Hand-cleaning etiquette?

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Today at the ED, an attending brought his kid into the ED for viral syndrome.
Well, we usually have those foam-dispenser outside the room. I used it before I walked in.
When I was about to start the exam, he was like, "aren't you going to wash your hands?"
I replied, "I used the foam outside the room"
He said, "Well, I didn't see it"
I further explained, "that's how I was shown when I was doing my peds last month and I religiously use it before I enter the room and after I exit"
He said, "Well, I didn't see it"

I mean, I just got off an AI at the Children's Hospital and that's what we do. Foam in and foam out. None of the attendings and residents wash their hands after they use the foam.

Is that not a standard practice?

One hospital I'm familiar with distributes fliers which encourage patients to ask doctors/nurses to wash their hands before touching them. It also says something to the effect of "if you don't see it, you don't know if it happened" and that it's OK to ask them to do it again so you know for sure. I believe it's a JCAHO publication about patient safety/empowerment.

EDIT: just realized it was the attending requesting this, not the pt. Well, if it's his kid...

Originally Posted by CityLights

One hospital I'm familiar with distributes fliers which encourage patients to ask doctors/nurses to wash their hands before touching them. It also says something to the effect of "if you don't see it, you don't know if it happened" and that it's OK to ask them to do it again so you know for sure. I believe it's a JCAHO publication about patient safety/empowerment.

I remember that.
I mean I had no problem washing hands in front of them too but I just saved the foam in my hand and use it in front of the parent for the rest of the evening. It worked as well.


But are we supposed to wash hands or can we just use the foam?

The foam is fine unless there is a patient with cdiff. Then you must wash your hands after seeing them.

If you opt to bedside wash rather than foaming then some clipboard-carrying infection control nazi will swoop down from on high and shit on you. I always squirt on the foam, then walk into the room while I'm visibly rubbing it in. Two birds, one stone.

Originally Posted by Tic

If you opt to bedside wash rather than foaming then some clipboard-carrying infection control nazi will swoop down from on high and shit on you. I always squirt on the foam, then walk into the room while I'm visibly rubbing it in. Two birds, one stone.

This.

If you don't wash in front of the patients...they will think you are gross.

If you don't squirt the gel/foam before going in the room, you will get dinged by the infection control people. At my med school infection control actually incentivized nurses/clerks/etc to be "spies" and report people entering/exiting rooms without washing.

Originally Posted by southernIM

This.

If you don't wash in front of the patients...they will think you are gross.

If you don't squirt the gel/foam before going in the room, you will get dinged by the infection control people. At my med school infection control actually incentivized nurses/clerks/etc to be "spies" and report people entering/exiting rooms without washing.

Agreed.

I also apologize to patients for my hands being cold/goopy "because I just used the hand disinfectant". +1 verbal reinforcement. (plus they often are cold/goopy)

Originally Posted by atethesun

I just saved the foam in my hand and use it in front of the parent for the rest of the evening. It worked as well.

This is what our IC folks recommend.

As a parent, I totally get the attending's request. If I didn't see it, I don't believe it happened. And s/he of all people knows the nasty stuff you may have touched in an ED before coming in the room. Good for them for asking, I say.

Originally Posted by ZagDoc

Agreed.

I also apologize to patients for my hands being cold/goopy "because I just used the hand disinfectant". +1 verbal reinforcement. (plus they often are cold/goopy)

Love it.

why'd an attending bring a kid to the ER for viral syndrome? take him to his doctor's office...

Originally Posted by Rendar5

why'd an attending bring a kid to the ER for viral syndrome? take him to his doctor's office...

This.

Originally Posted by PostHaste

This is what our IC folks recommend.

As a parent, I totally get the attending's request. If I didn't see it, I don't believe it happened. And s/he of all people knows the nasty stuff you may have touched in an ED before coming in the room. Good for them for asking, I say.

I didn't mean to make him sound bad. I do agree that he had the right to ask me to wash my my hands and I did explain to him how I picked up the bad habits of just using the foam outside the rooms.

I was just wondering how everyone on this forum does in their own hospitals.

Originally Posted by Guillemot

The foam is fine unless there is a patient with cdiff. Then you must wash your hands after seeing them.

I agree

Originally Posted by atethesun

Today at the ED, an attending brought his kid into the ED for viral syndrome.
Well, we usually have those foam-dispenser outside the room. I used it before I walked in.
When I was about to start the exam, he was like, "aren't you going to wash your hands?"
I replied, "I used the foam outside the room"
He said, "Well, I didn't see it"
I further explained, "that's how I was shown when I was doing my peds last month and I religiously use it before I enter the room and after I exit"
He said, "Well, I didn't see it"

I mean, I just got off an AI at the Children's Hospital and that's what we do. Foam in and foam out. None of the attendings and residents wash their hands after they use the foam.

Is that not a standard practice?

1. It takes less time and energy just to do it again than it does to argue. "Sorry, dude, I washed outside, let me wash up right quick"

2. When you use the pump dispenser rub your hands together, and continue to do so as you walk into the room. You and I know that the purell is gone already, but rubbing your hands together long enough so everyone can see you're rubbing them together lets everyone know you've washed.

3. If you actually foam in and foam out for every patient interaction you are doing the right thing. Probably about 1000 times better than every other health provider. Don't worry about it, but to head 1 and 2 above.

Originally Posted by overactivebrain

1. It takes less time and energy just to do it again than it does to argue. "sorry, dude, i washed outside, let me wash up right quick"

2. When you use the pump dispenser rub your hands together, and continue to do so as you walk into the room. You and i know that the purell is gone already, but rubbing your hands together long enough so everyone can see you're rubbing them together lets everyone know you've washed.

3. If you actually foam in and foam out for every patient interaction you are doing the right thing. Probably about 1000 times better than every other health provider. Don't worry about it, but to head 1 and 2 above.

this

Originally Posted by shaggybill

This.

Why would you take a kid anywhere for viral syndrome?

Originally Posted by atethesun

I didn't mean to make him sound bad. I do agree that he had the right to ask me to wash my my hands and I did explain to him how I picked up the bad habits of just using the foam outside the rooms.

I was just wondering how everyone on this forum does in their own hospitals.

I don't have to touch any patients so it's a non-issue for me.

Originally Posted by Guillemot

The foam is fine unless there is a patient with cdiff. Then you must wash your hands after seeing them.

Or wear gloves if they have something like that...I doubt the "average hand washing" with soap is going to get c diff spores off your hands, just sayin.

Originally Posted by HooahDOc

I don't have to touch any patients so it's a non-issue for me.

Ideally psychiatrists should still be doing a cursory physical exam on all patients.

Originally Posted by McGillGrad

Ideally psychiatrists should still be doing a cursory physical exam on all patients.

It's hard to get someone to be open with you if you subject them to the power differential that is a physical exam. You get to put your hands on someone and see them essentially naked, then immediately ask them things that they may not even feel comfortable revealing to their family. The ED and medical staff should do a good job ruling out organic causes of disease before the patient reaches the psych floor. But that's neither here nor there.

As far as hand washing, our peds attendings would say, if the patient didn't see you do it, you didn't do it.

Look at CS. The patient knows that you've washed your hands 11 times that day, but you still need to do it the 12th time to get credit. Get into the habit now, and if your infections disease control requires hand sanitizing before entering the room, your hands will be that much cleaner.

Or you could just wear gloves...

Originally Posted by drno31

It's hard to get someone to be open with you if you subject them to the power differential that is a physical exam. You get to put your hands on someone and see them essentially naked, then immediately ask them things that they may not even feel comfortable revealing to their family. The ED and medical staff should do a good job ruling out organic causes of disease before the patient reaches the psych floor. But that's neither here nor there.
.

You couldn't be more mistaken. I understand that you're only a medical student, but the human touch is what allows them to trust you (not the opposite). I am not sure if you've done your psych rotation but one week in a psych ward reminds you of how many diseases are caused by the medications alone.

This type of thinking is the root cause of nurses/psychologists thinking they can do a physician's job.

Originally Posted by drno31

It's hard to get someone to be open with you if you subject them to the power differential that is a physical exam. You get to put your hands on someone and see them essentially naked, then immediately ask them things that they may not even feel comfortable revealing to their family. The ED and medical staff should do a good job ruling out organic causes of disease before the patient reaches the psych floor. But that's neither here nor there.

We do actively (most of us) try to rule out organic causes of psychiatric disease before they get out of the ED, but that doesn't mean that they don't have non-psychiatric disease when they get to you, and it doesn't mean they're not going to be in withdrawal from their meds or they're not going to have a dystonic reaction to your meds. Doesn't mean their primary psychiatrist has to do the exam, but someone needs to.

This is semi related, but do you guys shake every patients hand when you walk in the room? I feel stupid for even having to ask that question, but I am just not sure.

Originally Posted by IJL

This is semi related, but do you guys shake every patients hand when you walk in the room? I feel stupid for even having to ask that question, but I am just not sure.

you should if they'll let you and aren't crazy.