Which is better for surgery: soap or bacteria?
Doctors might be better off washing their hands with yogurt instead of relying on antiseptic soap-scrubbing, according to a new discussion paper by a UCL (University College London) researcher.Scientists should investigate whether saturating the skin with 'good' bacteria would offer better protection against deadly germs, says the paper. Professor Mark Spigelman, of the UCL Centre for Infectious Diseases and International Health, is calling for a study to be set up in hospital units in which antibiotics would be banned, to explore alternative health protection measures against MRSA.
Okay, I can go with that. Investigate novel ways to control pathogens. But pretty much after that, he loses me. From the article:
It must be remembered that after almost 40 years, MRSA has not become widespread except in hospitals where we use the most advanced antibiotics and most rigorous antiseptic measures. Why is this? More of the same does not seem to be working – new antibiotics and antibacterial soaps have not stopped MRSA.
Point taken, but community-acquired MRSA is becoming more common, as I mentioned here. While it remains a problem mostly of hospitals, it's spread beyond that.
Inappropriate use of antibiotics remains a major problem, despite our ever-growing understanding of how bacteria behave. For example, any student who has grown bacteria in a lab will know that they generally do not grow on top of one another. So when we wash our hands, we could actually be killing off harmless commensals to the extent that we leave space for other bacteria, such as MRSA strains, to settle."they generally do not grow on top of each other?" I hope he realizes that this happens because of dilution and streaking techniques--in other words, artifacts of how we grow them. (And what does he think colonies are, exactly, except bacteria "growing on top of each other?") Bacteria are happy to grow "on top of each other;" in fact, some of them depend on it. I hope he's head of a little thing called biofilms. But still, despite this, I agree with his assertion that by washing hands, we could be opening up space generally filled by non-pathogenic species for colonization with worse ones, such as MRSA.
Moving on,
Many bacteria that are pathogenic do lose their pathogenic islands or modify them when the need for them disappears. Perhaps here we have an explanation of why MRSA has never entered the community.Hold on--it has entered the community. And sure, sometimes pathogenicity islands or resistance genes are lost, but often, they are not. Anyhoo, he elaborates on this but it seems he doesn't have a very strong grasp on bacterial evolution.
Next, to his suggestions. He says that what must happen is to build surgical hospitals which are antibiotic free and:
1. The hospitals must be stand-alone separate units.
2. The surgeons must not order, or use, antibiotics on any of their patients.
3. No antibiotics can be used in the hospital.
4. A transfer to a hospital where antibiotics are used must be the way to treat wound infections.
5. The surgeons and staff operating in these hospitals should not be permitted to enter or treat patients in hospitals where antibiotics are used.
6. Continuity of care is something that must be sacrificed in this situation as it is for the patients' benefit.
First and most glaring--just because the surgeon may not be treating patients elsewhere where antibiotics are used, he can still be exposed to antibiotic-resistant bacteria. What Spigelman seems to be overlooking (multiple times) is that these *are* out there. Heck, they might be in your next sandwich, or on a doorknob you touched on your way to work.
He wraps up the article by suggesting that surgeons might dip their hands in a solution which contains "harmless bacteria," and even saturate the patients' wounds with it prior to surgery. That sounds like a hugely bad idea. One reason why many non-pathogenic bacteria don't cause disease is because they lack the ability to invade. Throw them on an open wound, and all sorts of bad things are bound to happen, even with "harmless" bacteria.
I'm all for "outside of the box" thinking, but it seems this one is a little bit too far out there to have any chance of success. Indeed, it sounds like it would endanger patients in several different ways.
