Holiday reading: The facts are the facts.

  • Vinay Prasad
  • Published 2012 in
    CMAJ : Canadian Medical Association journal…

Abstract

the facts. Juggling facts pervades all parts of medicine. In particular, we seem to love the little contraindications. “You can’t take more than 2 litres off in a thoracentesis before you run the risk of re-expansion pulmonary edema.” “Are you sure you want to give her a dose of Imodium? Her C. diff results are not back yet.” “You should wait 72 hours after he stops linezolid before restarting his SSRI.” Facts come in all shapes and sizes. There are the big facts: this patient is having an ST elevation myocardial infarction. Then, there are the little facts: you order a stress test from nuclear medicine, but you call interventional radiology to schedule a lumbar puncture. Recently, a bright intern pointed out a little fact to me, which was big to him, just before I put on a sterile gown and gloves, in aseptic fashion, to place a central line. “You need to wash your hands.” “I did.” “No, you didn’t.” “What do you mean? I did as I entered the room.” “No, you have to do it again before you gown and glove.” “Who says?” “Pronovost.” “What does he say?” “‘The use of gloves does not obviate the need for hand hygiene.’ The checklist paper. New England Journal. 2006.” “How can that be? I’m about to put on sterile latex gloves, sterilely!” “Hey, the facts are the facts.” Clearly bested, I went off to lick my wounds. I tried to get to the bottom of this fact. Sure enough, the supplementary appendix to the Pronovost paper included the line about handwashing, which cited a 1995 review on the subject. That paper indeed confirmed that infections had been reported, “even when gloves were worn.” Four references were provided, numbers 156 to 159. But, I didn’t stop there. I wanted the facts. I began with 156. “Removal of Nosocomial Pathogens from the Contaminated Glove”— clearly a must-read. The paper showed that when volunteers put on nonsterile latex gloves, soaked their gloved hands in pathogen broth, and washed and dried their gloved hands with soap, chlorhexidine or alcohol hand sanitizer 5 times, redipping them in broth after each wash, then some fraction of the volunteers had pathogen cultured from their hands. Obviously, this study has tempered my enthusiasm for cleaning and collecting all gloves I have used, but for the point in question, I’m not sure this study says anything. Nonsterile gloves may break down with repeated chemical exposure and agitation. Reference 157 had a more sobering title: “Risk of Human Immunodeficiency Virus (HIV-1) Infection among Laboratory Workers.” The paper was a case report from the early years of HIV (1988) about a worker, with no known risk factors, found to have HIV. The presumptive source was virus-laden broth in a biosafety level 3 environment. Upon rigorous questioning, the worker stated he always double-gloved and was not sure when he was exposed. Again, I was unsure of how this citation made the case. Surely 158 would provide the basis for the fact. With a title like “Latex and Vinyl Examination Gloves. Quality Control Procedures and Implications for Health Care Workers,” how could it not? The paper began like a case on Law & Order. In December 1987, in the wake of an outbreak of herpetic whitIn other words

DOI: 10.1503/cmaj.120953

Cite this paper

@article{Prasad2012HolidayRT, title={Holiday reading: The facts are the facts.}, author={Vinay Prasad}, journal={CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne}, year={2012}, volume={184 18}, pages={2029-30} }