Nice Shot!

LifeBridge Health leadership set the tone for this year's flu season yesterday: get your flu shot as soon as possible.

LifeBridge Health CEO Warren Green, Sinai Hospital President Neil Meltzer, Northwest Hospital President Erik Wexler and Levindale and Courtland Gardens President Aric Spitulnick all are pictured here getting their seasonal flu shot, courtesy of Peter Andrews, PA-C, Sinai and Levindale Director of Occupational Health.

This shot was for the "regular" seasonal influenza. LifeBridge Health is doing everything it can to make sure employees are as protected and prepared as possible. All employees are encouraged to get their seasonal flu shot, and receive a free meal ticket as an incentive. The seasonal flu peaks in February.

When the H1N1 vaccination becomes available, and, if there are enough, all LifeBridge Health employees will be offered that shot as well. If there is a shortage, those health care workers directly interacting with patients will be prioritized.

Meanwhile, there are cautionary steps everyone should take: wash your hands frequently; cough in the crook of your elbow; and stay home if you are sick. Stay tuned to learn more about what LifeBridge Health is doing to promote hand washing across Baltimore.

White Coats: Medical Professionalism or Infectious Risk?

Anyone who's seen me striding about the hospital knows that one of my distinctive Cmar-isms is that I always roll up the sleeves of my white coat, as well as my shirt. Far from being a mere affectation, to me it serves two important purposes, both related to infection control. One is that with sleeves extending to the wrist, there's a chance that they will become dirty or contaminated while examining a patient, and the bacteria involved could be passed on by said sleeves to the next patient I deal with. Secondly, it is easier to wash my hands between seeing patients more thoroughly without having soap and grime absorbent fabric right next to them.

While this represents my personal choice, and not an institutional policy, there is a growing level of concern nationally about the role that physician dress might play in the spread of infections in the hospital setting. Many studies have documented that items which come into contact with patients, from stethoscopes and pens to neckties and shirt sleeves, can easily become contaminated with organisms that can cause serious infections in otherwise ill hospitalized patients. Bugs that can cause life-threatening infections and are difficult to treat, such as Methicillin-Resistant Staphylococcus Aureus (MRSA) and Clostridium difficile (often abbreviated "C. diff."), are of prime concern.

Looking at things from that perspective, it seems obvious that a few simple changes in professional dress - getting rid of long sleeves and neckties, for example - would be an easy way to reduce the transmission of virulent organisms among patients, as well as encouraging physicians to wash their hands. In fact, the National Health Service in the United Kingdom did just that in 2007, instituting a "bare below the elbows" policy in all hospitals that bans long sleeved white coats and shirts, as well as long neckties. However, these changes on the NHS's part have met with some controversy.

For one thing, there isn't a robust body of evidence that looks specifically at how much such a change would actually decrease the rates of hospital-acquired infections in patients. More importantly to some, the white coat has been a symbol of physicianhood for over 100 years. Many doctors and patients alike believe they should not be done away with, because they represent the professionalism of physicians, and their knowledge of both the science and the art of medicine.

As recently reported by the Washington Post, the American Medical Association is currently debating a proposal made at its recent annual meeting to recommend against physicians wearing white coats. In addition to the infection control and professional respect issues noted above, some have opined that the white coat has changed from a symbol of trust to one of possible anxiety for patients. In fact, some doctors have taken to going without their white coats to affect a more casual rapport with their patients, especially in a time when health care is sometimes seen as an industrial, uncaring machine.

There are many nuances to this issue, and it's one that will not be resolved soon, especially in our current health care climate. Until the time when more science and firmer policies are available, I'm going to keep rolling up my sleeves, and of course, washing my hands.

What do you think?

Good Hand Hygiene Helps Prevent School Absences

by: John Cmar, MD

Lifebridge Health just contributed the following article to Newswise, including some commentary from myself and other colleagues in Infection Prevention and Control:

Newswise — With 82 million students and teachers – over a quarter of the population – expected to start school in the United States this fall, it’s important that everyone do his or her part to keep himself or herself and others healthy when class is in session.

Experts from Baltimore-based LifeBridge Health, which operates Sinai and Northwest Hospitals, say that the number one thing students and teachers can do to avoid getting sick is to adopt good hand hygiene.

“I often joke that the ways to not get sick are to wash your hands and don’t eat at questionable restaurants, but there’s a lot of truth to that advice,” says John Cmar, M.D., an internist at Sinai Hospital.

Hand washing helps prevent illness because most germs are spread when people pick them up from infected surfaces and then touch their eyes, noses or mouths. However when hands are germ-free, bugs don’t usually have a way to reach the face.

According to Northwest Hospital Infection Control Manager Mary Wallace, bacteria and viruses live on many surfaces found in a school environment such as desks and tables, computer keyboards, clothing, locker room benches, coins, and doorknobs, to name a few.

“Because hands can pick up germs from so many different types of surfaces, it is critical that students wash their hands after using the restroom, before and after eating, whenever they are soiled, and periodically throughout the day,” says Wallace.

Teachers and principals should not underestimate their role in helping students remain healthy through reinforcing proper hand hygiene. Kids model the behaviors of authority figures, so school officials need to be champions of hand washing.

“It’s especially important that teachers and parents teach children the proper hand washing technique,” says Marilyn Hanchett, R.N., a Sinai Hospital infection preventionist. “Many kids wash just their palms, missing their fingertips and areas around the thumbs and between the fingers. Unless an adult teaches them, kids don’t know they are supposed to wash those areas too.”

The American Society of Microbiology discovered that only 50 percent of middle and high school students say that they wash their hands after using the restroom. The statistics get even worse when one considers soap usage; only a third of females and 8 percent of males use soap. Without the cleansing effects of soap, water is less capable of removing germs and bacteria.

If your child’s school does not provide soap in the restrooms – a growing problem in many schools – send a gift to the teacher: a bottle of hand sanitizer to place on his or her desk for student use. Cmar, Wallace and Hanchett all stress the importance of each classroom having its own source of alcohol-based hand rub, as it’s impractical to leave the room to use a restroom sink to wash one’s hands as often as is necessary.

While hand washing greatly reduces the odds of catching a bug, sometimes sickness is inevitable. If your child contracts a bug and you’re wondering if the illness warrants a sick day, Cmar recommends that you ask your child’s doctor.

“People should have a low threshold about when to call their doctors to ask if their sick kids need to stay home or if they need professional medical attention,” says Cmar.

In most cases, sick people should stay home to ensure they get rest to aid recovery and to avoid coming into contact with others so they don’t pass along the virus. Cmar adds that the length of time that someone is contagious varies from illness to illness – another reason to consult your doctor.

Because avoiding other people is not always possible, encourage your kids to get into the habit of covering their coughs and sneezes. The old advice of covering one’s mouth with one’s hand is bad because hands are constantly touching other surfaces, so teach your children to cough or sneeze into a tissue or the crook of their elbows. If they do cough or sneeze into their hands, make sure they wash them promptly afterward.

“It’s really the basic stuff – hand washing – that helps us prevent the spread of disease,” says Cmar. “There aren’t any magic pills or mega doses of vitamins that protect us from cold and flu viruses. It comes down to just this: wash your hands, and don’t rub your face.”

LifeBridge Health is one of Baltimore's largest health organizations that includes Sinai Hospital of Baltimore, Northwest Hospital, Levindale Hebrew Geriatric Center and Hospital, and Courtland Gardens Nursing & Rehabilitation Center.

The original article posting can be found here.

Oh, and wash your hands.

Staying Healthy at the Gym

by Holly Hosler

Imagine this scenario: You’re at the gym and you’ve finished your laps, cooled down a bit, and now you’re ready to hit the weights. Damp hair clinging to your brow, you situate yourself at the bench press station only to lie down in a pool of someone else’s cold, smelly sweat.

Wouldn’t that be fun?

Though some people seem to forget it, the Golden Rule applies to the gym just as much as everywhere else. LifeBridge Health & Fitness Director Matt Carlen says he witnesses infractions of basic gym etiquette rules all the time.

“The things I see most often are used towels on locker room floors, weights that haven’t been re-racked and sweaty cardio machines,” remarks Matt. “There’s also a big problem of people taking up weight stations between their sets of reps – we have to remind people not to sit on equipment that they are not using at the moment.”

In fact, it’s not uncommon for other gym members to confront those guilty of an etiquette breach. While courtesy at the gym makes workouts more pleasant for all members, it may also have the added benefit of helping stop the spread of disease. Wiping down sweaty equipment helps protect the next user from your germs. If you want to be extra safe, you should clean your selected exercise machine both before and after use. At LifeBridge Health & Fitness, moist towelettes are provided to wipe down equipment.

“It’s also important to wash one’s hands before and after visiting a gym and after cleaning the equipment there,” says Jackie Daley, director of Infection Prevention and Control at Sinai Hospital. “While you’re in the midst of your workout, be careful not to touch your eyes, nose or mouth – at least not until you’ve properly sanitized your hands.”

The gym has alcohol-based hand rub stations throughout the complex, making it easy for people to sanitize their hands as often as needed.

So whenever you’re at the gym, be sure to clean your equipment before and after use and wash your hands as needed. It may just spare you from pools of sweat – not only the kind found on the equipment, but also the ones that come from being sick in bed.