high traffic to blame for OR bacterial contamination

[IMGASMD]

- Deborah Dogood, R.N., B.S.N., M.S.N., Ph.D., P.I.A.

Please. That’s Dr. Dogood for you.

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[woopedazz]

Please. That’s Dr. Dogood for you.

Her friends call her "Prof."
Everyone else calls her Dr. Professor

 

[fakin' the funk]

. IN fact, maybe those small pieces of bacteria turn out to be helpful.

Easily the dumbest comment in a thread full of them

 

[deleted875186]

Easily the dumbest comment in a thread full of them

This made my day. I love it.

 

[dhb]

Easily the dumbest comment in a thread full of them

Well you just added your part.

 

[epidural man]

Easily the dumbest comment in a thread full of them

eh maybe - but normal flora pay a significant part somehow in our well-being. do you know each species interact with us and what they do? I don't. What about GI flora? What about our interaction with flora on food? or even with other people? What affect does constant exposure to flora in the normal world do to our own immune system? What happens when you remove certain parts of that? Does seeding our blood with bacteria every time we brush our teeth help us?

You are right - it might be dumb...but it might not. I'm just saying - you and I have NO IDEA about how all these things interact.

 

[nimbus]

eh maybe - but normal flora pay a significant part somehow in our well-being. do you know each species interact with us and what they do? I don't. What about GI flora? What about our interaction with flora on food? or even with other people? What affect does constant exposure to flora in the normal world do to our own immune system? What happens when you remove certain parts of that? Does seeding our blood with bacteria every time we brush our teeth help us?

You are right - it might be dumb...but it might not. I'm just saying - you and I have NO IDEA about how all these things interact.

I love my trillions of microbiome friends. Hopefully I am a good host.

 

[dhb]

you and I have NO IDEA about how all these things interact.

But one of you knows he doesn't know.
Much like.... you know

 

[deleted171991]

It seems like a lot of the infection control measures we get stuck with are analogous to ERAS pathways: take a whole bunch of interventions that have questionable (or no) efficacy on an individual level, bundle them together, and point to better outcomes.

It’s not that there’s nothing to this approach (I’m glad our total joint infection rates are well under 20%)... But the obvious downside is that the bar has become very low for adding another thing to the bundle, and the downsides of each thing (environmental waste/time-wasting/annoying/expensive) are not fairly being weighed against the value that said thing adds to the bundle

Bureaucrats need to show a reason for their existence.

Stupid people (i.e. the average human) tend to have a mechanistic view about patients and diseases, and also tend to rise high in bureaucracies (A players hire A players, B players hire C players), so they become big fans of protocols. Humans are not airplanes.

 

[Iso4ane]

Bureaucrats need to show a reason for their existence.

Stupid people (i.e. the average human) tend to have a mechanistic view about patients and diseases, and also tend to rise high in bureaucracies (A players hire A players, B players hire C players), so they become big fans of protocols. Humans are not airplanes.

The problem is that 50% of people are dumber than your average (median) human.

 

[deleted171991]

The problem is that 50% of people are dumber than your average (median) human.

See my signature.

 

[MoMoGesiologist]

Bureaucrats need to show a reason for their existence.

Stupid people (i.e. the average human) tend to have a mechanistic view about patients and diseases, and also tend to rise high in bureaucracies (A players hire A players, B players hire C players), so they become big fans of protocols. Humans are not airplanes.

I’m starting to change my mind about protocols. Individuals are fallible. Letting nurses and RT have space to do things results on you depending on that individual being intelligent and u get in variable levels of care for the same cases/patient situations. No consistency. Protocols at least allow us to meet some minimum level of care. We need them for the stupid providers. But they suck for the smart people.

 

[deleted171991]

I’m starting to change my mind about protocols. Individuals are fallible. Letting nurses and RT have space to do things results on you depending on that individual being intelligent and u get in variable levels of care for the same cases/patient situations. No consistency. Protocols at least allow us to meet some minimum level of care. We need them for the stupid providers. But they suck for the smart people.

One problem with protocols is that they establish a "standard of care". Hence, if one overrides them, and something bad happens, it may even come across as malpractice. That's the reason even smart people do ACLS in stupid ways, killing patients every day (e.g. by bolusing tons of epi, by wasting time on intubation in the early phases etc.). To me, that's proof what happens when you let laypeople play expert. There is nothing more painful to watch than a brainwashed trainee running a knee-jerk code in the ICU.

There are certain things non-experts should almost never do, such as directing ACLS. Instead of inventing more stupid protocols, we should invent ways to have true experts available for every one of these situations, especially in the hospital (e.g. ACLS should always be run by an EM doc). With ERAS and pain control, the experts are already in the OR; they are called anesthesiologists. So there should not be protocols in the OR, except when these anesthesiologists deem them helpful (the same way I appreciate potassium replacement or hyperglycemia protocols in the ICU). And they should be easy to override, without any pushback from bean counters or surgeons.

The problem with protocols is that they are aimed to replace smart people, but they rarely do. They just empower the idiots, and make them dangerous ("a little knowledge is a dangerous thing"). They just put the patients at different kind of risks than the ones they are aimed to replace. I remember when I once stopped an amio load early, in the ICU, because it had achieved is therapeutic effect already, and the sensitive patient was slowly but steadily going bradycardic and hypotensive. Her knee-jerk surgeon wanted me to finish the "ACLS loading dose", and possibly the patient in the process.

Disclaimer: I am sure I can also be an idiot with various limitations when in certain situations. Except that I KNOW I am and what my limitations are, and don't play God, but happily let the real experts do their thing. Dubito, ergo cogito.

 

[Iso4ane]

I like it when I’m doing some of the ACLS retraining MCQs and the answer is ‘Seek expert consultation’.

‘Goddammit, I AM the expert.’