The article below was written by Rodney E. Rohde. Ph.D, for LinkedIn and has been re-published here with permission.

Last night I received my weekly phone call from my parents. My dad is a retired railroad conductor who is from the #GreatestGeneration. That’s him waving at you from the photo. He is one of the strongest people I know. My brother, sister and I grew up hearing him often say to us, “I don’t have time to be sick” as he headed out on another train trip.

Like many of us, our parents are our heroes. We think of them as being invincible – until they are not.

Being a railroad conductor was a great career for my father. In my hometown of Smithville, Texas, most men wanted the job because it provided a strong and steady income for a family. It allowed my mom to be a stay at home mother who raised the three of us – also a full time job! A railroad conductor is the boss of the train, not the engineer. Dad worked when there was still a caboose at the back of the train and I still remember the vivid stories of him telling us about “jumping on and off” of the caboose to walk the train for inspection. Unfortunately, those long walks past hundreds of railway cars meant that he was often walking at odd angles in hard rock. Well, thirty plus years of doing that wore out his knees and his ankles.

Finally, it became too much to bear and he received a medical retirement in his late 50’s. A great career, yet, one that took a terrible toll on his body. Last night, dad called to let me know that one of his feet had been bothering him a bit. What started as a small “corn” on one of his feet, opened up, and started draining. For my father, he knows what this means as he has had one knee replacement and multiple surgeries on both ankles to fuse bones with screws and pins. He has become my student with respect to trying to understand what the difference is between “regular staph infections versus #MRSA.” Dad has been in and out of the hospital the past several years receiving everything from incision and drainage (I & D) procedures to full blown surgery to remove an infected toe, tissue and bone. Likewise, he has become all too familiar with oral versus IV antibiotics from multiple classes of antimicrobials. Finally, he and mom have had long discussions with me about infection control and prevention in the healthcare and home / community setting because all #SurfacesMatter in the new post-antibiotic world of #superbugs and antibiotic resistance. It saddens me to see the confusion and sometimes surrender on their faces due to “another infection.”

It is not just my dad either. Since I first started conducting research on Methicillin Resistant Staphylococcus aureus (MRSA) and lecturing on the dangers of antibiotic resistant superbugs that cause healthcare associated infections (HAIs), it seems like my circle of friends, family, colleagues and total strangers have crossed paths with at least one person tormented by these nasty microbes. HAIs have no bias – they do not care if you are rich or poor; conservative or liberal; have healthcare or not; male or female, adult or child; black, white, or brown – they have just one purpose. That purpose is to reproduce and harm you. In addition, many times that purpose is to kill you.

After hanging up with dad last night, it got me to thinking about this post / blog. A thought has been crossing my mind for a while now.

Have we reached an era where elective medical procedures should not be performed?

There are always risks when having surgery. As I often say to others, “there is no true “minor surgical or medical procedure.” On top of the usual concerns, antibiotic resistant infections from HAIs have made me start to ask myself, “is that surgery or procedure truly necessary?” I mean, we all understand that trauma and life-threatening illnesses may require surgery. However, what about elective surgery or procedures? Things like knee or hip replacements. I cannot tell you how many consultations I have done on post-operative complications from an HAI like MRSA with a surgery involving a replacement of a knee, shoulder, or hip.

I have begun to inform people that they truly need to have a serious discussion with their healthcare team and themselves about just how badly they need that replacement. Certainly, many times it is necessary. I mean, my father is one of the toughest men I know and the pain had just become too unbearable. I am just saying that maybe we all need to ask ourselves these difficult questions.

A risk analysis should become part of your medical consideration prior to surgery or invasive medical procedures, especially elective surgery.

As a researcher, whenever I begin a new project involving humans (and animals), I am asked to analyze and explain the risk/benefit of my work to an Institutional Review Board or an Animal Care and Use Committee. Perhaps, this type of discussion needs to happen with our doctors and healthcare team.

In light of the ongoing issue of medical device sterilization / reprocessing problems, I even have concerns about things like a colonoscopy or other invasive diagnostic procedures. I am not saying these procedures or not lifesaving or necessary. I am just asking the question. If you do not really need it (elective plastic surgery, a colonoscopy very late in your life, endoscopy, etc.), maybe you should not have it due to the real risk of acquiring an HAI or antibiotic resistant superbug.

HAIs are Real!

I still think most people in the general public are not knowledgeable specifically about HAIs or generally about antibiotic resistance. #Healthliteracy, in my opinion, is a global problem when it comes to healthcare and science issues.  Projections by the World Bank predict that without intervention more than 10 million people will be killed by superbug infections by 2050[i] and healthcare costs will increase from $300 billion per year to $1 trillion. In their report[ii], the World Bank notes, “humans live in a permanent arms race with harmful microbes.”

Former World Health Organization (WHO) Director-General Margaret Chan has said the rise of antibiotic resistance could lead “to the end of modern medicine as we know it,” [iii] where things as common as strep throat or a child’s scratched knee could once again kill. A BBC report notes that while Chan’s comment may sound alarmist, “it may not be alarmist enough.”[iv] Practically, what this means if the current epidemiology continues is that there will be one new antibiotic resistant infection every three seconds.

HAIs and antibiotic resistant infections will surpass cancer!

Although significant progress has been made in preventing some infection types, there is much more work to be done. On any given day, about one in 25 hospital patients has at least one healthcare-associated infection. Unfortunately, HAIs affect 5 to 10 percent of hospitalized patients in the U.S. per year. Approximately 1.7 million HAIs occur in U.S. hospitals each year, resulting in 99,000 deaths and an estimated $20 billion in healthcare costs. REMEMBER, these statistics are based on a 1990’s study by Dr. Klevens. In my professional opinion, we are WAY underestimating infections and deaths caused by HAIs. Primarily, this is related to the system of reporting them in healthcare. In many instances for example, “HAI” will not be put on a death certificate because a patient might die from a heart attack, even though it was initiated by an HAI that became septic.

Last January, the Centers for Disease Control and Prevention (CDC) reported [v] an incident where a woman in Nevada died of an incurable infection caused by a strain of the bacteria Klebsiella pneumoniae resistant to all 26 antibiotics available in the United States to treat infection. In Texas, researchers at the Houston Methodist Research Institute are trying to deal with the thousands of infections that are increasingly showing up in their hospital system and apparently caused by another strain of the K. pneumoniae.[vi]

Seven states (New York, New Jersey, Illinois, Indiana, Maryland, Massachusetts and Oklahoma) have become flashpoints for infections from a superbug-like, multi-drug-resistant fungus called Candida auris that is emerging in U.S. hospitals and has grown from seven to 122 cases in the past nine months as of the end of May.[vii] Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center, has said of the superbug threat: “People have asked me many times ‘How scared should we be? … How close are we to the edge of the cliff?’ And I tell them: ‘We’re already falling off the cliff.’”[viii] I agree. In fact, I spend more and more of my time consulting with family, friends, colleagues and total strangers regarding this topic.

Everyday Heroes

I am on a CRUSADE to increase awareness of the unheralded professions that are so critical in the battle against HAIs and the antibiotic resistant superbugs that cause one in every seven HAI[ix] (one in four in long-term acute care hospitals). In November of 2016, at a TEDx Talk[x] whose theme was “Everyday Heroes,” I shined a spotlight of my own on two such professions – the medical laboratory professional and the Environmental Services (EVS) hygiene specialist. Recently, I also have been talking about how important your pharmacist is to this issue.

I have a special love for the medical laboratory professional since I teach clinical laboratory science also known as medical laboratory science. Similarly, I firmly believe EVS comprises first-line-of-defense specialists whose training has included learning best practices for effective infection prevention, on-going in-service education and effective hygiene management in patient rooms and all other areas of the hospital.

In my opinion, the hygiene specialist is a “secret weapon” [xi] in preventing HAIs. This is especially true when they are included as a component of a multimodal, collaborative intervention-type solution

However, everyone in healthcare and the community needs to step up their vigilance in preventing HAIs.

We have reached a new era. One in which our great-grandparents and grandparents dealt with daily. A post-antibiotic era is on our doorsteps if not already walking through our door. We still believe that it is an easy thing to “take an antibiotic” and everything will be fine.

Ladies and gentlemen, I believe those days may be over. Act Now! Educate yourself…

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[i] “Drug-Resistant Infections: A Threat to Our Economic Future,” World Bank. 2017. Washington, DC: World Bank. License: Creative Commons Attribution CC BY 3.0 IGO

[ii] ibid

[iii] “Who Director-General Briefs UN on Antimicrobial Resistance,” remarks, Dr. Margaret Chan, Director-General of the World Health Organization, April 18, 2016

[iv] “How We Can Stop Antibiotic Resistance,” Erin Biba, BBC, June 8, 2017

[v] “Notes from the Field: Pan-Resistant New Delhi Metallo-Beta-Lactamase-Producing Klebsiella pneumoniae – Washoe County, Nevada, 2016,” Morbidity and Mortality Weekly Report, CDC, January 13, 2017/66(1); 33

[vi] “Scientists Find a Rare Superbug in Houston,” Alexandra Sifferlin, Time Health, May 16, 2017

[vii] “Superbug C. auris Grows to 122 Cases in 7 States, CDC Says,” Susan Scutti, CNN, May 31, 2017

[viii] “A Nevada Woman Dies of a Superbug Resistant to Every Available Antibiotic in the U.S.,” Helen Branswell, STAT, Jan. 12, 2017

[ix] “Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals – United States, 2014,” Morbidity and Mortality Weekly Report, CDC, March 11, 2016/65(9); 235-241

[x] “Saving Lives in the Shadows of Healthcare,” Rodney E. Rohde, TEDx Texas State University, Nov. 5, 2016

[xi] “A Secret Weapon for Preventing HAIs: A Scientist’s Message to Hospitals Trying to Rid Themselves of Healthcare-Associated Infections,” Rodney E. Rohde, Elsevier, July 15, 2014

About The Author

Dr. Rodney E. Rohde (@RodneyRohde) is Professor, Research Dean and Chair of the Clinical Laboratory Science Program (CLS) in the College of Health Professions of Texas State University, where he spends a great deal of time mentoring and coaching students in this sometimes mysterious and vague path. He has been recognized with teaching excellence at both Texas State and Austin Community College. Dr. Rohde’s background is in public health and clinical microbiology, and his PhD dissertation at Texas State was aligned with his clinical background: MRSA knowledge, learning and adaptation. His research focuses on adult education and public health microbiology with respect to rabies virology, oral rabies wildlife vaccination, antibiotic resistant bacteria, and molecular diagnostics/biotechnology. He has published a book on MRSA stories, over 50 research articles, book chapters and abstracts and presented at more than 100 international, national and state conferences. In 2015, Dr. Rohde received the Cardinal Health #urEssential Award as Champion of the CLS Profession, named a Top 20 Professor of CLS and received the Texas State Mariel M. Muir Mentoring Award. Likewise, he was awarded the 2015 and the 2012 Distinguished Author Award and the 2014 and 2007 ASCLS Scientific Research Award for his work with rabies and MRSA, respectively. Learn more about his work here. Dr. Rohde is the current Texas Association for Clinical Laboratory Science (TACLS) President and has been involved in licensure efforts in Texas since 2007.