were infected and later died from an emerging, highly pathogenic microorganism. We have witnessed many of these recently, including

  1. severe acute respiratory syndrome (SARS) primarily transmitted by aerosolized droplets and close contact with persons shedding the virus;
  2. methicillin-resistant Staphylococcus aureus (MRSA) acquired from contact with contaminated hands, other surfaces, and chronic nasal carriers;
  3. the increasing global incidence of multidrug-resistant tuberculosis due to poor compliance with treatment regimens;
  4. infection with antibiotic-resistant, bacterial, gastrointestinal infections after preparing chicken and not washing hands;
  5. seasonal and pandemic influenza viruses spread by airborne spatter from coughing, sneezing, and even speaking.

Infectious diseases described during the past four decades include those caused by newly discovered microbial pathogens, reemergent infections with drug-resistant strains, and infections that have become increasingly resistant to previously successful antimicrobials.

As more becomes known about the etiologic bacteria, viruses, or other microbial forms from clinical and research investigations, we can characterize them to ascertain how they survive in various tissue and outside environments, how they are transmitted to susceptible people, symptoms and manifestations of clinical disease, effective treatment approaches, and how to best use infection-control precautions to protect ourselves.

As expected, health-care workers (HCW) have continued to respond to these challenges by using effective preventive practices and protocols designed to protect against occupational exposure and infection. While renewed emphasis on the importance of hand hygiene, sterilization, disinfection, and other preventive measures often includes specific reference to highly publicized pathogens, long-standing basic principles continue to be used effectively.

However, we often are so involved in what we routinely do for infection control that it is possible to overlook the extent of an inquisitive public’s response. Think about it. A few years ago, concerns and fears stemming from reports describing fatal metastatic MRSA from initial pyodermas, which initially looked like small spider bites, caused a stampede to hospital emergency rooms by people who – you guessed it – had spider bites.

Most of us know individuals who are constantly wiping off and disinfecting virtually anything that is touched – purses, wallets, phones, and pens handed to us by others. For most, this is meant to be conscientious in reducing the potential for cross-contamination and cross-infection with microbes we are warned about. In a more progressive scenario, though, the overzealous person begins looking for ways to eliminate all microorganisms.

The thought that bacteria are present on objects, skin, or inanimate surfaces sets off a "yuck" reaction. In one example, a misperception has found its way into the public consciousness that all skin bacteria are life-threatening pathogens.

Recent information from opinion polls taken to gauge the extent of this public concern found that one in 10 people will not shake hands as a form of greeting for fear of becoming contaminated with unknown microorganisms (I have been on the receiving end of this behavior a few times), and more than 60% of persons interviewed said they avoid touching handrails or door handles in public areas. An increasing number of individuals admit to only using products at home that are marketed as antimicrobial.

Health professionals can be helpful in alleviating excessive fears. Included among things that can be discussed are:

  • Contact with multiple types of microbes frequently occurs, which in most instances is harmless.
  • We would not survive without the benefits provided by our normal, commensal microflora on epithelial and other body tissues. These provide a crucial, nonspecific defense against external, transient microorganisms that can cause disease and serve as a constant stimulus to our immune system. This keeps it primed against possible nonhost pathogens.
  • Assist in understanding the role of hand hygiene, the fundamental infection-control precaution, by washing hands properly or using waterless hand sanitizers to minimize cross-contamination. It may also be useful to relate that multiple clinical studies demonstrate that increased compliance with hand hygiene protocols was associated with a decrease in hospital-acquired (i.e., nosocomial) infections.

Continue to reenforce the correct messages to those who expect appropriate information from us. Appropriate precautions should be balanced by reason. Life is not germ-free, nor should it be.

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