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Other workplace factors

Influences on patient care

Environmental issues

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A number of factors may be associated with an increased incidence of infections. It is important to wash your hands between patient encounters. (However, some workplaces have inadequate facilities for hand-washing. Cleaning services may need improvement in others). The design of equipment may make maintenance difficult or complex. Overcrowding may also contribute to problems.

Case: Patients infected with virus


A patient with refractory headache, vomiting, blurred vision, and lightheadedness is referred for an EEG as part of a neurological workup.

The EEG is performed by an employee of a clinic owned by a neurologist. There is no evidence of seizure and the final diagnosis is migraine.

One year later, the patient is diagnosed with acute hepatitis B.

An investigation of the clinic reveals many patients contracted hepatitis B from contaminated EEG needle electrodes at the clinic. Although a sterilization protocol was in place, it was not followed.


Class action

The patient joined a class action suit alleging unsterilized needle electrodes used for the EEG studies caused the hepatitis B infections.

Class action is a lawsuit brought by a group of plaintiffs with a similar interest in a particular issue in a litigation.


Experts were critical of the infection control processes at the clinic.

The patients that had acquired hepatitis B at the clinic were paid compensation.


Case: A 10-day-old infant undergoing circumcision
Close up of newborn's legs


A 10-day-old infant undergoes a circumcision in his family physician's office and later develops Fournier's disease (gangrene of the perineum).

The patient requires reconstructive surgery of the penis and scrotum.


Inspection of the physician's office reveals there are workplace deficiencies including lack of hand-washing and disinfecting protocols, equipment that is difficult to clean, lack of appropriate sterilization, and irregular cleaning of the surroundings.

In this case, the physician ceased doing procedures of any kind until the deficiencies were rectified.


Case: Problems with a sterilization machine


A gastroenterologist learns from the hospital that there has been a problem for one month with the sterilization machine used to decontaminate endoscopes.

The machine is difficult to use. One of the drains had not been connected properly by the technicians, although other parts of the cleaning process were working properly. Over this time a patient with known hepatitis C was scoped.

A risk analysis by specialists in infectious disease determines the incomplete sterilization process was sufficient to eliminate bacterial pathogens, but might not eliminate hepatitis B and C viruses.


The gastroenterologist takes part in a multi-patient disclosure to all of the potentially affected patients. Patients subsequently undergo appropriately-timed testing for viruses. All test results are negative.

Several improvements are made to the sterilization equipment and process, with better training for all technicians.