One of the comments on my last essay made me think. Imagine, if you will, sitting alone in a hospital cafeteria at lunchtime, and a group of employees wearing their colorful pajamas is sitting at the next table. You overhear this conversation:
"Don’t you use sterile instruments?"
"No. It’s all baloney. Hey, they’re clean, you know. I wash them myself."
What would you think? If you knew nothing else about medicine, you know that instruments, whatever they are, should be sterile, whatever that means. You also know that you should quickly and quietly leave this hospital.
Now suppose you overhear a slightly different conversation:
"Don’t you follow universal precautions?"
"No. It’s all baloney. Besides, we don’t have time."
What would you think? A professional says that something or other isn’t necessary because it isn’t true, and it wastes time. Seems plausible.
If I heard either of these fictional conversations, the second one would make me run, not walk, to the nearest exit. The principle underlying sterilization of instruments, eliminating bacteria, is similar to the principle of universal precautions, eliminating the spread of bacteria, i.e., infectious disease.
There is no hocus-pocus to universal precautions: Keep the other guy’s bodily secretions where they belong. Wash hands properly, wear gloves, gowns, masks, hats, and booties when necessary. When is it necessary? Aye, that’s the question.
Please allow me to digress on my own education at this point. As a student of philosophy, literature, and languages in 1963, I walked into a hospital and applied for a job. They made me an orderly, and a middle-aged nurse’s aide taught me bedside patient care. Six months later I talked my way into the operating room, and learned the technician’s trade from watchful and demanding RNs. I learned how to clean an operating room, how to wash instruments, wrap them, autoclave (sterilize) them, how to prep patients, how to scrub for surgery, how to pass instruments, and so on. Five years later I switched to respiratory therapy full-time and focused on intensive care treatment. This was a learn and perform education with firm and set rules and only one alternative: get out.
I am far removed from standard systems of education today — my role as a clinical instructor ended in 1979 — so I am not qualified to judge what’s going on today, but I have had some hints. For example, I had to re-certify in CPR (cardiopulmonary resuscitation) in 2000 to keep my license. I was working for a large teaching medical center. After the session I asked the RN who ran it about the practicality of some changes in procedure. He couldn’t answer. He said that he had never actually participated in a real CPR.
This raises more issues than I can address here, but I wonder how medical professionals are taught about infection control these days? How does a practitioner arrive at the conclusion that it’s all baloney? The very idea startled me, yet I get to look at and live with the results of that idea every day: an arm crippled by a post-op staph infection. It never occurred to me before that the surgeon might think infection control is baloney. What are these people being taught? I don’t know.
The continual spread of infections in hospitals has raised monumental obstacles for the staff. One isolation room out of forty rooms is tolerable, if tiresome, but a dozen or more strain the whole organization to its limits. People will naturally break rules when the situation becomes intolerable, so isolation doors are left open, staff foregoes the gowns and gloves, and maybe even the hand washing. "Oh, I’m just popping in to check." Right. Or the gofer from radiology, who knows nothing, transports a patient from the ward to the x-ray department with no precautions whatever.
What’s the next step in this process? Why, to downgrade the problem, of course. What’s the big deal if everybody is infected? And when it starts killing off the debilitated? That’ll be good for society. I am hearing that kind of talk already.
What’s the solution? Remove interior designers and bureaucrats from planning committees, remove all carpeting and cloth curtains, strip hospitals down to hard surfaces that can be disinfected, retrain all housekeeping staff for that job, and put some hard-nosed, experienced RNs in charge of enforcing infection control procedures. That would be a good beginning, given the mess we’ve got. Better would be a money-back-guarantee: No Infection, or your money back. Don’t hold your breath waiting for that one.
American medicine is a half-stride into a giant step backwards toward the superstition and magic of the Dark Ages. The reasons are multiple, but we can trace the symptoms back to the ultimate source: the State. Only a hypothesis? Sure. So here’s a prediction: The CDC will change the definition of hospital infection to enable a relaxation of the rules. It’s all baloney, after all.