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Infection control dilemmas are preoccupying Dinah

Monday

Surgery – minor op booked, nurse has everything set up in advance. What is this strange blue bottle dangling from her belt? 'It's alcohol'. Took me a while to realise it is for hands, not drinking, but still confused: don't we wash hands any more then? 'Yes, of course we do but the patients like to see it, it gives them confidence'. Arrange lunchtime hand-washing session with practice staff and new notices all over the place, including instructions such as 'rub the dorsum three times'; staff go along with it valiantly.

Afternoon: visit local children's nursery for 'Meet the Doctor and Nurse' session; played with stethoscopes and auroscopes for half an hour. Finished with making ambulances out of toilet roll tubes. Nursery staff obviously don't read BMJ so oblivious to danger of E. coli (can travel through two layers of toilet paper).

Provide info for nursery manager who immediately pins notice on front door: 'Toilet rolls banned – carry infection'.

Tuesday

PCT meeting – acute trust performance indicators: looking at healthcare associated infections especially MRSA and C. difficile. Hard for local hospitals to meet target reductions since we had such low baseline levels, and hospital cleanliness such an emotive area, especially for patient groups. We are so careful with antibiotic prescribing now – but have we gone too far? Last year I had an eight-year-old patient with rheumatic fever after a sore throat – once upon a time she would have had penicillin and that's that.

Rush off to catch London train – giving a talk, hurry to type it up on the journey. Always worried about those notices banning toilet flushing while in a station; previously emailed GNER customer care to check whether deposits really are made onto the line. Received politely dismissive reply so write back to GNER complaining they haven't taken my inquiry seriously. Ignored.

Thursday

Surgery. Final appointment is mum whose three-year-old has diarrhoea. Child attends local nursery. Mother has seen our nurse's portable alcohol dispenser: should the nursery get some? Could child's illness be caused by toilet roll used for model making? Or any other household junk donated to nursery (who knows what sort of household it came from)? Longer than usual consultation for D&V but manage to end by suggesting hand-washing may be a useful skill to acquire at this age and promise to send hand-washing poster to nursery (tempted to send a copy of 'Fungus the Bogeyman' as well).

Home late. Uproar as usual. All my notices have been removed from bathroom instructing that toilet lid must be left down to stop E. coli getting out.

Crisis: no clean wine glasses – extract unwashed one from dishwasher and swill it out with cold Chardonnay. Lovely.

Dinah Roy is a GP in Spennymoor, chair of Sedgefield PBC group and co-PEC chair of County Durham PCT

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