for what it's worth, mrsa is no longer classified as "community-acquired" and "institutional-acquired" strains. they are both everywhere, and there are actually more than two anyway. "nosocomial" means "contracted as a result of being in the hospital," an infection that is acquired while hospitalized. could be the same old, same old bugs we all carry. it's not the one you have on your shoes as you climb into your car.
i just read a study saying that many, many people carry clostridium difficile ( our old buddy, c. diff.) in their guts; some people get sick from it, and some don't, and moreover, some of the people who get sick from it in the hospital do not exhibit strains that match other strains found on the same unit.
there was an interesting discussion on community bugs on another list lately- people were getting all upset about somebody wiping the seats and tabletop at a restaurant with the same rag, somebody else who won't set their silverware on the table at any restaurant, people in the supermarket deli who don't change their gloves all day, etc., etc. so somebody posted this:
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 worms 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 for your silverware? 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 worms; 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, or 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 alcohol gel first (come to think about it, how good is alcohol 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 immune system, don't live in a bubble...or delude yourself that you can.