Patients walk through your doors every day with active infections, carriage of infections or susceptibility to infections. Two out of every 100 patient encounters will be with a patient with methicillin resistant staphylococcus aureus (MRSA). Sneezing, coughing, oozing, or coming in contact with purulent wounds are all vehicles by which you and your staff may pick up an organism that can be transmitted to the next patient that you see.

Like our patients, we and our staff have behaviors that are conducive to transmission of infections of which we may be unaware. For example, when clinicians are observed, they touch their nose, mouth or eyes (the T-zone) an average of 9 times per hour. Clinicians are also teachers of good hygiene by their role modelling. For instance, clinicians who were observed to have less T zone touching were more likely to communicate more effective infection prevention messages to their patients.

Although use of hand washing with soap or sanitizing gel is a common practice, only 9% of clinicians in office practice meet CDC criteria for effective hand washing.  www.cdc.gov/handhygiene/Guidelines.html

So what can clinicians do to reduce the risk of infection transmission in the office practice setting? The Centers for Disease Control and Prevention have issued a guideline for infection prevention in office settings entitled “Guide for Infection Prevention for Outpatient Settings” (www.cdc.gov/hai/pdfs/guidelines/Ambulatory-Care+Checklist_508_11_2015.pdf ) that include the following strategies:

• Dedicate resources to infection prevention
• Education and train healthcare personnel
• Monitor and report healthcare associated infections
• Adhere to standard isolation precautions
• Appropriate handwashing
• Use of personal protective equipment (PPE)
• Injection safety
• Environmental cleaning
• Disinfection and sterilization of instruments and devices
• Cough etiquette

A cornerstone strategy to decease transmission to and from your patients is the appropriate use of handwashing. Although done frequently, it is rarely done correctly. Plain soaps, antimicrobial detergents, alcohol based washes, and germicidal foams are available. Although there are slight differences in effectiveness of each, the key determinant to successful microbial elimination is the procedure of handwashing. CDC offers some tips for practitioners found at: www.cdc.gov/handwashing/index.html . The World Health Organization has provided a pictorial step by step guide to handwashing that emphasizes the correct sequence of washing at:

www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf

The key points to effective handwashing are:

• Wash for minimum of 40-60 seconds
• Start with washing both palms
• Wash between fingers
• Wash back of fingers
• Wash thumbs
• Wash wrists
• Rinse or dry thoroughly

Protecting your patients from iatrogenic infections is a very important patient safety goal that is achievable through paying attention to the interactions between yourself, your staff, your instruments and devices, and your patients. Use the CDC guide checklist to determine how prepared your office setting is currently and learn the 10 strategies to reduce transmission.