Nice debate. Thanks for introducing outside references. Fewer personal insults would help the overall tone, though.

I'm not sure if they have this or not but I think doctors need some type of sanatizer spray to spray on their lad coats/clothes after visiting patients. They have a hand sanatizer so why not a spray. This would decrease the number of patients getting sick from a doctor who has just visited another sick patient. My doctor uses hand sanatizer after every patient but he also wears a lab coat from one room to the other. I know it sounds a little silly but hey! I'm sure it would work to some degree.

TheRanger:

You really are a simp. Let me help you out; you will probably never find an article about cat petting and nosocomial diseases. Toxoplasmosis (a protozoan), psittacosis (virus) and ringworm (fungus) are only examples of zoonoses from pets and other animals.

You don't understand the culture of aseptic technique. Since scrubs and white coats are already available, use them effectively. Change them at least daily; not monthly. Don't wear street clothes in the hospital. How often do doctors clean their business suits. If the wear shirt and tie, how often do they get their ties clean.

It is a culture (pardon the pun) of awareness from the janitor to the hospital administrator.

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CDC has recognized this fact. As an elementary school student I am sure you were told how important hand washing is, but if you think that is the panacea of infection control you are sadly mistaken. Even handwashing is at best casually done by most doctors. Even floor exam gloves are useless if the doctor puts them on and then touches fomites. Infection control is a culture of awareness. Unfortuately a lot of doctors only worry about protecting themselves.

Your suggested experiment might be good when you reach 7th grade, but how about culturing jackets and ties and see what grows like sab with chloramphenicol. Ring worm is so nasty when you are lying in bed.

Yes, you are doing a good job at being insulting and patronizing BUT neither of those links show anything showing that coats are a serious health risk. Did you *read* the ABC link I posted?

Can you culture a ton of bugs from probably anything in a patient's room, ties, scrubs, coats, stethescopes, etc? I'm sure you can. HOW MANY infections do these sources actually CAUSE though? That's the real question. Overuse of antibiotics is a MAJOR source of infection, as are invasive procedures. Can you find ANY information that doctors' coats are as well? If not, quit harping on it, and devote your energy towards decreasing overuse of antibiotics or something that will actually do some GOOD to change.

GLCII:

I'm not sure if they have this or not but I think doctors need some type of sanatizer spray to spray on their lad coats/clothes after visiting patients. They have a hand sanatizer so why not a spray. This would decrease the number of patients getting sick from a doctor who has just visited another sick patient. My doctor uses hand sanatizer after every patient but he also wears a lab coat from one room to the other. I know it sounds a little silly but hey! I'm sure it would work to some degree.

It probably would, but that's also going to be X number of tons of chemicals pumped into our atmosphere every year. Again, rather than focusing on coats, I'd rather go after things that we *know* are major sources of hospital-based infection.

To answer your question reguarding a spray for the coats I don't think that would work very well considering a hospital grade sanatizer is at least 64% alcohol too much of it would dry before coming in contact with the garment. I work at a health care orginazation that is very aware and proactive about communicatible diseases. Physicans have an option of professional attire or scrubs and all nurses wear scrubs. People like me who are not providers wear business casual clothing. I have seen Doctors change out of their suits into scrubs anytime they feel as though their suit would be inapproperiate. Some of my Physicians wear the white coat and some do not and to me their is no differance.

You are right. If you understood the microbiology, you would know that these things are in the area of good practices like sanitizing stethoscope between uses. You don't need a study to know it can spread germs.

Or look at things the other way. Gene sequencing tells us noscomial diseases are specific to a hospital. How then do they get spread??? Only by hands?

Ranger, Since you claim to be such an expert on micro, you should probably know that psittacosis is caused by a bacteria, not a virus. Also, do you think doctors are idiots or something? Everyone under the sun knows that washing hands prevents disease transmission. You go on and on about aseptic technique, but newsflash - we don't practice in a lab where you can UV every surface to ensure that bacteria are dead. That's not a luxury present in the REAL world. Bacteria get tracked on every surface/shoe/equipment. MRSA and C. diff are present in the general population but get selected for when antibiotics wipe out normal flora. Respiratory pathogens get passed in air vents. Catheters get colonized by staph and E.coli already present on a patient. Yes, clean white coats would help but they are by no means the primary problem.

You are right about psittacosis. However, yes many doctors are idiots when it comes to infectious diseases. Most wouldn't know a MIC from a gene probe. That is why lab reports always highlight oos values. The doctors don't have a clue. FYI, nosocomial diseases are usually hospital specific meaning while they may have started by antibiotic resistance, once established they are problematic by transmission. So when studies are done on catheter induced urinary infections, in a particular hospital it will be the same strain. This eliminates the patients as the source since there are multiple strains.

Question:

Science has known that bacteria are spread person to person for about 100 years. Why is that the emphasis on hand washing has only been in the last 5-10 years?

Yes, I understand that antibiotic resistance profiles vary among hospitals, but that is because it is dependent upon antibiotic use trends within hospitals. I.e., hospitals create their own populations of resistant bacteria. Resistance can arise de novo via mutation, or it can be transferred, as you probably well know. Resistance in an E. coli UTI patient, for example, does not mean that a patient picked up a novel E. coli strain within the hospital. It means the patient's E. coli picked up a resistance plasmid, which can be carried across both pathogenic AND non-pathogenic bacteria AND between species. The key here (so I will repeat it) is that even the surface bacteria harbor these resistance plasmids, and can transfer that resistance to the pathogens. I will reword this one more time for clarity. We are not just talking pathogens being spread person to person. We are talking harmless bacteria acting as a reservoir of resistance that provides the plasmids that make other bacteria deadly once antibiotics wipe out commensals that keep them in check. Since bacteria are fairly ubiquitous, even the best sanitation would be unable to prevent such spread. Unless you were able to absolutely sterilize every surface, object, and person. I am just saying the dynamics here are subtle. It is not necessarily as simple as saying Doctor X's white coat passed a unique strain of E. coli to Patient Y, ergo white coats are bad. It is not as simple as saying pathogens are in place X, Y, and Z, and all we have to do is sterilize between visits; no, it is the POTENTIAL for pathogenicity that is worrisome and it is ubiquitous. Even if a doctor never entered a patient's room, there is a good chance the patient will still develop a colony of resistant bacteria simply by being in the room. (Whether or not they become symptomatic depends on their immune status/drug use, etc.) The key to reduce transfer is to reduce this reservoir population that carries resistance plasmids - absolutely sterilizing rooms as best as possible between patients is the best place to start, in my opinion.

I actually typed that with paragraphs but it didn't post that way. Sorry about the block text...

TheRanger:

You are right about psittacosis. However, yes many doctors are idiots when it comes to infectious diseases. Most wouldn't know a MIC from a gene probe. That is why lab reports always highlight oos values.

Here's your problem! You are probably correct that most would NOT know a gene probe from an MIC. So what? In the clinical practice of medicine, what difference would that knowledge make in their day to day decision making?

In the second part you are wrong in saying that doctors are idiots when it comes to infectious diseases, dealing with them IS their job -- and apparently by your posts, NOT yours. They are in fact good at doing so.

It's a crackup that you think it's BAD for lab reports to highlight non-normal values! I assume that's what you mean by OOS. Uh, wouldn't placing attention on potentially life-threatening information be a GOOD thing? What do you want, NOT highlighting them to see what doctor is the "real man" and which one kills their patient by missing it? See, the difference between medicine and lab work is that medicine isn't a game you can repeat if you get it wrong. Someone gets *hurt* or *dies* if you do. A good doctor is an highly educated *tradesman*, really, and does the right thing, hopefully by the right thought process. A good doctor is NOT someone who can recite the formal definition of the chi square test or transfer cultures from one vial to another without contaminating them. There are other people that do that.

If you call a pest control company to your house on a complaint, they cannot do anything unless they identify the specific pest that is present and then treat it only with something that has been found and approved as effective for that pest.

A doctor on the other hand does not have identify what is infecting you or even if it is a bacterial infection and not something else like an allergy. Instead they prescribe the antibiotic recommended by the last pharmaceutical company salesmen who invited the doctor to a "conference" in the Bahamas or where ever. Most doctors only run cultures to determine if it is even bacterial and not viral if the current favorite antibiotic and its backup fail to work . Even then they don't run sensitivities and MIC's. This is why there is MRSA and other resistant bacterial strains.

OOS means out of specification btw. However think about what you are saying when a doctor orders a test and needs help to tell him what they mean. It is not about who is best but what the doctor understands. Many times medications change what the in specification values are. When that happens an in spec value may actually be out of spec for the patient if they are taking certain meds. Think of flying on an airplane where the pilot needs to whip out the manual in order to fly the plane.

MrRanger - obviously regardless of how educated you are, you cannot practise medicine because you are unable to communicate. Just keep loading the microbiology reports into the computer because until you learn the behavioural skills taught to pre-schoolers, you will not be able to actually work with physicians.

TheRanger:

If you call a pest control company to your house on a complaint, they cannot do anything unless they identify the specific pest that is present and then treat it only with something that has been found and approved as effective for that pest.

A doctor on the other hand does not have identify what is infecting you or even if it is a bacterial infection and not something else like an allergy. Instead they prescribe the antibiotic recommended by the last pharmaceutical company salesmen who invited the doctor to a "conference" in the Bahamas or where ever. Most doctors only run cultures to determine if it is even bacterial and not viral if the current favorite antibiotic and its backup fail to work . Even then they don't run sensitivities and MIC's. This is why there is MRSA and other resistant bacterial strains.

OOS means out of specification btw. However think about what you are saying when a doctor orders a test and needs help to tell him what they mean. It is not about who is best but what the doctor understands. Many times medications change what the in specification values are. When that happens an in spec value may actually be out of spec for the patient if they are taking certain meds. Think of flying on an airplane where the pilot needs to whip out the manual in order to fly the plane.

Ranger,

Case 1: Someone comes in to the hospital and they are frankly septic. They are *dying* right before your eyes, you draw some blood and the lab says there are gram negative rods in there, or gram positive cocci, whatever. Do you:

1. hit that with the best drugs you can at that time or

2. wait for the culture and sensitivity report to come back in 2-3 days to tailor the most appropriate antibiotic to the job?

If you chose option 2 - your patient is dead. Pretty much without question.

Case 2. Someone comes in with their 6th UTI in the year. They've already been instructed on hygeine, sent to urology, etc., you just need to treat the UTI, symptoms are mild. Do you:

1. Act like Ranger's hypothetical doc and hit it with cefkillitall or

2. get a u/a and c&s and give whatever it's NOT resistant to?

In this case, probably option 2.

The point being doctors use sensitivities *every day* to tailor their therapy, BUT there are ALSO times NOT to, such as when the delay in treatment caused by waiting would be detrimental to the patient. Your doctor knows when it's appropriate to do one or the other, that's their job.

And on the OOS, say your normal hemoglobin should (in your area) be between 12 and 15. A value comes back as 6. You don't need that highlighted because you *don't know* what it means!!! You have it highlighted to *bring it to your attention*. If you are ordering a test you'd d@mn well know what the results of it mean. To imply your doctor doesn't is.... amazing - and not in a good way.