To first do no harm is a fundamental principle followed by physicians and advanced practice clinicians (APCs). And few would argue that a decided majority believe they adhere to that precept most of the time. But it isn’t always the case when health-care folks are faced with the conundrum of sitting out or going to work while showing symptoms of infection, potentially spreading illness to patients and colleagues.
Reasons Why Physicians and Advanced Practice Clinicians Work While Sick tries to identify a comprehensive understanding of the reasons attending physicians and APCs work while sick. Of the medical professionals surveyed, 95 percent believe working while sick puts patients at risk. But of this same group, 83 percent reported working while sick at least once in the previous year. Nine percent said they worked while sick at least five times the previous year! Among the reasons cited for this disconnect: difficulty in finding someone to cover, a strong cultural norm to come to work unless remarkably ill and ambiguity about what constitutes “too sick to work.”
Effective hand hygiene is another way to help ensure no harm is done, yet hand hygiene remains low in most hospitals. Hand hygiene among physicians: performance, beliefs, and perceptions shows that at a large university hospital adherence averaged 57% and varied markedly across medical specialties. In multivariate analysis, adherence was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution. Conversely, high workload, activities associated with a high risk for cross-transmission, and certain technical medical specialties (surgery, anesthesiology, emergency medicine, and intensive care medicine) were risk factors for non-adherence. Another related piece: Physician ‘defiance’ towards hand hygiene compliance: Is there a theory–practice–ethics gap?
Even when hand hygiene is practiced, potential problems arise. Contamination of Medical Charts: An Important Source of Potential Infection in Hospitals notes that medical charts should be considered a source of infection. The authors say “our study confirms that a hospital chart is not only a medical record but also an important source of potential infection. The plastic cover of the medical chart can harbor potential pathogens, thus acting as a vector of bacteria. Additionally, chart contamination is more common in ICUs. These findings highlight the importance of effective hand-washing before and after handling medical charts. However, managers and clinical staff should pay more attention to the issue and may consider some interventions.” In short, hand hygiene that is practiced at the door upon entry is largely negated when a non-gloved hand then pulls back a contaminated curtain or handles a bacteria-laden medical chart. We must stay ever aware of infection vectors all along the chain of infection.