Medical World News,
Needless to say “between patients"
is a ludicrous place to wash ones hands, but a good starting point. Certainly a
basin of antiseptic placed near a patient’s bed would provide a rinse that
would enable the doctor to get to the sink without transmitting infectious
material.
Without having to resort to serious
double-blind crossover experimental studies or to have traffic counters strewn
across hospital hallways to direct traffic to the sink, it seems eminently
sensible to create a halfway house of antisepsis. The reality of hospital
practice is that about 50% of the patients are probably “dirty”. Hospitals are host to bedsores, cuts,
abrasions, incontinence, feces in bed, stomas, stumps, post operative wounds,
coughs, spittle and contaminated indwelling catheters. There is the inadequate peri-anal cleansing after use of a bed pan, and since the
semi-private (a misnomer, really semi-public) room came into vogue one “dirty”
patient in a room contaminates the whole room. Pneumonias and diarrheas are not
segregated from “clean” cases.
It is almost impossible to examine a
patient and come out of the room with a sense of cleanliness. I must handle my
stethoscope, other instruments, the patient’s chart. The nurse who helps me
handles the patients. A catheter is straightened; a digital examination of the
rectum is done; a bedsore is debrided; the patient coughs. Lots of things
happen. The nurse always seems to exit the room running her fingers through her
hair to arrange her coiff. Some doctors run their hands through their hair,
through a nurse’s coiff, or even their own, if they have gotten one recently.
Mindful of this, I wrote CDC to suggest
that small basins filled with sani-wipes, containing some antiseptic material
or Lysol wipes be available to get the doctor from the bedside to the sink
without contaminating everything in between. After all, the faucets are not
positioned so one can use a convenient elbow. They must be handled. Same with
the soap containers. The foot pedal soap dispensers never seem to work.
The matter must have received intense
study, since it took me about 4 months to get an answer, and guess what the
answer was. Nyet, plus a few tear sheets from the CDC manual on nosocomial infections
with instructions on how to wash your hands. No wonder Semmelweiss went nuts.
But the lessons he taught about washing hands has taken root and one hundred
years later no one wants to budge from his original concept for fear of further recidivism!
I spoke with important hospital
personnel who were put in charge of Godliness because it is so close to
cleanliness, but to little avail. There was no point to putting any additional
cleansing baths between the patient and the sink, particularly since the CDC
hasn’t advised the same.
I called the CDC and was given an
opportunity to talk with the doctor apparently in charge of such matters. He
sounded very tired, and perhaps it was that which gave me the impression that
he was bored with the subject.
“Look, doctor,” he drawled, “why fuss,
just wash your hands.”
“That’s not the problem. The problem is
that I have to handle charts and instruments after handling the patient, and I
am transferring infectious material all over the place. No I haven’t started a
plague yet, but who knows what damage I might have done.”
“Don’t worry,” said the reassuring
voice from
“Well, I haven’t caused puerperal
sepsis,” I told him, “but that’s only because I don’t deliver babies. But I
would like the opportunity of rinsing my hands before getting to the sink. This
will prevent me from contaminating the sink. I would like to be sort of rinsed
before I pick up another chart. This will prevent me from contaminating it.
Lots of people handle the charts,” I told him.
“Any of them sick yet?”
“Look I don’t know whether or not I am
starting plagues. It is just a thought that the hospital and patients would be
better off if all of us had the opportunity to rinse off, you know, just get off
some spittle or stool before we touch the faucets.”
“Hello boy, what kind of a hospital you
work in? Aren’t there sinks in the patient’s room?”
“Sure but patient’s don’t pay $200 per
day to have their sinks contaminated. It’s not my sink! It’s theirs. They
bought for the duration of their stay.”
“Watcha you want from me boy?”
“Just some moral support for rinses.”
“CDC has looked at that and their
consultants didn’t give it much shrift.”
“That means the subject is dead?”
“Right! The subject is dead. But I’ll
tellyawhatI’mgonnado. I am going to send you our instructions on how to wash
your hands.”
Now I have two sets of instructions on
hand-washing from the CDC. But there is
no doubt in my mind, without having to engage in scientific study, the small
basins with disinfectant baths, or disinfectant wipes, would be very helpful
and would inhibit the spread of contamination and infection in the hospitals of
America.
I can hear Semmelweiss laughing from
his grave. “Poor schnook. He forgot the sequence. First he has to go crazy.
Then, maybe they will rinse their hands.”
But I disagree with Semmelweiss. Even
if I go crazy they won’t rinse their hands. You know why? Because in all the studies the word “rinse”
has never been used. Only the word “wash”.
And the CDC already has a protocol for
“