Infection Control – an uphill battle

You can’t make this stuff up.  My friend and colleague Ilene Corina from PULSE  (patient safety organization) shared this story and has given me permission to share it with you:

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Ever Wonder: Why Bother?

By Ilene Corina 

I took my son for a skin procedure and the doctor who was working on his face did not wash her hands before touching him. I did ask her about it, like we have been telling patients to do for years. “Shouldn’t you wash your hands first” I suggested innocently enough. She explained she washed her hands before coming into the room.

I could have told her that since she came into the room, she touched her pen, his chart, some other papers, the arm of the chair, brushed the hair out of her face about twenty times and this doesn’t even count for the door knob that I too touched when I came in the room.

I knew my son was not going to get a deadly infection that may cause long days in the hospital or even a visit to the emergency room, or did I know that? I did know that my instinct was to ask, and I was not comfortable with her response. At least she could have said, “Oh, let me wash up now” or “you’re right, thank you for reminding me”. After all, isn’t this the way it works in the patient safety training manuals?

But the training manuals are not the real world and the real world is not accustomed to patients being advocates for themselves or their family. In a doctor’s office, where procedures are often done, there is no accreditation or oversight. There may even be less training in procedures that we are accustomed to when using a big, well known hospital.

“You know” I told this doctor, “I teach people about patient safety and infection control and patients are being taught to ask their doctor to wash their hands so they don’t get an infection”. Not missing a beat, and still paying close attention to my son’s procedure she replied, “I told you I did wash my hands”. As she turned towards me she promptly dropped my son’s biopsy on the floor and began to search for it with tweezers, stopping the search only to clean and dress the wound. Her assistant found the biopsy and put it in the “sterile” container to be shipped off for analyzing. Speechless, I left the room and wonder why I do this at all.

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So what is the option here?  What is a patient, or an advocate to do?  I was speechless when I read the story.  Anyone have suggestions for us?  I’m happy to forward them to Ilene, or you can get in touch with her through PULSE

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3 Responses to “Infection Control – an uphill battle”


  1. 1 effusion February 16, 2007 at 10:13 am

    That’s an interesting and appalling story. Given all the news reports about disease transmission in medical facilities, one would think that physicans and other medical personnel would be conspicuous with hand cleaning and sterility controls.

    More of us are noticing possible or obvious failures to observe sterility control protocols, but, for many of us, speaking up is not easy. I remember seeing a lab technician drop a needle that she was about to use to draw blood from my very elderly father. The needle only tapped my father’s jacket. As it turned out, no infection resulted, but there occurred to me the mortifying realization that some microbes release spores that could settle on nearly any surface. I wished that I had spoken up as I had thought about doing, and I resolved to do better in the future. Resolving it is one thing, doing it is another.

  2. 2 JENI DINGMAN February 16, 2007 at 9:37 pm

    Thanks for posting this. Patty of Colorado Citizens and Ilene have told me so much about you. I just wanted to thank you for all that you are doing for patient safety and tell you to keep up the great work. I hope that someday we might chat or meet.

  3. 3 Lisa Lindell February 19, 2007 at 10:29 pm

    You do about the only thing we can do, post the incident all over the internet. I’m curious, though, about Ilene’s comment that there is no oversight in a doctor’s office. From a patient perspective, there’s no oversight in a hospital, either.


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