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Be careful what you look for
AJI¢ April 2001
1 3 2 Letters to the Editor
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4. 5.
mial pathogens in the intensive care unit. AJIC Am J Infect Control 2000;28:465-70. BardeyJ. Water issues in healthcare. In: Pfeiffer JA, editor. APIC text of infection control and epidemiology. Washington (DC): Association for Professionals in Infection Control and Epidemiology,Inc; 2000. p. 78-84. NeelyAN, MaleyME Warden GD. Computerkeyboards as reservoirs for Acinetobacterbaumannii in a burn hospital. Clin Infect Dis 1999;29:1358-9. NeelyAN, Maley ME Survivalof enterococci and staphylococci on hospital fabrics and plastic. J Clin Microbiol2000;38:724-6. NeelyAN. Asurveyof gram-negativebacteria survivalon hospital fabrics and plastics. J Burn Care Rehab 2000;21:523-7.
doi: 10.1067/mic.2001.114664
BE C A R E F U L W H A T YOU L O O K F O R
To the Editor: One of the i m p o r t a n t lessons I l e a r n e d i n m y early days as a n infection control professional was to ask two i m p o r t a n t questions to persons who wanted to culture floors, walls, doorknobs, etc. The first q u e s t i o n is "What are you looking for?" The second is "What will you do if you find it?" This usually ends the h u n t for h i d d e n pathogens that are thought to be c a u s i n g everyt h i n g from sinusitis to surgical w o u n d infections. Recently, I was not i n the decision-making loop w h e n the request was m a d e to screen patients a n d staff for drug-resistant organisms. I work for a tertiary care hospital that established a referral p r o g r a m with a n island nation. Patients are sent here for complicated medical a n d surgical procedures, a n d o u r physicians go there to see patients. The referring c o u n t r y has n o t seen m u c h in the way of vancomycin-resistant Enterococcus (VILE) a n d methicillin-
resistant Staphylococcus aureus (MRSA). They would like to keep it that way. We were requested to screen all patients r e t u r n i n g h o m e for MRSA a n d VRE a n d all surgeons w h o travel there to treat patients. I m a g i n e my surprise w h e n I received a report of "Many VRE" cultured from a rectal swab from one of o u r young, healthy surgeons. I i m m e d i a t e l y called the referring Infection Control D e p a r t m e n t a n d asked t h e m m y seco n d question, Now what? Will you deny this talented surgeon with a perfectly low surgical w o u n d infection rate privileges to practice at your facility? We certainly w o u l d not a t t e m p t to eradicate c o l o n i z a t i o n in this y o u n g m a n , n o r could we. The a n s w e r was perfect... "We never h a d a case of a doctor who was positive for VRE carriage, we don't k n o w what to do. We'll call you hack." As I sat next to m y telephone a n d p o n d e r e d this situation, I b e g a n to recall the furor a few years back a b o u t testing surgeons for HIV after the case of the dentist i n Florida who t r a n s m i t t e d HIV to some of his patients. W h e n the dust settled, it was clear that good infection control practices are i m p o r t a n t here (ie, S t a n d a r d Precautions). My early teachers were so right...be careful what you look for, you m i g h t just find it...and t h e n w h a t will you do with it? I c o n t i n u e to wait for a call from this small island n a t i o n to a n s w e r m y questions. Sandra Willey, MT(ClC) InfectionControl Officer Lahey Clinic Burlington, Massachusetts doi:10.1067/mic.2001.110778
1 3 2 Letters to the Editor
2.
3.
4. 5.
mial pathogens in the intensive care unit. AJIC Am J Infect Control 2000;28:465-70. BardeyJ. Water issues in healthcare. In: Pfeiffer JA, editor. APIC text of infection control and epidemiology. Washington (DC): Association for Professionals in Infection Control and Epidemiology,Inc; 2000. p. 78-84. NeelyAN, MaleyME Warden GD. Computerkeyboards as reservoirs for Acinetobacterbaumannii in a burn hospital. Clin Infect Dis 1999;29:1358-9. NeelyAN, Maley ME Survivalof enterococci and staphylococci on hospital fabrics and plastic. J Clin Microbiol2000;38:724-6. NeelyAN. Asurveyof gram-negativebacteria survivalon hospital fabrics and plastics. J Burn Care Rehab 2000;21:523-7.
doi: 10.1067/mic.2001.114664
BE C A R E F U L W H A T YOU L O O K F O R
To the Editor: One of the i m p o r t a n t lessons I l e a r n e d i n m y early days as a n infection control professional was to ask two i m p o r t a n t questions to persons who wanted to culture floors, walls, doorknobs, etc. The first q u e s t i o n is "What are you looking for?" The second is "What will you do if you find it?" This usually ends the h u n t for h i d d e n pathogens that are thought to be c a u s i n g everyt h i n g from sinusitis to surgical w o u n d infections. Recently, I was not i n the decision-making loop w h e n the request was m a d e to screen patients a n d staff for drug-resistant organisms. I work for a tertiary care hospital that established a referral p r o g r a m with a n island nation. Patients are sent here for complicated medical a n d surgical procedures, a n d o u r physicians go there to see patients. The referring c o u n t r y has n o t seen m u c h in the way of vancomycin-resistant Enterococcus (VILE) a n d methicillin-
resistant Staphylococcus aureus (MRSA). They would like to keep it that way. We were requested to screen all patients r e t u r n i n g h o m e for MRSA a n d VRE a n d all surgeons w h o travel there to treat patients. I m a g i n e my surprise w h e n I received a report of "Many VRE" cultured from a rectal swab from one of o u r young, healthy surgeons. I i m m e d i a t e l y called the referring Infection Control D e p a r t m e n t a n d asked t h e m m y seco n d question, Now what? Will you deny this talented surgeon with a perfectly low surgical w o u n d infection rate privileges to practice at your facility? We certainly w o u l d not a t t e m p t to eradicate c o l o n i z a t i o n in this y o u n g m a n , n o r could we. The a n s w e r was perfect... "We never h a d a case of a doctor who was positive for VRE carriage, we don't k n o w what to do. We'll call you hack." As I sat next to m y telephone a n d p o n d e r e d this situation, I b e g a n to recall the furor a few years back a b o u t testing surgeons for HIV after the case of the dentist i n Florida who t r a n s m i t t e d HIV to some of his patients. W h e n the dust settled, it was clear that good infection control practices are i m p o r t a n t here (ie, S t a n d a r d Precautions). My early teachers were so right...be careful what you look for, you m i g h t just find it...and t h e n w h a t will you do with it? I c o n t i n u e to wait for a call from this small island n a t i o n to a n s w e r m y questions. Sandra Willey, MT(ClC) InfectionControl Officer Lahey Clinic Burlington, Massachusetts doi:10.1067/mic.2001.110778