Working in the health care setting is potentially risky business, particularly when it comes to possible exposure to infections. Nurses frequently approach me with questions regarding their risk of getting an infection from a patient.
This week, a nurse asked me how was it that she had not already been infected with MRSA (methicillin resistant Staphylococcus aureus), given that she takes care of patients with this infection almost on a daily basis.
In the hospital, when a patient is suspected of having, or has been diagnosed with an infection caused by a resistant bacteria, special isolation precautions are instituted. This entails persons caring for them wearing gowns and gloves, to prevent the resistant germs from getting onto their skin and clothing, and then being transmitted to other persons, including other patients in the hospital.
Of special concern, is transmission to other patients, since sick people in hospital are weaker generally, with weaker immune systems, and so they are less able to resist infections.
What happens when it takes us 3 to 5 days to find out that a patient has an infection with a resistant organism? In that period of time, surely, exposures to that ‘bad bug’ could have occured. But, we don’t see doctors and nurses coming down with these resistant infections on a regular basis.
How is it that healthcare workers do not constantly come down with infections from their patients?
1 – Hand hygiene
We do not come down with infections, because for one, healthcare workers are, for the most part, very particular when it comes to hand hygiene. Most of us are careful to wash or sanitize our hands before and after caring for patients.
2 – Good health
Healthcare providers are generally healthier than their patients. You have to have a certain level of health to be able to care for very sick people, lifting and bathing them etc, for 8-12 hour stretches. A healthy person automatically has a stronger immune system, and therefore is able to fight infection.
3 – No foreign devices going into the body
Healthcare providers do not have tubes in veins, arteries, the stomach, urinary bladder, etc. These tubes, which many hospitalized patients have, serve as entry points for infection into the body.
4 – Unlikely to be on repeated courses of antibiotics
Healthcare workers, because they are relatively healthy, are less likely to have been on multiple courses of antibiotics. Repeated courses of antibiotics (experienced by many people sick enough to be hospitalized) results in killing of good bacteria in the body. When most of the good bacteria are killed, the balance is thrown off. With this imbalance of the body’s ‘microbiota’ as it is called, it means that resistant ‘bad bugs’ have less competition, and therefore are better able to thrive, on the surface of, and within the body.
5 – Good hygiene
Whereas sick patients are often unable to get thorough showers/baths (meaning that bacteria can overgrow in various body creases), healthcare workers are able to clean up after getting home from their shifts. As simple as this may sound, bathing after work, results in a reduction in the load of any bad bacteria that may have gotten onto the body, before these bacteria are able to multiply, and ultimately cause infection.
Sometimes, healthcare workers do become ‘colonized’ with resistant bacteria such as MRSA. Colonization with MRSA means that it (MRSA) essentially ‘hangs out’ on the skin and in the nostrils, in balance with the other germs naturally present in these areas. It does not invade to cause actual infection. Colonization with MRSA can last for months, then resolve spontaneously.
Colonization with resistant bacteria can be on and off and it is not possible to say, precisely, who will become colonized. However, the 5 factors mentioned above decrease the likelihood, and duration, of colonization with resistant bacteria.
The discussion above pertains mainly to bacterial infections. Viral infections are a little different in that they are transmitted mainly by airborne droplets. So if a patient with a viral infection such as influenza or RSV (respiratory syncytial virus), for example, coughs in close proximity to a healthcare worker, it is very possible for the infection to be acquired. Fortunately, there is a vaccination against influenza to protect healthcare workers, and everyone else. For other viral infections, if suspected, surgical masks are worn to reduce risk of infection.
Though healthcare workers are constantly exposed to bad bacteria from infected patients, most of us will never succumb to infections with these bacteria. This is because we frequently wash our hands, we are generally in good health, we are unlikely to have tubes and other devices invading our bodies, the good bacteria in our bodies that help resist infection, have not be depleted by multiple courses of antibiotics, and lastly, we maintain good overall hygiene.