Increase in I&D's in the South?

Specialties Emergency

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I was just wondering if other places through out the South were experiencing a marked increase in wounds w/ staff that require I&D..... what the old folks called "risens".

I have recently moved back down South after being away several years and I have never in my life seen so many of these type infections. In our ER, we are doing up to 10 a day. I moved back the Thursday before Katrina hit (I've always had great timing).......

I've heard that it could actually be due to Katrina.....

Specializes in NICU.
Reading this and coming from the UK, I know nothing of Dial. I do however believe that antibacterial soaps and the like might actually do more harm than good in the long term! Bare in mind that I don't have the research at hand at the moment, but I know that I've read in medical journals about allergies and asthma increasing in houses which are kept meticulously clean in childhood, children vaccinated and not exposed to chicken pox etc as we were as children developing the more dangerous equivalents later on, good bacteria on the skin being killed off with the bad by antibacterial agents etc!

I grew up in a house where my mum kept the place so clean I'm sure I could have eaten off the floor and yet I have asthma and so many allergies I couldn't list them ;)

I'll stick to using antibacterial stuff when I have a wound or I am at work and just good old fashioned hygiene the rest of the time ;)

Dial is a very popular brand of antibacterial soap here. It's sold for handwashing and also in bar and gel form for bathing. Lots of scents, formulas, etc.

While I agree that using antibacterial products like crazy might not be a great idea in a healthy household, I think it's really important to use it in a family where there is currently a staph outbreak going on. This friend of mine has a roommate and they share a bathroom and hand towels. I think while he has these wounds that are actually weeping, it's vital that he use something that might help stop the spread, both to his roommate and to other parts of his body. Now, I don't know if the antibiotic in Dial would kill the staph he has going on (they haven't told him if it's MRSA, just that it's staph), but it can't hurt.

Normally, I myself don't use an antibacterial soap except for handwashing and dishwashing. But if I started having wounds, you'd better believe I would switch!!!

Specializes in ER, NICU, NSY and some other stuff.

It seems like over the last year or so I have seen soooo many more "spider bites." Most, but not all, of these are definitely hygenically challenged.

I have wondered why the big jump myself.

I heard a surgeon discussing an I&D pt with another doc, and he mentioned that a huge percent (can't remember the exact figure), are actually not spider bites-just look like it. He said he got his info from a study that was published in one of the medical journals, and he was glad they had finally published one because he always suspected the percentage of true spider bites was much less lower than anyone could guess.

Specializes in Cath Lab, OR, CPHN/SN, ER.
It seems like over the last year or so I have seen soooo many more "spider bites." Most, but not all, of these are definitely hygenically challenged.

I have wondered why the big jump myself.

I've seen several "spider bites" also. Then I have to try to explain to them that it's an infection, not a spider bite. I would hate to mess with the spider that would crawl up someones butt crack to bite them there. :rolleyes:

Also the girl who keeps shaving her privates and then gets infected follices. New razors with shave gel work wonders- maybe she should take the advice and just stop shaving all together.:rolleyes:

I've also recently seen a bunch of them, almost all due to poor hygiene, however, in my area (where I just was that it, right now I'm nowhere!) most of the people having these infections were quite obese, I know there's a correlation, but I can't quite explain it...

Specializes in ICU,ER.
most of the people having these infections were quite obese...

This is true...many are obese and the ummm...butt... is a popular area. I am guessing that they can't reach that area well.

I know that hygiene plays a major factor but I guess my point was that there seems to be so much MRSA out there. A doc I work with believes that all the infection post Katrina has migrated. Since I have lived "up north" a few years and then moved back down right when Katrina hit, I just wanted to know if anyone else has seen any correlation.

I cant speak for down south but up here in oregon the incidence of community aquired mrsa is very high. As an RN who is clean, not obese, and not the poorest person around, I have had 2 mrsa skin lesions. My md and infectious disease doc told me that I probably did not get it from work, that mrsa is everywhere, in our community.

It is not just poor, fat, and dirty people who get mrsa. Consider that the poor people are presenting to the er because they do not have the resources to be seen in a doctors office(where I was treated)

Here is some info about mrsa, and the 'spider bite'/mrsa link

http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html#6

http://www.aafp.org/fpr/20041100/10.html

http://www.emedicine.com/EMERG/topic547.htm

p.s. I wash with antibacterial soap at home and at work, kind of obsessively since I took micro...

oh yeah, they were on my butt, which I am told is the most popular location

Specializes in NICU.

Well, my friend who had the abcesses started getting them in September, completely out of the blue. One day, he had a bump under his arm, the next day he had two, the first one doubled in size. The third day, they doubled in size again, and the big one was red. Curious, he palpated the big one to see really how deep it went. It BURST on him, and continued to ooze and bleed pretty badly for an hour, so he went to the ER and had an I&D on both of them. He was told, the next week, that it was staph-related but they didn't say MRSA. Of course, he didn't ask because he didn't know it was a big deal.

That first time, they didn't give him ANY antibiotics. Shouldn't he have had a dose of IV antibiotics during the I&D??? I don't work ER, but if it was me, I'd have wanted something, especially because with all that blood it was getting into his bloodstream. Only after he came back for a dressing change and they found two more, did they start antibiotics. He's been on and off ABX for a few months, and only when he is on them do the abcesses quiet down. I told him next time he sees a doc to ask to be swabbed for MRSA...

He is overweight, but has good hygeine. Like I said, though, he doesn't use antibacterial soap in the shower like I told him to when he has outbreaks. :uhoh21: The doc asked if he routinely reapplies deodorant during the day - he said, yes, usually he puts it on two or three times a day. The doc felt that he was doing two things with this - for one, he was putting more pore-clogging deodorant on his underarms, which possibly led to the abcesses - and for another, if he had any infection going on, he was spreading it to the bar of deodorant, and it just went back and forth. He was told, if necessary to reapply during the day, to sponge bathe his underarms first, so they'd be clean, and THEN reapply. Also told to toss the current stick he had and get a fresh one.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

In this area, we seen a large amt. of I and D pts. coming from one particular county. Different bacterial cultures though.

And lack of good hygiene has been a factor as well.,

The friend with the infection in his armpit should have been started on abx right away!

A good sign that it is mrsa is when it goes from bad to unbearable in 24-48 hours. both of my lesions started as small bumps and doubled or tripled in size every 12-24 hours. Both times the doc put me on broad spectrum abx asap, and then changed the med later when the cultures returned. different strains can be resistant to more than just the methicillin.

Specializes in ICU,ER.
It is not just poor, fat, and dirty people who get mrsa. Consider that the poor people are presenting to the er because they do not have the resources to be seen in a doctors office(where I was treated)

Oh, I totally agree with you....I said in an earlier post that we are seeing them from all walks of life. I also pointed out that the reason we are seeing the lower socio-economic group is due to lack of insurance/mindset.

And thanks for the links.... very informative.:)

Specializes in NICU.
The friend with the infection in his armpit should have been started on abx right away!

A good sign that it is mrsa is when it goes from bad to unbearable in 24-48 hours. both of my lesions started as small bumps and doubled or tripled in size every 12-24 hours. Both times the doc put me on broad spectrum abx asap, and then changed the med later when the cultures returned. different strains can be resistant to more than just the methicillin.

That's another reason I think it actually was MRSA that my friend had. They just told him staph, put him on an oral antibiotic (the second time, not the first) and that was it. Personally, I think the first time he should have had IV fluid, IV antibiotics, and IV pain meds while in the ER. He came there first thing in the morning, was there for six hours, had nothing to eat or drink, and from what he told me, he sounded a bit shocky. First of all, they didn't even medicate him at all for pain. They were going to use a local, but the doc said that because the lesions were so deep, lidocaine wouldn't help much. So he used NOTHING while he dug around my poor friends lesions for over an hour. The nurse came in at one point, asked the doc if he wanted her to mix up a bag of *something my friend couldn't remember, wasn't vanco, but sounded like an antibiotic to him* and the doc said, no, he doesn't need that, and he doesn't have an IV either. The nurse looked shocked at that, my friend said, like she couldn't believe that he didn't have an IV and that the doc didn't want whatever med she mentioned. :angryfire

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