under the microscope
By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc
Sitting at the Intersection of Microbes
and Surfaces
I n
the coming months, this column will explore the
imperatives relating to microbiology and its importance
and application in the real-world healthcare environment,
especially as it relates to surfaces, and the roles they play in
pathogen transfer. I will also feature a monthly microbe on
the growing list of deadly antimicrobial resistant microbes.
This past week, I received my weekly phone call from
my parents. My dad is a retired railroad conductor and one
of the strongest people I know. My siblings and I grew up
hearing him often say to us, “I don’t have time to be sick,”
as he headed out on another train trip. Like many of us, our
parents are our heroes. We think of them as being invincible
– until they are not.
Being a railroad conductor was a great career for my
father. In my hometown of Smithville, Texas, most men
wanted the job because it provided a strong and steady
income for a family. It allowed my mom to be a stay at home
mother who raised the three of us – also a full-time job! A
railroad conductor is the boss of the train, not the engineer.
Dad worked when there was still a caboose at the back of
the train and I still remember the vivid stories of him telling
us about “jumping on and off” of the caboose to walk the
train for inspection. Unfortunately, those long walks past
hundreds of railway cars meant that he was often walking
at odd angles in hard rock. Well, 30-plus years of doing that
wore out his knees and his ankles.
Finally, it became too much to bear and he received a
medical retirement in his late 50s. A great career, yet one
that took a terrible toll on his body. Last night, dad called
to let me know that one of his feet had been bothering him
again. What started as a small “corn” on one of his feet
opened up and started draining blood. My father knows
what this means, as he has had one knee replacement
and multiple surgeries on both ankles to fuse bones with
screws and pins.
He has now become my student with respect to trying
to understand what the difference is between “regular
staph infections versus MRSA.” Dad has been in and out
of the hospital the past several years receiving everything
from incision and drainage procedures to full-blown surgery
to remove an infected toe, tissue and bone. He and Mom
have had long discussions with me about infection control
in the healthcare and home/community setting because
all #SurfacesMatter in the new post-antibiotic world of
#superbugs and #antibioticresistance (#amr). It saddens
me to see the confusion and sometimes surrender on their
faces due to “another infection.” While I cannot prove it, my
professional opinion as an infectious disease microbiologist
and medical laboratory professional leads me to believe that
his problems started with the metal components inserted
8
into my dad’s knee and/or feet years ago – you see, ALL
surfaces matter ALL the time.
Staphylococcus skin infections and the emergence of
methicillin-resistant Staphylococcus aureus (MRSA) are a
major health concern. Staphylococcus aureus and other
species are typical normal flora for human skin. For the
average person, this means that you have bacteria growing
on your body and it is normal. Normal flora grows on/in
you and often can be a symbiotic relationship. However,
complications can arise if the bacteria enter the host through
breaks in the skin. Whether exposure leads to infection
depends on several factors: bacterial virulence; overall host
status; amount of exposure or infectious dose; and the time
of exposure as longer exposures increase the chance that
bacteria will gain entry. Should entry occur and the host’s
immune system become overwhelmed, symptoms can range
from a minor skin infection to serious systemic infection. In
some cases, severe infection can result in death.
MRSA first emerged as a serious infectious threat in the
late 1960s as the bacterium developed resistance to the
synthetic form of penicillin known as methicillin. In fact, even
the discoverer of the miracle drug penicillin in 1928, Alexander
Fleming, observed resistance to his wonder drug and warned
society in the 20th century. Unfortunately, we did not listen.
Although Staphylococci bacteria commonly colonize the
skin of healthy people, often posing little to no threat, these
bugs are quick to exploit any opportunity to invade wounds,
nasal passageways or mucosal membranes where they can
rapidly produce infections that can become life threatening.
It is not surprising that MRSA has been the focus of intense
scientific and political interest around the world and has
frequently been labeled as a superbug in the popular media.
This tiny, microscopic organism is just one of many that
have become resistant to commonly prescribed antibiotics.
It can also remain viable for extended periods of time
on different surfaces in the community and healthcare
environment.
A perfect storm waiting for its next unaware victim,
like my dad.
Join me in the coming months as I begin to show you
what’s behind the curtain and Under the Microscope with
respect to these deadly and often hidden microbes that can
take a terrible toll on us and our loved ones.
Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM,
FACSc, serves as chair and professor of the Clinical Laboratory
Science Program at Texas State. He also is a member of
the board of directors of the Healthcare Surfaces Institute.
Follow him on Twitter @RodneyRohde /@TXST_CLS, or on
his website: http://rodneyerohde.wp.txstate.edu/
october 2019 • www.healthcarehygienemagazine.com