With drumbeat regularity, reports appear on the emergence and adverse health consequences of environmental microbes resistant to antimicrobial drugs.
I am addressing reports of environmental microbes that infect humans and are then difficult or impossible to medically control or eradicate due to resistance to traditional drug therapy. Worsening rates of human morbidity and mortality often follow.
Indeed, many respected peer-reviewed medical and science journals publish research papers on the subject, especially the emergence of antibiotic resistant bacteria. Newspaper, television, radio and internet media then globally republish the dire results.
Over the years, these reports increasingly follow a similar progression.
The recent reports have been very disturbing.
First, development of drug resistance.
Environmental microbes such as strains of bacteria or fungi are reported as being drug resistant. Often times, the initial identification of such resistance microbes is in hospitals or other healthcare settings.
Estimates are that over 50% of healthcare-acquired infections are by drug resistant microbes.
Second, development of resistance to multiple drugs.
Some drug resistant microbes acquire additional resistances and then become multi-drug resistant. That is these microbes become resistant to more than one antimicrobial. Such drug resistant microbes are often referred to as "superbugs".
Third, spread of drug-resistant microbes in the community.
Many drug-resistant microbes (but certainly not all) emerge in the community and trigger community-acquired infections that are drug resistant.
Some of these drug-resistant microbes developed this resistance in a healthcare setting, and then spread into the community. There are other routes of the emergence of community-acquired drug resistant infections.
Fourth, community transmission is often human-to-human touch, by the hands.
See a previous article by Frank Hang on hand hygiene.
Of course this four-step summary does not apply to all drug resistant microbes that threaten human health. There are plenty of exceptions. But for me, this summary is a good starting point.
Most of us have either experienced a drug-resistant microbial infection, or know someone who has suffered from a drug resistant microbial infection. Or read about someone who has so suffered. It is a distressingly common occurrence.
What am I going to do?
I am not a physician, nor trained professionally in the medial arts, at all. This column is my opinion, not medical advice. Certainly don't follow what I am going to do before you first check it with your own physician.
But from the reading I have done and written about previously in this column, I outline four things I have decided I am going to do.
1. Always Ask About Antibiotic Use Prescribed For Me
The first thing I will do is to insist that any healthcare provider prescribing antibiotics for me is following updated evidence-based guidelines on use of antibiotics for human illness. I will ask.
2. Tighten Up My Hand Washing Protocol
Next, I will more closely follow a schedule for washing my hands.
I will wash my hands when needed. This includes when they are dirty, before I eat, and in those circumstances when I have been in contact with other people.
I will be diligent in washing my hands when out in public. For example, I will wash my hands when entering an office or other business format. And then I will wash my hands when I exit. I will be diligent and wash my hands before and after I shake hands with lots of people in a business or social setting. I will wash my hands before and after public meetings and gatherings.
I will also wash my hands upon entering and leaving my home. Not such a big deal. I take my shoes off when I get home. Going forward, I will also make sure I wash my hands as well.
And this washing will be with hot soapy water, or with an antimicrobial gel.
See a previous article by Frank Hagie on Global Handwashing Day.
3. Ask That Others Wash Their Hands As Well
After much thought, I believe it is socially acceptable for me in certain circumstances to ask others to wash their hands as well.
For example, when a person enters my home (and they take their shoes off), I believe it appropriate that I ask that that they wash their hands as well.
Further, when I am in public or at work, in a professional setting where custom and professionalism welcome a hand shake, I believe it is appropriate to ask that others wash his or her hands as part of the custom. I will wash mine before and after I shake hands.
Or when I am in a business setting where custom and friendship calls for a hand shake, I will wash my hands to possibly protect others. I will ask that others implement the same possible protection for me.
There are many other situations as well where hand washing is appropriate for me, and those to whom I come into contact with in public.
At work I have hand washing gels for use by everybody. I ask that they be used.
4. Ask A Physician If My Program Makes Medical Sense
Finally, during physician visits, I will describe my hand washing program, to see if it makes medical sense. And if it does not based on some recent medical or scientific advance, I will evaluate changing my program
But until then, I will wash my hands in a regular manner to try and protect me, and to try and protect others. As previously reported, it is important.
Yes, you too, please wash your hands.
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