Dirty Places, Part 3: Your Doctor's Office

Any congregation of ill people should be considered high on the list of dirty places -- hospitals, nursing homes, and yes, your doctor's office. The Centers for Disease Control estimates that nearly two MILLION patients in the U.S. get infections in the hospital, and about 90,000 of these patients DIE as a result of their infections. Serious efforts, including legislation, have been proposed to reduce this terrible toll on human life.

Earlier this week, I spoke with a man on his way to Seattle to see his seriously-ill father. His father has a routine prostate procedure and is now fighting for his life because of a serious hospital-acquired infection.

When my wife had a hysterectomy many years ago, she spent less than a day in the local hospital. Due to my fear of infection, I wanted her home in a cleaner environment. Of course, I was able to stay home and take care of her postsurgical needs, not something everyone is capable of doing. Although a large part of my medical training was in the hospital, the bulk of my career has been in the outpatient arena, so this will be the focus of this entry - getting sick FROM your doctor's office.

In pediatrics, we have both a WELL and a SICK waiting room. We also have an isolated RASH room for children who may have chicken pox, measles, or other infectious diseases.

Although isolating the sick from the well is a good start, I feel really sorry for those parents and kids sitting in on the sick side of our waiting area. There are no rules in medicine that state you can only have one illness at a time. There is always a risk that you will come in with a cold, and go out with diarrhea...if you are not careful. We do not have a sick examination room, and a well examination room. Perhaps, we should.

We are always at odds with our janitorial service. They empty the trash, vacuum and mop the floors, wipe off the counter tops, clean the bathrooms/sinks, etc. every night. If I gave them a grade for those cursory efforts, it would not be a passing one.

Cosmetic cleaning is totally different than disinfection. For instance, if you just wipe off a counter top that had blood and urine specimens sitting on it all day, it does not remove the pathogens. It will take a chemical disinfectant to do that job. It is often left to our busy medical assistants to take this final, critical step. Not only will disinfection protect our patients, they will protect US. Controlling the spread of infectious disease is EVERYONE'S responsibility in the medical office.

When the examining room door closes, I am the one that will see contamination. I am the one that will chastise the Dads for throwing a poopy diaper in the top of the trash can (Mothers know better). I am the one that sees fresh blood on the examining table after checking a child's hemoglobin. So, I am the one that is going to need to properly clean this area after the patient leaves.

My medical assistant is supposed to disinfect the table tops before putting fresh paper on the examination table, but I still ask that the parents lay down their own blanket first when I examine a child. Not only is a blanket warmer and softer than paper, it is cleaner -- or at least, it just has the family's own germs.

It is nearly impossible to contain toddlers, however. Short of duct-taping them to a chair, they will open all drawers, try and dig through the trash can (another reason why diapers should not be in there), and try and put the little fingers in the tongue depressor or cotton ball jar.

Parents usually do a good job with this, but children are natural explorers and touch everything. My own two-year old once came in carrying a dog turd in his hand, telling me that people should never eat poop (A good rule). That little boy is now an RN in the emergency room.

I estimate that I wash my hands about 150 times per day. I wash them in front to the parents so they know it did it; after seeing their child, and again, after I leave the room just for added insurance. Additionally, I use an alcohol-based hand sanitizer.

I go through a forest of paper towels every day. In spite of my own efforts to avoid spreading microorganisms to myself and to other patients, I suspect it happens. I gave up wearing my wonderful collection of pediatric neckties after I realized that I drag it across a fair number of babies, many of which grab and chew on it.

I use alcohol swabs on my stethoscope, knowing of course, that it would take HOURS of soaking in alcohol to kill every viral or bacterial pathogen. I choose not to wear a white lab coat since I think it scares the children, but I worry about my contaminated clothes at the end of the day.

I think that I do the best that I can, but there is still ample room for improvement. Instinctively, I know that people (especially kids) are germ-magnets, so there is only so much we can do as medical providers. The rest is up to the patient or parent.

1. Assume that many things in your doctor's office are contaminated: the arms of the chairs, door knobs, faucet handles, etc. By knowing these "hot zones", you can try to avoid them, or know that you will need to wash your own and children's hands.
2. Contain your children into a safe zone where you can watch them. As natural as it is for them to be social, a doctor's office is not the place to socialize with potentially-ill children. Children are very curious, so keep them from rifling through the drawers and exploring other dangerous places.
3. Bring toys, games, books, etc. for the kids from home so that they will have something to do. Waiting room toys have been eliminated from our office to reduce the spread of infectious disease.
4. Wash everyone's hands once you get to the examining room; wash them again after you leave the office.
5. Keep in mind that most pathogens enter the body via the nose or eyes, so avoid rubbing or touching these areas with contaminated hands.

Related Topics: (WebMD Video) The Dirty Truth on Handwashing, (WebMD Video)C Diff: Common Infection is Acquired in Hospitals

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If you're just now joining us, you'll want to read Public Toilets (part 1) and Airplanes (part 2).