Monday, July 21, 2008

Surgical Schmear

The surgical scrub sink is being replaced with schmear.

The days of slathering povidone iodine or chlorhexidine solution over your hands and scrubbing your hands for 3-5 minutes with a soapy watery mess dripping from your elbows as you enter the procedure room or operating room no longer flies. Instead, you get to don “emollients” that stick like gooey glue to your hands and provide continuous “kill” to the bacteria throughout the surgical case. It seems there’s some industry-sponsored research that proves its improved bacterial kill rate. Just wipe in on your dry hands (yes, doctor, they must the dry), let the alcohol evaporate, and slide on those gloves! Total prep time – about 15 seconds. Fast, efficient, effective and relatively cheap.

What could be better?

But it was shocking to find this little orange dispenser next to the scrub sink (arrow) and my usual water-based soap dispenser removed:



Now, I look at our poor scrub sink. Lonely, cold, dull stainless steel. Who will love it when water no longer flows there? Instead, I now look down at my hand after squirting a bit of this slime there and wonder about its uncanny resemblance to… oh, never mind…



All in all, it’s been a paradigm shift in the way I prep for cases. Yes, it's faster. But there's never enough of this stuff to cover your hands and arms with one little squirt. And I ask myself, is it better for the patient? I'm not sure - it's just too early to tell. But one thing's for sure: the residue that remains bound to my hands at the end of each case is most disconcerting - bound for eternity to my dermis so that super-resistant organisms grow on my keyboard.

Why do I know this?

Because I no longer have any regular soap available to wash this stuff off.

-Wes

Ref: Guidelines for Hand Hygiene in Health-care Settings (pdf): Recommendations of the Healthcare Infection Control Practices Advisory Committee and the ICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force, Morbidity and Mortality Weekly Report. October 25, 2002 / Vol. 51 / No. RR-16.

6 comments:

rlbates said...

Where I operate, they ask us to do our usual 5-10 scrub with soap brush for the first case of the day. Then switch to the schmear stuff.

Ian Furst http://www.waittimes.blogspot.com said...

When I trained we had a particularly anal surgeon - 5 strokes on each side of each finger, then palms, arms, etc.... rinse from fingers to elbows to wash the bacteria down, blah, blah, blah. Now we've gone to the alcohol based stuff - 30 seconds.

BTW the stuff in your photo caused wicked contact dermatitis in two of our scrub nurses.

Anonymous said...

Dear Dr Wes,

Your soup and water Vs Goo maybe a problem that runs and runs for you! There are though lots of solutions to the ever looming contamination threat of keyboards in hospitals

Take a look at http://www.devlin.co.uk/downloads/healthcarekeyboard.pdf I'd like to see a superbug sneak past that!

Rogue Medic said...

I guess you will have to go to the bathroom to find regular soap and water, to clean this stuff off, before doing other things.

I does seem silly to make that sink practically useless by removing the soap.

Anonymous said...

The stuff we use states that you are supposed to use a fingernail cleaner first, then smear the goo.
I've never seen the fingernail cleaner.
CardioNP

DrWes said...

CardioNP-

I think those fingernail picks are with the other scrub brushes they removed...