Thursday, October 6, 2011

Out out damned spot

I have a confession. I used to read Science Fiction. Not the pulpy stuff but quality writers like Arthur C. Clarke and Ray Bradbury. I especially like Bradbury who doesn't always write science fiction. It is one of his non-SF pieces that I just thought about.

The story is about somebody who after a disagreement with a friend or acquaintance murders said individual. He prudently decides that he must remove all evidence that he was in the house and starts wiping every surface he may have touched. He of course keeps on remembering places he may have touched and so has to wipe these off and so on and so on. The result is of course that he never leaves the house and is still there the next morning when the police come to arrest him. The last thing he does as he is lead out handcuffed, is to wipe off the door-knob.

This unfortunately reminds me of the hand-washing campaign at our hospital.

Hospital acquired infections are not nice and anti-biotic resistent ones are even worse. Anything we can do to prevent these is a motherhood issue and hand-washing is a pretty simple and cheap solution. Our zone went through an audit of hand-washing several months ago and our hospital did not do well with of course doctors leading the way. This sounds really bad until at an executive meeting I learned (for the first time) the rules that we are supposed to follow.

It is not enough to wash your hands after seeing a patient, you must also wash your hands before you see the next patient even if all you do is walk from one bed to next without even picking your nose. Even if you have no intention of touching the patient you must wash before and after. If you wear gloves, you must wash before putting on the gloves and after "doffing" the gloves. (It is so nice to see an archaic verb like doffing come back into use.) Miss a single step and you are non-compliant. Because of this a lot of well meaning docs failed the test.

Because you now have to wash your hands twice for each encounter, visualize this. If I see 24 patients in the pain clinic and see them an average of two times each visit, that is 96 hand washes in 7 hours (13.71 hand washes per hour). I could do this more because hand sanitizer bottles are conveniently placed by every door in the hospital and being slightly obsessive compulsive I actually stop and wash my hands.

To help with our compliance, bottles of hand sanitizer are appearing on walls all over the hospital. Many of these are empty which is a good thing because people are washing their hands but a bad thing because you have to look for another one to wash your hands before the hand washing Stasi see you. Our receiving area on the other hand doesn't have room to put a hand sani dispenser at every cubicle, a single dispenser has to do for 7 cubicles. (They had to take them out of the emergency department of our inner city hospital because people were drinking the alcohol gel).

Hand sanitizer doesn't work for C. diff of course and we don't know who has this but we are going to just forget about this for a while.

Private doctors offices which is where most of the doctor patient interractions occur are of course exempt from this well intentioned madness and in some offices like the one I am working in today, you actually have to go way out of your way to wash your hands. I recently saw a patient at a private office and referred her to my hospital pain clinic where the nurses somehow discovered to their horror that she was MRSA positive and wisked her off to the isolation room where she was placed in the magic yellow gown.

Stethoscopes are another issue. Wiping your stethoscope with hand sanitizer which I do apparently doesn't work and it is necessary to use another anti-septic. Unfortuately this anti-septic eats plastic so they have not yet made any recommendation about what you do with your stethoscope. Fortunately most doctors have forgotten what exactly a stethoscope actually is so we don't have to worry in that respect.

Thinking of all the times you forgot to wash your hands,all the times other people forgot to wash your hands and the surfaces all of you touch has made me feel like Bradbury's character. Who for example knows what germs are on this keyboard I am typing this on. We can eliminate a lot of germ transmission but even the best intentioned most OC person is going to slip up.

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