Introduction

Reviews

Don't Let Your Doctor Infect You

Timothy B. McCall, M.D.

Since half a dozen people in Florida were infected with HIV by their dentist, hundreds of news stories have focused on the possibility of catching AIDS from your doctor. In fact the likelihood getting HIV from a doctor or a nurse is remote. This is not to say that doctors shouldn’t take precautions to protect themselves and their patients—they should—only that the risk has been greatly exaggerated for its headline value.

A far bigger problem is the risk of catching other kinds of infections from your doctor. According to the Centers for Disease Control, more than 2 million Americans annually acquire infections—from pneumonias to surgical wound infections—in the hospital. Each year these infections cause 19,000 deaths directly and contribute to another 58,000. Yet how many stories have you seen about this risk compared to the multitude on “AIDS-Infected Doctors?”

Many hospital-acquired infections are transmitted to patients on the hands of health care workers. This is not new information. In the 1840's, the Hungarian Ignaz Semmelweis, while a medical student in Vienna, investigated why so many women who delivered their babies in the hospital died of childbed fever. Childbed fever was rare in women who delivered at home. Semmelweis concluded that germs carried on the hands of medical students, who went straight from the autopsy room where they performed dissections to the maternity ward, infected the expectant mothers.

When Semmelweis instituted the practice of thorough hand-washing with soap and water prior to examining the women in labor, the death rate from childbed fever plummeted. The physician-in-charge, however, was not impressed with Semmelweis' dramatic success—perhaps out of jealousy or ignorance—and prevented Semmelweis' promotion and eventually drove him from Vienna. Distraught over the failure of the medical profession to accept hand-washing, which led to countless unnecessary deaths, Semmelweis died at 47, in an insane asylum. The medical profession still hasn't fully adopted the practice 150 years later.

How Often Do Doctors Wash Their Hands?

Researchers at the University of Washington studied how often medical personnel in intensive care units washed their hands. If the workers had followed standard infection-control practices, they would have washed their hands after every contact with a patient and every time they manipulated potentially contaminated equipment like I.V.s. The researchers discovered that on average the workers washed their hands only 38 percent as often as recommended. Many even failed to wash their hands after such activities as changing soiled dressings or manipulating urine bags. Respiratory therapists washed their hands about 70 percent as often as they should have, nurses and X-ray technicians each about 40 percent of the time. Physicians were the worst offenders, washing their hands less than 26 percent as often as recommended.

The seemingly trivial action of hand washing is according to experts the single most important way to prevent hospital-acquired infections. It is recommended after every single contact with a patient even when doing something as simple as taking the blood pressure or touching a patient's hand. Hand-washing is not just a problem in the hospital but also in clinics and doctors’ offices. I once spent an entire afternoon working with a specialist who examined dozens of patients and didn't wash his hands once.

Although it's not always possible, the best way to protect yourself from a doctor-acquired infection is to make sure that the doctor washes his or her hands either before or after seeing you (after is OK as long as they did it after the last patient too). Doctors should lather their hands for a good 30 seconds. A quick rinse is not enough. If you don't have the opportunity to observe the physician directly, glance in the office sink. Is it wet? Has the soap dispenser been filled? This method isn’t always reliable since clinics may have multiple sinks. Another technique is to simply say to the doctor before you’re examined, "Excuse me doctor but I've been hearing a lot about catching infections lately … Have you washed your hands?"

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