Germs can be dangerous, causing a wide range of infectious diseases. Some people go to extremes to avoid germs, but for most of us, we just try to be careful, while trying not to think about it. But we can’t escape germs, even in places we think are clean. Did you know doctor offices and hospitals are often breeding grounds for germs? Pretty ironic – we visit these places for healing, but by simply being at a medical facility, we increase our risk of disease. The fact is, across the board, there are dangerous germs in hospitals and doctor offices. What can you do to reduce your risk of getting sick?
A brief explanation of terminology – germs that cause diseases are called pathogens. For ease of reading, when I say “germs”, I am referring to pathogens.
Why should you care?
Because some germs cause serious infections, several of which are resistant to antibiotics. And, some are life-threatening. Health care associated infections (HCAIs) are a leading problem of health systems worldwide, including in the US. In 2015 in the US, approximately 687,000 hospitalized patients acquired HCAIs while being treated for other health issues, and more than 72,000 patients died while in the hospital. And those statistics don’t include non-hospitalized patients, such as patients receiving care through long-term care centers, ambulatory care centers, family medicine clinics, and at home.
How do germs spread?
Although germs are microscopic, they can easily spread to and between patients. Germs can get into your body through contact with your eyes, nose, mouth, genitals, and/or open wounds. In most cases, these germs come from your own hands (if you touched contaminated surfaces) or from someone else’s hands (who touched contaminated surfaces and then touched you). But you can also get infected from contact with contaminated medical instruments.
Germs really like to hang around.
Studies show that germs can live for weeks on stainless steel or polymer surfaces. Other studies found that antibiotic-resistant MRSA may exist on surfaces up to 360 days, and spore-forming bacteria, including C. diff., can survive for months.
Where are the germs in hospitals and doctor offices?
Some of the many places where germs lurk in medical facilities, are on:
When doctors, nurses and other staff don’t routinely wash their hands, they can spread germs from one patient to another. Although it seems obvious that all medical staff should wash their hands before and after seeing each patient, sadly it doesn’t happen consistently. In fact, a 2014 study found that less than 1/3 of healthcare workers in an ICU (intensive care unit) always washed their hands. Why are so many skipping this important step? Likely a combination of forgetfulness and apathy.
What can you do?
Although it might feel awkward, you can, and should, ask all medical professionals to wash their hands and/or put on clean gloves before they touch you. Also mention it before they touch medical equipment. I’ve had to make this request several times myself, and some doctors agree quickly while others grunt. But they’ve all washed their hands or put on clean gloves. This one step can easily reduce your risk of serious infections.
Also, you should wash your own hands frequently in medical settings. Additionally, before you leave a medical office or hospital, wash your hands. This advice applies to patients, family members and guests.
2. Items in waiting rooms.
It’s safe to assume that sick patients touch everything in the waiting rooms of doctors’ offices and emergency rooms. Whether it’s toys, books, arms of chairs, door handles or knobs, it’s likely covered in germs. Same goes for the “community pen” you use to sign in and/or fill out forms.
What can you do?
First, bring your own entertainment, including toys and comfort items for your children. Bring your own pen and use it to fill out forms. Also, try not to touch your face while in waiting rooms. And wash your hands when you leave.
Stethoscopes can be covered in germs, including some strains that are antibiotic-resistant. Unfortunately, an analysis of 28 studies found that, on average, 85% of stethoscopes were covered in germs, with a range of 47 – 100%. In other words, the vast majority of stethoscopes have germs on their surface. The good news – most of the germs on stethoscopes don’t cause illnesses. But, there is concern that stethoscopes could harbor dangerous germs which can make patients quite sick. Additionally, research shows that the germs can transfer from scope to skin.
Cleaning helps significantly.
Research shows that frequent disinfection reduced rates of contamination from 84% to 33%. Moreover, research shows that cleaning stethoscopes significantly decreased the rates of stethoscopes contaminated with MRSA, an antibiotic-resistant germ.
What can you do?
Although the risk of infection is low, the possibility of getting an antibiotic-resistant germ is reason enough to pay attention. Cleaning the diaphragm of a stethoscope (the part that touches your skin) is easy, but it must be done frequently – as often as every 5 patients – to keep germs off the surface. So, before your doctor places a stethoscope on you, ask him/her to clean the diaphragm with alcohol, an alcohol wipe, or with an alcohol-based hand sanitizer.
4. Doctors’ white lab coats.
Many doctors routinely wear white lab coats, but it turns out that these coats often harbor germs. According to a NY Times article, dozens of studies show that white lab coats are frequently contaminated with harmful bacteria, including antibiotic-resistant strains. As many as 16% of coats were contaminated with MRSA, and up to 42% had Gram-negative germs (an increasingly drug-resistant class of bacteria that includes E Coli and other dangerous germs).
Why? One likely explanation is that the long sleeves can easily come into contact with patients’ bodies – thereby both picking up and spreading germs. Interestingly, in 2008, Britain’s National Health Service started requiring doctors to go “bare below the elbows,” to prevent the spread of infections from long sleeves.
What makes this worse?
Doctors don’t wash their lab coats frequently. A survey of 183 doctors and medical students at one hospital revealed surprising, and upsetting, results for how frequently this group washed their lab coats:
- 1% – every day
- 2% – every other day
- 39% – once a week
- 40% – once a month
- 17% – never
What can you do?
The good news is that many doctors no longer wear white lab coats. The bad news is that unless you feel comfortable asking your doctor to either remove his/her coat or roll up his/her sleeves, there is little you can do. However, I hope that if more patients state a preference for doctors to abandon the white lab coats, the trend to forgo these germ-ridden coats may continue.
5. Health care workers’ cell phones and tablets.
Doctors and other medical staff regularly use cell phones and tablets as part of their job. Health care workers use them for a variety of tasks, including calculating medication dosages, reviewing laboratory and imaging results, and accessing patient data. But, their phones are covered with germs, including dangerous antibiotic-resistant MRSA.
How many germs? A recent study of cell phones used by staff in ICU units found 107 dangerous species of bacteria in 491 samples.
Why is this an issue for patients?
Unfortunately, health care workers rarely clean their mobile phones – research shows that approximately 90% never clean their phones. Since health care workers often touch their phones during or after a physical examination of patients and handling specimens, it’s easy for staff to transfer these germs to patients. And the problem persists because health care workers don’t wash their hands as frequently as they should (see #1 above).
What can you do?
First, for this reason and many others, always make sure your doctors (or other staff members) wash their hands in front of you or puts on clean gloves. Additionally, if they use a tablet or phone in your presence, make sure they re-wash their hands or put on clean gloves. Don’t be afraid to speak up – your health depends on it!
6. Hard and soft surfaces in patient rooms.
Germs are everywhere in hospital patient rooms! There are germs on pretty much everything in a patient’s hospital room, including bed rails, call buttons, tray tables, light switches, privacy curtains, medical equipment, IV poles, telephones, chair armrests, door handles, the floors and even on the bed sheets!
A few examples:
- One study of patient privacy curtains found that after 2 weeks, over 60% newly cleaned curtains tested positive for MRSA.
- Researchers found that conventional laundering of hospital bed sheets left 60% of C. diff. spores on the newly laundered sheets.
- Floors in hospitals are dirty and often neglected. Researchers found that floors in patient rooms were frequently contaminated with disease-causing germs, such as MRSA and C. diff. Furthermore, items frequently touched by patients and staff, such as blood pressure cuffs and call buttons, were often in contact with the floor. Not surprisingly, touching objects that had been in contact with the dirty floor frequently led to the transfer of these disease-causing germs from the floor to a hand. Learn more about this in my post How Dirty are Hospital Floors?
What can you do?
First, assume that all surfaces contain germs. Periodically use wipes with bleach to clean surfaces that the patient and/or visitors will touch. And, wash your hands often, throughout the day, especially after touching objects in the room. Additionally, since research shows that single-patient rooms are associated with a significant reduction in infections and in the quantity of germs present, try to get a private room.
7. Contaminated medical instruments.
Contaminated instruments can cause infections that can cause serious harm, even death. Many complex, reusable instruments, such as endoscopes, duodenoscopes and arthroscopic shavers, are hard to clean, disinfect and sterilize. And since these germs are microscopic, no one can see any contamination. If instruments are not thoroughly cleaned and disinfected, the tissue or fluid from one patient can remain on the instrument and infect subsequent patients. An analysis by ECRI found that staff did not always follow required cleaning steps, increasing the risk of infections.
However, sometimes the design of the instrument makes it impossible to thoroughly clean, allowing infections to occur even when staff follows the manufacturer’s instructions for cleaning, disinfection and sterilization. This is a particular concern with duodenoscopes, which have persistent high levels of contamination due to cleaning challenges. On August 29, 2019, the FDA issued a statement recommending that “health care facilities and manufacturers begin transitioning to duodenoscopes with disposable components to reduce risk of patient infection”.
What can you do?
Unfortunately, there is little patients can do to reduce their risk of infection from improperly-cleaned, unsterile instruments. But, if you need a procedure that will involve the use of invasive instruments, it can’t hurt to ask your doctor how the hospital keeps its instruments contamination-free. You can look up healthcare-acquired infection rates on Medicare’s Hospital Compare website, but the site doesn’t provide data on infections from medical instruments. But, it will give you an idea about how the hospital fares on other infections. You can also review the hospital-acquired infection rates on The Leapfrog Group website.
Wash your hands the right way to eliminate germs!
Although washing your hands won’t protect you from all of the hazards described above, knowing how to properly wash your hands will help you reduce your risk of infection. In order to protect yourself, wash your hands following these 5 steps recommended by the CDC:
- Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
- Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
- Scrub your hands for at least 20 seconds.
- Rinse your hands well under clean, running water.
- Dry your hands using a clean towel or air dry them.
Importantly, realize that alcohol-based hand sanitizers will not kill all germs, including C. diff. Of course, using a sanitizer is better than nothing, but if possible, use water and soap. And if you must use a hand sanitizer, look for one that has at least 60% alcohol.
For more information on infections, read my blog posts:
- Reduce Your Risk of Exposure to Superbugs in Hospitals.
- How Can Patients Protect Themselves from Hospital Infections?
- Why is Hand Washing in Healthcare So Important? What You Need to Do to Stay Safe.