on the old white coat

I once worked with a charge nurse who never wore her scrubs home. When I asked her why, she said that she didn't want to bring whatever germs she encountered home to her family. Despite the fact that she was the infection control nurse for the hospital, I thought it was a shame that she didn't share this insight with the rest of the hospital.

Surgical nurses and doctors never wear their scrubs from home to work, but most of the nurses in the ER wear their stuff to work and home again. What role does clothing play in the transmission of disease? From Today's New York Times:

Amid growing concerns about hospital infections and a rise in
drug-resistant bacteria, the attire of doctors, nurses and other health
care workers — worn both inside and outside the hospital — is getting
more attention. While infection control experts have published
extensive research on the benefits of hand washing and equipment
sterilization in hospitals, little is known about the role that ties,
white coats, long sleeves and soiled scrubs play in the spread of
bacteria.

The discussion was reignited this year when the British National
Health Service imposed a “bare below the elbows” rule barring doctors
from wearing ties and long sleeves, both of which are known to
accumulate germs as doctors move from patient to patient.

....

Another study at a Connecticut hospital sought to gauge the role
that clothing plays in the spread of methicillin-resistant
Staphylococcus aureus, or MRSA.
The study found that if a worker entered a room where the patient had
MRSA, the bacteria would end up on the worker’s clothes about 70
percent of the time, even if the person never actually touched the
patient.

“We know it can live for long periods of time on
fabrics,” said Marcia Patrick, an infection control expert in Tacoma,
Wash., and co-author of the Association of Professionals in Infection
Control and Epidemiology guidelines for eliminating MRSA in hospitals.

Hospital
rules typically encourage workers to change out of soiled scrubs before
leaving, but infection control experts say enforcement can be lax.
Doctors and nurses can often be seen wearing scrubs on subways and in
grocery stores.

Personally, I don't change out of my clothes at work, but I probably should. I can say I don't let anyone touch me when I come home until I'm out of my scrubs. (My girls know I have a no hugs policy until I'm in my comfy clothes.) After this article, however, I might need to be a bit more aggressive about keeping the hospital germs in the hospital and out of the community.

Comparing Health Care Plans - More coverage vs. less...

If you are still on the fence of who to vote for this year, hopefully, you've started to look at the issues and where the candidates stand. The republicans are leaving the fate of the middle class to market forces while providing aid and comfort to the corporate and well - off as always. While Obama is trying to march us a toward universal health care which is likely to include tax increases and more regulation on the way.

The Wall Street Journal had an analysis and an Op-Ed this week.

Republican presidential candidate John McCain's health-care plan
would make only a small dent in the ranks of the uninsured, at best
covering about five million more people, two new reports conclude.

Democratic nominee Barack Obama would cover more people --
eventually adding about 34 million, according to one of those reports,
by the nonpartisan Tax Policy Center

Sen.
Obama's plan would be costly, the center concluded: $1.6 trillion over
10 years. Sen. McCain's would cost nearly as much: $1.3 trillion over
the same span. The center doesn't give either campaign credit for
initiatives to reduce the cost of health care.

Here's how the New York Times and the Washington Post breaks it down:

New studies from the nonpartisan Tax Policy Center and the policy
journal Health Affairs suggest that Obama's proposal would eventually
cover more than 34 million of the roughly 47 million Americans
currently without insurance, while McCain's would cover at best 5
million uninsured.


Obama's plan relies on a variety of measures to reduce the number of
uninsured, such as increasing the number of people in programs such as
Medicaid and the State Children's Health Insurance Program, requiring
all children to have insurance and offering subsidies for people who
cannot currently afford insurance.


Obama's plan was crafted with the intention of creating universal
health insurance, although both studies suggest some people would
remain uninsured. McCain, meanwhile, touts his plan as one that will
rely more on the consumer market to reform health care.

The journal Health Affairs has a more detailed analysis of both plans and a few suggestions of their own.

One Stop Medicine

Why are Emergency Rooms so crowded? Slate Magazine gathers the most recent data and shows that the uninsured are no more likely to use Emergency care for nonemergent conditions any more than the insured. Instead, patients are going to the ED to get answers they can't get from their doctor's office. "E.R.s have become one-stop shops, assuming that you're willing to lie on a foam stretcher in a hallway for eight hours."

The problem is that this story of the healthy, cavalier, uninsured E.R. abuser is largely a myth. E.R. use by the uninsured is not wrecking health care. In fact, the uninsured don't even use the E.R. any more often than those with insurance do. And now, a new study shows that the increased use of the E.R. over the past decade (119 million U.S. visits in 2006, to be precise, compared with 67 million in 1996) is actually driven by more visits from insured, middle-class patients who usually get their care from a doctor's office. So, the real question is: Why is everybody, insured and uninsured, coming to the E.R. in droves? The answer is about economics. The ways in which health information is shared and incentives aligned, for both patients and doctors, are driving the uninsured and insured alike to line up in the E.R. for medical care.

Instead it is the logistics, liability and economics of outpatient care in the US.

Assume a patient calls his doctor about a new symptom. Ideally, after listening on the phone and deciding that it's probably nothing serious, the doctor arranges an office visit for the next day, offers reassurance, and averts an unnecessary late-night E.R. visit. But doctors don't get reimbursed for that call. And what if they tell a patient to wait and something bad happens? Then malpractice lawyers have a field day.Either way, this scenario assumes that a patient can get through to his
doctor. Many come to the E.R. because it's always open. We thank the
many doctors who do talk to their patients (even though they don't get
paid) and schedule the urgent appointments that keep their patients out
of our E.R.s. But they may be more the exception than the rule. The old
adage "Take two aspirin and call me in the morning" has been replaced
by an office secretary or voice-mail message that says, "Hang up and
call 911 or go to the nearest E.R."

In other words, you may have to wait but you know you will eventually
see a doctor and know one way or another what is going on. That's no
longer the case in the outpatient doctor world.

The problem, of course, is that societal health costs end up higher
because of E.R. overuse. This is because many conditions can be prevented
through health maintenance programs, like managing blood pressure or
cholesterol, which E.R. doctors don't do. Instead of the relatively
small costs of seeing the doctor and taking a generic blood pressure
pill, we foot the bill for expensive, high-tech services when the
uninsured with no preventive care develop strokes and heart attacks.

Here's the original article with all the links -- worth reading.