As a physician as close or remote to infectious disease as the author, I wonder whether this article should have gone for peer review with a specialist in nosocomial infections before publishing it here.

The hand- and stethoscope issue is well known in the medical community... and maybe some patient vigilance can help the push that most hospitals and clinic do: urging doctors and nurses to comply with handwashing or desinfectant use after each encounter. This is very important, no doubt.

However, I have serious doubts about the sniffles issue. Common cold/upper respiratory are due to virusses that are around pretty much anywhere. They are not "superbugs", they are not antibiotic resistent bacteria (which are a real concern as mentioned above). And I don't think they can kill routine patients (and if so, the patient probably gets the virus from visiting and hugging relatives) .... the severely immunocompromised are in protected areas of the hospital, and these patients are treated with precautions only (gloves, masks etc.).

I've been an ID doc "officially" for about 6 months now, if that fits your requirement.

I also thought that the author was making a bit much of the whole "physician with a URI" issue. The spread of things like MRSA, VRE, and c-diff have been studied pretty extensively, but the spread of viruses in the hospital, outside of probably the "biggies" like HSV, EBV, and such, hasn't even been looked into much, to my knowledge.

So, no, the doctor who visits you with the sniffles is not going to give you a "superbug". It's a virus, (which, incidentally, wouldn't be any nastier than the same virus the average person on the street would get.) And yes, the average, non-immune-compromised patient would not be at risk for dying of that. Transplant patients would, but these patients are (or at least should be!) protected by being in special units and having visitors wear masks.

This is completely different from multi-drug resistant bacteria, like MRSA, VRE, ESBL-producing gram negatives, and the rest. These are spread by direct contact and are therefore prevented by handwashing and contact precautions (which, by the way, need to apply to EVERYONE entering an effected patient's room--it's pretty frustrating to have doctors and nurses respecting contact isolation only to have Great Aunt Edna put her hands all over a MRSA patient and then leave without even washing--it's a personal beef of mine.) Carriage of these organisms is also completely asymptomatic--they don't cause colds or sniffles, and they aren't detected until someone gets infected with one.

And, let's not forget that part of the reason these bugs even exist is because of antibiotic overuse.

I've already seen enough patients that think they have SARS or something every time they have a cough--let's not make things worse.

The "common cold" that doctors, nurses, and other staff bring into the hospital which is likely to do the most harm is influenza. Influenza is responsible for the deaths of millions of people every year-- most are elderly and have other medical conditions and many are hospitalized. The flu is not nosocomial (hospital acquired) but it kills hospitalized patients. It even counts as a superbug (see the high rates of resistance to medications like Tamiflu in the current flu outbreak in the U.S.). When patients come into the hospital with the flu they get put in isolation so they don't spread it to other vulnerable patients. When doctors come into the hospital with the flu, they have no such restrictions. I believe this is the most compelling part of what the authors wrote about and they alluded to the flu question in the article.

Rabscuttle, I have my doubts about what you write. I work in a hospital (in addition to seeing outpatients), and to my knowledge, there is no simple, reliable straightforward test separating flu patients from other infections (e.g. bacterial pneumonia), and therefore, they are not isolated, at least not that I know of (not my specialty). But maybe the friendly and highly qualified Grungie could comment on that.

Ummm,

I hate to point out to the authors that 95% of the patient care (hence patient contact) in hospital settings is rendered by nurses, and nurse aides, not physicians. Personal care, wound care, feedings, etc. all administered by nurses. And yes, if you are ill and dare to call in sick, you are made to feel guilty as hell, because now your shift is short-staffed, etc. So in a hospital, everyone is allowed to be ill but the staff.

The infectious disease folks on here are correct that it's not the Upper Respiratory Infections one needs to worry about, but rather the consistent hand-washing issue all staff should follow. Nosocomial infections of staph, VRE and others are more worrisome in patients than a cold.

Additionally, family members who are ill or who have small children (germ resevoirs) should stay home. How many times have I had to have my titers re-done or my vaccination records reviewed because someone brought little Jane/John into the hospital with their chicken pox (varicella pneumonia anyone?) or measles/mumps or haemophilous influenzae infection to visit 'gran-gran' who has been admitted for a bypass or a knee replacement.

Unless your loved one is in the ICU and about to punch their final ticket, leave the kiddies at home and they can visit at home after discharge (the average stay is less than three days).

Hospitals run on thin staffing margins, so epidemics among the staff wreak havoc with patient-staff ratios. Managment tends to treat ill staff as malingerers if they call out for more than 24hrs.

Plus, I think the kind of people who can do (and want to do) all the work to get through nursing or medical school are the kind of people who don't stop working when they feel sick.

Sorry Traugott but you are wrong. The simple rapid test that say doesn't exist is called the Rapid Influenza antigen test and it is standard of care for hospitals to use it on all patients with suspected influenza and isolate (with droplet precautions) those patients who test positive. Its also used to do surveillance on health care workers. My guess is that your own hospital has the same infection control policies in place and its workers (ie you) are required to be familiar with these policies in order to maintain priviledges. Time to bone up on your reading.

I refer you to the CDC link <link>on influenza control. I culled the important parts for you:

• Perform rapid influenza virus testing of patients and personnel with recent onset of symptoms suggestive of influenza. In addition, obtain viral cultures from a subset of patients to determine the infecting virus type and subtype and to confirm the results of rapid tests since most rapid tests are less sensitive than cultures.
• Implement Droplet Precautions for all patients with suspected or confirmed influenza.
• Separate suspected or confirmed influenza patients from asymptomatic patients.
• Restrict staff movement from areas of the facility having outbreaks.
• Administer the current season’s influenza vaccine to unvaccinated patients and health care personnel. Follow current vaccination recommendations for the use of nasal and intramuscular influenza vaccines.
• Administer influenza antiviral chemoprophylaxis and treatment to patients and health care personnel according to current recommendations.
• Consider antiviral chemoprophylaxis for all health care personnel, regardless of their vaccination status, if the health department determines the outbreak is caused by a variant of influenza virus that is a sub-optimal match with the vaccine.
• Curtail or eliminate elective medical and surgical admissions and restrict cardiovascular and pulmonary surgery to emergency cases during influenza outbreaks, especially those characterized by high attack rates and severe illness, in the community or acute care facility.
• Monitor healthcare personnel for influenza-like symptoms and consider removing them from duties that involve direct patient contact, especially those who work in high-risk patient care areas (e.g., intensive care units [ICUs], nurseries, organ-transplant units). If excluded from duty, they should not provide patient care for 5 days after the onset of symptoms.

I'll gladly admit that you are right about the testing, rabscuttle (thanks for the link and the exerpt), but I think I made it also clear that this falls out of my specialty (and that might be why I didn't remember people with any Flu testing in their charts - I probably don't see them).

Still, I am not sure whether you can make the case that doctors and nurses with a sniffle are a significant risk for spreading flu in the hospital (compared to the average patient/visitor), esp. considering that (at least in my hospital), 70% of the staff are vaccinated ... but I might be wrong here and would be happy to stand corrected here as well.

At the center where I trained, all patients admitted to the ICU with pneumonia or something like it were screened for influenza and put in droplet isolation if they had it. The screening was only done during flu season. Different hospitals have different policies, of course.

I agree that it would be possible for sick doctor or nurse to spread influenza, as much as anybody else, but I'd hope that they'd be able to differentiate between common cold symptoms and influenza (which usually feels much worse.)

Oddly enough, I haven't seen much flu at all this season--either it wasn't that bad a year or nobody's getting ID consults for them.

Showing up with the flu wouldn't be a problem if Dr's didn't have ready access to potent pain killers to deal with the severe muscle pain experienced with the flu. Without percocet or vicodin or even tylenol #3 it is simply impossible to function because otherwise you would be writhing in the bed like the rest of us. Maybe sprinkle a little upper in with it to help maintain focus and concentration and you're ready to go-still sick as a dog but present and accounted for.

I have gone to the hospital with the flu before and worked a full day (with no narcotics or other similar meds, thank you very much), and you ask how can one physically get along? The same way I get along physically when I've been awake for 30 hours straight every 4 days. The same way every doctor who's been awake all night makes it through. You just suck it up, just like physicians do all over the country. It is physically possible, just very unpleasant.

I had the flu - actual influenza - in 1999 when I was a medicine intern. It was brutal, with 103 degree fever, chills, and awful aches, and I had to miss 2 ER shifts. I usually chuckle when someone with sniffles tells me they have "the flu".

In practice you can nearly always identify a patient with influenza just by looking at them. This sounds ridiculously simple, but they just look sick. (I am a pulmonologist now.)

The question of whether doctors come to work with influenza and spread it to patients is moot. It is nearly impossible for anyone, even a superman physician, to actually work with true influenza. No matter how tough you are or how bad your patients (or colleagues) need you, no one with influenza gets out of bed.

People shed the influenza virus before they become symptomatic. So yes you can work with the flu and give it to others. <link>.

OK .... but moot point in the context of this discussion (are doctors putting pt. at risk by going to work sick?).

go_sox:

People shed the influenza virus before they become symptomatic. So yes you can work with the flu and give it to others. <link>.

yes, but if the doctor doesn't KNOW they're sick at the time, how are they supposed to know to stay home? Now if you want to get the .gov to pay doctors to stay home when they feel well, but think they might be getting sick in the next few days.... I'm sure that would be a good use of stimulus money, especially if one could take weeks or months off at a time making sure they weren't about to develop the flu.