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with Rod Moser, PA, PhD

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Monday, January 30, 2012

The Dirtiest Place in Your Doctor’s Office

By Rod Moser, PA, PhD

Medicine can be a dirty business, when it comes to germ exposure and the potential to transmit germs to others. Most hygiene studies have focused on unwashed hands, perhaps the most contaminated area; however, hands are not the only problem. During a medical encounter, there are ample chances to be exposed to pathogens: the sign-in pen in the waiting room, the furniture, door knobs, faucets, exam tables, computer keyboard, and the various non-disposable medical instruments that are used during a typical examination. All of these areas can be crawling with disease-causing organisms. Sort of makes you want to stay at home!

I stopped wearing neckties about five years ago after a few research studies found them to be bastions of contagion. Many of my patients are babies, and it was not unusual for my necktie to drape across a snotty nose during an examination. If I was not paying attention, a baby would reach out and suck on the end of my tie. Yuck! To complicate matters, I accumulated a large collection of pediatric novelty neckties covered with cartoon characters which attracted their attention. So, I gave them up. They are now collecting dust in my closet.

I am a conscientious hand-washer, both to protect myself and others. I usually wash my hands three times with each encounter: once in front of the patients, once after the examination, and then again more thoroughly, after the patient leaves. I use hospital-grade antibacterial liquid soap and follow it with an alcohol-based hand sanitizer.

Patients notice dirty offices and they are not shy about commenting on breaches of infection control. If a medical provider doesn’t wash their hands, a patient will comment. If the office seems dirty, they will comment. Any and all efforts to clean up our acts goes a long way in patient comfort and confidence. A satisfied patient returns.

Although I should wear a lab coat to cover my street clothes, I do not, since the white coat tends to scare the kids. After a day of patient contact, my clothes go directly in the laundry. Ideally, we should all be wearing scrubs at work and take them off before going home. If the rest of the group did it, I would happily join in, but it is inconvenient to change back into street clothes when going out to lunch.

I am aware that our stethoscopes are contaminated. If I think about it (not with every patient, I have to admit), I will wipe it off with an alcohol pad. While alcohol can be an effective disinfectant, it requires a lot of surface time to work. Just wiping it off quickly doesn’t really do much, and is more for show. Even wiping off the skin with an alcohol swab before an injection is primarily for show. In order to completely sterilize the skin, you would have to rub that area for an hour or so. Over time, alcohol has the potential to ruin sensitive (and expensive) parts of the stethoscope head and even the tubing, necessitating their replacement.

How contaminated are stethoscopes? A study at the University of Arizona found that 100% of stethoscopes are contaminated with disease-causing viruses and bacteria – about 2,400 germs per square inch of surface space. In comparison, a toilet has 49 germs per square inch. Pretty gross, huh?

A new start-up company called Cleanint came up with a novel idea to decontaminate those nasty stethoscopes (appropriately named CleanStethoscope). A simple plastic holder containing a disposable sponge soaked in a safe and highly effective disinfectant is magnetically attached to a shirt or lab coat. After an examination the stethoscope, normally draped over the neck, is inserted into this holder so that it can be continuously disinfected. At about fifty cents a day, this little device could stop the spread of pathogens and ultimately save lives. For the bean-counters, these things can save money, too. Sick patients and sick employees end up costing more than a half-buck a day.

Along those same lines, Cleanint also tackled another “hot” item – the shared ink pen used to sign in before your appointment. Their CleanPen device uses the same technology to decontaminate the pen between uses. Although I do not use a stylus on a portable computer, they have a device for those, too.

These are simple solutions for serious problems. For a device of this nature to be successful in a skeptical market, it has to be (a) inexpensive, (b) durable, (c) easy to use, and (d) highly-effective. I feel that the CleanStethoscope and CleanPen nailed all four criteria –Kudos to this new company.

Look for them sticking to your medical providers soon.

Want to hear more from Dr. Moser? Join him in our Ear, Nose and Throat community.

Posted by: Rod Moser, PA, PhD at 4:05 pm

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