MRSA in Thailand

[Khundon1975]

I was booked in for elective surgery here in the UK and 3 weeks ago went for a surgical pre-assessment check, which included an assessment by the surgeon and anaesthetist.
I was also swabbed (groin and nose) for MRSA and the tests came back positive. That buggered my planned op date and my holiday plans.

No problem, I was given a de-colonisation kit which would clear it up before the operation.

Mupirocin Calcium cream 3x daily up the nose and Chlorhexidine gluconate liquid, that I used as a whole body wash each day for 5 days.
I also had to make sure all cloths, bedding, towels and flannels etc that I had used, were washed each day.

A second set of swabs, taken eight days later, showed I was now MRSA free and I had the operation.

I spoke to the surgeon and asked him what the implications of having MRSA prior to having an operation were and he explained that in my case I was going to have a foreign object inserted into my body (there are 5 jokes in that line, I know, I counted) and there was a danger that MRSA could contaminate the implant.
Whilst they could, by using antibiotics, clear the infection from the bloodstream, they could not kill any bacteria on the implant and I could suffer severe consequences, amongst which were blood poisoning and endocarditis, neither of which I wanted.

This experience led me to think what would have been the procedure for preventing MRSA in Thailand, so I googled MRSA Thailand and came up with a few articles, the first from 2010 in which they tracked MRSA, vie genome sequencing, as it spread from one patient in a Thai hospital around the World. This would not have happened, had correct procedures been followed.

http://news.bbc.co.uk/1/hi/health/8471137.stm

This one is a study on the spread of MRSA in Asian countries and for me, it touches on the quality, or lack thereof, of staff following procedures to prevent cross contamination. Warning: very technical reading.

http://jac.oxfordjournals.org/content/e ... 4.full.pdf


Finally, this next one, is a study on whether human sweat could eventually be used to kill super bugs.

http://www.medicalnewstoday.com/articles/256818.php

So, the questions for all of you in the LOS are:

What procedures were followed for anyone having elective (pre-planned) surgery in Thailand, were you tested for MRSA?

What procedures were followed for anyone having emergency surgery?

What was the quality of barrier nursing for those found to have MRSA?

Did you go into hospital MRSA free and acquire MRSA whilst you were in there?

Any other experiences you may have had with MRSA infections?



Edited one time to add some text.

[Big Boy]

I've recently had 2 pre-planned operations at Bangkok Hospital in Hua Hin. There was no testing for MRSA. However, cleanliness was taken seriously.

Regarding barriers, the hand cleanser that seems to be big business everywhere these days is not really prominent at Bangkok Hospital until you get to the cashier's desk on the way out.

Similar experience at Petcharat Hospital in Petchaburi. Additionally, there is never any soap in the Gents Toilet there.

[Khundon1975]

Actually Big Boy I had you in mind when I asked those questions, as I had seen on the forum you had undergone surgery. Hope the ops were successful.
Did they install the microwave successfully.

I'm not surprised there was no MRSA test, after all, why would the Thais bother, we are only Farangs after all, what germ would choose to live on us.

Seriously though, testing for MRSA should be high on their list before anyone is operated on, too late after the surgeon has infected you and the limited antibiotic treatment does not work. Still, they will already have your credit card number or health insurance number, so you are going to pay one way or another.

Over here, as I'm sure you are aware, anti bacterial dispensers are placed at every hospital entrance, at the entrance to the wards and every nurse and doctor uses them between patients. Nurses and doctors also change gloves and aprons between patients to reduce cross contamination. Bedsteads, mattresses, bedside cabinets are disinfected when a patient vacates a bed and before a new patient is installed.
Also, the infection control departments, test each ward (I think with those agar gel things, together with swabs from surfaces and door handles) for bacteria and viruses and if needed they close the ward and disinfect it.

As for soap, maybe we have to learn to carry a small bottle of antibacterial gel with us when not staying in 5 star hotels.

[Big Boy]

I think they could be in self-denial about MRSA. I'm sure I've read that they don't consider it a problem in Thailand.

[Khundon1975]

I think they could be in self-denial about MRSA. I'm sure I've read that they don't consider it a problem in Thailand.

Yes BB they did a similar thing with AIDS a few years ago.

[Dr Mike]

I was very interested in the remarks about protocol in the UK hospital to avoid community MRSA being brought into the hospital. That is excellent.
There is an interesting counter-view about the washing with anti-bacterial soaps that you are better off being covered by your own bugs, that your immune system knows, than new ones acquired in the hospital. But I admire the method that you describe.
I am not aware of similar protocols in Thai.

[Khundon1975]

Dr Mike I forgot to mention the recorded voice that is activated when you enter through the automatic doors. "Please use the hand wash before entering the hospital" frightens the bejesus out of me!

It seems, that deaths from MRSA, will soon overtake deaths from HIV/Aids in many countries.

This is an article written by Dr Kevin Fong.

http://www.guardian.co.uk/lifeandstyle/ ... NTCMP=SRCH

I'm sure there are accurate figures out there on the net, that prove just how serious this problem is.

[Big Boy]

Dr Mike I forgot to mention the recorded voice that is activated when you enter through the automatic doors. "Please use the hand wash before entering the hospital" frightens the bejesus out of me!

I experienced the same shock at Bristol's Southmead Hospital, but only when entering wards where the really seriously ill patients were housed.

[Khundon1975]

Dr Mike I forgot to mention the recorded voice that is activated when you enter through the automatic doors. "Please use the hand wash before entering the hospital" frightens the bejesus out of me!

I experienced the same shock at Bristol's Southmead Hospital, but only when entering wards where the really seriously ill patients were housed.

Even better than that recorded voice BB, is the one that says "This is a no smoking zone, please extinguish your cigarette". To watch the people that have snuck out for a quick fag when they hear that, is priceless, as they look around and up to see who was watching them, when in fact, that message is repeated every 5 minutes, irrespective of who is outside.

[migrant]

I had caught MRSA a couple years ago. The doctor said that it is being found in many places now besides hospitals.

I had to have a couple places cut, and scraped, and massive antibiotics. No fun

[Dr Mike]

When Sir Alexander Fleming, who first discovered the penicillium mold that became penicillin, received his Nobel Prize--his address was about how great care must be taken in the use of antibiotics or resistant strains would emerge.

[Khundon1975]

When Sir Alexander Fleming, who first discovered the penicillium mold that became penicillin, received his Nobel Prize--his address was about how great care must be taken in the use of antibiotics or resistant strains would emerge.

Yes Dr Mike very true and we are now reaping what some doctors sowed in the 70' and 80's when they handed out AB's for minor illnesses.

Thailand pharmacies are more than happy to give you a mixture of AB's, that will do more harm than good in most cases.

[Dr Mike]

A huge factor in all this is the amount of AB that are given to healthy animals as protection. 80%of all AB in the USA are given to animals and the residuals are in the meat that you are eating.
And dont get me started on growth hormone being given to beef cattle.
So what are you going to do--eat fish with its high mercury content or veggies with their pesticides.
The planet is totally polluted. The organic movement is NOT something invented by wierdos, it makes sense.

[MrPlum]

No idea the scale of the problem in thailand but I don't think MRSA will affect you unless your 'inner terrain' is compromised in some way. Being in hospital, you are likely to be in a weakened state.

There is also a lot of research going on into the various bacterial strains that inhabit the gut. There are said to be 900 strains and only 400 have been identified. In the future I can see a more sophisticated use of bacterial implantation to resolve specific diseases. For now, though, a good way to re-populate your own AB-decimated strains is a baby-poo enema (if you can scrape it off the Pampers). Work on Colostrum is also yielding positive results.

There are other ways to kill the MRSA. Oxidation with Hydrogen Peroxide or Ozone... http://www.ncbi.nlm.nih.gov/pubmed/22884127

I'm not a believer in the bacterial soaps. Your 'mantle' needs its bacteria.

This site has a number of suggestions... http://www.earthclinic.com/CURES/MRSA.html

I haven't tried them. If you think it's 'quackery' or have some philosophical objection to trying anything that hasn't been approved by your Doctor, that's ok. Be happy nursing your infection, while others are giving it a go.

[MrPlum]

Just to add. I have used H2O2 (Hydrogen Peroxide) topically against fungi and bacteria with great success. It does not work and should not be used on allergic skin reactions, like contact dermatitis. I once had a reaction to a new pair of sandals, which I assume were coated in chemicals and put some HP on the itchy area. Made it worse. Lesson learned.