Published October 27, 2005 in issue 0443 of the Hook

BY JOHN HONG, MD

I remember in elementary school, kids would touch each other to spread cooties. However, if you crossed your fingers, you were immune. Once I was tapped with cooties, and I immediately touched a girl and said, "You've got cooties!" She smiled confidently, marked herself with an imaginary "X," and said, "I'm cootie-proof." Hmm... Do cooties even exist?

A nurse at UVA wrote to me about her concern that some family members who visit the hospital get upset if the patient is under contact isolation. "What? I have to wear a mask, gloves, and a yellow gown?" Zsa Zsa Gabor probably would complain, "I'm wearing Chanel. Don't make me cover up, darling."

Hospitals can be a scary place for people, and emotions can run high. Being requested to gown-up to look like an extra from Dustin Hoffman's Outbreak can make people feel like they're in the Rocky Horror Picture Show mansion instead of the hospital.

Why are some patients put under contact isolation? MRSA, VRE, and C. diff. Was ist das?

MRSA is methicillin-resistant staphylococcus aureus-- staph bacteria that doesn't respond to penicillin products. Believe it or not, MRSA was first identified in the early '60s before Julie Andrews won an Oscar for Mary Poppins, and you know Mary Poppins was too spit-spot to ever deal with MRSA.

Thirty to fifty percent of hospital patients are contaminated with MRSA. The other half cross their fingers, hoping not to catch cooties. MRSA is usually transmitted patient to patient by-- well, healthcare workers. MRSA is found on pens, tables, walls, and even ceilings. (MRSA is hanging on the chandeliers!)

That's why I always clean my stethoscope after using it on a patient-- the same way my mother always wiped off the chair with a napkin in a restaurant.

At risk for MRSA are patients with a prolonged hospital stay, who have had antibiotics, have a surgical site infection, or are in an intensive care unit. Those infected with MRSA tend to have longer stays in the hospital because treatment can be tricky.

Family members and roommates of those with MRSA are often contaminated. MRSA loves to live in the nose and can cause resistant sinus and ear infections. MRSA-caused skin infections and abscesses can be very difficult to treat. MRSA that lands on a heart valve or a prosthetic joint can lead to surgery.

MRSA can go away in time, but 40 months is the median time. In the community, there's another version of MRSA-- but how does one prevent spread of that, unless you become The Boy in the Bubble?

VRE is vancomycin-resistant enterococcus. Enterococcus naturally lives happily in the bowels. However, because of increasing antibiotic resistance, it's now becoming resistant to our last-line antibiotic, vancomycin (which also is used to treat MRSA). VRE tends to occur in the hospital. (I hope you don't hate the hospital after this article. While it isn't exactly Oz, it isn't Alcatraz either.) Usually if a person with VRE eats yogurt and takes probiotics, the VRE goes away in a few months.

C. diff is a bacteria also found in many colons. If all the good bacteria in the gut is wiped out by antibiotics and not C. diff, then C. diff causes pseudomembraneous colitis-- i.e. you have severe diarrhea and poop out material that looks like tissue paper. Yes, tissue paper. I'm telling you, the colon is like Wyoming: a wilderness.

So if you're asked to gown up and put on gloves and a mask due to contact isolation, do it not only for yourself but for others. You can cross your fingers for good luck and to keep from catching cooties, but realize doing only that puts you at risk of going up you-know-what creek.

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