Monday, August 23, 2010

Bring on those Germs!!!

My grandmother immigrated to America by boat as an infant. She told me that she was sick the whole way and that her mother expected to find her dead every morning of the trip.

She then lived a healthy life. In the days of quarantine for things like scarlet fever, she was the one to deliver food and supplies to the isolated household because it was generally known that she never got anything. She died a few months short of her hundredth birthday.

I was reminded of that by an essay forwarded to me by David Keith of Ocala, Florida, with whom I share two grandsons. The author is his friend nurse Wendie Howland who wrote in response to a discussion that had appeared in the publication NurseNet.

The essay was in response to a discussion on the NurseNet about egregious sanitation practices some members had observed. Here it is as it originally appeared in NurseNet and in the Paradigm Bytes (http://paradigm97.blogspot.com:

You know, I hear you about the hospital vignettes, and we should always continue to do all we can to protect people who have indwelling lines, immune weakness, and other well-known risks for iatrogenic infection with the nasty bugs we warehouse in our hospitals.

However, the other vignettes give me pause. Assume for the most part that the writers have been buying food at those counters or restaurants for most of their adult lives, perhaps feeding children with those foodstuffs, and so on. Now, how many deadly illnesses did they contract in these seething slurries of germiness?
There are plenty of studies to show that children who grow up with pets have fewer illnesses and fewer allergies. In the developing world, the incidence of pediatric atopy and asthma skyrockets in one generation after pinworms are eradicated from schoolchildren-- but not in untreated adults or neighboring populations who still carry their normal commensals. Every first grade teacher can tell you which kids didn't go to preschool-- not because they don't know their numbers or letters, but because they spend their first year in a mixed population getting sick. In a recent cholera outbreak in a resort area in Indonesia, about 200 people were affected, and the only ones that died, that did not respond to ordinary IV fluids and support, were the Japanese, that notoriously germ-phobic culture, where every piece of clothing you can buy comes with embedded antimicrobials, where people wear masks on the subway, and doctors don't tell you what your diagnosis is. Many, many studies show that the majority of people, men and women, do not wash their hands after handling or wiping their genitals in the toilet. If so, since we are in constant contact with humans, how come we aren't all down for the count with GI disease ALL THE TIME? Don't even get me started on our favorite germ-swapping practices, all related to reproduction and all pleasurable. There's probably a reason for that.

More studies are indicating that the immense numbers of chemicals, including antimicrobials, we are exposed to are --gee, I know this will come as a shock-- BAD for us. The tremendous growth of resistant organisms-- heard of that? "Kills 99.5% of household germs!" What are those other ones doing? Multiplying, that's what.

So you ask for an extra napkin to put your silverware on after somebody wiped the table and the banquette with a rag? Who handled that napkin between the dryer and your table, and how? So you put your silverware on the edge of your plate instead of your table? Who handled the edge of that plate? Or the silverware, for that matter? So you think there are "butt germs" on the vinyl banquettes at the Country Buffet? Does your butt slide onto them, and then do you touch your pants, or your purse, or the car seat that your pants just sat on after your meal? Does your hand that helped you slide into your booth then touch the salt and pepper? Did the hands of the people who sat there before you arrived? Do you touch the rails on stairs, the buttons on elevators, try on clothes in department stores? Do you just get the sterile ones, or maybe did someone else touch them too? What did they do with their hands before that?

You can see where I'm going with this. Actual pathogens are bad. I'm not advocating that we should go back to wells on the street corners that dispense hepatitis and typhoid with every bucket. I'm not saying we take Semmelweiss and Pasteur out of the medical and nursing curricula. I'm not saying we shouldn't change enteral feeding bags really often, give up scrubbing before surgery, forget glutaraldehyde in the endoscopy suite, use linens from off a hospital floor, or save money in Surgicenters by making single-use vials and lancets multi-use.
But honest to god, this phobia about germs, all germs, is ridiculous. There's increasing evidence that your gut and skin bacteria (and BTW, how did they get there and from where, huh?) have beneficial effects. People evolved to live with commensals like pinworms; our immune systems are built and maintained to work with that. If you don't let them do what they are on guard to do, they are weakened when we need them, and they go looking for something else to do, and that's when the trouble starts.

Maybe we should start a campaign to have people STOP washing their hands so much, in the interest of the overall public health. Boost the collective immune system, and the whole population benefits. It's what immunization was before Jenner-- exposure to germs makes your immune system make antibodies. So get out there-- pick your nose, scratch before you make dinner for your family, stick your fingers in the batter to taste it, then do it again. Pat the dog, then form the meatballs and roll out the pie crust. Don't panic if your kid has a permanent snot-nose the first three years of her life-- she'll probably never be sick much again. Let your grandchild gnaw on your fingers even if you haven't just slathered them with alco-gel first (come to think about it, how good is alco-gel for a baby, anyway?). Go play in the dirt, swim in a pond. It's a big bacterial-laden world out there. If you want a decent, robust immune system, give it some exercise. Don't live in a bubble...or delude yourself that you can.”

Ms. Howland’s identity and location are as follows:

Wendie A. Howland RN MN CRRN CCM CNLCP
Principal, Howland Health Consulting, Inc.
Editor, Journal of Nurse Life Care Planning
Life Care Planning, Case Management
508-564-9556/866-604-9055 toll free
Fax 915-990-1367

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