Sometimes you have to be the ‘bad cop’

Sometimes you have to be the bad cop’

CDC expert struggles to prompt hand hygiene

Even those deeply aware of the risks of acquiring health care associated infections (HAIs) can find it surprisingly difficult to speak up on behalf of themselves or a hospitalized loved one. Ask Michael Bell, MD, the deputy director of the division of healthcare quality promotion at the Centers for Disease Control & Prevention.

"It’s really hard. When my own mother was in the intensive care unit, I found it hard to pipe up," Bell says. "If I find it hard, I can’t imagine what it’s like for everybody else."

Another time when a mutual friend was hospitalized, Bell and a buddy decided to run the old "good cop/bad cop" routine, taking turns being the bad cop who hectors health care workers trying to slip by with unwashed hands.

"It’s easier to do when you decide up front I’m going to be the bad cop today," he says.

Another technique is to display a kind, but relentless curiosity.

"I’m always asked, What can I do to protect myself or a loved one in the hospital?’" Bell says. "The short answer is ask questions. It’s hard, but you have to ask questions. And the questions to ask are things like have you washed your hands? It sounds basic, but it’s important. And you can ask it in a nice way. You can say, I’m sure you just washed your hands, but it would mean a lot to me and my mother if you would wash them again.’"

Ask how long a catheter must remain in place, knowing that removal when it is no longer necessary may prevent the onset of infection. "Ask every day Can the catheter come out?’" he says. "If [they] say in two days, at day two start asking Can the catheter come out today?’"

Another important line of questioning deals with testing and antibiotic susceptibility of the infecting agent.

"Ask Are you doing tests to make sure I’m on the right antibiotic?’" Bell says. "These questions are very hard to ask if you’re the patient receiving care. You [already] have plenty to think about. It’s a good idea to bring a friend or family member whose main job it is to be the persistent asker of these questions. Because at the end of the day, the doctors, the nurses, the entire medical team wants you to get better. Even though it might be annoying for a minute, it’s a helpful reminder to have hand washing, catheter removal and appropriate antibiotic use be at the top of their minds."

Bell’s comments came at a recent CDC press conference announcing new national HAI data.