Our stinky dirty hands

[175961]

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This is just a post out of curiosity for all you pre meds who have shadowed/seen in action several different docs.....

So right now I volunteer at a free health clinic and the doc there is freakin religious about washing his hands (i'm surprised he still has skin on em) and on the side I shadow a family doctor and I dont think I've seen him wash his hands once. The family doc is a great guy, hes not a bad doctor at all or anything like that. I just havent seen his hands, soap and water meet up at the same time

So do they not emphasize the importance of washing hands in med school anymore or is it really not that important

 

[ryandote]

.

 

[Maxprime]

This is just a post out of curiosity for all you pre meds who have shadowed/seen in action several different docs.....

So right now I volunteer at a free health clinic and the doc there is freakin religious about washing his hands (i'm surprised he still has skin on em) and on the side I shadow a family doctor and I dont think I've seen him wash his hands once. The family doc is a great guy, hes not a bad doctor at all or anything like that. I just havent seen his hands, soap and water meet up at the same time

So do they not emphasize the importance of washing hands in med school anymore or is it really not that important

It's just annoying and difficult to get clinicians to do it. It takes more time out of an already packed schedule. That's one of the reasons you see hand sanitizers on the walls at hospitals - trying to get people to do it without the time required. I would bet it's much more religious in critical settings (ICU is full of bad bugs and compromised patients) - obviously, surgeons are nuts about scrubbing for the OR.

 

[cgsgarcia]

Does the family practice doctor tend to touch patients/things a lot?

 

[Jolie South]

this is a little off topic, but has anyone visited a developing country where clean water is scarce?

they use this nasty smelling liquid on their hands to disinfect between patients. just thinking about the smell makes me want to vomit. it's like a combination of Aunt Jemima syrup and industrial solvent. i've never encountered it here.

anyone have a clue what it is?

 

[Maxprime]

Does the family practice doctor tend to touch patients/things a lot?

I assume he does H&Ps on most people - decent amount of touching there.

Here's a good question - your PCP walks in for your physical and doesn't wash his hands - do you say something?

I'm pretty busy right now w/ research and blah blah blah - if I got a decent bug for a week it would really mess up my graduation schedule. I tend to be a little more vigilant when I can't afford as much downtime - so I think I'd say something to him/her. It's kind of a dick thing to do, but nobody can knock you for protecting your own health.

 

[175961]

Does the family practice doctor tend to touch patients/things a lot?

well today.....looking in patients ears, pressing on the front of their chests when he listens to their lungs, the ultrasound machine when doing an ultrasound. just stuff like that

 

[Maxprime]

this is a little off topic, but has anyone visited a developing country where clean water is scarce?

they use this nasty smelling liquid on their hands to disinfect between patients. just thinking about the smell makes me want to vomit. it's like a combination of Aunt Jemima syrup and industrial solvent. i've never encountered it here.

anyone have a clue what it is?

What color?

 

[Jolie South]

I assume he does H&Ps on most people - decent amount of touching there.

Here's a good question - your PCP walks in for your physical and doesn't wash his hands - do you say something?

I'm pretty busy right now w/ research and blah blah blah - if I got a decent bug for a week it would really mess up my graduation schedule. I tend to be a little more vigilant when I can't afford as much downtime - so I think I'd say something to him/her. It's kind of a dick thing to do, but nobody can knock you for protecting your own health.

yea, you can bet he won't be "comping" your next visit when you need antibiotics or whatever.

though as i've never been a practicing physician, i can't accurately comment on the time constraints involved with handwashing.

 

[Jolie South]

What color?

not sure. clear, i think.

it has a lingering smell that will stay with you for hours after it's been applied.

 

[HumidBeing]

Whether it's emphasized or not, I'm one of the "freakin religious" hand washers in my daily life. Sit in a desk in class, or a even a public table, & you don't know who's coughed on it, had what on their hands without washing them.

Frequent hand washing and keeping your hands away from your face are two of the easiest habits there are for good hygiene. I wash frequently and carry a small bottle of sanitizer. I've got to admit that my own hands get pitifully chapped, and I don't even live in one of the colder climates. Burt's Bees hand balm has worked well to get them back into decent looking condition and keep them that way.

 

[Jolie South]

Whether it's emphasized or not, I'm one of the "freakin religious" hand washers in my daily life. Sit in a desk in class, or a even a public table, & you don't know who's coughed on it, had what on their hands without washing them.

Frequent hand washing and keeping your hands away from your face are two of the easiest habits there are for good hygiene. I wash frequently and carry a small bottle of sanitizer. I've got to admit that my own hands get pitifully chapped, and I don't even live in one of the colder climates. Burt's Bees hand balm has worked well to get them back into decent looking condition and keep them that way.

I'm the same way and Burt's is awesome. 🙂 you should check out the coconut foot creme. it's obviously for feet, but it works well on hands too and smells minty and coconutty.

I cringe when people at the gym don't wipe down their equipment. it's nasty.

 

[nutrition]

I was once shadowing a surgeon when he told me this really funny joke about surgeons' compulsive habit of washing hands. It went something like this (sorry if i butcher it):


One evening, two doctors (a man and a woman) meet at a medical conference. After some innocent flirting over a few glasses of wine, they decide to go back to the woman's hotel room.

Right when they come back to the hotel room, the woman heads to the bathroom and thoroughly washer her hands. She returns. They start flirting again. Things get serious, and they decide to have sex. The woman abruptly gets up, goes to the bathroom, and again washes her hands. She returns and they have sex. After about an hour of sex, she gets up again and goes to the bathroom and washes her hands.

Interested by her peculiar habit, the man thinks for a moment and says: "You wash your hands so much, you must be a surgeon!" The woman replies with: "and you an anesthesiologist."

The man was very surprised. Perplexed, he asks her "how she know." She replies: "cuz I didn't feel a thing."

 

[RySerr21]

so i'm in my dorm washing my hands cuz i just went to the bathroom.....

this kid comes in, goes to the sink, pretends like he turns the water on, rubs his hands together as if hes getting them wet, goes to the soap despenser, pretends to pump it a few times, goes to the sink, "washes" his hands free of soap, goes to the paper towel despenser, grabs paper towels to "dry" his hands, and walks out.

someone please explain what i witnessed.

 

[Toohotinvegas33]

Typically you take the history, then wash your hands (if you have sink in room, if not then wash before hand). Some of hand washing is to put the patient at ease. Then you do the physical. If you touch any "dirty" area like armpit or feet you wash your hands again before touching a "clean" area like the face.

Personally I just wear a bubble because people have cutties.

 

[Maxprime]

My PCP growing up washed his hands when he entered the room - I remember because, as a kid, it seems so weird that someone always washes their hands before dealing with you.

Are you supposed to wash your hands if you touched a patient with gloves on? If not, that will be my solution.

 

[Maxprime]

Typically you take the history, then wash your hands (if you have sink in room, if not then wash before hand). Some of hand washing is to put the patient at ease. Then you do the physical. If you touch any "dirty" area like armpit or feet you wash your hands again before touching a "clean" area like the face.

Personally I just wear a bubble because people have cutties.

You mean cooties? They have a vaccine for that, most of us got it as kids (it involves both circles and dots).

BTW, I remember someone telling me at an interview tour that people fail their simulated patient exams if they don't wash their hands.

 

[spanamit]

I was once shadowing a surgeon when he told me this really funny joke about surgeons' compulsive habit of washing hands. It went something like this (sorry if i butcher it):


One evening, two doctors (a man and a woman) meet at a medical conference. After some innocent flirting over a few glasses of wine, they decide to go back to the woman's hotel room.

Right when they come back to the hotel room, the woman heads to the bathroom and thoroughly washer her hands. She returns. They start flirting again. Things get serious, and they decide to have sex. The woman abruptly gets up, goes to the bathroom, and again washes her hands. She returns and they have sex. After about an hour of sex, she gets up again and goes to the bathroom and washes her hands.

Interested by her peculiar habit, the man thinks for a moment and says: "You wash your hands so much, you must be a surgeon!" The woman replies with: "and you an anesthesiologist."

The man was very surprised. Perplexed, he asks her "how she know." She replies: "cuz I didn't feel a thing."

HAHAHA thats awesome!

 

[nonesuchgirl]

You mean cooties? They have a vaccine for that, most of us got it as kids (it involves both circles and dots).

BTW, I remember someone telling me at an interview tour that people fail their simulated patient exams if they don't wash their hands.

CIRCLE, CIRCLE,
DOT, DOT,
NOW YOU'VE GOT
YOUR COOTIE SHOT!

 

[spanamit]

CIRCLE, CIRCLE,
DOT, DOT,
NOW YOU'VE GOT
YOUR COOTIE SHOT!

YOU THINK THAT BOOTIE IS HOT,
I THINK I WOULD RATHER NOT.

 

[nonesuchgirl]

My PCP growing up washed his hands when he entered the room - I remember because, as a kid, it seems so weird that someone always washes their hands before dealing with you.

Are you supposed to wash your hands if you touched a patient with gloves on? If not, that will be my solution.

wash before and after dealing with patients, and after taking off gloves.

 

[XerxesMD]

I was once shadowing a surgeon when he told me this really funny joke about surgeons' compulsive habit of washing hands. It went something like this (sorry if i butcher it):


One evening, two doctors (a man and a woman) meet at a medical conference. After some innocent flirting over a few glasses of wine, they decide to go back to the woman's hotel room.

Right when they come back to the hotel room, the woman heads to the bathroom and thoroughly washer her hands. She returns. They start flirting again. Things get serious, and they decide to have sex. The woman abruptly gets up, goes to the bathroom, and again washes her hands. She returns and they have sex. After about an hour of sex, she gets up again and goes to the bathroom and washes her hands.

Interested by her peculiar habit, the man thinks for a moment and says: "You wash your hands so much, you must be a surgeon!" The woman replies with: "and you an anesthesiologist."

The man was very surprised. Perplexed, he asks her "how she know." She replies: "cuz I didn't feel a thing."

😆

 

[nata]

I was just reading Atul Gawande's new book Better last night that has it's first chapter all about hand washing (same author who wrote Complications). It's a good read. I shadowed in Family Practice as well, and the MD was big on hand washing. It's absolutely essential to prevent spread of infections, and there is so much stuff out there. My own daughter even had one hell of a staph infection that took 2 rounds of antibiotics to get rid of. I wouldn't go to a family practice or take my kids to a pediatric doc who didn't wash.

 

[smq123]

So do they not emphasize the importance of washing hands in med school anymore or is it really not that important

Years ago, they didn't. But, then again, 40 years ago, wearing gloves when drawing blood on patients was optional.

Nowadays, they are pretty strict about handwashing. On your videotaped patient encounters in medical school (as well as your Step 2 CS), you could have points deducted from your final grade if they DON'T see you wash your hands or at least use hand sanitizer.

 

[centersharpie]

Yea... I haven't seen my doctor do this either... but he's the chief of neurosurgery, and during his clinical hours he's in and out of each room so fast that he barely touches the patients... for surgery though, he does scrub in...

 

[sunny1]

Hand hygiene is a big deal. It's one of the JCAHO patient safety goals to follow WHO or CDC guidelines for hand hygiene to reduce the risk of health care acquired infection.

In some hospitals, they do something akin to the secret shopper deal where an anonymous person keeps track of how much nurses vs. doctors. vs. other staff wash their hands when they are supposed to and the rates are reported so people can be urged to improve hand hygiene before and after seeing patients. They also hand out little CDC pins on hand hygiene to attach to your namebadge or lanyard.

http://www.cdc.gov/handhygiene/download/hand_hygiene_core_minus_notes.pdf

 

[novastorm]

I would be suprised if the JCAHO spies didn't complain about adequate hand washing wherever they are. Where I come from if your hands are visibly soiled you have to wash your hands, otherwise you can use the industrial strength hand sanitizer. Either way your hands get dried out like crazy, our soap is brutal.

 

[sunny1]

I would be suprised if the JCAHO spies didn't complain about adequate hand washing wherever they are. Where I come from if your hands are visibly soiled you have to wash your hands, otherwise you can use the industrial strength hand sanitizer. Either way your hands get dried out like crazy, our soap is brutal.

Do they not have lotion dispensers next to the soap? I wouldn't be able to live without lotion!

 

[Moshe Rabbenu]

Well, I'm religious about handwashing, but that's because of my religion, so...yeah.

I don't think I've ever seen my PCP wash his hands after coming into the exam room. I just kind of assumed he washes them afterwards before seeing the next patient, since he walks into a back room away from the patients. I've never gotten anything that I didn't walk in with, so I'm willing to bet he does.

 

[joyrunner]

I was just reading Atul Gawande's new book Better last night that has it's first chapter all about hand washing (same author who wrote Complications). It's a good read. I shadowed in Family Practice as well, and the MD was big on hand washing. It's absolutely essential to prevent spread of infections, and there is so much stuff out there. My own daughter even had one hell of a staph infection that took 2 rounds of antibiotics to get rid of. I wouldn't go to a family practice or take my kids to a pediatric doc who didn't wash.

This book is a great read, and there's also some big movements in medicine to make hospitals safer for patient that really really concentrate on hand washing. See Donald Berwick's 100,000 lives campaign.

 

[deuce924]

wash before and after dealing with patients, and after taking off gloves.

This was the protocol I was used to seeing.

 

[monkeyman12]

YOU THINK THAT BOOTIE IS HOT,
I THINK I WOULD RATHER NOT.

Wow, qouting Jamie Kennedy what has sdn come to? (btw i love the music video for that)

 

[bodonid]

I would think handwashing would be more important at a free clinic: it is possible that he was just setting an example for the other people that work there?

 

[skyeblue0610]

I'm one of those "religious hand washers" I wash my hands alot for everything. In the bathroom in public I don't even touch the facet without at least 2 paper towels. Then I use another 2 for the door and IF my hand touches that door handle....back I go to the facet.

For some reason whenever I'm in a public bathroom washing my hands I will look in the mirror and see that ONE woman come right out of the bathroom and out the door without washing no way in the world I'm touching that handle

 

[Moshe Rabbenu]

That's how I am. I don't touch anything in the bathroom without a bunch of paper towels once the water touches my hands. I just use the same towel for the faucet and the paper towel dispenser. Then, I use the towels I dried with to open the door. The worst is when you go to wash your hands and like three people are at the sink, and they take the towel you purposely pushed out of the one dispenser. I wait until they all leave and then wash my hands. I'm sick of washing my hands 3 times.

 

[CubaLibre]

at mt sinai, all the computer screen desktop backgrounds and screen savers contain huge warning messages urging you to wash those hands

 

[HumidBeing]

Yea... I haven't seen my doctor do this either... but he's the chief of neurosurgery, and during his clinical hours he's in and out of each room so fast that he barely touches the patients... for surgery though, he does scrub in...

Is not washing because you "barely touch" the patients like the five second rule for when you drop food on the floor?🙄

 

[grobbins91]

I've seen older docs not wash as often, like some older paramedics don't wear gloves because back when they went to school it was a requirement or even a comon practice. Most just use the sanitizer on the wall now and wash a couple times a day rather than every time, thats what we at the fire department I work for (no running water on an engine/ambulance). I personally use the sanitizer right after, and wach when I have a few minutes.

 

[fireflygirl]

not sure. clear, i think.

it has a lingering smell that will stay with you for hours after it's been applied.

Jolie - in India it's called Dettol and the organic compound that makes it up is called parachlorometaxylenol. I feel like everyone smells of it there but that stuff disinfects like nothing else! I am not sure if that is what you were talking about....

On the other hand, this thread reminds me of that Seinfeld episode where Papi doesn't wash his hands at the pizza shop and Seinfeld can't date his daughter because he watched Papi leave the bathroom without washing his hands and then knead his pizza dough and serve it to Seinfeld and his date at the restaurant.

 

[smq123]

Do they not have lotion dispensers next to the soap? I wouldn't be able to live without lotion!

Lotion, as in moisturizer? No.

Lotion, as in hand sanitizer "lotion" that has alcohol in it? Yes, but the alcohol dries out your hands just as badly.

Moral of the story: Carry a small bottle of moisturizing hand lotion in your white coat.

 

[Concordia]

I work in a lab but this is hand washing/glove related. I am pretty compulsive about washing my hands (paranoid micro major) so my hands tend to look pretty raw. And I do have some awesome moisturizer to take care of that, but I can't put it on if I have to wear gloves. Not only does it make my hands sweat like crazy, whatever is in those gloves mixes with my lotion and makes my hands smell awful.

 

[Jolie South]

Jolie - in India it's called Dettol and the organic compound that makes it up is called parachlorometaxylenol. I feel like everyone smells of it there but that stuff disinfects like nothing else! I am not sure if that is what you were talking about....

that might be it. it's bad when you're not feeling sick, but try having food poisoning or amoebic dysentery and then smelling that everywhere. 👎

if it smells like aunt jemima + organic solvent, that's probably it.

 

[Karen12345]

Jolie - in India it's called Dettol and the organic compound that makes it up is called parachlorometaxylenol. I feel like everyone smells of it there but that stuff disinfects like nothing else! I am not sure if that is what you were talking about....

On the other hand, this thread reminds me of that Seinfeld episode where Papi doesn't wash his hands at the pizza shop and Seinfeld can't date his daughter because he watched Papi leave the bathroom without washing his hands and then knead his pizza dough and serve it to Seinfeld and his date at the restaurant.

I thought about Seinfeld too. And it disgusts me when people, physicians on duty especially, don't wash their hands. We are talking about the basics here.

 

[ModernAlchemist]

I shadow a family doctor too and I definitely noticed that he will not wash his hands very often either. Maybe the teach you not to do it in the residency? 😕

 

[AKu2984]

I was once shadowing a surgeon when he told me this really funny joke about surgeons' compulsive habit of washing hands. It went something like this (sorry if i butcher it):


One evening, two doctors (a man and a woman) meet at a medical conference. After some innocent flirting over a few glasses of wine, they decide to go back to the woman's hotel room.

Right when they come back to the hotel room, the woman heads to the bathroom and thoroughly washer her hands. She returns. They start flirting again. Things get serious, and they decide to have sex. The woman abruptly gets up, goes to the bathroom, and again washes her hands. She returns and they have sex. After about an hour of sex, she gets up again and goes to the bathroom and washes her hands.

Interested by her peculiar habit, the man thinks for a moment and says: "You wash your hands so much, you must be a surgeon!" The woman replies with: "and you an anesthesiologist."

The man was very surprised. Perplexed, he asks her "how she know." She replies: "cuz I didn't feel a thing."

I feel stupid....cuz I'm sitting in my house all alone laughing my a$$ off. That's hilarious!

 

[lsumedgirl]

One of the ER docs that I used to work with said that he'd read a study (maybe in JAMA, I dunno...) about med-students, residents, and faculty, and their hand-washing habits. The most frequent hand-washers were the students, followed by the residents, and coming in last - the faculty. Hand-washing is certainly emphasized in med school... but that emphasis doesn't always continue. When it's first emphasized, you're more likely to be a fanatic about it. As the years go by, it's more likely to fall by the way-side.

So I would have to guess that maybe that's why you didn't see the FP washing his hands that much.

 

[thefallen]

Many hospitals have hand-sanitizer dispensers right by the doors of patient rooms. Very convenient to use right before you enter the room, and right after you leave.

There are also patients where you're required to put on a gown and gloves to enter the room since they have some nasty bug. Of course half the staff ignores the warning sign on the door and just barges in. No wonder people catch so many infections in hospitals.

 

[coffeebythelake]

Many hospitals have hand-sanitizer dispensers right by the doors of patient rooms. Very convenient to use right before you enter the room, and right after you leave.

There are also patients where you're required to put on a gown and gloves to enter the room since they have some nasty bug. Of course half the staff ignores the warning sign on the door and just barges in. No wonder people catch so many infections in hospitals.

I'm pretty sure hand sanitizer (i.e., ethyl alcohol) only kills bacteria, not viruses. The best bet is still to wash your hands.

 

[brianmartin]

I once saw an ER doc lay his un-gloved hands all over an extremely cellulitic and swollen thigh abscess. Pt was there for a re-check, erythema was increased over the past week. We checked the cultures - "Hmm, it's staph and is resistant to everything except vancomycin." Turns out he had just wiped his nose and eyes with his hands 😱

 

[smq123]

Many hospitals have hand-sanitizer dispensers right by the doors of patient rooms. Very convenient to use right before you enter the room, and right after you leave.

The hand sanitizers are "more effective" because the action of rubbing the hand sanitizer into your skin more effectively kills bacteria. It's better than the quick "run some water over hands, slap some soap on, run some more water over hands" routine that most people do. Most people do not wash their hands for a long enough duration to be effective.

I'm pretty sure hand sanitizer (i.e., ethyl alcohol) only kills bacteria, not viruses. The best bet is still to wash your hands.

Some hand sanitizers DO kill Hep A, Hep B, and Hep C. Others have (reportedly) killed norovirus, rotavirus, and rhinovirus.

(EDIT: I should probably add that the "hand sanitizer" that you may be thinking of is NOT the Purell stuff that you get in the drug store. The hand sanitizers that are in every hospital room are things like Avagard which contains ethyl alcohol and chlorhexidine gluconate. The other brands of hand sanitizers contain other stuff (not necessarily CHG) besides ethyl alcohol for disinfecting.)

The biggest problem in hospitals is that hand sanitizers (including the stuff that the hospital uses) don't kill c. diff spores. In that case, soap and GOOD handwashing is better. But, generally speaking, using hand sanitizers is considered to be better than soap and water, just because people don't know how to properly wash their hands.

There are also patients where you're required to put on a gown and gloves to enter the room since they have some nasty bug. Of course half the staff ignores the warning sign on the door and just barges in. No wonder people catch so many infections in hospitals.

Well, nosocomial infections also partly due to the fact that hospital workers are colonized with all kinds of stuff. Working in a hospital, you're guaranteed to become colonized with MRSA and C. diff. Probably VRE, 20 years down the road.

But you're right - people don't observe enteric precautions nearly as often as they should. Well, if they want to come down with C. diff colitis, have so much diarrhea that they need to be hospitalized, and face the possibility of a stool transplant (look it up: http://www.washingtonpost.com/ac2/wp-dyn/A22098-2004Mar24?language=printer), then that is their perogative. 🙄