October 8, 2015

Antibacterial Soap is not Better than Regular Soap… and learning from death

So, fun fact of the day: according to our MSTP seminar speaker tonight, apparently the FDA agrees that “antibacterial” soap is not any more effective at preventing disease transmission than regular soap, assuming both are used to wash hands properly!  Did not know that.  And to back that up, here’s an article straight off the FDA site that speaks about that, from 2013.

He also described a painful experience he had had as a clinician, where he did a procedure on a patient, and that patient ended up dying, even though he had done everything technically right.  This, in itself, was one of his lessons – that you can be technically right, but mess up intellectually.  Because, as it turns out, after that, they did a retrospective study, and apparently that patient was at high risk for bleeding out after that procedure, as they’d had a bone marrow transplant before that.  That wasn’t known at the time, but it cost that patient their life.  There are two lessons I learned from this:

The first, which is rather scary and sobering, is that as a doctor, we’re all going to make mistakes at some point.  Mistakes that may even cost people their lives.  And some of them, like the case here, won’t really be our “fault”, in the sense that it wasn’t anything that could be prevented at the time due to lack of knowledge, but in hindsight, for whatever reason – new research coming out, a new technique our clinic/hospital was not aware of, etc… we’ll realize that our decision at that point in time was what directly or indirectly, caused harm to the patient.  To be quite honest, that scares me quite a lot.  I don’t know if I can handle that. I think that would tear me apart from the inside.  And yet… if no one makes those decisions… even more people may come to harm.  It’s a tough job.  I guess time will tell.  I just pray that over the course of my career, I will be fortunate enough not to do anything so bad that it costs a life or cripples someone the rest of their time on earth.

The 2nd is that even in one’s darkest moments/worst mistakes, something good can come of it.  In this case, research that probably has saved at least a few lives since.  He recognized that maybe there was something about this patient that made them susceptible to the procedure, even though he did nothing wrong, and they went back and looked at records and realized this predisposition, and published a paper on it.  So now, anyone encountering this type of patient before this procedure will know that it is a high risk thing to do in these people, so they may be much more cautious about ordering that test to be done.  So even when making mistakes, analyzing it and building off of it may lead to research that helps others in the future.  And I guess that’s how we have to look at it, in order to keep moving forward, lest we crumble from the guilt and sadness of those we were unable to help.

June 8, 2013

Random Step 1 find of the day – Growth hormone

So… you know that growth hormone stuff that are used to help some children grow (if they are legitimately deficient in it) and that some athletes abuse?  Well, it used to be made from either animal carcasses, or ground up and extracted human cadaver pituitary glands.  Ick!  Which also meant that if it was taken from someone with Creutzfeldt-Jakob disease (aka a prion disease), people who got the growth hormone (GH) could develop it 10-15 years later (and die in a not-so-pretty, rather quick, fashion).  This actually happened to some people, apparently. :\

Thankfully, according to wikipedia, that old method of getting GH has been done away with, and now there is a biosynthetic one one on the market.

Also, other causes of Creutzfeldt-Jakob disease (that are known, according to UWorld) are apparently contaminated corneal transplants and implantable electrodes.  And of course if you happen to handle brains in some capacity (neurosurgeon, pathologist, in the morgue…)

Moral of the story: be careful with what medications/treatments you’re getting!  Might be a good idea to check out how they’re made (and any side effects too, as a general rule).

March 11, 2013

Random thought of the day: Hospital sanitation/hand-washing

My friend and I somehow got on the topic of Ebola and spread of infection today, and naturally thus fell into talking about  the importance of handwashing.  This has been a big deal in our training so far, in the sense that we’re told to always wash our hands first thing when going in to see a patient (and we are marked off for it in our clinical-based tests in ICM if we don’t).  However, this does not necessarily seem to hold true in practice.  I’ve definitely seen providers in the hospital/clinics being pretty casual about handwashing, and not wiping off their stethoscopes after each patient, and not washing their white coats much.  I myself haven’t either (but I also take much more care than most in not touching anything with my white coat and never sitting on anything in the hospital with it because I’m slightly paranoid with that haha).

Anyway, recently, the clinic we both go to for our personal health has started a new program where they give every patient a paper that asks everyone to mark whether each healthcare giver that saw them washed/sanitized their hands before proceeding with the check-up/procedure.  On my last visit, the technician did.  However, my friend’s story was pretty interesting… and maybe a bit alarming if you think about the implications.

It was pretty impressive how he found it out too – a little bit of sleuth work there haha.  But basically, when the nurse came in to see him, she pumped at the hand sanitizer (antibacterial gel) dispenser and rubbed her hands together when she came in.  He then waved the paper at her cheerily and told her he was checking off that she had washed her hands before talking with him.  She then responded with “Yeah, gotta make sure to get that handwashing in!”  or some such thing.  Then when she put her hand on his arm to put on the blood pressure cuff, he noticed that her hand didn’t feel like it should after being rubbed with the alcohol-based gel.  So when she left, he pumped the dispenser to check.  It was completely empty.

I think the part that bothered me most wasn’t the fact that the dispenser was empty, or even that she hadn’t sanitized her hands (although that in itself is a pretty bad thing – most infections in hospitals are actually spread for that very reason – because nurses, doctors, and other healthcare providers don’t wash their hands).  The worst part of that was her attitude – that it was ok, and that it was so ok she could lie to her patients by faking the handwashing and even lying/acknowledging that she did it verbally when it was pointed out to her attention.

That got me thinking.  It would be a really interesting study to empty out all the hand sanitizer dispensers that are conveniently located at/near patient rooms and see what happens. Maybe have cameras over the sinks and see how many times people actually wash their hands in the sinks.  See how long it takes before someone reports that they are empty.  And see how many people actually report it (and how long it takes for a significant portion, or all, people to report it).  Surely it would become a nuisance if their daily routine was interrupted by having to wash their hands before each patient instead of using the convenient hand sanitizers.  Surely the sinks would become crowded or at least people would frequent them much more often.  Surely, surely, especially since we all “know” that handwashing is so important to prevent infections.

But if the way that nurse acted was any indication, perhaps people would not be that careful after all.  Perhaps people would find washing hands so much to be bothersome, and would skip a few in between without washing.  It would be an interesting psychological experiment.  And then it would certainly be interesting to do an outcomes study out of that as well – to see whether or not the number of nosocomial (a fancy doctor’s way of saying “hospital-transmitted”) infections increase significantly during that time period.

I really wonder what the results would be.  What do you guys think with what you’ve experienced?  Hopefully I’m not being too harsh on the healthcare providers here and elsewhere.  At any rate, I think I may have inadvertently helped given my friend a new idea of what he could do with his degree/life with this discussion (health policy), so for that I’m glad 🙂

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