Infection risk: is your physician office safer than the hospital?

Many Americans know about hospital-acquired infections (HAIs). What most people probably don't know is that every year more than 2 million hospitalized patients will get one. According to the American Hospital Association, there were 35 million hospital stays in the U.S. in 2017. Two in thirty five is an alarmingly high percentage, even without looking at comparative data.

Health.Gov (https://health.gov/hcq/prevent-hai.asp) notes that many HAIs are associated with Catheters (bloodstream, endotracheal, and urinary), surgical procedures, injections, health care settings that aren’t properly cleaned and disinfected, communicable diseases passing between patients and healthcare workers, and the overuse or improper use of antibiotics.

Even more concerning is that, of those 2 million people, 100,000 die from the infection they contracted just by being in the hospital. Maybe you even know someone who did. I do.

That said, most hospitals are exceedingly vigilant and careful, not just because the HAI cases are carefully and increasingly monitored, but they are passionate about the care and safety of their patients. Even reimbursement is linked to safety scores (which is indexed to HAIs). The awareness is high, as it should be. But there is yet work to be done - and every hospital knows it.

But what about other settings of care? Places where there is less oversight? Less accountability? According to the CDC, there were 990.8 million outpatient visits in 2017. Visits to primary care doctors, pediatricians, oncologists, allergists, ENTs, dialysis centers, radiology centers, outpatient surgery centers, speciality treatment clinics, etc.

If you've ever been to one (and I know you have), have you felt safe (from "catching something") in the waiting room? Did you notice anyone cleaning the exam room before you entered? Did your provider wash their hands in front of you? Their stethoscope?

A colleague of mine mentioned today that two days after his daughter was scoped by an ENT for an annual check-up, she contracted a sinus infection. Disinfection and prevention protocols should be especially important when using medical devices and instrumentation, especially endoscopes and similar devices. Right?

What about Pediatric physician offices? So many parents - for decades - have complained about children getting sick - soon after visiting their pediatrician for routine visits - that the American Academy of Pediatrics has issued disinfection and prevention guidelines for every pediatric office. These guidelines include waiting area cleaning processes, managing and isolating contagious children before they enter patient areas, exam room disinfection, etc. I've been to hundreds of pediatric offices. If they were grading compliance to AAP guidelines, they'd have to use a very liberal bell curve.

And dialysis centers? In the study, "Prevention of peritoneal dialysis-related infections" Dialysis Transplantation, Volume 30, Issue 9, 1 September 2015, Peritoneal dialysis (PD)-related infection, including peritonitis, exit-site infection (ESI) and tunnel infection, is a common complication that results in considerable morbidity and even death in up to 3.5–10.0% of patients. While there are many safety and disinfection guidelines to prevent (and treat) these infections, anyone who has been to a busy dialysis center can easily see the obvious infection risk. Dialysis chairs are set side by side, where patients often lay prone for hours. Most are in the clothes they arrived in. They are often sick with multiple comborbid conditions, their immune systems already compromised.

Interestingly, Dialysis Centers are required to document and submit their individual infection rates. Some infections (such as wound sites) may be obvious, others may not be traced back to the dialysis center - ever.

Finally, if you're especially brave, use the restroom in the ER waiting room. You might not be admitted to the hospital - at least not that day.

So just because you didn't get a hospital acquired infection because you were never there, how did you - or your parents or children - get so sick last year?

We can - and we will - do better.