hi,

Carbapenem Resistant Enterobacteria (CRE) and in carbpenem resistant in non fermenting gram negative rods is increasing nowadays. May be this is due to lack of proper antibiotic policy in the hospital setting as well as lack of proper management policy.

Regards,

Dr Anand

As Dr. Anand stated, there may be an issue with proper hygiene control amongst that group of surgeons. Even in teaching hospitals and higher academia like Mass. General and NYP Columbia, people forget to wash their hands between patients and operations. 

Another potential cause is the sheer exposure that surgeons encounter. Their opening of patients and direct manual interaction with potentially infectious tissues can lead to higher prevalence of bacterial species with varying amounts of antibiotic resistance. By bacterial horizontal gene transfer, bacteria can provide each other with new antibiotic resistance genes, forming "super bugs."

No disrespect to any surgeons who do wash their hands properly;with my experience in doing several hand hygiene audits in operating theatres,surgeons are the most non-complaint health professionals in maintaining poor hand hygiene and not adhere to 5 moments of hand hygiene.

Without a doubt the most important factor would be hygiene issues of doctors washing hands as pre mentioned. This is not exclusive for surgeons. Nasal carriage for MRSA for example is also high in other specialties. The main difference is that surgeons have a greater access to open tissues and therefore high infection rates. Even so, proper hygiene might not be the only important step. Regular screening policies for colonization should be performed in all doctors and not only in surgeons.

My opinion coincides entirely with that of Mr.Constantinos Alifieris.

I agree with Constantinos, simple exposure of the surgeon despite cleanliness and a supposedly relatively good immune system, can cause the surgeon to become a carrier. I don't think this is exclusive to Surgical Specialities.

It's a very interesting point Constantinos - having screening can probably reduce MRSA carriers - but would the change be significant?

Superbugs, also known as drug-resistant bacterial infections, can cause infections that are hard to treat.  According to the CDC, health care workers (including surgeons) should keep their hands clean to prevent the spread of MDR bacteria. In fact, surgeons have a greater access to open tissues and therefore high infection rates.

To answer Mark Portelli's question, I believe that screening for MRSA and other bacteria should be performed once a prespecified number of infections have occured in the clinic. Then the personell should be screened. Blind screening does not sound cost effective. But if an outbreak of MRSA cases (or other resistant bugs) occur in a week in a department maybe someone should consider it.