These days, antibiotic-resistant tuberculosis and staph are making headlines, while this year’s flu shot is uncertain protection against this year’s flu strain.
Germ phobia is in the air, and some patients are wondering if medical visits could make them sicker instead of healthier. Others are worried about what they’ll pick up in the waiting room or on the examining table.
Of course, people have been going to doctors’ offices for at least a century without worrying too much about germs. But if you’re still concerned you can reduce your family’s risk by taking a few simple precautions.
Start by speaking up to health care providers. Experts say it’s not rude to insist on clean hands and sanitary office equipment — it’s essential.
“The single most important thing a patient can do is ask everyone who is going to be treating you to clean their hands,” says Betsy McCaughey, founder of the Committee to Reduce Infection Deaths. “Ask that they do it in front of you. Don’t be misled by gloves; gloves are no assurance at all.”
When kids are the patients the precautions may need to begin in the reception area. According to the American Academy of Pediatrics, “An office waiting room often presents opportunities for transmission of infectious diseases among patients.”
At the pediatrician’s office many moms and dads dread a room full of sneezing kids in the height of flu season and try to keep their toddlers away from much-handled community toys.
“Bring along a children’s book,” McCaughey suggests. “Bring an alcohol-based (waterless) hand cleanser, too. Don’t worry about looking obsessed — other parents will catch on.”
She advises parents to be especially careful if a child has a scraped knee “or another gateway for infection. “If your kid has a wound — keep him or her on your lap and cover the wound; have them wear long pants.”
Some medical offices have “sick child” and “well child” waiting rooms. But while dual waiting rooms may appease worried parents, they don’t work, says Dr. Steven Hirsch, a pediatrician in solo practice in Rockville, Md.
“It’s an imperfect system; ideally, though you would want to separate out children with contagious infections such as a common cold or stomach virus from those who are not contagious, it’s too difficult to figure out,” Hirsch says. “A lot of children there for well visits actually have contagious viruses — or their siblings do.”
Sneezing and coughing aren’t the biggest problem, Hirsch says: “The flu virus is not spread by aerosolized particles floating in the air. Transmission usually occurs when you come in direct contact with a droplet.”
This can happen when a sick person touches his or her eyes, nose, or mouth then touches an inanimate object such as a doorknob or elevator button. That living germ gets transferred to the inanimate object. If you touch the same object soon afterward, then touch your child’s eyes, nose or mouth, that virus gets transmitted into her body, Hirsch says.
So instead of shared toys, Hirsch’s staff provides individual buckets of toys for each child to play with during their visit. At day’s end, staff members wipe down the toys and let them dry overnight, long enough for most germs to die.
Inside the exam room, Hirsch says that fresh, unwrinkled paper on the table is a tangible — but inadequate — proof of a sanitary space. “You rip the used paper off after each patient and people see the clean, crisp paper and are reassured that the office is clean,” he says.
But that’s not good enough, he adds. “After every patient, it only takes a short period of time with an antibacterial wipe for me, or a staff member, to clean the examining table, door knobs, chair railings and counter tops — anything that’s been touched.”
Marian Sonnenfeld, M.D., former chief of mammography at Brigham and Women’s Hospital in Boston, agrees that patients should be aware of the health care environment.
Unlike exam tables, mammography equipment doesn’t lend itself to paper coverings, so patients have to look for other cues. When receiving a mammogram, for instance, “you would want to know that you’ve been given a clean gown to change into, and if the staff is respectful of your privacy, it might show that they’re also thinking along the lines [of infection prevention],” Sonnenfeld says.
Her own medical issues have forced Sonnenfeld to take a much less active role as a clinician and increasingly view infection prevention from the patient’s perspective. Her personal precaution include “using my own pen when filling out forms in a doctor’s office. I figure I have no idea who’s been handling the pens, and I would guess that very few offices would ever think to clean them.”
She says that the nature of the medical practice can affect the level of awareness. She describes a gastroenterology practice — whose patients include transplant recipients — that supplies tissues, hand gel and masks in the waiting room, and posts signs urging people — whether vulnerable patients or visitors with contagious illnesses — to use them.”
Not all practices are as fastidious, so patients have to be vigilant.
Bradford Jordan, director of development for McCaughey’s committee, says a recent medical appointment left him nonplussed “I didn’t see the doctor wash her hands,” Jordan says. “There wasn’t a sink in the examining room.”
Jordan was also worried about germ transfer from a blood pressure cuff. “I asked if she would spray the cuff with an antibacterial cleanser, but she didn’t know where it was,” he says. He settled for having the cuff placed over his sleeve.
Be alert, speak up — but don’t let fear of contagion keep you away from needed office visits. “The risk of developing infection after an outpatient clinic or office visit has been evaluated. In all instances, children who visited physicians’ offices had better outcomes than children who did not receive regular care,” the AAP concludes.
Clean medical offices and uncontaminated caregivers are worth insisting on — but isn’t it hard to question the person to whom you’ve entrusted your family’s health?
“Absolutely, it is hard to assert yourself and to speak up,” Jordan acknowledges. “But as long as doctors, hospitals and administrators are not taking it on, it’s our only line of defense.” He says to avoid infection, prepared patients have to get comfortable with the idea of making their health care worker feel uncomfortable.
Sonnenfeld says it’s possible to be respectful of the practitioner while “making sure one’s own needs are addressed and met. A patient might say, “‘I know you’ve had a lot of sick patients here today and just for my own comfort, I’d like to confirm that you’ve washed your hands between the other patients and me.’”
If you find it hard to be assertive: “Bring a family member, bring a brochure with the steps for reducing infections,” McCaughey says.