Balancing infection control with the patient experience

Hospitals have recently been stepping up their infection control procedures, in the wake of news about iatrogenic infections afflicting patients when they are admitted.

Doctors are increasingly wearing a variety of protective garb — gowns, gloves and masks — while seeing patients.

In an interesting New York Times column, Pauline Chen wonders how this affects the doctor-patient relationship.

She cites a study from the Annals of Family Medicine, which concluded that,

fear of contagion among physicians, studies have shown, can compromise the quality of care delivered. When compared with patients not in isolation, those individuals on contact precautions have fewer interactions with clinicians, more delays in care, decreased satisfaction and greater incidences of depression and anxiety. These differences translate into more noninfectious complications like falls and pressure ulcers and an increase of as much at 100 percent in the overall incidence of adverse events.

Hospitals are in a no-win situation here. On one hand, they have to do all they can to minimize the risk of healthcare-acquired infections, but on the other, doctors need to strive for a closer bond with patients — which protective garb sometimes can impede.

More research is clearly needed to determine how much protection is actually needed to prevent the spread of infectious disease.

For instance, Dr. Chen cites studies where,

researchers at the Medical College of Virginia in Richmond found that the rate of infection was identical whether health care workers wore gowns and gloves with only the patients in isolation or whether they wore only gloves with all patients.

So there’s some evidence that being overly protective may not necessarily help.

The key is finding the right balance between infection control and preserving the physician-patient relationship. With rapidly advancing, and sometimes impersonal, technology, combined with the legitimate fear of hospital-acquired contagion, it’s easy to forget about the patient experience during their hospital stay.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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  • stargirl65

    That being said, one easy way to decrease infectious diseases in the community is to try to keep them isolated. Hospital staff should have to put on their scrubs when they get to work and these scrubs should not be worn outside the hospital. They should be kept and washed in the hospital. Short sleeves should be worn and NO TIES. Hair should have to be up and even shoes should be left in the hospital. This could make some dents in decreasing community resistance.

    • anonymous

      What you’re suggesting is going to be difficult logistically. Hospitals would have to front the costs of the scrubs and laundry services. They would need to build locker rooms not just in the OR area but in all the wards (wouldn’t it make sense to change your scrubs after leaving the ER before going into the maternity unit?). The sizes provided invariably don’t fit a large portion of the population, people complain about the harsh detergents used. And is the hospital providing the shoes too? Not saying you’re wrong; just that it will be difficult.

  • anonymous

    Has anyone started working on the new OSHA regulations yet? The ones about preventing aerosol transmission? Is California the only state affected? Masks and gowns are going to be everywhere, but that’s not the worst of it. They actually expect us to retrofit our offices with negative pressure rooms!

  • Dr Joe

    Much “infection control” is about being seen to be doing something regardless of whether it actually makes a difference. Dehumanizing the interaction between doctors and patients does make a difference. Medical defense insurers know that unhappy patients are far more likely to litigate than happy ones.

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