Purell instead of Triple Antibiotic Ointment?
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Andrew Shapira
(northwesterner) - MLife

Locale: Pacific Northwest
Re: 0.2 oz for the 20 cc syringe on 10/06/2009 14:44:24 MDT Print View

Do you actually have that syringe? The product weights at Amazon are often wrong. I hope this one is right!

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Sterile Lancets on 10/06/2009 14:53:28 MDT Print View

If anyone cares, I usually bring a few sterile disposable lancets for blisters -- you get 'em in the diabetes care aisle of any drugstore. I don't reuse them -- one per blister popping session. Really try to soak the feet in warmish water and a little soap first. One of my remaining luxuries will surely be my Sea to Summit 5 L Kitchen Sink.

Edited by backpackerchick on 10/06/2009 15:05:07 MDT.

Gary Dunckel
(Zia-Grill-Guy) - MLife

Locale: Boulder
Irrigating syringe on 10/06/2009 14:55:01 MDT Print View

The Monoject 412 irrigating syringe (12 cc) weighs just .35 oz. in a snack baggie. Your dentist should have a free one to give you. We use them to irrigate tooth sockets and also small intra-oral wounds and lacerations. It has a small opening at the tip, so you can get pretty good pressure coming out of it (but you need a fair bit of soft-touch dexterity when flushing an eye...). Cheap, compact, light, functional.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Getting one :) on 10/06/2009 15:02:56 MDT Print View

No, I don't have one…yet. I've used plenty of them -- they are real small. Good point re: product weights at Amazon -- usually seem to be high though to accommodate packaging. You can just google the syringes -- many medical suppliers will carry them. How much does the NOLS one weigh? Haven't checked all the posts yet? Think I may have seen them in Target drugstore. Will update.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Gear Lists. on 10/06/2009 15:08:13 MDT Print View

Bet a lot of people have already weighed them!

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Different Kinds on 10/06/2009 15:37:01 MDT Print View

Different Materials. Also, some have locking mechanisms, etc. which no doubt add weight. For this purpose, think the vial and plunger is all you need. That cheapy looking one at amazon is probably lighter than the clear ones. You are just squirting water and don't need to worry about exact measurements etc.

Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Re: A straightforward post by an Emergency Room Physician on 10/06/2009 17:40:08 MDT Print View

"BTW, what is this stuff about dogs? Pets? Wild dogs? Never heard dogs implicated in this context. We do exchange skin flora --staph in particular -- with our pets and with each other -- not that big a deal.

Apparently it's getting to be a bigger deal these days. I have come across two articles recently, one in my local newspaper and the other, IIRC, in the NY Times, stating that dogs have become a vector for MRSA. Researchers are not sure yet exactly how, but the speculation is that human colonized with MRSA plays with their dog, who then plays with dog #2 who in turn plays with its owner, etc. Something to ponder.
If a person who has been colonized with MRSA in an urban environment then goes backpacking and cuts their
self, a very serious infection could ensue if the wound is not properly treated. I, personally, as a former MRSA sufferer, would not want to depend on irrigation alone when treating a wound. That is why I carry Bactroban, with Bactrim tablets in reserve. I assume I am colonized with garden variety staph at a minimum, and possibly MRSA. Any of them can result in serious infection if introduced into a wound or, even worse, the bloodstream. I'll take the extra ounce or so of prevention, just in case.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
MRSA "sufferer"? on 10/06/2009 20:32:43 MDT Print View

What happened? Were you just labelled as a carrier and treated to eradicate it.? Or are you one of those people who get chronic soft tissue infections from it? I have been following some of the news reports about families that can't seem to eradicate it from their house -- members suffering serious soft tissue infection. it has been hypothesized that there may be a genetic immune deficiency in some of these clusters or some additional environmental factor. And yes, the family dog can be in the chain.

MRSA is out there. In some, it is just part of the normal organisms that live on the skin, in the nose and elsewhere. There was a theory at one point that healthcare workers should be tested for such "carriage" especially in the nose-- not because MRSA colonization was doing the worker any harm just living there but because the healthcare worker presumably comes into contact with immunosuppressed people and it was assumed MRSA from the nose of the the healthcare worker might infect this already weakened person. Think inadequate hand washing came to be seen as the greater risk -- anyway, for most up date info -- the CDC maintains a fantastic up to date website -- www.cdc.gov.

As would be expected, MRSA is developing increasing resistance to Bactroban and some oral antibiotics that were once somewhat effective. Note: community and hospital patterns differ. Extensive info on this is easily found.

Doubt being labeled as a carrier and having MRSA eradicated from the nasal passages would put one at a significantly increased risk of deep tissue infection. CDC would probably have some good info on this. Still proper wound management is the key. Those who carry it and weren't routinely tested as healthcare workers were for a while, might never know they had it. We don't generally go around testing the noses of healthy people for Staph or more specifically MRSA carriage. We can expect some significant % of healthy people to have Staph and even MRSA happily living alongside them. All sorts of microbes live on our every surface and in our every orifice.

Basic principles stil apply.

Edited by backpackerchick on 10/06/2009 21:32:09 MDT.

David Olsen
(oware)

Locale: Steptoe Butte
Re: Purell instead of Triple Antibiotic Ointment? on 10/07/2009 13:47:37 MDT Print View

I have had occasion to use antibiotic
ointment where nothing else would do.
Both times were in wilderness areas, but with
domestic animals being the carrier.

One was an eye infection from horse manure on the trail,
and contact lenses being left in too long.

You don't put Purel in your eyes.

I aquired Barber's Itch from a cow pond and blister
combination that spread over my whole body wherever
the pack straps rubbed. THAT was miserable. Purel would have
done nothing for that. The water for any irrigation would have
come from that cow pond, tho treated first.

Also, the antibiotic ointment works well for chaffing,
tho staying clean is important prevention.

Edited by oware on 10/07/2009 14:18:45 MDT.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
What's so great about Purell? on 10/07/2009 13:52:14 MDT Print View

Lots of Purell stuff on this site! Is it any different form other hand sanitizers? Hand sanitizers are for cleaning hands!

Edited by backpackerchick on 10/07/2009 13:53:35 MDT.

Joe Clement
(skinewmexico) - MLife

Locale: Southwest
Purell instead of Triple Antibiotic Ointment? on 10/07/2009 13:57:27 MDT Print View

And starting fires.

Lori Pontious
(lori999) - M

Locale: Central Valley
re: Purell on 10/07/2009 14:08:50 MDT Print View

It's sort of like Kleenex. Everyone will recognize the brand name. My current supply has the brand Walgreens on it, but hand sanitizer is hand sanitizer.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
EO hand sanitizer on 10/07/2009 14:47:48 MDT Print View

It's the Whole Foods Market brand. Comes in a 32 oz economy bottle and smaller bottles. UNSCENTED!!!

Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Re: MRSA "sufferer"? on 10/07/2009 14:48:47 MDT Print View

"MRSA "sufferer"?"
"Were you just labelled as a carrier and treated to eradicate it.? Or are you one of those people who get chronic soft tissue infections from it?"

Since you put it in quotes, which typically indicates skepticism, I'll go into some detail for you. I finished a backpacking trip in 2006 with some nasty infected hairs in my nasal passages and what I thought was shin splints. The shin splints turned out to be cellulitis, though there was no visible break in the skin. The cellulitis was successfully treated with Levaquin. Two weeks later I developed a very painful infection on an index finger in a matter of hours, again with no visible break in the skin. It became so painful during the night that I couldn't sleep.
At this point I checked into an emergency ward. They lanced the lesion, took a sample of pus to be cultured, and sent me home with a prescription for Bactrim. About an hour
after I got home, I noticed red streaks moving up my arm and headed back to the E.R. where they administered an antibiotic parenterally. The test came back positive for MRSA. At that point they swabbed my nose and tested for MRSA. Again, positive. You probably know the drill from this point on, so I won't bore you with the details. Suffice it to say it took several weeks to get me totally clean. In the meantime, I did a lot of research to educate myself on what I was dealing with. It's a nasty bug. My particular strain was resistant to 9 front line antibiotics.
My guess is that I picked it up in Harborview hospital where my Mother spent her last days. They have had a lot of trouble with MRSA there. Another possibility is the gym I work out at. 2 other people acquired it there. It has also occurred to me that I was the vector for bringing it into the gym, but I'll never know for sure. So, yes, MRSA is definitely out there, B.C. One of the lessons I learned is that because it is out there, there is a reasonable chance I have it happily coexisting with various other bacteria, including garden variety staph, on my skin. Based on my experience with the infection, I would be a fool to go far into the mountains without carrying the few items necessary to either prophylactically address the issue by treating any significant wound or, in the event the wound gets infected anyway, to start taking Bactrim and buy myself enough time to get to a hospital. As I said in a previous post, it's only an ounce or so. I can live with that. I dont', BTW, go around slathering Bactroban on every little granite cut or mosquito bite, nor have I ever used the Bactrim. I am aware as anybody of encouraging resistance in bacteria. I also check with my primary doc every year as to whether Bactroban/Bactrim are still effective against MRSA and other staph/strep strains.
I hope this lays your skepticism to rest.

"not because MRSA colonization was doing the worker any harm just living there but because the healthcare worker presumably comes into contact with immunosuppressed people and it was assumed MRSA from the nose of the the healthcare worker might infect this already weakened person."

I would observe that health care workers also go home from work and, if they are carriers, potentially spread MRSA into the larger community. Hand washing alone is not an adequate response, IMO. Studies have been done indicating we put hands to nose dozens of times per day. Every time the hand comes away from the nose, it is a potential vector for spreading it to other parts of the body, or inert surfaces, and thus to other people or pets. I doubt people are going to wash their hands every time they touch their nose. If MRSA is detected in a person, they should be decontaminated to help prevent an already serious problem from becoming astronomically more so. My 2 cents.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Yeah, that's suffering! on 10/07/2009 15:03:11 MDT Print View

Hey sorry -- just wondering if you were referring to deep tissue infection with MRSA or nasal colonization. So yes, I call what you describe SUFFERING!!!

As for oral antibiotics, when concerned about my personal welfare, larger "resistance" issues be damned! I too am a fan on Bactroban for every scrape. Guess, my point is that simple wound care is probably MORE important. Hope you stay well! :)

Tom Kirchner
(ouzel) - MLife

Locale: Pacific Northwest/Sierra
Re: Yeah, that's suffering! on 10/07/2009 18:17:14 MDT Print View

"Hey sorry -- just wondering if you were referring to deep tissue infection with MRSA or nasal colonization"

No offense taken-all part of give and take in the forums. I was referring to both nasal and deep tissue, but it was my first and, I hope last, experience with the little buggers.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
:) on 10/07/2009 18:26:38 MDT Print View

"I hope last, experience with the little buggers." I think that's the idea behind the eradication strategies. Smart to be prepared just in case.

Dean F.
(acrosome) - MLife

Locale: Back in the Front Range
Re: :) on 10/07/2009 21:03:45 MDT Print View

Well, all the books do say that the only intervention PROVEN to reduce infection in minor lacerations is copious irrigation. Not antibiotics, be they topical, enteral, or parenteral. (Restated: If you've got pebbles in the wound it WILL become infected, no matter what antibiotic you're using...) That said, I carry a triple antibiotic ointment. Hygiene is just a bit unreliable in the wilderness, and I am unaware of any clinically significant issues with neomycin-resistant strains.

I will say that I think Bactroban is a bit overkill, unless you have a solid MRSA history or something. If you react to neomycin just get straight Bacitracin. I really don't see much point in getting the prescription stuff- it's a lot of hassle for trivial gain, excepting MRSA.

(And, as was INTENSELY discussed in these forums a while ago- I too carry a fluoroquinolone as my general-purpose enteral antibiotic. The tendon rupture thing isn't realistically going to manifest with two days or so of use.)

Edited by acrosome on 10/07/2009 21:07:15 MDT.

John S.
(jshann) - F
Re: Re: :) on 10/07/2009 21:15:40 MDT Print View

Paul Auerbach was a little late on talking about the black box warning, but here it is. Yep, mostly takes about a week to develop tendon issues.

http://www.healthline.com/blogs/outdoor_health/2009/05/fluroquinolone-antibiotics-and-tendon.html

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Tendon Rupture -- Fluoroquinolones on 10/07/2009 21:46:35 MDT Print View

Acrosome -- like the username.

The newer fluoroquinolones (levofloxicin and others) are very rapidly absorbed -- many equivalent to IV administration of a drug. High levels are reached very quickly. While the incidence of tendon rupture might be small, IMO it would be a serious consequence. Would be interesting to know whether risk increases in a tendon under stress (backpacking) -- based on the mechanism, I would suspect it would. There are reports of Achilles rupture during/after single 5 and 7 day (quite typical) courses. It's a black box I don't take lightly. I have and would use drugs in this class. But each time I pop one (typically for pneumonia, upper respiratory stuff), I do consider the risk I am taking. It takes pretty good evidence to earn a black box and the powerful pharmaceutical companies fight like hell to avoid it.