Hospital bans waiting-room magazines

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If you're looking to steal holiday recipes from the latest magazine, you'll have better luck at the dentist than at the hospital - at least in Toronto.

The tables in the waiting areas throughout Women's College Hospital - once covered with magazines - now hold signs explaining the absence of reading materials. Hospital staff decided that magazines, because they cannot be disinfected, can spread diseases such as C. difficile and influenza.

The Vancouver Island Health Authority stripped their hospitals' waiting areas of books and magazines last year at the height of the H1N1 scare - but now they are back.

The Alberta Children's Hospital no longer provides kids with blocks or stuffed animals - but it does have video games in its waiting area.

Some infection-control experts see removal of shared items as necessary to control the spread of disease, while others say such measures are pointless if proper triage and hand hygiene measures aren't prioritized. And for patients who have to sit in waiting rooms for hours on end? Such policing can be overkill.

The move by Women's College Hospital is the latest step in the dramatic changes to hospital waiting rooms in the past decade - reactions to the pandemic of the moment. Before SARS, avian flu and H1N1, waiting room signs politely asked that you return reading materials to tables before leaving. Now the areas have become environments filled with hand-sanitizing stations and disposable masks; and you can't even flip through a newsweekly.

But as recent history has shown, after each health scare fades, public and even hospital vigilance often does, too.

Is there a real cause for concern? What science says.

In the case of Women's College Hospital, the removal of shared reading materials from waiting areas was prompted not by science, but by an assumption of how disease can be spread through contact with paper surfaces.

"If you saw a used paper tissue lying on a waiting table, you wouldn't pick it up, would you? But when a magazine or newspaper is being held for a period of time, people may be coughing, may be sneezing," says Jim Ruderman, chief of staff at the hospital.

In a 2005 study published in the British Journal of General Practice, a researcher from Oslo swabbed the front pages of 15 magazines picked up in 11 different hospital waiting areas and looked for the presence of pathogenic bacteria several hours later. He concluded that the magazines had low levels of contamination, that there was "no cause for alarm."

What pandemic measures have stuck?

Hospital clinics and doctors offices were different beasts during the SARS outbreak: Patients with symptoms of acute illnesses were pulled into separate waiting areas, outfitted with masks and staggered at least a metre away from others. Some clinics have kept that measure, but too many went back to business as usual, says Doug Sider, acting director for infectious disease prevention and control with the Ontario Agency for Health Protection and Promotion.

Last fall, at the height of H1N1 panic, Shirley Paton, a technical adviser in health care and associated infections, and her team at the Public Health Agency of Canada advised hospitals to take the same measures recommended for every major outbreak during flu season: Make sure toys and personal effects aren't shared among patients.

The Vancouver Island Health Authority followed that advice, says Shannon Marshall, a spokesperson for the authority. Now the reading material is back. A continued ban is flawed since patients could leave and touch any number of other surfaces.

"If you're holding the strap on a bus or a subway or handling a grocery cart to picking up a grocery basket - the emphasis has to be on good hand hygiene," she says.

How far is too far? What should we prioritize when it comes to infection control?

Dr. Sider said if there's a hierarchy for preventing the spread of infection, snatching magazines from waiting areas ranks well below sequestering patients with symptoms of illness and promoting hand hygiene. You can't walk far in a hospital without bumping into a sanitizer dispenser, but there is no empirical evidence about how regularly they're being used.

In Britain, the move toward policing hospitals to prevent the spread of infection has been even more extreme: In 2006, the British Medical Association recommended doctors ditch neckties, since the rarely washed accessories can carry bacteria that cause illness. Some hospitals have put restrictions on doctors' jewellery and watches for the same reason.

"We're trying to prevent the spread of infection between individuals and then you cross the line towards personal rights and freedoms," says Mark Joffe, senior medical director of infection prevention and control with Alberta Health Services.

Katherine Clarke Murray, 41, a Calgary teacher and mother of two, says the measures taken to control infection in waiting rooms have been overzealous. A year and a half ago when her mother was treated for melanoma, the piles of magazines at the hospital offered her great company. When children's clinics still provided toys in their waiting areas, she let her kids play with them without hesitation.

"Who cares?" she says. "Nobody has the bubonic plague in the doctor's office."