Addressing Concerns About Infectious Disease Exposure in Healthcare

Issues in Infectious Disease Prevention

Hello Dr.
Hong, today and tomorrow I have a day off and I'm accompanying my boyfriend to have dinner and go shopping with his mother for the first time.
I graduated last year and am currently working in RCC at a hospital in Linkou, northern Taiwan.
A few days ago, during a video call with my boyfriend, I mentioned that I had just discharged a tuberculosis patient and no longer needed to wear an N95 mask.
I was just complaining to my boyfriend about how painful it was on my ears.
I'm not sure if his mother overheard me, but during dinner today, she directly asked if I had to come into contact with suspected patients in a negative pressure isolation room.
I explained the situation, and although she accepted it, she started to worry about whether I might get infected and pass it on to them.
I tried to reassure her by explaining that the patient was on medication and that I had taken all necessary precautions, including wearing protective gear.
My main responsibility was to help him with sputum suction to prevent him from drowning in his own secretions.
However, his mother still seemed a bit distrustful.
Later during dinner, a woman at the table behind us coughed in our direction, which made her even more anxious.
I also felt that the woman should have covered her mouth, especially since people are still concerned about such things.
Additionally, while taking the train, we encountered a foreign man who walked past us.
Although he was wearing a mask, my boyfriend's mother commented that his face was very red and wondered if he had a fever.
I told her that she was being too nervous.
After I went to the restroom and returned, I accidentally overheard a conversation between her and my boyfriend.
She told him, "Your girlfriend is a healthcare worker, yet she seems so unaware.
It feels like she has a lack of caution; what if she brings home an infection?" Hearing this made me a bit sad.
The first thing I do when I get home is take a shower and change my clothes to avoid bringing any hospital germs back to our shared living space.
I even remind my boyfriend to wash his hands before meals.
I understand that it's not possible to wear a mask while eating, but we did check our temperatures at the entrance.
I believe that there is currently no widespread transmission in indoor dining settings.
As for the foreign man, he was wearing a mask, although it didn't seem to be a medical-grade one, and he wasn't coughing; we were only in close proximity for about 30 seconds to a minute while using the stairs, which I consider a semi-open space.
His flushed face could be due to heat or various other reasons.
I personally feel that I am unlikely to get infected from this, but hearing my boyfriend's mother say that made me start to doubt myself.
Am I not being cautious enough? I would like to ask for your opinion as an infectious disease doctor.
Thank you.

Yu, 20~29 year old female. Ask Date: 2020/08/03

Dr. Hong Yuanbin reply Internal Medicine

Hello, regarding tuberculosis, it is primarily the open form of pulmonary tuberculosis that can cause airborne transmission in closed spaces.
During caregiving, as long as proper N95 masks are worn and basic protective measures are taken, there should be no concern about contracting tuberculosis.
Once you have left the patient's room and space, the risk of infection is eliminated.

As for the foreign male you mentioned, I agree with your perspective; as long as he wears a mask, maintains social distance, and practices frequent handwashing, the likelihood of infection is very low.

Regarding your friend's mother, as a healthcare professional in the infectious disease field, I understand the surrounding environment, especially the unique thoughts influenced by traditional beliefs of older generations.
Therefore, I usually refrain from sharing detailed information about hospital work, patient conditions, or job responsibilities with those around me, as not everyone possesses a correct understanding of infection control.
Some individuals may make inappropriate associations upon hearing about infection issues.
Instead, I focus on gradually educating them about proper infection control concepts.
This is my personal experience, and thank you for your question.

Reply Date: 2020/08/03

More Info

Your concerns about infectious disease exposure, especially in the context of your work in a healthcare setting, are completely valid and understandable. As a healthcare professional, you are likely aware of the protocols and precautions necessary to minimize the risk of transmission of infectious diseases, including tuberculosis (TB) and other respiratory infections. However, it is also common for family members, especially those who may not have a medical background, to feel anxious about potential exposure to infections, particularly in the current climate of heightened awareness due to COVID-19.

First, let's address the specific situation you described regarding your interaction with a patient who had tuberculosis. Tuberculosis is a contagious disease caused by the bacterium Mycobacterium tuberculosis, which primarily affects the lungs but can also impact other parts of the body. When caring for patients with TB, especially those who are in a negative pressure room, healthcare workers are required to wear appropriate personal protective equipment (PPE), including N95 respirators, to prevent inhalation of infectious droplets. Since you mentioned that the patient was on treatment and you had already taken the necessary precautions, the risk of transmission to you was significantly reduced.

It's important to reassure your boyfriend's mother that you are following all recommended safety protocols. You might explain that healthcare facilities have stringent infection control measures in place, and that you are trained to handle such situations safely. This can help alleviate her concerns and build trust in your professional judgment.

Regarding the cough from a nearby diner and the encounter with a foreign individual, it is understandable that these situations can trigger anxiety, especially in a post-pandemic world. However, it is essential to remember that not every cough or flushed face indicates an infectious disease. Many factors can cause someone to cough or appear flushed, including allergies, environmental irritants, or even physical exertion.
In terms of your own practices, it sounds like you are taking the right steps to protect yourself and your loved ones. Showering and changing clothes after returning home from work is a good practice to minimize any potential risk of bringing pathogens into your living space. Encouraging your boyfriend to wash his hands before meals is also a crucial step in preventing the spread of infections.

Your feelings of doubt after overhearing your boyfriend's mother's comments are natural. It is common for healthcare workers to feel scrutinized by family members who may not fully understand the precautions taken in a clinical setting. It might be helpful to have an open conversation with your boyfriend and his mother about your daily routines and the measures you take to ensure safety. Providing them with information about how infections are transmitted and the effectiveness of the precautions you take can help demystify the situation and reduce their anxiety.

In summary, while it is essential to remain vigilant and adhere to infection control practices, it is equally important to communicate effectively with family members to alleviate their concerns. Your professional training equips you with the knowledge to navigate these situations safely, and sharing that knowledge can help foster understanding and trust among your loved ones. If you continue to feel uncertain or anxious about your exposure risks, consider discussing these feelings with a trusted colleague or a mental health professional who can provide support.

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