Evo Terra (Host): This is Expert Insights with the Carle Foundation Hospital. I am Evo Terra. And today, I am joined by Dr. Robert Healy, Associate Chief Medical Officer for Quality, Safety, and Experience at Carle Health System, for a conversation about reducing your chance of spreading infection. And I'm sure there's more to it than just washing your hands. Dr. Healy, welcome to the show.

Dr. Robert Healy: Thank you. Great to be here.

Host: So, is it? Is it more than just washing our hands?

Dr. Robert Healy: If nothing else, if listeners just take one thing away from this, it's wash your hands frequently, often, as many times as you can. That would prevent so many infections being transmitted around our health system and our community. So, it really is that simple.

Host: And I think we all knew that. I mean, our grandmothers have been telling this forever, "Wash your hands before you do this." Clearly, 2020 taught us all the importance of hand washing, and that increased frequency. Are we the public washing our hands more, do you think? I mean, you can't sit there and watch us all the time, but do you think that's happening?

Dr. Robert Healy: I don't think it is. And the reason I don't think so is because, in the hospital system, we actually have people out there observing for nursing, for techs, for physicians, for advanced practice providers, what are they doing in the real world in the hospital. Now, you would think rightly so, we're very aware of our risk of spreading infections, of the importance of hand hygiene. However, when we measure it, we're not at a hundred percent. So, there are barriers to getting your hands washed, and that's real life. There's emergencies, there's things you got to do in a hurry. The hand washing apparatus might not be in the right place. So even in a place where we're hypervigilant, we're not perfect. So, I would say that the general population is much less than that.

Host: Yeah. Yeah. Well, that's depressing. But definitely, I understand, it is human nature, right? Because like you said, we get busy, and we do that one but providers like yourself are kind of the role model for things, right? We need more providers being more active as they are showing them washing their hands would not be a bad thing. Clearly, you're surgeons, you know, the surgeon will wash their hand. But even just nurses or techs, as you mentioned, it is so important. It makes sense. Makes sense.

Dr. Robert Healy: Yeah. In the surgery world, in the operating room, very aware of, yes, scrubbing for minutes at a time and proper hygiene is incredibly important and people call each other out. If I remember as a medical student, I would be washed up and have my gloves on and I would inadvertently scratch my nose. But a nurse would say, "Hey, you touched your nose." And I was gone to wash my hands again. We don't have that kind of hypervigilance in the real world. They definitely do there.

Host: Yeah. Yeah. Well, lessons to be learned, right? Lessons to be learned for certainly. So since we're talking about people in the hospital system, I am not in the hospital system. I'm just a lay person, but I definitely like to keep up with what's going on in this world. And speaking of 2020 all over again, PPE, Isolation, when you have someone really sick, talk to me about the importance of following good, solid isolation, PPE.

Dr. Robert Healy: One thing about patients in our people in the hospital, staff, visitors, patients, we have on us and around us some of the scary bugs that are out there. So, it could be a virus like it was in 2020. It could be bacteria. We have a lot of bacteria now that aren't readily treatable with our antibiotics. And there's things like new infections from fungus or fungi that are out there and scare us.

So yes, we're in an environment with the work that we do where there's a lot of bad bugs out there, essentially. So, we really need to be aware. We really need to know when a patient has a certain infection or the potential for that infection, the proper way to protect that patient, their family, us and our other patients and staff by wearing the proper PPE.

Host: That's got to be hard to figure out. Is this just a sniffle that someone has here? So, tell me the trend. What's happening in the hospitals? Are we seeing less vigilance when it comes to when they should be wearing the proper PPE?

Dr. Robert Healy: I think we do a good job of labeling, for certain symptoms. If someone comes in and they have symptoms that could be, for instance, tuberculosis or they have a history themselves of having one of these bacteria that are multi-drug resistant, we have the proper categories to put them in, whether they're isolation because it could pass through breathing or it could pass through touch. We have the proper isolation and we put labels on the rooms and we all should be aware of what those isolation categories are as well as what the proper PPE is, whether it be just a mask and gloves, or also wearing a gown, et cetera. And it goes up from there. So, we do a good job of labeling that. We do a good job of making people aware as they're walking into a room what they should be doing.

You mentioned something earlier, and that's about role modeling. This is where it becomes incredibly important. The physicians, advanced practice providers, nurses, techs, they're all incredibly important and they're looked up to within our own staff and by our patients and visitors. If we're not doing it, they're not going to do it, and we know it should be done. So, we really need to be hypervigilant and do it right each time every time. And that means every time you walk through the doorway of a patient's room, washing your hands on the way in, washing your hands on the way out, being obvious about it so people see that it's happening. That way everyone knows, "Oh, it's really important because he's doing it as well."

Host: Exactly. I mean, thinking about fungal infections already scares because I watch too much television. But leave the Last Of Us and talk instead about the isolation order. When someone has been found to have something or possibly something that is infectious, we need to isolate them up. How's that followed up? What are we doing when we have those isolation orders in the hospital?

Dr. Robert Healy: That's a great question. So, usually, what was done in the past is if an isolation order was ordered on admission or when symptoms started, then it would be there until the provider wrote an order to stop that isolation.

One new thing we're going to do at Carle Health is allow that to happen without a new order being placed. In other words, if someone comes in and they have symptoms or signs, and I suspect TB, I'll write for the proper isolation order. Once we know that TB has been ruled out or the symptoms are gone away and we're not worried anymore, instead of me getting a call or a message to write, an order to stop that, we'll just have a protocol where that can be stopped by the nurse. And that'll make it easier to make sure that the right people are on the right precautions. And when they're done with those precautions, we get them off of those precautions.

Host: Yeah, I mean, obviously being hypervigilant and aware is a good thing. I mean, overprotection is fine. But at some point, we certainly don't need to be when we get a clear objective. So, that's good. There's a new process that's in place to make sure that when you're removed from isolation, the patient can be removed quickly and everybody knows what's happening. That's good. That is fantastic.

And for the providers out there that are watching this, where can they find this information about this isolation discontinuation criteria?

Dr. Robert Healy: So, infection prevention has really nice site in our Two North web pages, that list all the different isolation categories and what they include and will list the discontinuation criteria where that isolation will be removed when your patient no longer needs it.

So, reaching out to Infection Prevention by looking at their information on Two North is an excellent resource. They're also readily available on Epic Chat in all of our regions, so you can send an Epic chat to Infection Prevention and they'll be happy to get back to you. There's always someone on call for infection prevention. You can call the Operator Communication Center, ask for them to be paged. They are a great group of professionals and they're readily available.

Host: Nice to have the support backing up. So when you've got a question, you can get an answer pretty quickly, know exactly what to do. Wonderful. Anything we didn't cover that you would like to?

Dr. Robert Healy: I don't think so. I think we started with, is it as simple as washing your hands? And really, it can be that simple. Wash your hands each time, every time. And realize that, even if you don't think so, people are watching you to see if you wash your hands. Patients are watching you, visitors are watching you, staff, colleagues are watching you. So, washing hands is incredibly important.

Of course, isolation protocols and the way we have to wear PPE is incredibly important to keep the bad bugs where they should be, which is isolated and not transmit them to ourselves or to our other patients. And then, the one thing that people who write orders will really appreciate is instead of getting a call to write another order to stop something, we're going to stop it based on the best evidence and not have to bother you with that order.

Host: All good information. Dr. Healy, thank you very much for joining me today.

Dr. Robert Healy: It's great to be here, and thanks for having me.

Host: Once again, that was Dr. Robert Healy, Associate Chief Medical Officer for Quality, Safety, and Experience at Carle Health System. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I have been your host, Evo Terra. For more information and to get connected with one of our providers, please visit carle.org. That is c-A-R-L-E.org. For a listing of Carle providers and to view Carle-sponsored educational activities, head on over to our website at carleconnect.com. And if you love this episode of Expert Insights with the Carle Foundation Hospital, please share it with your friends and family. Thanks for listening.