A friend recently came down with a mysterious illness that the doctors could not precisely diagnose. The lab tests indicated a severe dehydration usually associated with sedentary old age, but my friend is an active thirty-four year old. The doctors treated my friend cautiously, recommending fluids and rest. After a week, the symptoms went away, and the lab tests came back normal. What was it? How did he get it? We will probably never know what it was, but it seems fairly certain that my friend picked up a bug during extended visits with a relative in a hospital. Hospitals are dangerous places.

When I started working in hospitals in the early sixties, the most common infectious diseases were pneumonia, the common cold, and the flu. The ancient diseases of mankind were wiped out by improved sanitation, nutrition, and, supposedly, immunization. Even TB seemed to be gone.

Then in the seventies, on the heels of the marvelous improvements in life-saving technologies, came waves of staph, strep, and pseudomonas infections within the hospital environment. These infections seemed to begin in long-term traumatic-injury units, and then spread throughout the building. Hospitals adopted rigorous infection control procedures to stop it. In order to enter an infected patient’s space, a person (even family) was required to put on a gown, gloves, mask, hat, and booties, and then walk across a mat saturated with a disinfectant. Upon emerging from the patient’s space, a person had to remove the all the protective gear, put it in a bag labeled "contaminated," walk across the mat again, and then wash hands in a basin of disinfectant. The procedure was time-consuming, annoying, expensive, and hard on the hands, but it worked.

The class of powerful new antibiotics also worked for a while, but these microorganisms have a way of mutating into resistant forms that defy pharmaceutical science, so "mechanical" infection control procedures remain of first importance. However, the procedures have changed.

The things that vanished, around the time of the first Medicare financial crisis in the eighties, were the saturated mats and the basins of disinfectant. When I asked the infection control nurse why they were missing, she said they cost too much to maintain, and they weren’t necessary anyway. So that meant that the legions of nursing personnel and ancillary technicians can step in infected material in one patient’s room, and take it to another patient’s room, or to the neonatal intensive care unit, or to the cafeteria, or take it home on their shoes. Disinfectant soap replaced the basins that were a hallway nuisance, but that meant washing hands in the patient’s bathroom, or skipping the chore until later.

The sudden appearance of HIV and the reemergence of TB sensitized hospital personnel anew, so the use of masks, gowns, and gloves never disappeared altogether. Indeed, the staff who handle patients at all these days usually wear gloves, and nobody goes near body secretions without an impermeable gown on. Then where do the resistant infections come from, and how do they get around?

They come from people who have been very sick, often comatose, for months, or years, who have been treated for repeated infections with the most powerful drugs available, until they finally acquire a chronic infection by a microorganism that can’t be killed. Body secretions wind up everywhere in the patient’s room after a while, even in a strict isolation room — the floor may be scrubbed daily, but not the walls, the bed frame, the call light, the television control, the door handles, the telephone, or the other furniture. One harried and overworked person who runs into the room to take a peek at the patient, or to punch a button on the beeping IV pump, will inevitably touch something, and carry away the infection on clothing, fingers, or shoes. Or a family member might visit, and simply ignore the rules.

Sometimes symptoms of infection subside, and lab tests can no longer detect it, so the patient goes home or, more likely, to a nursing home, where infection control procedures are even more difficult to carry out. The patient gets sick again, and before anybody becomes aware of it, the infection spreads to any susceptible person nearby. Back in the hospital again, the sick patient is left overnight in the same room with an otherwise healthy post-op patient, and guess what?

To safeguard yourself and your loved ones, here are some simple suggestions for visiting a hospital. Try to not touch anything with your bare hands; there are disposable gloves in every room, and you ought to use them. Don’t give grandma a kiss until you know what’s wrong with her. If you find a sign on the door giving you confusing instructions about using gloves, gown, and mask, don’t try to figure it out, just use them all. If you must be a patient in a hospital, either insist on a private room, or insist that your doctor write clear orders in your chart to not put you in a room with anyone who is coughing or throwing up. Never walk around barefoot in a hospital. Never take children to a hospital, unless you must. Beware of ER exam rooms; you don’t know who was there before you, so don’t touch anything with bare hands. Finally, it would be prudent to keep a bottle of disinfectant in the car to spray the bottoms of your shoes after you leave the hospital.