tag:blogger.com,1999:blog-8066238290370557389.post8050371046401986327..comments2024-03-20T04:44:15.540-05:00Comments on Controversies in Hospital Infection Prevention: Don't tie one on!Dan Diekemahttp://www.blogger.com/profile/10231929371552334184noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-8066238290370557389.post-25355437080786860952013-12-06T11:27:43.766-06:002013-12-06T11:27:43.766-06:00I agree that a lack of evidence does not necessari...I agree that a lack of evidence does not necessarily mean something is not worthwhile. But you have ignored the observation made by the microbiologist in the BMJ editorial I cited. She says that bare below the elbows has resulted in scruffy dress by doctors and slovenly personal hygiene. This is what I meant by unforeseen consequences. If someone never washes his white coat, what makes you think he washes his shirt or pants regularly or washes his arms up to the elbow after every patient encounter?<br /><br />By the way, don't get me wrong. I like your blog. I particularly enjoyed the post on whether hands need to be washed before donning unsterile gloves, a particular Joint Commission obsession. I never did understand that rule and you have given me some ammunition to refute it. Not that the JC cares about evidence.<br /><br />And congratulations on getting over 1000 comments on Reddit. Not bad at all.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-71370423269199158512013-12-05T17:18:57.370-06:002013-12-05T17:18:57.370-06:00Over the past several years, we have blogged many ...Over the past several years, we have blogged many times on the topic of the potential transmission of pathogens via clothing. In a nutshell, the literature can be summarized as follows: (1) there is conclusive evidence that the patient and the patient's immediate surroundings are contaminated by pathogens; (2) there is conclusive evidence that healthcare worker clothing becomes contaminated by patient and environmental pathogens; (3) there is some in vitro evidence that clothing can transmit pathogens; (4) there is no evidence to date that removing ties and white coats from the clinical environment will reduce healthcare associated infections. In toto then we have biologic plausibility that clothing may transmit pathogens. The issue with ties and white coats, in particular, is the infrequency of laundering. We recently surveyed physicians and found that >20% NEVER wash their white coats. I don't think a randomized controlled trial is needed to tell us that is bad.<br /><br />So as I see it, since there is no harm to practicing bare below the elbows, there is a potential benefit, and there is essentially no cost, it seems reasonable to recommend bare below the elbows, and at my institution that's what we have done. We haven't mandated it because we don't have enough evidence for a mandate. <br /><br />There is a great essay in JAMA last week on the six dangerous words of EBM--there is no evidence to suggest. It's worth a read and applies directly to this issue. As the author notes, there's no evidence to suggest that looking both ways before crossing the street is better than not looking both ways. It's just plain common sense. <br /><br />The guidelines committee of the Society for Healthcare Epidemiology has recently reviewed the literature of clothing contamination and their expert guidance paper is currently in press. Mike Edmondhttps://www.blogger.com/profile/03722011490008008883noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-19823208046397550912013-12-05T13:28:30.775-06:002013-12-05T13:28:30.775-06:00From the Methods section of the paper. "Micro...From the Methods section of the paper. "Micrococcus luteus (ATCC) was suspended in sterile saline and adjusted turbidometrically to a concentration of ~1.5X10 8th colony-forming units (cfu)/mL .A Dacron swab was dipped into the bacterial suspension and was rubbed over the terminal 6 cm of the tie for those tests involving the tie and the corresponding location on the front of the shirt for tests involving no tie. The terminal circumferential 2 cm of the cuffed portion of long and short sleeve shirts were inoculated in a similar manner."<br /><br />6 cm of tie? How many people are getting that much bacterial contamination on their ties and shirt sleeves? If you are, then you need to reassess your approach to infected patients.<br /><br />The only significant difference among all the sites was for ties. It is therefore incorrect to assume that because short sleeve/no tie had no contamination it was somehow proven to be the best way to dress just because you think so.<br /><br />Apparently there is no evidence to support the bare below the elbows rule and it may be having some unforeseen consequences. http://www.bmj.com/content/346/bmj.f3211 Here are two quotes from that article. "It could be argued that ditching the white coat and tie for hygiene purposes has had the converse effect, in that the informal attire now gracing our wards has encouraged a less robust view of infection control." And "The dress code for UK doctors was imposed more as a political gesture than as an evidence based strategy likely to reduce infections acquired in hospitals."<br />Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-71989449922624770452013-12-05T11:02:59.306-06:002013-12-05T11:02:59.306-06:00http://www.readit.me/2013/07/40-maps-that-will-hel...http://www.readit.me/2013/07/40-maps-that-will-help-you-make-sense.htmlENGGPThttps://www.blogger.com/profile/11409638811859034434noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-34047051390525220742013-12-05T08:10:17.010-06:002013-12-05T08:10:17.010-06:00It's reasonable to hope that forearms will be ...It's reasonable to hope that forearms will be washed between patients. Clearly shirt sleeves will not. Topher Ehttps://www.blogger.com/profile/12813321623024005909noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-26888419776048463202013-12-05T01:10:34.819-06:002013-12-05T01:10:34.819-06:00the study should have also had bacteria on his for...the study should have also had bacteria on his forearms. its not like bacteria only attach to clothes...Dbabitthttps://www.blogger.com/profile/10345487536813396724noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-29211534975434361822012-02-04T09:51:53.595-06:002012-02-04T09:51:53.595-06:00I have no problems with bow ties when they're ...I have no problems with bow ties when they're coupled with short sleeves (though kind of a dorkish look, I think) or long sleeves rolled up above the elbows.Mike Edmondhttps://www.blogger.com/profile/03722011490008008883noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-18966326441258334682012-02-04T09:10:18.888-06:002012-02-04T09:10:18.888-06:00but what about Bow Ties? (yes, I am serious ... ev...but what about Bow Ties? (yes, I am serious ... every Endo prof I know wears one on rounds ...)Anonymousnoreply@blogger.com