Infection Control Today - 08/2003: Microbe Hunter Shares His Perspectiveson Life With Germs

Microbe Hunter Shares His Perspectives on LifeWith Germs

By Kelly M. Pyrek

Whenyou discuss bacteria, emerging infectious diseases and the rise of the superbugs,you must include the thoughts of Philip M. Tierno Jr., PhD, director of clinicalmicrobiology and diagnostic immunology at New York University Medical Center. Heis the author of The Secret Life of Germs: Observations of a Microbe Hunter andis the scientist who solved the mystery behind toxic shock syndrome. Here, heshares his views on life among the microorganisms.

Q: The Secret Life of Germs was writtenbefore Sept. 11, 2001. Did that tragedy and the subsequent anthrax scare makeyou feel prophetic somehow?

A: At the time the anthrax chapter waswritten, about two years before 9/11, then-mayor Rudy Guiliani read it and saidit was far-fetched. He was going to be one of the books reviewers. After9/11, he told me he reread it and the chapter gave him the chills. My beliefsare the same after 9/11 but it helped me get my message across better. Theanthrax attack, and especially SARS, emphasizes the importance of not onlywashing your hands, but also taking care of contact surfaces.

Q: You have a strong opinion aboutcomparing the number of deaths from nosocomial infections as opposed to agentsof bioterrorism, dont you?

A: The nosocomial infection rate inmany institutions is a problem and many nurses who read my book say theyreglad I emphasize the fact people take the number of deaths associated withnosocomial infections for granted;

100,000 people dead from hospital infections is alarge number. But re-evaluate that in light of the handful of people who diedfrom anthrax. Look at the stir anthrax deaths created, yet thousands of deathsfrom hospital-acquired infections didnt create as much of an issue. Sept. 11woke everyone up with regard to germ warfare.

Q: Who are the interlopers man ormicrobes?

A: Microbes were here at the verybeginning of the formation of the earth; we are the interlopers, the ones whoarrived late on this planet. We should not think we are the superior entity.Microbes have the chemical ability to learn processes that are useful tocircumvent their demise by even the smartest of all beings man. Even thoughmicrobes continue to evolve, we are uncovering germs deepest biochemical andgenetic workings. In so doing we are gaining the capacity to use that knowledgefor the benefit of humanity. Its interesting that the smallest of creatures,these invisible agents, will allow us to resolve the most pressing problems weas humans face, such as disease, hunger and pollution. We must continue toexplore the gargantuan potential of germs so we can harness their power for thegood of man.

The future of man is dependent upon an intimatecooperation with germs a profound circumstance. We are now coming fullcircle from believing ourselves to be at the mercy of nature (mankinds lotsince the beginning of time) through entertaining the hope that we could conquernature with our scientific ingenuity, to recognizing that nature, themagnificent architect, has already devised the remedies for even our mostgrievous afflictions if only we would throw ourselves upon its mercy. The youngscience of microbiology is now only beginning to scratch the surface of themysteries that govern the most powerful life source on Earth germs. If manrecognizes that he must work with microorganisms rather than against them,trying to defeat them with all of these chemicals, which they cant, I thinkwe would be better off.

Q: As an expert on germs, do you share thebelief we may be too clean for our own good?

A: There are no black-and-whiteanswers. As I mention in the chapter Too Clean for Our Own Good, thatsituation can never be. No matter what kind of sanitizer you use, you cannoteradicate germs. You interface with them every day, no matter how clean theenvironment is kept. With a plethora of antimicrobial products, you are onlycutting down on pathogenic forms and reducing your likelihood of experiencingunnecessary diarrheal episodes, foodborne illnesses, colds and flus. In ahurried world, many people cant wash their hands according to Elaine Larsonsdictates 30 seconds of getting between digits, knuckles and under nails,rinsing and repeating, which can take several minutes. You are lucky if peopledip their hands under running water. People may benefit from a handrub thatcontains a longacting germicidal. You can never be too clean, and you cantliterally get too clean by using any sanitizer. Thats not going to preventyou from being sneezed upon, not prevent your hands from being shaken, notprevent you from kissing someone or other ways you pick up germs thesandwich you eat, the counter you touch, the computer, the phone you havegerms everywhere and there is no way any product is going to eradicate germs.

Obviously you need the germs for your health.

Q: Have the CDCs new hand-hygieneguidelines clarified or complicated the issue?

A: There is a great deal of ignoranceabout the whole hand-hygiene concept and common sense is going down the drain.No guidelines nothing really change the advocacy of washing of yourhands with soap and water, especially in the hospital setting. You might want toadd a germicide to this hand-hygiene protocol, but the use of alcohol productsis to be used at the bedside to wash your stethoscope, to wash your handsbetween patients when water is not readily available or when it is inconvenientfor that situation.

Thats when you best use the product, and itdoesnt replace sinks.

Q: Do you embrace contact precautions as aroutine measure?

A: Contact precautions and activesurveillance. And dont forget education, re-education and then re-educationone more time, because as healthcare workers come and go, you have tore-emphasize the basics that people should know but take for granted or ignore.It is sad that handwashing seems to be the most difficult thing we can getpeople to do. When we get an outbreak of a nosocomial infection at our facility,our infection control group meets and goes over the same grind. Some of theenvironmental organisms we face are superbugs in the environment that mayrequire extensive cleaning for eradication. We had a case where Klebsiella wasresistant to the germicide we were using; I tested it and it would require threetimes the concentration that was recommended by the manufacturer. So, activesurveillance and continuous education are very important to help back upenvironmental cleaning.

Q: You peaceably co-exists with germs; howcan people become less afraid of them in an era of SARS?

A: I dont have a germ phobia and Iwork with germs everyday. I dont carry a mask, I dont have any duct tape,I dont have any suits for protection, but I have knowledge and knowledgeis the only empowerment you need. Knowledge is what eliminates fear, and fear ismerely the result of ignorance.