hospital infections


She Wiped Her Nose, Then Prepped My Biopsy. Still, It's Hard To Ask The Nurse To Wash Her Hands

Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. (Arlington County/Flickr)

Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. (Arlington County/Flickr)

I was lying on my back on a gurney, getting my abdomen washed by the nurse.

She dipped Q-tip-like sticks into the brown antiseptic and then swirled them on my skin where the physician would make his incision. He would penetrate layers of skin and muscle to get into my liver and extract cells. He would send the cells to the laboratory to assess what kind of cancer I had. Eight days earlier, I had learned I had masses in my abdomen and chest. Three days earlier, I had learned the masses were cancer. That day I was on the gurney getting prepped for a liver biopsy, to find out what kind of cancer it was.

While one nurse washed my incision site, another nurse prepared the room. She was adjusting the lights, surgical equipment and my gown. And she rubbed her nose with her hand. Everyone rubs their nose. Humans unconsciously touch their nose or mouth more than 3.6 times per hour.

When we do this, we spread germs into our body from whatever we were touching before and spread germs from our body onto whatever we touch next.

I laid there and wondered if I should say something to her.

In medical school in the early ’90s, I had learned about the risk of normal nose bacteria infecting surgical sites. While on the gurney that day, I remembered a story about a patient with a massive infection in his surgical wound site. The hospital searched for the source of his Staph aureus. They found it in the surgeon’s nose. This story was told to us to remind us of the dangers of what we were seeing on the wards in medical school — which was still full of old-school clinicians who drew blood without gloves and washed their hands only intermittently.

Today things are supposed to be different. Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. The compulsory annual online classes for all clinicians include specific directions on how to wash your hands. There are signs on the walls and screen savers on the hospital computers reminding us to wash our hands.

But there I was, flat on my back, wondering if I should say something to the nurse. I was afraid she’d be upset with me if I said something — I was all but naked, lying on my back and pretty much in her hands. The hands that had just wiped her nose. I didn’t say anything. I tried to get my courage up to say something — but couldn’t. A few minutes passed. I decided it was too late to say anything. But I told myself if she did it again, I would say something to her.

And then she did. She rubbed her nose with her hand and then reached for the equipment table with that same hand. The equipment that would be in my liver in a few minutes.

I called her on it. Continue reading

Even Maureen Dowd, Who Calls Out Presidents, Did Not Confront Doctors

New York Times columnist Maureen Dowd

Darn that new New York Times paywall. If you’re past your 20-story limit and don’t subscribe, you won’t be able to get to today’s Maureen Dowd column, which I, personally, would headline “Nerviest Woman In American Newspapers Says Even She Is Intimidated By Doctors.”

Taking off from recent news about new efforts to stem hospital infections, she describes an encounter with a young doctor who was wearing a tie while he attended to her brother, Michael, who had been hospitalized for pneumonia. Why, she asked, had Michael contracted four additional infections in the hospital?

“It could be anything,” he said. “It could be my tie spreading germs.”

I was dumbfounded. “Then why do you wear a tie?” I asked. He shrugged and left for rounds.

Michael died in that I.C.U. A couple years later, I read reports about how neckties and lab coats worn by doctors and clinical workers were suspected as carriers of deadly germs. Infections kill 100,000 patients in hospitals and other clinics in the U.S. every year.

Love her or hate her, Maureen Dowd is a towering and verbally fearless columnist who has called out president after president. Yet, she writes:

I saw infractions of the rules in the I.C.U. where Michael died, but I never called out anyone. I was too busy trying to ingratiate myself with the doctors, nurses and orderlies, irrationally hoping that they’d treat my brother better if they liked us.

Maureen asks Elizabeth Cohen of CNN, author of “The Empowered Patient,” how best to confront health care providers, and Elizabeth says we have to get over “the ‘waiter spitting in your soup scenario,’ that the medical professionals will somehow avenge themselves, by giving less attention, if you insult them.”

Easier said than done. But the stakes are so high. Long ago when you could smoke in hospitals, a friend of mine once picked up an emergency room ashtray — you know, the waist-high metal cylinder kind? — and bashed it against a wall when he felt his loved one was not receiving proper attention. I appreciate his passion, but you can’t help a patient much from a jail cell.

Perhaps we need inspiration from examples. I wish Maureen had ended her column with an example of how she now actively questions doctors. Instead, she describes practicing assertive tactics on taxi drivers.

Readers, have you ever stood up to a health care provider on behalf of a loved one? Please share. Here’s the voice of experience from a commenter on the Times column, the mother of a medically fragile child:

i also learned very quickly to question doctors — not in a nasty confrontational, in-your-face way, but firmly, with courtesy. in the end, it’s the life of your loved one that you are protecting, if not your own. and i’d like to think that docs know full well that hospitals are havens of disease — and that it’s part of their job to keep people safe. a simple, “oh, would you mind purelling again? we’re really struggling with his condition today” is not something a doc can really so “no” to.