By Xeni Jardin at 2:49 pm Tue, Mar 9, 2010
They need to talk to this guy…
About his book, â€œThe Checklist Manifestoâ€
Hopefuly they at least put on clean gloves…
My mom is a NP and says she has to wash her hands twice for every exam- one ‘for show’ before she touches a patient and then again after the patient leaves the exam room to get the patient’s germs off her.
My first thought was, “when they… what?” Reading the article, I’m still not sure. Before surgery? After surfing the web?
Anyone in physical contact with a patient should be washing (or disinfecting) their hands twice: as they enter the room and as they leave. No excuses for not doing so, and a 30-40% rate is practically criminal.
They also tend to wash their lab coats about once a decade. We need to change the term ‘nosocomial infection’ to ‘iatrogenic infection’, because that’s the real source of the problem.
There’s a surgeon like that where my wife works. Guess who has the highest mortality rates after he’s done with his operations? Infections constantly. The nurses call him Dr Death. :o
And of course the nurses with the roguishly ghoulish sense of humor have filed reports on the surgeon with the state medical board, right? And his colleagues have too, right? And sky-high malpractice insurance costs have effectively removed him from practice, right? The feedback loop is open.
Of course not! They’re sissies, but they do have that ghoulish sense of humor!
I hope to god you are trolling. If not…
Why don’t you call your local media and stop the deaths? WTF, dude. You are lame. Here, tell us the name of the hospital, I’ll fucking take care of it immediately.
Do they feel partially responsible for the ongoing infections and deaths? It sounds like they are partially responsible. Perhaps someone needs to test that in court.
So, they wash 8 hours a day? That would be about 30% of the time.
I work at a hospital. These creeps think they walk on water and don’t carry germs.
30%-40% of all time? That’s like eight hours a day.
30 – 40% of the times that they should wash.
These are the same guys who are clamoring for “tort reform.”
Funny how their “fear of unreasonable lawsuits” motivates them to order extremely lucrative tests, but not to perform basic hygiene.
I completely understand the need for good hygiene in hospitals but am not sure of how to deliver this practically. Let’s say that I see 22 patients on my morning ward round and 10 in my afternoon clinic. If I wash my hands for the recommended 5 minutes before, and then after each patient, that’s 10 minutes a patient, 32 patients makes… 320 minutes, or 5 hours 20 minutes of hand-washing per day. Not sure where I’m gonna fit that in.
Purposeful bull’ing doesn’t win you any points. The “recommended 5 minutes” is for surgery and you know it.
I thought it was 30 seconds of hot water with soap. It may be longer for medical procedures though. I don’t know if the full 5 minutes would be necessary between simply examining each patient. The article makes it sound like the doctors aren’t washing their hands before procedures.
Also, what about hand sanitizer?
What part of “first, do no harm” is hard to understand?
Not sure where I’m gonna fit that in.
It’s easy. See less patients. Do a professional job. Save lives. Be less greedy. Did I mention be a professional???
Once again, READ THIS BOOK. Maybe a course in ethics wouldn’t hurt, either.
Sorry, but that’s what’s called being a professional. We have to deal with it in other lines of work too where we can’t sacrifice quality for quantity unless we want our professionalism to suffer (no matter how much extra unethical cash we may pull in). Killing less people would be nice too.
I bet you’re a conservative, aren’t you?
@Cowicide (and others). Actually, I work in the ‘socialised’ healthcare service in the UK. So, I don’t get much option in the number of patients that I see and I don’t get paid per patient so seeing fewer patients is not an option. I don’t have any private patients.
I probably phrased my comment poorly, judging from the reaction, and failed to put across my position. (I was being facetious.) I am in favour of good hygiene measures but get fed up with excessive (often non-evidence based) rules telling us how to do things. Some rules are good but others increase work for no benefit. Our local advice includes five minute handwash which as @dculberson points out is more for surgical procedures than general patient care. Following that would lead to the excessive handwashing. What we do is employ alcohol gel (similar to the foam mentioned by others) which enables us to see all those patients, hopefully in a relatively clean way. @Davedorr9 has it right, it is essential that the facilities for this are put in place. Handwashing where infective spores likely (diarrhoea).
We have ditched white coats, ties, watches and long sleeves in the last few years but in my opinion, the current vector of infection is probably the stethoscope. These are seldom washed – I spend ages trying to wipe it down which cumulatively probably equals my handwashing time! Other option is one steth per patient.
Thank you for clarifying, MovingPictures. Sorry, my sarcasm detector wasn’t in gear.
I don’t get much option in the number of patients that I see
Where are you in the UK if you don’t mind me asking? I thought there was a limit in the amount of patients you could see, not some sort of mandatory minimum. Are you somewhere they have a mandatory minimum that’s too high? I’m genuinely curious about this. I’ve tried digging around and haven’t found a clear answer/
@MovingPictures: it is perfectly acceptable, barring visible detritus on your hands, to use alcohol-based foams. So, no, time is not an issue.
It requires both culture and infrastructure changes to do well. You need dispensers in front of every room; you need people to expect clean hands. The best you can do as patients and families is to ask whether they washed their hands.
Heh, I think we could ask more than simply put the onus on patients and their families. Atul Gawande’s checklist article (mentioned above, and is online here http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande ) cites unequivocal proof that stupidly simple things–like a checklist used by a medical assistant to make sure the doctor remembers to wash his or her hands–would save thousands of lives and millions of dollars in treating preventable hospital-acquired infections.
I think it’s nuts to expect a sick patient to ask if his doctor has clean hands, but it’s far more nuts that a free tool (a checklist) can save lives and yet isn’t widely used.
A UK study also showed that Dr.’s ties were great at spreading infections from patient to patient.
After some thought, I think I should expand on the importance of reading â€œThe Checklist Manifestoâ€…
This book has literally saved lives. Everywhere the system outlined in the book has been put into place it’s reduced complications and deaths by double-digit figures. One of the parts of the checklist manifesto is as simple as remembering to wash your hands.
Airline pilots have checklists and have been using them for many years to much success. Why not Doctors? They both have lives in their hands and can kill with mistakes and carelessness.
Sigh… this is why republican tort reform can suck my.. ok, nevermind… I’ll stop here….
Whoops. US study, confirmed in the UK: http://news.bbc.co.uk/2/hi/health/3745235.stm
Homer’s triple bypass episode…?
Dr. Nick Rivera in operating theater to crowd.
“Hokay everybody! Remember, we are all in this together, one hand washes the other… Wait! That reminds me!”
Runs washes hands…
Arrogant doctors refusing to wash has a long tradition- Ignaz Semmelweis was vilified (and eventually committed to an asylum) for suggesting that doctors should wash their hands between dissecting corpses and treating patients*. This followed his observations that post-childbirth mortality was more than twice as high where women were treated by doctors rather than midwives.
*Some doctors apparently believed that the smell of cadavers made them more attractive to women.
Popular Science’s cool tech of 2009 included a system to monitor handwashing in hospitals, that also alerts the patient if the doctor hasn’t washed his hands since coming in the room.
This has been a real sore point for me for years. I pay attention to this. I work with a bunch of microbiologists so have a real gut-level feel for sterile technique.
I can’t tell you the number of doctors who I have seen with absolutely horrible hygiene.
I once saw a dermatologist whose “white” coat was so filthy it was dark gray.
I was in the ER with a friend 2 months ago and the resident came in, dabbed a tiny bit of ethanol gel on the tippy-tips of his fingers, made a hand wiping gesture and was done. I was horrified.
But then so many MDs have such major god-complexes and love for pricey tests (as opposed to caring for patients) that the hand cleaning is just one small visible symptom of the larger disease.
And people tell me I’m obsessive compulsive about hand washing because I wash my hands after every time I use a keyboard. (Especially in a health care setting.)
Frightening. Frightening. Frightening. No wonder so many die from infection rather than the health problem that brought them into the doctor’s office or surgery.
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