So if not changing the way we dress (as discussed in yesterday’s blog post), what can hospital doctors do on a daily basis that really works to reduce healthcare-associated infections?
Plenty.
There are lots of evidence-based techniques on how we can lead the charge against hospital infections, many of which we are already doing. For instance, washing hands thoroughly with soap and water for at least 30 seconds1 in between patients. This is probably more likely to help stop infections than anything else. Regular use of alcohol scrub is effective against most organisms (although doubts exist for its effect on Clostridium difficile).
Gloves, gowns, and bleaching rooms are other common sense measures. If we’re talking specifically about preventing Clostridium difficile, one of the most feared HAIs, another article in the Journal of Hospital Medicine concluded that the cornerstones are; contact precautions, strict hand hygiene, environmental cleaning and antibiotic stewardship2. Allied with sensible advice such as regularly laundering your clothes, disinfecting stethoscopes in between patients and ensuring your tie doesn’t “hang down” over patients, we can all take small but powerful steps whenever we are on the floors. Keep in mind too that scientific progress may soon render this debate obsolete anyway, as antimicrobial sprays and other infection-combating inventions arrive at the frontlines.
The most rational way to proceed for now would be to carefully weigh all the evidence, look for local trends, and act accordingly. Which hospitals have low infection rates and what are they doing right? Let’s learn from those that are already ahead of the curve while we wait for more quality studies to come out.
I must confess, I like dressing up professionally to go to work. Patients sometimes compliment me on my shirt and tie, and when I put on my seasonal ties around the Holidays, it frequently brings a smile to my patients’ faces! But rest assured, the minute high-quality controlled studies show that white coats and ties cause infection, I’ll be the first to advocate removing them. The challenge of science in general is to establish causality, and to avoid mass hysteria. While we undoubtedly have a lot of work to do in lowering hospital infection rates, we should avoid knee-jerk unproven reactions.
Hippocrates, who seems to have had so many words of wisdom for the medical profession from two-and-a-half millennia ago, had a clear idea in his mind of what a doctor should look like. This included three pieces of advice on being: “clean in person, well dressed, and anointed with sweet-smelling unguents.” We should be sure before ditching the second one.
Dr. Suneel Dhand MD
Dr. Suneel Dhand is board-certified in internal medicine. He was born in London and grew up in Berkshire, England. Suneel went to medical school at Cardiff University and then moved across the pond, completing his internal medicine residency in Baltimore, Maryland. He currently lives in Boston, and practices as a hospital medicine physician.
Suneel’s clinical interests include frontline healthcare quality improvement, improving hospital processes, enhancing patient experience, and healthcare information technology development and integration. He regularly writes and speaks about these topics. As well as his clinical duties as a frontline doctor (which he enjoys the most), Suneel has experience in the implementation of hospital IT systems, and was the lead hospital physician for the successful implementation of a Computerized Physician Order Entry (CPOE) system in Worcester, Massachusetts. Suneel also has experience in a number of different healthcare environments and systems. In addition to practicing as a physician up and down the East coast, including in Florida, he previously worked in the United Kingdom’s National Health Service, and undertook an elective experience in Australia, where he worked with the Royal Flying Doctor Service.
Suneel held a faculty position with the University of Massachusetts Medical School as an Assistant Professor of Clinical Medicine, regularly teaching medical residents and students. He has authored numerous articles in clinical medicine that have been published in leading medical journals, covering a wide range of specialty areas. He has also authored chapters in the “5-Minute Clinical Consult” medical textbook. His other main area of interest is preventive medicine and wellness, and he is the author of two well-being books; High Percentage Wellness Steps, and the historical fiction book, Thomas Jefferson: Lessons from a Secret Buddha.
When he is not working in the hospital or on healthcare-related projects, Suneel enjoys running, cycling, playing tennis and golf, traveling (he tries to visit a different country every year), and getting back to London as often as possible!
Suneel blogs at: www.suneeldhand.com and www.HealthcareImprove.com.
Follow Suneel on twitter: @SuneelDhand
References
1. Noskin GA et al. Recovery of vancomycin-resistant enterococci on fingertips and environmental surfaces. Infect Control Hosp Epidemiol. 1995 Oct;16(10):577-81.
2. Dubberke E. Strategies for prevention of Clostridium difficile infection. J Hosp Med. 2012 Mar;7 Suppl 3:S14-7.
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