You may have heard a discussion on NPR yesterday about MRSA.  (Methicillin-resistant staph aureus, to friends.  A nasty bug that causes nasty infections, and is hard to kill.)  As an ER nurse, I'm acutely aware of this issue, dealing regularly with the painful (and costly) incision of MRSA abscesses. 

While medical and housekeeping staff, and state inspectors,  have good intentions, I see glaring gaps in how sanitation is approached. 

The primary reservoir for MRSA seems to be in nostrils (warm, moist, frequently touched by fingers.  Well, in SOME people. . .  )

MRSA is, clearly, spread primarily by hands - either contacting other hands or touching surfaces that other hands touch.  Yet the emphasis on between-patient cleaning is on mattresses, pillows, floors, and tables.  Less commonly bedrails, and rarely pulse-oximeter probes (the little clip that reads your oxygen level from your fingertip), doorknobs, monitor buttons, or computer keyboards cleaned.

MRSA can live for several days on a surface after deposited there by hands.

At a recent state survey of a hospital where I was working, the inspectors required that plastic blood pressure cuffs be discarded after each pt (they could easily have been wiped down), and went so far as to require triage nurses to write the patient's name on each one with a Sharpie marker.  On their next visit they inspected the garbage cans to ensure that we were tossing out one reusable cuff per patient (don't EVEN get me started on how environmentally criminal this is), but made no mention of pulse ox probes, which are routinely placed on finger after finger without cleaning.  Many of those fingers have. . . how can I put this delicately?. . . been inside noses, a hotbed of MRSA colonization. 

It seems to me a major education of infection control staff and, through them, hospital staff, is in order.  I've talked this stuff up, to sometimes-glazed eyes.

Here's what would happen, if I ruled the world:

Pulse oximeter probes would be cleaned with an alcohol swab after each use.

Bedrails, doorknobs, computer keyboards, IV poles, monitor controls, chart holders, pens - anything that numerous hands touch - would be cleaned regularly.  If possible, every time they are touched.

Patients who are given a clipboard and pen to sign out would first be asked to use hand sanitizer.

Of course, much of this would be irrelevant if all staff (including - dare I say it? - physicians) would be diligent about using hand sanitizer after EVERY TIME they touch someone or something.  It's not hard, if it's available.  Which, alas, it often isn't - this leads me to believe that staff aren't using it and don't notice that it's absent.

I'd also like to see research into using heat to treat MRSA infections, as an alternative to the ever-enlarging list of drug-resistant antibiotics.  In my own experience, I've never seen it fail for superficial skin infections  - a wet washcloth in a Ziploc baggie, microwaved for 15-20 seconds, applied every hour at the first sign of infection.  It needs to be as hot as you can stand it without burning the skin.   Great caution would be required in those with sensory impairment to prevent burns, but I think research could determine the optimum temperature for effectiveness without damage.  There is, of course, not much money to be made in researching this.  Wait. . .  Ziploc?  Oh Ziploc? ? ?