For the last century, medical professionals and microbiologists have waged a war against germs of every type and with the breakthrough of antibiotics, changed the world in which we live. It also changed the world for our symbionts, the 4 to 6 pounds of bacteria, fungi and viruses who have hung on to our species through thick and thin for eons of time; to them we are their movable feast.
It was indeed a war that we appeared to be winning. We thought we were firmly living in the 'Antibiotic-Age' and it was here to stay for all time. However, while we were basking in its potency, unfortunately we were also rapidly and inexplicably sowing the seeds of its demise.
In a recent landmark report, US health policy makers warn that, with mounting evidence of superbugs overcoming our antibiotics, that our situation is extremely serious. The report gives a glimpse of the world to come, as even now there are a dozen different drug resistant microbial species that have totally overcome our existing antibiotics. These resistant strains are now responsible for causing 2 million infections and 23,000 deaths each year in the US alone. According to the WHO, the rapid emergence of multi-drug resistant (MDR) strains calls for a comprehensive and coordinated response to prevent a global catastrophe. The WHO warns that, "...many infectious diseases are rapidly becoming untreatable and uncontrollable."
CDC director Tom Frieden says that we must take urgent action to “change the way antibiotics are used” by cutting unneeded use in humans and animals and take basic steps to prevent infections in the first place. The tools we have at our disposal, besides tracking resistant infections, are vaccines, safe food & patient infection control practices, paired with effective and enlightened hand hygiene.
Human populations weathered numerous plagues before antibiotics were discovered. It is edifying that geneticists have found that the human genome is littered with the remnants of our past battles with pathogens. The difference is that today we know how to effectively apply all of the preventive measures that are at our disposal.
We should keep in mind that the advent of infectious disease adapted to humans is a relatively recent phenomenon. The 'Post-Antibiotic Age', if it comes, represents the ongoing evolution between a microbe and its human host, with hand & surface hygiene reigning supreme as the most effective means of preventing infection. These elements, along with water sanitation and hygienic treatment of human waste, have formed the basis for the hygiene revolution over the last hundred years. Within this, the discovery and development of antibiotics is perhaps the short lived apex or crowning glory of the revolution.
To rise to the challenge, we need to recognize that our bodies are complex ecological systems and the maintenance of our barrier function is critical to preventing skin infection and keeping out invading pathogens. This is no more than an extension and further development of the original hygiene revolution, where we see the true relations between living organisms and the many elements of the environment. Skin health is critical to maintaining hand hygiene compliance. Hand hygiene is certainly capable of rising to the challenge, but not if skin is damaged. In the 'Post-Antibiotic Age', maintaining healthy skin will be essential to preventing a wide range of infections caused by strains we helped to create."
Healthy hands are safe hands, but hand hygiene does not have to go it alone if there is a “sea-change” with respect to how agri-food producers and healthcare professionals utilize antibiotics. CDC Director Frieden stated that, “It's not too late,” but that there is a list of urgent and life-threatening infections that must be addressed via a more effective collaboration; they include carbapenem-resistant Enterobacteriaceae (CRE), drug resistant gonorrhea and C. difficile. The WHO has called for the agri-food industry to take the threat of MDRs seriously and curb over use of antibiotics, particularly as it is estimated that there is at least a 1000-fold greater use of antibiotics (in absolute tonnage) compared to humans. In hospitals we must embrace best antibiotic and hygiene practices to make a turn from what the Center for Global Development has called "a decade of neglect". We need to "Get Smart" and set targets for reducing antibiotic use in healthcare facilities.
Let's all appreciate the good microbial flora and fauna that exist on and in us, as without these little creatures life as we know it would not exist. We should also recognize that the more bad bugs encounter antibiotics, the more likely they are to adapt. As Health Canada puts it, "Do bugs need drugs?". While antibiotics have allowed us to temporarily gain the upper hand, nothing lasts forever; but with a holistic view of hand hygiene there is no reason why we can't continue to improve our control of infections. But for this to happen, there can be no excuses or compromises for effective hand hygiene practices.
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