Last week, I told a story about a med student who was told he wasn't sterile, and refused to re-scrub. This is a story that actually happened to someone in my class:
I was on my surgical clerkship with a guy named Dave, who was a bit of a character. He told me that soon after scrubbing and walking into the OR, he accidentally touched something, and was told that he was no longer sterile and he had to scrub again.
Dave left the OR, and he noticed that the sponge he had just used to scrub was still lying in the garbage. It wasn't IN the garbage, exactly. It was on the garbage. Hovering, like an angel. It seemed wasteful to him to open up a brand new sponge.
Long story short, Dave picked up the sponge from the garbage and used it to re-scrub.
As far as I know, nobody developed a horrible infection.
I'm glad the patient didn't get an infection, but why would anyone risk the chance of it happening by reusing a sponge that has already been used and then placed in a non-sterile area? I can think of plenty of other ways medical staff can cut down on waste. This ain't one of them.
ReplyDeleteYou're starting to freak me out with these stories.
I think he was probably resentful of having been banished from the OR.
Deletea personality trait not really suited for a doc if you ask me
DeleteThat's disgusting, not to mention infantile.
ReplyDeleteInfantile isn't the word. Dangerous, disgusting, stupid, willful, and ... MALPRACTICE! Hope you don't have sharks, er, lawyers reading this!
ReplyDeleteWell, *I* didn't do it. I'm not sure what a lawyer reading this would do with information like this. I mean, they don't know the patient's name, the student's name, or the hospital.
DeleteNot malpractice unless there is harm and the harm can be directly attributable to the negligence. Tricia
DeleteIn a really good charity hospital I spent 6 weeks with in Uganda a year ago they washed the surgical sheets and gowns by hand and then hung them out to dry outside. They hadn't an infection rate any significantly higher than many modern hospitals as far as I'm aware.
ReplyDeleteSometimes wonder if it's a bit of overkill.
Still, that student was very irresponsible to do such a thing. It's annoying to not be trusted to keep sterile in theatre, to the extent that sometimes the surgeons make you stand in awkward positions just so they can see your hands at all times to make sure they're sterile, even though clasping them in front of you at chest height would be equally sterile. Still should have some respect for the patient on the table though and at least take minimal measures to prevent infection.
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ReplyDeleteWhile very gross, he was not actually posing any threat to the patient.
ReplyDeleteA) Scrubbing is not a necessary part of preparation, so it's perfectly fine to do it once in the morning, and then just disinfect hands between cases, provided you don't get stuff on them by going to the toilet/picking your nose/doing a rectal exam/whatever.
B) Scrubbing most especially is not necessary after getting yourself unsterile. Your hands have not touched anything, your gloves/gown have. Unscrub correctly and you can get gowned up right away, except we do tend to disinfect cause we're sticklers for tradition. I mean, none rescrubs for the post-resection glove change, so why do it for this?
C) Used brush or not, he did remove (nonexisting) dirt from his hands with it, and used brush or not, he disinfected his hands afterwards. All goals of scrubbing accomplished.
But really... didn't his mom teach him not to play with the trash?
I agree. I think scrubbing is overkill. I think studies have shown that it's equally fine to just spritz some alcohol.
DeleteI guess I get confused because I'm doing a preceptorship in anesthesia and the anesthesiologists don't scrub in and walk freely in and out of the OR. They spirtz down alcohol and wear gloves and makes and caps and stuff, but what makes the invisible 3 feet around the surgery 'sterile' and anything outside 'not sterile'?
ReplyDeleteDolce -- In the OR, blue=sterile. Usually that's just the field (i.e. the patient and the blue drapes covering him/her), the surgeons/scrub nurse with their blue gowns, and the blue towel covered trays that the instruments sit on. You don't need to scrub and gown to enter the OR, but you do to touch the sterile field.
DeleteIt's worth noting that a surgeon's ass is sterile no matter what color scrubs he is wearing. A med student, by contrast, is filthy by definition.
And the water to wash the soap off with isn't sterile.
ReplyDeleteI'm always a bit confused by how, exactly, one defines sterile. If I'm shorter than someone else, does that mean that the vertical sterile zone where I'm standing is different that the vertical sterile zone where the 6'5 guy is? And what if we switch places? Or what about when you reach under someone's arm, isn't that technically a "non-sterile" zone?
ReplyDeleteIt's important, it's just that it sometimes seems to me as if we make up arbitrary rules to feel better about the whole process. It's almost like OCD....
I heard of a medical student (friend of a friend of a friend, I know...) whose glasses dropped into an open body cavity as he leaned over to see what the attending was demonstrating. That's the worst I've got!
ReplyDeleteJasmine
Story told to me by witness:
ReplyDeleteGlasses dropped directly into open chest by a medical student observing from the head of the bed.
Copious betadine was poured, with a bunch of washout.
This is why loupes have those crock-things on them. (Plus, they're heavier than plain glasses.)
I would have been mortified.
The "glasses dropped in" is a story that's pretty much made the rounds at schools and/or hospitals, including mine. Our variation had the surgeon yelling and throwing a fit and exclaiming "Hell, next time why don't you just jump up on the table and take a sh-- into the patient?"
ReplyDeleteI've met guys that went to school across the country that tell the same story.
Wow that is incredibly irresponsible of him. He sounds the type to wipe his hands on his surgical gown after eating a sub (I've seen that happen).
ReplyDelete