Thursday, May 24, 2007

A Sticky Situation

I have a complaint. A small one, mind you. But a complaint, nonetheless.

You see it all starts when I see patients on inpatient ward rounds. Being a “good” doctor, I’ve been trained that we have to wash our hands before, and perhaps especially after, touching the patient. This makes good sense, I’m told. You don’t want to spread all those nasty germs between patients, after all.

I was on call this past weekend. For those of you unfamiliar with this responsibility, call is one of those necessary evils of medicine. Every doctor knows it. Lives and practices are shaped by this responsibility. It is the opportunity to be sure patients care continues over the weekend in an uninterrupted manner and acute issues that cannot wait until the following week are addressed immediately. After all, the practice of medicine does not care if someone becomes sick on the weekend, after 5 PM, or on holidays. Life happens. Illness happens. And so too, therefore, does call.

I have learned over many years that rounding very early in the morning is to your advantage. Patients are seen more efficiently because the nurses are busy documenting in their charts about events of the prior evening (can't stop and chat); the patient is most interested in getting a few more winks of sleep before the daily grind occurs in the hospital (questions are kept to a necessary minimum); and family members have not arrived yet to slow your work progress through the myriad of patients that need to be seen. It is not uncommon for a call physician to round on well over 20-30 patients while fielding new consults, performing some testing, and answering patient phone calls. Since housestaff and patients have yet awoken or arrived to see their patients, a brief uninterrupted work period ensues.

Recently, our hospital (and I’m sure many others) has adopted the use of alcohol hand gels (in lieu of hand-washing) when seeing patients. These gels are handy, since water is really not necessary to rinse the residue from your hands. The gel is good for most bacterial contageon in the hospitals, but some bugs still require the old hand-washing technique (like c. difficile, I'm told). And so the old soap must stay. But this is where I’ve found it gets, er, sticky.

The damn dispensers are always in a different place from room to room. You have to play hide-and-go-seek to find them, sometimes. But that’s not the real problem. Oh, no.

You see there’s another medical error that occurs because of mistaken identity - especially early in the morning when the lights are low in a patient's room. We all know how bad having the wrong patient can be, but what about the wrong soap?

This is an egregious error, my friends.

Look at these two dispensers for soap below. One is for the hand gel (that evaporates quickly and requires no water to rinse from your hands), and the other for garden variety liquid soap. (Quickly, can you tell which one? No reading allowed.)

After squirting some of the liquid soap on my hands and walking half way to the next patient’s room, I discovered to my horror that the gunk in my hands had to be rinsed off rather than air-dried.

Damn, what a mess.

And did I feel like a fool…



Margaret Polaneczky, MD (aka TBTAM) said...

I did the exact same thing the other day :)

Here's what I found myself wondering, though. Now that we are all electronic, what kind of germs do you think are on all those keyboards? One might argue that in addition to washing our hands before and after touching the patient, we should also wash befoer and after touching the keyboard....

DrWes said...

No doubt those keyboards are worse than our neckties! And besides that, the alcohol gel only kills some of the bacteria.

Hey, maybe that soap left on my hands was a clandestine operation coordinated by the infectious disease and Information Systems departments to clean the keyboards!?!

AMiB said...

On first glance of the pictures, I think the "Stat-Rinse" gave it away, but then again in a dark room...y'never know.

at our hospital, we have identical looking dispensers, but one is for alcohol gel, and one for moisturizing lotion. why they felt the need to put up lotion dispensers, i will never understand...