Lack of handwashing, infection control protocols in medical offices

[VeteranMom]

I've been noticing interesting habits by doctors and medical staff at a couple of offices I've visited recently.  At my daughter's orthodontist visits, the staff don't wash their hands between patients- they switch to a new pair of gloves between patients.  I've been to their office 3 times now and all I've ever seen anyone do is use the medical grade hand sanitizers- sometimes they use it in between patients and sometimes they don't.  Even the doctor is participating in the behavior.  I used to use those hand sanitizers when I worked in the medical field and a person still needs to wash their hands after 3-4 uses of the sanitizer. 

Yesterday, I went in for the second part of my root canal treatment.  I had to have several x-rays at different points during the procedure.  The dental assistant would grab the arm of the x-ray unit with her gloved, dirty hand.  There were tons of saliva smear on the x-ray machine.  I know all that saliva didn't come from me.  Yuck.  

Am I the only one noticing these sorts of things?  It freaks me out that so little care is given to something so important.  Should a person say something or keep quiet and look for another doctor/dentist that places an importance on infection control? Btw, I could use some prayers that I don't get an infection after yesterday's dental visit.  :laugh:     

[Annie Anne]

I notice.

[mysticmomma]

Wow, my docs and dentists wash at bed side every time. My dentist office wipes and retapes the machines in front if you.

[Valley Girl]

Honestly, I'd look for another provider, but I'd let the dentist himself know why I was leaving. Yuck!

[Pippen]

I would be gone. I found another podiatrist after seeing him double dip with a swab while working on my bloody foot.

[Spryte]

I haven't noticed specifically, but every time we take a child to the pediatrician, we've noticed that within a few days - we have a sick child.

 

This doesn't happen when the kids go with me to my doc, a family doc, and I even let them play with the toys in the waiting room.

 

We are just finishing up a solid month of illness here - a viral infection turned to bronchitis and sinusitis, complicated by asthma.  And now as a result of a visit to the doc's office, one of the kids (so far) has Hand Foot and Mouth.  Has to be the doc's office, we haven't been anywhere else.

 

So, yeh, I haven't seen a lack of handwashing, but clearly there is a lack of sanitizing!

[prairiewindmomma]

I call them on it. Seriously. I have pointedly asked doctors to wash in front of me before they touch me.

[Cera]

I notice.  It's why we use the family practice doc we do instead of the closer pediatricians office.  I can take my kids in and not worry that they will come home with three or four illnesses worse than what they were being seen for.

[Spryte]

I notice.  It's why we use the family practice doc we do instead of the closer pediatricians office.  I can take my kids in and not worry that they will come home with three or four illnesses worse than what they were being seen for.

 

:(  Yep.  Isn't it sad?  (Says the mama of the kiddo with HFM, as a result of being seen for bronchitis last week.)  

 

I know, I posted above, but just had to post again.  Clearly, this is on my mind at this very moment.  

[FaithManor]

I left a pediatrician who kept wearing suits and ties to work. The evidence that dry clean only clothing creates a petri dish of biohazard was well documented. I kept telling him to take the dang tie off because he was going room to room leaning over sick patients who cough and sputter on it, not to mention babies stick everything in their mouths. Sometimes he had spit up on his coat sleeves and tie. Everytime I took healthy kids in for well child checkups, they would get sick the following week. So I went to someone else because he wouldn't listen. I think he was nothing more than a roving biohazard lab in those clothes.

 

Once we stopped seeing him, the kids stopped getting sick after well child and sports physicals. Our current GP is very careful about sanitary issues.

[zoobie]

That's nasty. I wouldn't have stayed! It's not the Middle Ages.

[dirty ethel rackham]

Yuck. That would bother me.  My dentist's office and doctor's office are very good about infection control measures.  If I see anyone who doesn't appear to be following proper procedures, I question them on it (and report them if they don't have an adequate answer.)  I am not a germaphobe, but these places need serious attention to sanitation for a reason.  (I rock climb in a gym - who knows how often those holds are washed?) 

[Starr]

The days of using gloves for everything, medical, food service, etc appears to have decreased hand washing. I think without gloves we pay attention to what we touch and wash. With gloves there is the sense you are protected and you don't think about others. We were taught to wash and then put on  gloves for a procedures and then wash again when finished. 

[fairfarmhand]

ew.

 

Every time a doctor or nurse enters our exam rooms at our family dr. they visit the sink and scrub first. (I don't count if they are just taking notes or talking to us. But before they touch anyone they always wash)

[MomtoCandJ]

Ewwwww

[ashfern]

Say something. When I was in the hospital for my last birth they had a handout for the patients and that was one of the things on there. To remind the staff to wash their hands if they didn't before they touched you.

[Seasider]

I would be tempted to ask him if my kids could do a science experiment in his office. It would be simple and involve a little glo-germ powder and a black light...

 

Seriously, you have every right to ask him about his infection control procedures and to point out exactly what you've noticed. But not while he's got one of those sharp scraper tools in your mouth.

 

My family's oral care providers use a plastic sleeve up and over their adjustable light fixture arms and replace it between patients.

[kroe1]

Ugh, it is a catch 22. But, the sinks, handles of soap dispensers, etc. are germ centers. Gloves are actually more sanitary in some instances. I would never let a working health provider touch me without clean gloves. I will also not shake their hands.

 

I work in an ER myself. I always put on fresh gloves when I have to enter a patient room. Just doing nothing but hand washing is supposedly adequate, but I like that extra physical barrier. And, I never use the sinks in the patient rooms. Sick patients also may use them. I would rather wash at a central sink used just by staff. True, patients may feel no one washed, but I do not like the in room sinks knowing sick people use them, too.

 

As a patient, one can just ask. But, if I saw a healthcare worker wash in the sink in my exam room and then touch me, I would be grossed out. I would much prefer them wash somewhere else not available to the sick patients.

 

In regards to the clothing, I remember a study which cultured physician's white coats. Let's just say, I would not be giving my doctor a hug.

[Mrs Mungo]

But, if I saw a healthcare worker wash in the sink in my exam room and then touch me, I would be grossed out. I would much prefer them wash somewhere else not available to the sick patients.

 

? The sinks in all of the exam rooms that we've been in lately have foot pedals. The provider wouldn't be touching anything after washing in that case. Is this not the case in your area?

[Saddlemomma]

Interestingly enough, we just had a conversation with an ER doctor about this.

 

Last Tuesday, DH cut off his left thumb pad with a table saw.  Basically he just had a thumbnail sticking up with nothing behind it.  While I got stuff together and dressed, I told him (hand wrapped in a towel) to go retrieve his thumb pad in case they could reattach it.  I put it on an ice pack and we headed to the ER (made the 45 min trip in about 20).

 

While the DR was impressed that we remembered to bring the pad with us in the first place.  He indicated that he wasn't going to try to reattach.  I started questioning him thoroughly, citing several reason why it would enhance healing even if the graft didn't take.  I in no way wanted DH's thumb left the way it was. 

 

At this point, the DR asked if I was in the medical field.  I told him no, that my mom had been a surgical RN for 28 years, and I used to go on call with her.  That's the point when he started washing his hands for each time he touched something and actually put on gloves.  He then asked if we would like him to confer with a hand specialist.  We said definitely!  So, the x-rays were sent to a hand specialist (confirming, thankfully, that DH had missed the bone by a hair), and the specialist told the ER DR how to clean the pad, remove the fatty tissue, and reattach it to DH's thumb.

 

This is the interesting part:  They were short-handed because 7 other patients were in the ER.  The DR had to work alone.  He washed his hands, put on gloves, and proceeded to wash DH's wound and the thumb pad with saline.  He then removed the gloves, washed his hands again, and got a new pair of gloves on.  However, he then remembered he had to get to silk.  He asked me to open the appropriate drawer, get the 4.0 silk, open it the proper way, and drop it on the tray in front of him.  I did so. 

 

While stitching DH, he told us that the new protocols for stitching a patient stated that it could be done with bare hands and that tap water was the norm for cleansing the wound.  Tap water?! I told him it was a very good thing he was wearing gloves and irrigating the wound with saline while I was there.  He agreed, but he just wanted me to know what was now normally done.  I told him I really didn't care what was considered normal now.  All I knew was that with the prevalence of the flesh-eating bacteria--especially showing up in hospitals after a surgical procedure--I was very vigilant when it came to my family being treated, and I will question whatever practices I feel may be detrimental to my family's health.  That's when he said that people don't realize how that bacteria is becoming more prevalent.

 

Thirteen stitches later, DH was done.  Then the nurse came in, washed her hands, put on gloves, irrigated DH's thumb with betadine, then put an antibiotic ointment on before wrapping it in a cocoon of bandages.

 

I must say, the people were lovely to us and took great care of DH.  In fact, the DR and I talked quite a bit about what experiences I had through my mom, and he talked about his training.  We all even joked about maybe sewing DH's thumb print upside down, but I feel like the only reason that they were so careful with the washing of hands and cleaning the wound was because they knew I had just a little bit of knowledge and was watching carefully.

 

This experience just reaffirmed my belief that you are your own best advocate and you need to be proactive when it comes to your health and the health of your family.  Physicians aren't gods.  They are human and can make human errors.

 

 

 

[Slartibartfast]

I would be gone. I found another podiatrist after seeing him double dip with a swab while working on my bloody foot.

 

This made me queasy, I am not sure I can cook dinner. :lol:

 

Is it too much to hope that whatever he was dipping into is changed for each patient?

[Slartibartfast]

My dentist washes his hands and our Dr washes her hands as well.

 

 

[Slartibartfast]

 

 

 

While stitching DH, he told us that the new protocols for stitching a patient stated that it could be done with bare hands and that tap water was the norm for cleansing the wound.  Tap water?! I told him it was a very good thing he was wearing gloves and irrigating the wound with saline while I was there.  He agreed, but he just wanted me to know what was now normally done.  I told him I really didn't care what was considered normal now.  All I knew was that with the prevalence of the flesh-eating bacteria--especially showing up in hospitals after a surgical procedure--I was very vigilant when it came to my family being treated, and I will question whatever practices I feel may be detrimental to my family's health.  That's when he said that people don't realize how that bacteria is becoming more prevalent.

 

 

 

That just killed some people at a local hospital.

 

http://www.greenvilleonline.com/story/news/local/2014/07/21/fourth-patient-dies-hospital-infection-water-identified-source/12958379/

[ocelotmom]

I work in an ER myself. I always put on fresh gloves when I have to enter a patient room. Just doing nothing but hand washing is supposedly adequate, but I like that extra physical barrier. And, I never use the sinks in the patient rooms. Sick patients also may use them. I would rather wash at a central sink used just by staff. True, patients may feel no one washed, but I do not like the in room sinks knowing sick people use them, too.

 

Yes, this drives me crazy. We not only have to use the in-room sinks, but they're in the patient bathroom. (There are sinks that aren't in bathrooms, but they aren't readily accessible)

 

So, for a c-diff patient (which is spread through fecal contact, and where alcohol-based hand sanitizer isn't adequate), we're supposed to gown up outside the room, do whatever we're doing, ungown/glove in the room, go further back into the room to open the door to the patient bathroom, go in and wash our hands, leave the bathroom (touching the door handle, as the doors swing closed automatically), and pass through the room ungowned/gloved to leave the room. Yes, we can use a paper towel to touch the door handle on the way back out of the bathroom. Assuming they're stocked and uncontaminated, anyways. It's still less than ideal.

 

But of course workers in the facility are blamed for spreading infection. I mean, I *know* handwashing compliance is less than adequate. They don't facilitate it. In addition to the above, there are no hand sanitizer stations - you have to carry it with you if you want it. And handwashing is inconvenient and an easy way to cut time with a heavy workload. But I suspect the handwashing protocol itself is potentially contributing to the spread.

[rjand6more]

Well, I spray and wipe down every contacted area after patients are in my room.  The Cavicide does sometimes look "smeared" on the xray unit head.  I can confirm that.  Kind of like a window does after it is cleaned.  We do not wrap our units.  We spray and wipe them after patients are out.  Wrapping is a false sense of security :)  And I certainly do not sanitize anything while patients are in my room.  That is just nasty.  I want all things completely clean when the next patient sits down.

 

I wash my hands before each patient, but not during patient care, like if I have to remove my glove to retrieve an item and then reglove.  I do not always wash in front of my patient,  though.  My hands are sensitive to gloves, so they have to be completely dry and that takes a few minutes.  

 

Dr. uses hand sanitizer prior to putting on gloves, but he does wash *after* he hand shakes each patient and before he walks in the next room.  Sure, he is not showing everyone what he is doing, but it is being done.

 

I am always happy to answer questions from my patients regarding asepsis procedures.  i show them the Cavicide I use and the measures I take to keep them safe, if they are interested.  Every once in a while, a patient wants to know how we test the Chemiclave, or which items are disposable, etc.  Please ask. 

 

[LabRat]

I'm glad to know that I'm not the only one that notices these things. I thought I was just strange like that. :laugh:  I was having my blood drawn once and the phlebotomist was having some difficulty finding a good vein.  She had not actually stuck me yet, and she  laid the needle down (with the cap off) on the counter ledge of the sink while she continued to find a vein.  I don't think the needle actually touched the counter, but the very thought of the bacteria in that sink area grossed me out.  Needless to say, she wasn't sticking me with that needle, and I asked for a new one.  If you're uncomfortable with the practices of a healthcare worker, ask them to wash, change gloves, etc.  If they're offended, I'd go elsewhere.  

[ocelotmom]

I agree - please feel free to ask. These things are often easier to see from the perspective of an outside observer! I take no offense at someone looking out for their safety.

[dirty ethel rackham]

I am amazed at how many people in the health care field think that putting on gloves somehow makes everything all sterile.  First of all, the gloves are not sterile unless they came out of a sterile package.  Non-sterile gloves are to prevent passing bodily fluids between the patient and HCP.  They are not magic and do not prevent picking up germs from other surfaces in the room.  I once made a hygenist change her gloves after she adjusted the light.  She was confused.  I told her that she just transfered my germs onto that light and how many more did she transfer.  She somehow thought that the plastic on the light would have prevented germs and that the gloves were magic germ eating factories.  I complained, got a new hygenist for that appointment and never went back to that office. 

[Joanne]

This won't be popular.

 

But I think that *some* of the bugs and bacteria trying to be avoided by that protocol have been *created* by the increasing protocol.

[rjand6more]

I am amazed at how many people in the health care field think that putting on gloves somehow makes everything all sterile.  First of all, the gloves are not sterile unless they came out of a sterile package.  Non-sterile gloves are to prevent passing bodily fluids between the patient and HCP.  They are not magic and do not prevent picking up germs from other surfaces in the room.  I once made a hygenist change her gloves after she adjusted the light.  She was confused.  I told her that she just transfered my germs onto that light and how many more did she transfer.  She somehow thought that the plastic on the light would have prevented germs and that the gloves were magic germ eating factories.  I complained, got a new hygenist for that appointment and never went back to that office. 

 

 

I'm confused?  Of course we touch our light.  We touch lots of surfaces.  We also use Cavicide to clean them and follow the recommendations on kill times.

[dirty ethel rackham]

I'm confused?  Of course we touch our light.  We touch lots of surfaces.  We also use Cavicide to clean them and follow the recommendations on kill times.

I am talking about touching surfaces that may or may not have been cleaned between patients - how would I know?.  Using a gloved hand to touch lots of things and putting the same gloved hand in someone's mouth is gross - like the pen to write in my chart?  like the keyboard to enter my next appointment?  Gloves are not germ eating factories. 

[rjand6more]

I am talking about touching surfaces that may or may not have been cleaned between patients - how would I know?.  Using a gloved hand to touch lots of things and putting the same gloved hand in someone's mouth is gross - like the pen to write in my chart?  like the keyboard to enter my next appointment?  Gloves are not germ eating factories. 

 

I do see what you mean.  You do need to have a level of trust in your provider.  Light handles, instrument trays, handpieces, pens, computer mouse(specially designed to be used in our setting) are touched, used, adjusted and cleaned after you leave(using proper chemicals and kill time recommendations).  I am the one to wipe down my room, because I know what I touch; it is my routine.

 

I wish I could say for certain that all HCP follow the same routines and have the same pressure to keep patients safe.  I have worked in offices that do not.  We all have to sit through the same OSHA training annually.  The majority do, though.

 

I see gloves as a barrier, that is all.

 

Again, when in doubt-ask. :)

[indigomama]

After the birth of my first baby, I was having some difficulties breastfeeding, so I went to see a lactation consultant. She worked in the local WIC clinic and she was awful. She only had one room, and she often had more than one client at a time in the room. Besides being uncomfortable it was not hygienic. One time she was still finishing up with the mother in before me. She was speaking Spanish with her, and assumed I didn't understand (silly assumption when in CA), she was explaining that the baby and mom had an infection, I think it was thrush, anyways after handling the mom and the baby she came over to pick up my baby. I pulled away from her, told her I had just heard her conversation, and that she could not touch us until she had washed her hands! She jumped to the sink to wash, all the time going on and on about how she usually washes, and is usually so careful, and it was just a little infection, etc,etc 

 

I still regret that I didn't report her.

[redsquirrel]

I left a pediatrician who kept wearing suits and ties to work. The evidence that dry clean only clothing creates a petri dish of biohazard was well documented. I kept telling him to take the dang tie off because he was going room to room leaning over sick patients who cough and sputter on it, not to mention babies stick everything in their mouths. Sometimes he had spit up on his coat sleeves and tie. Everytime I took healthy kids in for well child checkups, they would get sick the following week. So I went to someone else because he wouldn't listen. I think he was nothing more than a roving biohazard lab in those clothes.

 

Once we stopped seeing him, the kids stopped getting sick after well child and sports physicals. Our current GP is very careful about sanitary issues.

 

Lol, my dad was a medical doctor and I grew up around docs. I grew up thinking all men who wore ties kept them tucked inside their shirts.

 

My family GP always keeps his tie tucked inside his shirt as well. He wears either short sleeves or keeps his cuffs rolled up. In his office they make a point of either hand washing or sanitizing the moment they walk in the room and again before touching a patient. There is a sign up in the examination room letting patients know that if someone doesn't wash hands to feel free to remind them, it also invites the patient to wash his or her hands as well. This office also has a box of face masks at the door and instructs anyone there for a 'sick visit' to wear one and invites anyone else who wants one to take one. My kids always take one and pretend to be bandits on the walk home :001_rolleyes:

[swellmomma]

I notice and say something if they haven't done anything.  BUT all the people we have seen wash hands before touching us, they use the wipe things to clean equipment like the x-ray thing at the dentist, the chairs, the bed at the dr(in addition to pulling down the paper cover thing to be fresh) etc.  If they didn't they would not be treating us at all.  
 

It sounds like I wash my hands at the daycare and the A&W more often than your dentist does which is really really disgusting

[rjand6more]

I notice and say something if they haven't done anything.  BUT all the people we have seen wash hands before touching us, they use the wipe things to clean equipment like the x-ray thing at the dentist, the chairs, the bed at the dr(in addition to pulling down the paper cover thing to be fresh) etc.  If they didn't they would not be treating us at all.  

 

It sounds like I wash my hands at the daycare and the A&W more often than your dentist does which is really really disgusting

 

If your dentist/medical office is wiping in front of you after using equipment, they are probably just wiping.  Asepsis protocol says we must spray, wipe, spray again and let dry.  I do not do this with my patients in the room.  I use a mask when I do this and do not allow my patients to breathe these chemicals.

 

If your office is wiping in front of you, I would not be certain the equipment is clean.

 

Again, don't assume things are not being cleaned when you are not present.  Ask what their hygiene protocol is.

 

Alcohol waterless systems have been approved by the CDC as appropriate in a dental setting(between handwashings).  I do not use them because my hands become very dry.

 

ETA:  I think those paper cover things are gross.  They never clean the chair itself.  At the ped office, my kids rarely sit still and they squirm and rip that paper.   When I go to OB, I know things leak through that paper and I sit down on it with a barrier of paper!!?  Gross.  Especially when you see the icky paper they pull off when you get in the room.  *cringe*