Wednesday, June 04, 2008

Wipe-O-Mania!



The "superbug" epidemic is not new. I remember many a medical school lecture, many an article, and many an attending waxing poetic (whilst on rounds) about the problem of growing bacterial resistance.

This was usually used as a caution against throwing antibiotics at non-critical illnesses that were likely viral in nature. This is hard in the ER, especially since the advent of the rule of "customer satisfaction", as most folks want antibiotics whether they need them or not. But that's a topic for another post...

So, if you read this Reuter's article what do you conclude? Are you even more scared than before? Here's my conclusion. Buy stock in disinfectant wipe manufacturers, or options, but do not buy a long position.

Another possiblity? We are the victim of the technological imperative. These bugs have always been there but we couldn't find them as well until now (or we never looked as hard). Personally, I think that infection transmission by these routes is very patient specific, and more related to the patient's immune status than to meticulous aseptic technique OR lack of using enough antibacterial wipes. One more thing. Using as many wipes as they seem to want us to use will fill up the landfills, clog incinerators, put poisonous chemicals in the air, and increase global warming (or cooling).

30 comments:

  1. I never understood the whole idea behind Scrubbing prior to Surgery and when I could get away with it, never did. Maybe it had a place back when they operated barehanded, but what are the gloves and gowns for? Where I DO scrub, is after seeing Outpatients, 5 minutes Betadine minimum.

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  2. "I never understood the whole idea behind Scrubbing prior to Surgery and when I could get away with it, never did."

    Now I am scared Frank.

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  3. Yeah, and they thought Columbus was crazy too. Think about it for a minute. Scrubbing was originally done AFTER the operation, then they discovered germs, and even then alot of Surgeons operated bare handed sans scrubbing. Last time I checked, Surgeons usually wear gloves and gowns, the only non sterile exposed surfaces are face and eyeglasses, and no ones scrubbing those. If Latex is smart enough to keep out HIV, it should be sufficient for enterrococcus and Staph. Check out my old post about a nationally renowned Heart Surgeon who went straight back to the OR after takin a dump. He didn't even do an unsterile scrub.

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  4. Ok, Frank, the dump thing is nasty. Are you advocating him not doing an even unsterile scrub after taking a dump? Ewwwww. I realize that those latex things and drapes make a nice barrier, but still. Wash your hands man.

    Did you never shake his hand again?

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  5. Dude, kids that roll around in dirt and dust have buffed-up immune systems and less allergies and asthma. Why the fuck do we use these things? I say, let surgical patients roll in dirt before we cut 'em open. We got to be SMARTER than these bugs, man.

    I'm gonna' go smoke another joint.

    Peace.

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  6. I actually don't buy antibacterial things if I can help it. They're really harsh, and they do kill off all of the good bugs too. My kids get dirty too. I think it keeps them healthy. But when we moved to a new area, they were sick all winter. All the dirt in the world won't help new exposures in a new geographical region. It totally sucked, especially RSV.

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  7. Teaching kindergarten has exposed me to pretty much every noxious germ in existence. I almost never even get a cold anymore, though I was sick constantly as a newbie.

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  8. 911doc,

    "Buy stock in disinfectant wipe manufacturers, or options, but do not buy a long position."

    Buying stock is buying a long position. Or do you mean that we should not hold it for a long time?

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  9. Frank Drackman,

    The scrubbing before surgery is probably taken much farther than is necessary. So is being NPO prior to surgery - the patient being NPO, not the doctor.

    While putting on the gown, mask, hat, and gloves there is the possibility of contaminating sterile fields. I wouldn't expect it to be completely safe, but perhaps more to protect the patients from the clumsier, or more careless, surgeons.

    Is there any research on this?

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  10. Frank: Maybe you can tell me this: How did I get a staph infection in my back two more than full months after spinal surgery? I was fine in the interim, all healed up. Nobody can figure this out. The infection was less fun than the surgery, of course.

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  11. Duuuude. Guys. I need help.

    I need a topic for a ten-minute oral report in my physiology lab. Does anyone have any ideas for a Really Interesting disease that also isn't terribly generic (like ebola).

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  12. Hannah: Fibromyalgia...oh wait.

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  13. hannah,
    do tetanus or rabies. either would be neat because both are completely fear-inducing even amongst docs and the incidence is really quite rare. we immunize and boost almost everyone for tetanus and it would be to pull a few stats and see how many cases we have had in the US in the last ten years. same for rabies. the cdc website would be a good place to start.

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  14. RM,
    i mean don't hold for long. probably a foolish play and more to make a point than anyting, but you are right, for folks not interested in pissing their money away stocks should be long.

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  15. 911doc,

    In the trading world being "long" means owning the stock (or call options). You profit when the stock goes up (at least if you sell it before it comes down).

    Being "short" means borrowing the stock, selling it, and profiting if it goes down (owning put options would work similarly, but without the borrowing). You buy the stock back at a lower price and make your money on the difference.

    You can lose money by all of these methods. :-)

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  16. RM,
    i understand. i simply mean that in my investing world, i do not buy a stock and watch its day to day moves. not a day trader iow, think making quick moves is very dangerous and i don't buy anything that i don't plan to hold for 5 years or more.

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  17. That is a good idea. I was just referring to the terminology.

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  18. Hey Hannah,
    Go for androgen insensitivity syndrome.. its a good example for a reproductive endocrine disorder and shemales are always interesting.

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  19. Boredmedstudent, that is a cool one. How about hemangiomas? Lots of people have them, no one knows why they form or how, and many doctors, dermatologists included don't know a lot about treating them.

    Or how about vestigial organs and characteristics? A freak show is always really cool. LIke gals who have 6 lactating breasts. Or people born with claws, or warewolf suits.

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  20. "Like gals who have 6 lactating breasts" my last patient...nevermind, I'll spare details.

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  21. I am immunosuppressed (liver transplant). My housemate is waiting for a transplant. She's f-ing neurotic about using disinfecting wipes. I asked her if she hadn't heard the axiom "God Made Dirt, Dirt Don't Hurt"? Sure, I have a suppressed immune system but I'm not the girl in the friggin' plastic bubble.

    When I do get a touch of sniffles I sty in my Bat Cave with the covers pulled over my head. But I can hear her in the kitchen wiping down everythingjust in case I breathed on it. I usually wait 'til she's asleep and I sneeze and cough all over her clean dishes.

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  22. Hannah, one word:PSUEDOPSUEDOHYPERPARATYROIDISM
    guaranteed "A"

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  23. Why is this news?

    They've been telling us for years that sponges and rags spread nasties around the kitchen, and that "escessive cleaners" spread more bacteria than slobs. They didn't think the same applied to the hospital?

    Seems to me that this is common sense.

    DD

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  24. Ahh, common sense and medicine parted ways many years ago...

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  25. Didn't someone say there's more bacteria in the average vagina than grains of sand on all the beaches in the universe?

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  26. You may be the first to make that statement.

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  27. and what if you have a sandy vagina?

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  28. Yes, there is hords and hords of bacteria in the vagina. But if a baby has an infection it has to be my fault!!!! Soon they will blame me for knocking her up too!!!

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  29. "Ahh, common sense and medicine parted ways many years ago..." May I have permission to quote you on that, sir?

    It made me laugh, so true.

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