Infection Control

If we're wondering why we're failing at protecting health care staff from Ebola, take a look at this picture from a google search for "stethoscope covers" :

Aren't they cute? Can you imagine the number of bacteria they carry from patient to patient?

Check out all of those adorable stethoscope covers. There are patterns you can get, you can make them your own. I even saw a super cute alligator one.

And don't worry, I'm sure every nurse, doctor, medical assistant, and tech takes them off between patients and washes them, right? I mean, they do that, right? (No. They don't. And good hospitals have made it clear that these covers are nothing more than infection magnets, but they are still sold to clinicians in health departments, surgery centers, and clinics across the country.)

Here's the scary part of the game, kids: very few medical staff actually are enforcing good infection control in the average clinic or hospital. Most staff got a quick OSHA training on it and then just do what they're told by their supervisor. We couldn't control infections enough to prevent MRSA from becoming a household name. It's not that medical staff are stupid. It's not that they're malignant. It's that we are complacent. We haven't seen a truly terrifying plague like Ebola in the US since HIV/AIDS. (To be clear, I do not consider Ebola a plague or even an epidemic in the US. I'm comparing it to HIV/AIDS only in the level of fear among US citizens, not in its scope or reach or impact on the actual health of the population. I am just calling out the irrational fear and hand wringing.)

It was the HIV epidemic that introduced us to the idea of universal precautions against blood and body fluid exposure in the first place. But then more people were tested, treatments improved, and we realized that the people at risk were generally gay men and injection drug users. So, well, we stopped worrying. Magic Johnson got it and he didn't die, what's the big deal? I mean, does the guy who gives me my flu shot really need to wear latex gloves anymore?

According to a 2010 article in the NY Times, in the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year.

The problem here isn't that we don't have the technology or the sophisticated medical care or access to great treatment. It's that we rely entirely on those things, and we have become complacent. I've witnessed in my career numerous blood draws done where the phlebotomist took off his gloves because the patient was "a hard stick" and the vein was hard to feel through the gloves.

I've seen vaccines administered by nurses and medical assistants without gloves where the syringes were then stuck into the table to prevent a needle stick, rather than the clinic paying for the safety needle systems, pictured to the right, that are so readily available. I've accidentally stuck my own finger a few times. Luckily for me, it was only in the stage where I was drawing up the

medications I was about to use, and the needle hadn't been used on any one else. I've seen dirty gloves removed in the course of treatment and tossed casually aside on a counter top or even the floor, only to be picked up by cleaning crew or other staff, who were sometimes wearing gloves and sometimes were not. I've seen simple procedures, such as incision and drainage of an abscess or removal of a skin lesion performed without eye protection. And, I'll admit, I'm guilty of that last one more than I like to admit.

I'm not saying these things to say that doctors, nurses and medical assistants are lazy or malignant. I'm saying them because we're complacent. But it's not limited to just clinicians. There's an entire community of complacent parents out there who have never seen a case of polio or measles or whooping cough outside of a movie or a historical documentary. Those parents have decided that their non-scientific based fears are more important than some historical disease, and refused to vaccinate. And now, the epidemic we should be fearing and working to stop isn't Ebola, but rather measles.

Look, no medical system is perfect. No individual is perfect. But if medical systems (clinics, health departments and hospitals) don't take this opportunity to review their infection control models, don't put into place aggressive hand washing programs and don't take the time to update their processes for dealing with communicable diseases as they present, then this is a lost opportunity that may cost people lives. Those lives won't be lost to Ebola, as the chances of getting Ebola in the US right now is less than the chances of winning the lottery or being struck by lightning. Those lives will be lost to MRSA, to nosocomial infection, to influenza. And that will be the policy fail that is unforgivable, not that a nurse got on a plane or that we allowed a man who had recently traveled to west Africa to leave the ER with symptoms.