Infectious Disease: Spread in Hospitals
Guest: Dr. Bob Cantey – Infectious Disease, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. Bob Cantey, who is Professor of Internal Medicine and a specialist in infectious disease. Dr. Cantey, a topic that a lot of people are concerned about these days; doctors and nurses, and healthcare workers, as much as patients, is the problem of hospital-acquired infections. How big of a problem is this?
Dr. Bob Cantey: American medicine, in the hospital, even in the clinic setting, it is a major concern for reasons that are not completely clear. But the idea is that the increasing population; the increasing density of patient populations, travel by airplane, infectious organisms are evolving at a more rapid rate than they used to. And, they have always had very effective mechanisms. So, what they’ve done is adapted to the hospital setting in a way that makes it possible for them to find niches in the hospital setting and spread the germs around, and make people sick in the process. It’s hard to know, but, certainly, the possibility that infections are spread from patient to patient as a source of very significant morbidity and mortality is of great concern, more so than any time in my career.
Dr. Linda Austin: What are some of the steps that healthcare workers and hospitals are taking to decrease the occurrence of this problem?
Dr. Bob Cantey: The thing that we push the most is handwashing with alcohol-based hand washes. They are more than 95 percent effective in removing the majority of the infectious agents that spread from patient to patient. If we could just do that, that would be a major help. That would help with the spread with any kind of staphylococcus, actually; persistent organisms like enterococcus, or diarrhea-causing organisms like Clostridium difficile. Although, alcohol-based hand washes don’t prevent that, necessarily, as well as they do with other infectious organisms that spread; like some of the antibiotic-resistant gram-negative rods. Clostridium difficile makes little round spores when it’s attacked by antibiotics, or other things. You have to wash those off with soap and water, so that’s [alcohol-based hand wash] less successful.
The second would be wearing gloves and gowns in rooms with patients who are known to have these hospital-acquired infections. And this is the biggest weakness in the hospital setting, because not everybody believes that they need to do this when they go in the room. They say, I’m not going to touch the patient; I’m not going to do this; I’m not going to do that. But, even when they tell you that, 60 percent of the time they come out of the room telling you that they didn’t touch anything, they’ll be contaminated. How they got that way without touching anything is not clear. But that’s the reality.
So, it’s just a reminder. When you look at any surface, like the surface of this table, it looks pretty clean to you. But, actually, if we could magnify enough, it would like a shag carpet, with living organisms just reaching up, waiting for you to put your hand down. Organisms can live on these surfaces for days, actually; the ones that we’re concerned about.
So, handwashing, we push; as well as gloves and gowns, if the patient is colonized. In our hospital, we actually swab everybody’s nose who’s admitted to the hospital; and their perirectal area. And if they have organisms we’re concerned about, they’re immediately put into isolation. That is, you have to wear gloves and gowns to go in the room. So, a major strategy is convincing people to do hand washing. And, if they know the patient is colonized, or infected with one of our organisms of major concern, they must take proper precautions.
An interesting problem has been what to do with family members. At present, we don’t concern ourselves with family members. They are probably colonized with these same agents. For what we call opportunistic infections, for the most part, you have to have some selection factor to get them; like, be on antibiotics to get C. difficile, or have an invasive device in one of your blood vessels.
Dr. Linda Austin: So, by virtue of being sick, or having an instrument in, or having an immune problem? Patients are much more susceptible than visitors, is that right?
Dr. Bob Cantey: Exactly. But that doesn’t mean that the patients might not have some consequence on occasion. The patient’s family should also exercise handwashing.
Dr. Linda Austin: I saw a piece recently, actually. In England, now, they’ve done away with white coats because they feel that they harbor various forms of pathogens; bacteria, and are now using plastic aprons. Would that be wise for us to be doing here in the U.S.?
Dr. Bob Cantey: The white coat and, actually, stethoscopes; things that you carry patient-to-patient, I actually wipe my stethoscope between patients with alcohol. But that’s because I’m an infectious disease person. Most people would not do that.
Coats can be shown to be very contaminated with infectious organisms, and can cause disease in patients that don’t have them. But, the level of risk is uncertain. If we look at 100 patients, how many of them got it by that mechanism? Maybe one would be a guess. It’s important, but I still think that handwashing, and gloves and gowns, before you go into the room are more important.
I agree that we need to have a culture change. I think white coats are a bad thing. Plastic is not necessarily a good solution in the South because of humidity. There’s a lot of complaint about the humidity when you wear these things. Plus, they’ve got to be changed from room to room; so you’re changing them all the time. And you’re going to be putting a lot of carbon into the atmosphere making plastic gowns because they’re an oil-based product. Is it really worth it? Where it’s needed, it’s deathly worth it. But, do we need to do that everywhere? I think if we could change from civilian clothes into scrubs when we come into the hospital every day, that would take care of most of the problem. Wearing a white coat for a month, or wearing the same suite off and on for a couple weeks, isn’t good. Long sleeves are probably not good. You can’t wash them. So, I think surgical-type scrubs would be the way I would go. But, I do think we need to have a cultural change along the lines of what’s been recommended.
Dr. Linda Austin: Dr. Cantey, thanks so much for talking with us.
Dr. Bob Cantey: Thank you.
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