An ID question for all you guys

[ucsfgaspain]

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Okay here's the deal.

I just switched locations for my practice...to be close to my honey. At my previous gig, I would always wear the under armour gear underneath my scrup top cuz I freeze in the OR. (I do triathlons and when I cut weight for racing, my body fat dips to around the 5% mark and so thermal regulation in the OR becomes a big issue). Never had an issue with anyone about my OR attire, and I hate those blue paper cloth jackets! They make you look like such a dork.

At the new gig, someone complained. The "policy" is no clothing below the scrubs. I kind of see this lilke how in the old days we used to insist on shoe covers. Studies showed that that practice clearly didn't prevent squat. Does anyone know if there are any studies about t-shirts/ underarmour compression tops being worn under scrubs and what this does to perioperative infections? Any help would be appreciated cuz I'm on the war path.

The sad thing is that most of the people I work with are fat f+cks. So they don't mind the cold. There's a few of us (mostly those in my department) who actually get off their butts and exercise. We're the ones who freeze in the OR and wear the compression tops underneath our scrub tops.

BTW I asked the ID doc, but he doesn't want to get involved in the political brouhaha.

 

[dfk]

no studies here.
but i've been to a few sites that require no outside shirts.
i ended up wearing a size smaller scrub underneath a larger one.
seemed to work fine.
and yea, they usually ARE the fat phucks..
these are the same ones that will wear their scrubs home on the bus or to the grocery mart.
yea, THATs clean.

 

[militarymd]

There's little data to support anything. The Infectious Disease folks know it.

Most of this crap is stuff generated by nursing policy.

I'm always around 5 percent body fat, so I'm always cold.

and yeah, the fat fuchs love the cold.....another incentive for people to be fat and out of shape.

 

[Noyac]

A hospital that I interviewed at in Boulder that had fleeces for the anesthesia dept. I complained enough along with my partners and I got the hospital to buy us each 2 fleece jackets to wear in the hospital only. You should see the envy of the surgeons when we put the jackets on in the OR.

I can't imagine any problems with clothing under the scrubs. What does the maintenance crew or the IT guys wear when they come to the OR. Ours put jumpsuits on over their clothes.

 

[Noyac]

Oh wait, was this a thread about % body fat? Did i miss the theme of the thread? I'm not above listing my body fat.

 

[urge]

At the new gig, someone complained. The "policy" is no clothing below the scrubs.

So, is everybody going commando or freeballing?

 

[jwk]

So, is everybody going commando or freeballing?

HA - my favorite line from Seinfeld - "my boys need a home"

The AORN conveniently keeps their standards in book form, meaning you have to BUY it - it's not available online. As I recall, the policy is something along the line of no long sleeves or anything poking out from under the scrubs.

BFD - We all got fleece jackets. We told them that when they raise the temperature of the OR to a point that's beneficial to patients as opposed to being for the convenience and comfort of the surgeons that we'd rethink our clothing options. Besides that, how many of your surgeons, assistants, salespeople, and even the nursing staff, wear their scrubs over from the office or from home and don't change? I know lots of ours do. Same response - when the OR administration want to deal with THAT issue, then you can come talk to us.

The other response used occasionally (of course they don't like any of our retorts) is that we're not subject to "nursing" policies. ')

 

[fakin' the funk]

The AORN conveniently keeps their standards in book form, meaning you have to BUY it - it's not available online.

As you implied, many of the AORN's policies on infection prevention are hand-waving and hocus-pocus. They cite studies with intermediate outcomes like bacterial counts on the hands or clothes instead of the actually important outcome, surgical site infection.

 

[pgg]

and yeah, the fat fuchs love the cold.....another incentive for people to be fat and out of shape.

I find it remarkable that our pediatric surgeons never EVER complain about the room being 85 degrees when the patient is a preemie or neonate ...

... yet the fat ungowned nurses, general surgeons, and especially the OB cutters endlessly complain about the room being too hot at 72.

We have one insane obstetrician who swears that the Bair Hugger touching her side gave her renal failure (!) and that it's not safe for the patient if the surgeon is too hot. Personally I think no patient is safe in her hands, regardless of the ambient temperature.

I've started to take a kind of perverse pleasure in keeping the room warm, at least until the drapes are up and I'm happy with the temp trend. But my patients are never ever hypothermic going to the PACU.

 

[coprolalia]

Somehow when you said "ID question", I immediately thought this forum was going to derail into an Intelligent Design debate, and urge was going to regale us with tales of how Darwin fudged his data and that carbon dating is b.s. and that dinosaur fossils were put there by God or constructed by aliens or whatnot...

Whenever I hear the song "Free Fallin'" by Tom Petty, I can't help but hear "Free-Ballin'" in my head.



-copro

 

[pgg]

Somehow when you said "ID question", I immediately thought this forum was going to derail into an Intelligent Design debate

I thought the same thing. 🙂

 

[SleepIsGood]

This whole topic has nothing to do with actual infection rates as it does with nursing wanting to 'police' doctors for those years when they were put down. At my institution now they are saying we can not bring back packs to the OR either?

Sometimes you want to bring a book/money with you where do you put it? It's insane! We're not surgeons, most of what we do is not sterile (for God's sake we're in patients mouths all the time!!)

I just wish our attendings would stick up to the nurses at times...but of course, none of them will.....

 

[Salt Creep]

It amazes me that some of these people think wearing a t-shirt under a scrub top is worse than a guy's chest hair hanging out. I wear sleeveless t-shirts under my scrubs, because I'm not shaving my chest.

They'd want me to wear one of those stupid bonnets if I had a beard. A t-shirt covering the chest hair doesn't really seem different. But then again, no one ever said these people were capable of logic.

 

[climbingdocs]

so bras allowed under scrubs? or would I have to be free boobing?

 

[Monty Python]

At the new gig, someone complained. The "policy" is no clothing below the scrubs. .

1. Are you under Nursing Service? No ... then end of discussion.

2. If they insist on making an example of you, then take your case to the Medical Executive Committee (where the RNs' case will be met with appropriate derision), thus effectively squashing this entire anti-physician effort by some frustrated Nurse Ratcheds.

 

[core0]

1. Are you under Nursing Service? No ... then end of discussion.

2. If they insist on making an example of you, then take your case to the Medical Executive Committee (where the RNs' case will be met with appropriate derision), thus effectively squashing this entire anti-physician effort by some frustrated Nurse Ratcheds.

Here is the policy statement:
" RECOMMENDED PRACTICE I

All personnel should be in surgical attire before beginning the surgical hand scrub.

Interpretive statement 1:

Before entering the restricted areas of the surgical environment, all personnel should wear scrub clothes, hair coverings, and masks. Protective eyewear and other protective barriers should be worn as needed.

Rationale:

Surgical attire reduces shedding and promotes environmental control.(1)"

Notice it doesn't say anything about what is under the scrubs.

I would ask for a copy of the "policy". My guess is that it doesn't exist. If it does actually exist and says no clothing underneath the scrubs then write up every nurse manager that is wearing underwear. Every day. Make sure the boys are hanging "free" to prevent counterattacks. The funny thing is that for JHACO they have to respond to each incident report and if it violates policy form a plan of action. If you have a computerized system it gives you something to do while doing cases. Of course the punishment is "management" coming in without underwear

David Carpenter, PA-C

 

[Bougie]

We have one insane obstetrician who swears that the Bair Hugger touching her side gave her renal failure (!)

What the heck?? Did you ram the Bair Hugger hose down her throat and then pour Aprotinin down it??

 

[jetproppilot]

There's little data to support anything. The Infectious Disease folks know it.

Most of this crap is stuff generated by nursing policy.

I'm always around 5 percent body fat, so I'm always cold.

and yeah, the fat fuchs love the cold.....another incentive for people to be fat and out of shape.

Me too.


Not the 5% part (I'm prolly 8-9%)...the cold part.

Gosh, how true that is....can't tell you how many complaining, hot, sweaty ORCAS work in our OR....no shortage of XXL pants in the female nurse lockerroom here.

Dontcha think when your thighs rub together (mine do but for a different histologic reason) to the point that you start waddling it'd be time to slow down on the mashed potatoes and gravy?

 

[coprolalia]

The funny thing is that for JHACO they have to respond to each incident report and if it violates policy form a plan of action.

F**k JCAHO! F**k 'em! (Read my other post on this thread.) Please deal with this issue in house!

I mean, F**K! What the hell is wrong with us as a set of supposed "professionals"? Jeezus, doesn't arguing about what should be warn under scrubs just seem... I dunno... completely f*ckin' pathetic?!!?! And, involving JCAHO in it seems like a good idea? Get JCAHO involved? JCAHO should be dissolved, not further empowered!

Christ almighty! No wonder the trial lawyers have a field day with us. We can't even agree on a f*ckin' t-shirt under a scrub top, with no evidence base, and we want to get some eighteen-headed hydra of ineffectualism and policy wonking to adjudicate the argument for us?

And, meanwhile I gotta look at my Chairman's (who believes the B.S. that you shouldn't wear a t-shirt under your scrubs) chest hair hanging out of the top of his scrubs when I'm forced to do cases with him. He's got more hair poking outta the top of his scrub v-line most men his age have on their heads... and yet the bald guys still have to wear surgical caps!?!???

It's f*ckin' madness, this healthcare world, I tell you. F*ckin' madness.

-copro

 

[TrustMe]

I was told at our hospital that you can wear t-shirts under scrubs as long as the sleeves of the shirt do not stick out past the sleeve on the scrub top. However, we have a couple of freakishly skinny residents and they routinely wear long sleeves under their scrubs and have not been "reprimanded" by the nursing staff.

Also, in med school we had an anesthesia attending that shaved his head and he never wore a surgical cap. He always said that since he didn't have any hair he didn't feel there was any reason to cover his head. He had been doing it for years I'm told.

 

[elwademd]

F**k JCAHO! F**k 'em! (Read my other post on this thread.) Please deal with this issue in house!

I mean, F**K! What the hell is wrong with us as a set of supposed "professionals"? Jeezus, doesn't arguing about what should be warn under scrubs just seem... I dunno... completely f*ckin' pathetic?!!?! And, involving JCAHO in it seems like a good idea? Get JCAHO involved? JCAHO should be dissolved, not further empowered!

Christ almighty! No wonder the trial lawyers have a field day with us. We can't even agree on a f*ckin' t-shirt under a scrub top, with no evidence base, and we want to get some eighteen-headed hydra of ineffectualism and policy wonking to adjudicate the argument for us?

And, meanwhile I gotta look at my Chairman's (who believes the B.S. that you shouldn't wear a t-shirt under your scrubs) chest hair hanging out of the top of his scrubs when I'm forced to do cases with him. He's got more hair poking outta the top of his scrub v-line most men his age have on their heads... and yet the bald guys still have to wear surgical caps!?!???

It's f*ckin' madness, this healthcare world, I tell you. F*ckin' madness.

-copro

to be clear, what i think core-o meant that all complaints generated in house must be met by a response... i.e. a paper trail. whenever the jcaho flunkies come around, and various random charts/files/papers are pulled, they want to see that paper trail. so, even if you don't intend to get jcaho flunkies involved, you do... if you file a formal complaint.

either way, it is indeed madness.

 

[pgg]

What the heck?? Did you ram the Bair Hugger hose down her throat and then pour Aprotinin down it??

That's a great idea. I don't believe we stock aprotinin any more though.

She's insane. If you don't watch her like a hawk, she'll actually take a roll of tape and seal off the half of the upper body Bair Hugger on her side. She once declared she wouldn't operate until we turned the temperature in the room down to 65. We argued while the nurse prepped the patient, we argued about the Bair Hugger, we argued while the OB resident draped the patient, and finally when the patient was covered and warm, I turned down the OR temp and she realized she hadn't scrubbed yet, so we sat around and waited a while before she went ahead with assaulting the patient.

She's insane.

 

[Noyac]

That's a great idea. I don't believe we stock aprotinin any more though.

She's insane. If you don't watch her like a hawk, she'll actually take a roll of tape and seal off the half of the upper body Bair Hugger on her side. She once declared she wouldn't operate until we turned the temperature in the room down to 65. We argued while the nurse prepped the patient, we argued about the Bair Hugger, we argued while the OB resident draped the patient, and finally when the patient was covered and warm, I turned down the OR temp and she realized she hadn't scrubbed yet, so we sat around and waited a while before she went ahead with assaulting the patient.

She's insane.

PGG, are you in Alb?

 

[pgg]

PGG, are you in Alb?

No. Sound like someone you know? 🙂

 

[Strength&Speed]

I want to find the people who complain about these things and kick them in the crotch. Not only are they misinformed, but they are honorless bastards as well.

 

[Gern Blansten]

What the heck?? Did you ram the Bair Hugger hose down her throat and then pour Aprotinin down it??

Hilarious!!

 

[cubs3canes]

Me: "The patient's cold 34.5, I am raising the room temp to 72"
Surgeon: "I am hot, do not do that"
Me: Okay (raise temp to 75)

Patient happy. Surgeon never the wiser. When they start complaining, I start quoting volatile anesthestics, coagulation, and normothermia and try to bore them. They usually do not understand what I am saying and they just agree.

 

[Monty Python]

Me: "The patient's cold 34.5, I am raising the room temp to 72"
Surgeon: "I am hot, do not do that"
Me: Okay (raise temp to 75)

Patient happy. Surgeon never the wiser. When they start complaining, I start quoting volatile anesthestics, coagulation, and normothermia and try to bore them. They usually do not understand what I am saying and they just agree.

I've not seen it in writing, but rumor has it JCAHO will soon begin tracking PACU on-arrival temps as a performance standard (or is it Medicare) ??

Anywho, it wouldn't surprise me if in the near future payment is denied due to failure to give the pre-op abx at the right time, failure to narrate periop beta blocker usage, and unacceptable PACU-arrival temp.

 

[jwk]

I've not seen it in writing, but rumor has it JCAHO will soon begin tracking PACU on-arrival temps as a performance standard (or is it Medicare) ??

Anywho, it wouldn't surprise me if in the near future payment is denied due to failure to give the pre-op abx at the right time, failure to narrate periop beta blocker usage, and unacceptable PACU-arrival temp.

It's Medicare - and it's coming real soon.

 

[IceDoc]

I find it remarkable that our pediatric surgeons never EVER complain about the room being 85 degrees when the patient is a preemie or neonate ...

I was once in a room with a 3yo when the A/C broke and the room temp went down to about 60. At the end, the surgeon remarked "I should've known something was wrong. I'm actually comfortable at the end of the case."
So, the peds surgeons aren't any less comfortable, they just don't complain b/c it's a benefit for the kids.