Are you satisfied with local infection prevention protocols?

April 3, 2015

“I’m not satisfied. We could all do a whole lot better," one urologist told Urology Times.

“Our hospital went through all the necessary steps and did a lot of training on proper protections if Ebola patients came through. Since the U.S. Ebola outbreak never amounted to much, it somewhat dropped by the wayside.

RELATED: Has the current state of medicine affected your retirement plans?

For general infection control, I think the hospital is operating the same way it did 5 to 10 years ago.

Hospitals are the worst place for people who are not healthy; they harbor all the bad bacteria of the world under one roof. That’s really been part of the impetus to get surgical patients out of the hospital quickly, before they get those bad bugs. I don’t think it’s just a matter of wearing more gloves or better gowns. I’m sure all doctors are slathered in this horrible, bad bacteria. We have to be.

We see patients every day in clinic all day with no precautions. We talk to patients, shake hands, and the next day we see them at the hospital to do a procedure and put on gloves, gowns, and facemasks. It’s like, ‘Wait a minute, if I have to do all this now, why didn’t I have to do it 12 hours ago in the clinic?’ That’s the great irony. Sure, it’s a problem with the multidrug-resistant bacteria out there, but what’s being done is probably appropriate for the problem that’s going on. I think hospitals do a pretty good job of sterilizing rooms, so I don’t have any great concerns about it.”

Daniel Zapzalka, MD

St. Louis Park, MN

NEXT: "We could all do a whole lot better."

 

Dr. Sonn“I’m not satisfied. We could all do a whole lot better. It’s a complicated issue.

The actual source of the problem with multidrug-resistant organisms is the community or ER physician. People prescribe antibiotics indiscriminately. Community and ER physicians should determine if patients are symptomatic before prescribing antibiotics. It takes a lot of effort and patient education not to give antibiotics when they’re not necessary. The best way to control superbugs like they had in California is by prevention-to think long and hard before prescribing antibiotics.

The other issue is the question of infections like Ebola. In the United States, everyone travels. Subways and airplanes are all enclosed spaces, so if Ebola ever became an epidemic here in the United States, it would be very problematic to contain it.

There need to be national protocols for an Ebola outbreak, because it is just a matter of time. I don’t think my local hospital could handle an Ebola patient. Screening questionnaires are like putting a Band-Aid on a major problem. We should have a national system where a suspected Ebola case would trigger a special EMS unit to transport the patient to a center that can handle those cases.

I don’t have an issue putting my patients in the hospital. I don’t hospitalize them unnecessarily, but there’s no Ebola outbreak, so it’s not an issue right now.

A lot of multidrug-resistant organisms circulate in the hospital, although they’ve done a great job the past few years with infection control. There has been a sea change in the attitudes of hospitals, probably tied to the financial penalties of having patients acquire an infection in the hospital.”

Donald Sonn, MD

Springfield, MA

NEXT: "I feel comfortable with the safeguards."

 

Dr. Zlatev“In the Stanford residency, I work at the hospital, the adjoining pediatric hospital, the VA in Palo Alto, Santa Clara Valley Medical Center, and Kaiser Santa Clara. They’re all different in what they do for infection, but as soon as anyone has a contagious infection, they get put in isolation with contact precautions. I feel comfortable with the safeguards.

For example, the VA checks for MRSA and nares when they discharge patients. That’s part of the discharge orders I cosign.

Stanford has so many safeguards; sometimes, it’s tough to keep up with all the protocols. One major precaution is sepsis protocol for nurses. Based on vital signs, if patients meet certain criteria, it triggers a sepsis protocol. It’s all nurse based.

In urology, the infections we deal with most often postoperatively are either skin infections or urinary tract infections, like C. diff, which can occur in outpatients who have had antibiotics when they’re scheduled for surgery. Even a single dose of antibiotics can lead to a C. diff infection. At Stanford, if a postoperative patient has loose stools, a sample is almost automatically sent off for testing. One time, the C.diff diagnosis came back before I even knew about a patient’s loose stools.

There were definitely protocols for Ebola. It’s mostly at the emergency department level, but they’d developed a protocol to look for signs and symptoms of Ebola.

From urology’s perspective, I feel very comfortable with all the hospitals.”

Dimitar Zlatev, MD

Stanford, CA

Check out these other recent Urology Times articles:

Extended antimicrobial prophylaxis raises C. diff risk

Sexual effects data lacking on 5-ARI for hair loss

Say farewell to fee for service

Subscribe to Urology Times to get monthly news from the leading news source for urologists.