By Rod Moser, PA, PhD
I primarily work with children; sick children. I am exposed daily to a wide array of respiratory, intestinal, and infectious dermatological conditions. Most of the time, those pediatric bugs bounce off of me, but one nasty respiratory strain hit home last week. Coupled by some seasonal allergies, I have not felt very well. I am sure my illness is an unwanted gift from one of my little, sick patients. Even if I entered the room wearing a hazmat suit and took a decontamination shower after each encounter, I would still get sick once in a while. I consider it an unavoidable, occupational hazard.
To make matters worse, our medical group does not provide us with sick days. We work with sick people, but we are financially docked if we get sick ourselves and have to remain home. It is a sad fact that many medical provider go to work sick. Some clinicians may even be highly-contagious. Because of the duration of my illness, I am beyond the logical period of contagiousness for viral respiratory illnesses (about two to three days).
If I think I am sick, I wear a mask. While this may not fully protect my well patients, at least I am trying. I only wear gloves when I am examining a potentially infectious condition, but I scrub my hands at least two to three times during a typical encounter. At least one of those hand-washes is probably because I couldn’t remember if I washed my hands, so I just do it again.
I wash my hands so many times during the day that I am surprised that I have skin. Our examination rooms are small with windows that do not open for ventilation, and I have yet to feel any sort of air circulation coming from the ceiling vents. Our medical assistant wipes down the tables with disinfectant between patients and we do use table paper. If I could see germs in the air, I imagine that that it would be foggy, to say the least. Children openly cough in the air. If they do cover their mouths, all they do is contaminate their hands. Those same hands explore every inch of the room, from my keyboard to unwashed fingers getting into my clean tongue depressors.
If I was working in a hospital on a daily basis, the chance of being exposed to a disease causing pathogen is even higher. It used to be that I would only see MRSA (a particularly nasty, drug-resistant Staph infection) in the hospital, but I routinely see this now in the clinic; even in the diaper areas of babies. These are the same kids that play with your kids in school or day-care.
Day-care facilities are acutely aware of the inherently-poor hygiene habits of kids, so they are cleaning all of the time. You can disinfect a surface, but ten minutes later, it is contaminated again. You can spray down shared toilets, but it will become contaminated after the next use. It often seems futile. When you see videos of kids in Africa crawling around in yak poop and they rarely seem to get sick, you wonder if we are doing the right thing. There are some experts who feel we are trying to keep are kids too clean. Knowing that the number one cause of child death worldwide is diarrhea, I am not sure. Perhaps the answer is somewhere in the middle – between Lysol-covered surfaces and yak poop.
I colleague of mine mentioned that he joined the Peace Corp and was heading for Tanzania. He was trying to familiarize himself with the management of pediatric AIDS; a disease that is (fortunately) rare in our practice. One can only imagine the array of unfamiliar tropical and hygiene-related diseases that he will see in Africa. I will live vicariously through his adventures for now. Some day, I would like to do be a medical volunteer. That would be a nice way to sum up a long career.
I feel a little better this morning (my day-off), so I suspect I will be back to the germ-pit tomorrow again, perchance to catch something else.