Thursday, 14 July 2011

Infection Control or "oh, I hadn't thought of that"

Would you believe me if I told you that infection control issues are some of the most challenging that I have to face in terms of access?

It's true, dear readers.

You see, at some point before I started medical school, the NHS decided to promote the use of alcohol hand gel before and after patient contact to reduce the spread of infectious disease. I'm sure someone has proved its effectiveness, and that can only be good, the fact that it has left a generation of staff with allergic dermatitis and that it is not effective against C.diff (which doesn't need any help to spread around) notwithstanding. Personally, I would rather there were more sinks, so that I could properly wash my hands around, but apparently people weren't using them or something.

I think it's good common sense to wash your hands between patients. Folk should wash their hands anyway. It's just nice, and not icky. But, here is my problem, as I explained to the last infection control nurse to teach me to wash my hands (I've been taught 11 times since I started med school...) :

I see a patient, I pick up my stick, I wash my hands, I pick up my stick, thus all the patient germies hang around.

She gave me a look that said "this is not on my algorithm", and then said that I should wipe my stick with a Tuffie wipe between each patient. This makes sense, except that Tuffie wipes all seem to come in tubs of 5 million (and with my stick I already have one less hand to carry stuff), that this means I take longer between patients than everyone else, and the ward round waits for no student, and that I would have to buy them out of my own pocket.

I explained what I had been doing - that is putting a surgical glove (which are all over the wards) over the stick handle each time I wash my hands. This seems an imperfect solution - it's really wasteful, the gloves aren't sterile (people will stick their hands in to the box to get a glove without washing first), and it makes me look silly...

She didn't like this idea (but couldn't explain why) and thought I should use Tuffie wipes. Which hasn't happened for aforementioned reasons.

The other option is to put gloves on every time I see a patient, taking them off before I pick up my stick. This combines two of the earlier problems - gloves not being sterile, and carrying something else around in my one free hand - plus the fact that I don't like making patients feel like lepers from the Bible. I found a newspaper article in the depths of the internet that said that this was the approach taken by a wheelie medic - but on wheels you have more capacity for carrying stuff around.

It's confusing and horrible to feel like I'm not perfectly conforming with a policy that people are so obsessed with. People also comment on it left, right and centre - either telling me off, or telling me I've found an ingenius solution.

That's the major IC issue, but there are others. "Bare below the elbows", brought in in Scotland in 2006, means that I can't wear splints, supports or bandages on fingers, hands or wrists. It's also caused problems for colleagues because of scarring.

I've shown here that I don't have simple answers to these problems, and I don't expect anyone else to - it's just that noone's thought about it. It seems assessing the equality and diversity impact of a policy only relates to patients and not staff. Noone has considered wheelies, or stick users, or splints etc. It's a really isolating feeling when everyone you ask double takes, and says "oh, I hadn't thought of that".


  1. Bare below the elbow has led to more than one person I know changing job or career because of self-harm scars, & someone else having plastic surgery. Stigma, from colleagues even more than patients, is such a huge issue, & it forces people to 'out' themselves at all times.

    It isn't as if bare below the elbow is even evidence-based policy.

  2. Yes. And the impetus (sp?) is very much on the individual to try and ask for an alternative, which still involves telling people personal information, opening yourself up to all kinds of comments, and the reaction to that varies so much by trust - some can wear long sleeves with good reason (mostly religious, others tend to get too much hassle), but they get constantly asked why.

    Self-harming as a medic makes things really hard. One of the worst issues, is that because the GMC so strenuously avoids offering any real definition of 'fitness to practice', you have to tie yourself in knots to try and figure out what someone's position is on the issue before you tell them. And noone will assume that their colleague self-harms before mouthing off about folk who come into A/E. It's not just juniors either, who can plead inexperience - it's consultants, who have worked for years, know of multiple people going on leave for 'stress' or 'breakdowns' or whatever. They just don't link things in their head - the lack of true reflection that seems to go on day-to-day is stunning(despite mandatory reflective practice in a formulaic way being part on the continuing professional development...).

    It irritates me, because countries who have stuck with the white coat have it completely right - give folk a clean one at the start of each day, or when they get soiled, and they don't get disgusting and germy - there are computer systems to stop people getting away with not returning them each day they're working. Yes, it's a barrier to a more equals-working-together style of consultation - but how many doctors provide that anyway? (What would you do if the patient disagreed? Heavens!)

    These policies come in on what is practically a whim, with no consideration for diversity. In Scotland you can wear a plain wedding band, but noone can tell me if | can wear a plain metal finger splint...

  3. Hmm. An eminent PS I know always wears white coats with bulging pockets (purse, notebooks, pens etc) that come below the elbow, along with dangly jewellry and everything that contradicts the signs in the patient cubicles about how medical staff should dress!!! Oncs seem the best at hand washing - but they have better faciltities.

    Cos I'm not a medic and don't know, are the little bottles of spirigel (that M&S or Boots sell) that I have to carry around these days any use for you or your stick (apart from making her very slippery)?

  4. They're not that useful, because they srip the varnish off, which makes infection control more of an issue.

    Having posted this yesterday, there was a tub of wipes at each handwash station on the ward today, because I mentioned this stuff to one of the student nurses. I actually nearly cried, it made things so much easier =)