Module 2 – Practice Medicine Safely

How to Prevent DEADLY Consequences to You and Your Patient!

Apprentice Doctor Club / Chapter: Module Two: “For the Sake of Your and Your Patient’s Safety”

Doctors and other medical professionals are there to help – to heal and not to harm their patients. All too often – inadvertently the opposite happens – the patient acquires an infection from the doctor or nurse attending to their problem, and not too infrequently the patient infects the attending medical professional – even with a deadly virus – like the HIV virus.

Hospital acquired infections are a serious problem all over the world – the Centers for Disease Control and Prevention estimate that roughly 1.7 million hospital-associated infections occurs and cause or contribute to 99,000 deaths in the United States of America each year!

Preparation: Apprentice Doctor Club -Module Two:

The Club leader will have to do a bit of research before the meeting.

• Read the following article from Snopes.com. The article considers a claim that Hand air dryers spew out large numbers of bacteria… See and read the article: CLICK HERE
• Study the CDC’s latest guidelines for hand-washing: CLICK HERE
• Download the World Health Organization’s hand hygiene document: CLICK HERE

Study the following pages: 140 – 143 and 155 and 156

1.Give a short lecture regarding the CDC’s guidelines for hygienic hand-washing – see *Below

2. Practical Projects:

You will need (available from any pharmacy):

• A box of clean non-latex gloves size medium
• A dispenser with liquid soap
• A dispenser with an alcohol base antiseptic hand-rub
• A roll or absorbent paper towels

Do the following projects as explained on the relevant documents:

• Project 00 A: How to Hygienically Wash one’s Hand.  See: WHO page 156 – follow the steps meticulously!
• Project 00 B: How to Apply Antiseptic Hand Rub.  See: WHO page 155 – follow the steps meticulously!
• Project 00 C: How to Put on Clean Glove.  See: WHO page 141 – follow the steps meticulously!
• Project 00 D: How to Remove Contaminated Gloves.  See: WHO page 141
• Project 00E:(How to Gown and Scrub for Surgery – Only at Apprentice Doctor Camps)

BARRIER TECHNIQUES

Medical Professionals use Barrier Techniques to avoid infectious agents like bacteria to cross-over in two directions:

1.  Avoid infectious agents crossing from the medical professional to the patient

2.  Avoid infectious agents to cross from the patient to the medical professional

Protective clothing and items commonly used for this purpose include:

Gloves

Gloves are the most common type of personal protective equipment (PPE). Gloves are considered a barrier protecting both you and your patient from the transfer of harmful microorganisms. Always use gloves when you work on a patient. Hygienically prepare your hands before gloving and clean your hands again after removing the gloves and before moving on to your next patient. Gloves are absolutely essential when you have an existing cut or small wound on your own hand and when you are touching any bodily fluid/secretion/excretion.

Boots

Theater boots

The operating theater can be a messy/bloody/gutsy place. Surgeons often wear waterproof boots as a protective measure from contamination with blood, puss, amniotic fluid etc.

Boots for emergency workers like paramedics

Boots should protect your feet. Steel toes are best for this purpose. It should be water-proof, flexible and they must be exactly the right size. They should also be able to protect you against cold weather and punctures. The soles of your boots must provide good traction to prevent you from slipping and sliding down slopes.

Over-shoes

Shoe covers are important as they help maintain a sanitary environment by eliminating tracked-in dirt and microbes and they protect the wearer from accidental spills and bodily fluids. Always use shoe covers when entering the operating room or Intensive Care Unit.  Alternatively use dedicated surgical boots or shoes.

Surgical caps

Even clean recently washed hair is contaminated with loads of bacteria. The surgical cap minimizes the risk of hair falling into the sterile area during surgery. Ensure that all your hair is covered by the surgical cap before proceeding with scrubbing for surgery!

Masks, Visors/glasses

A face masks is worn as a barrier to protect the patient against the transfer of harmful microorganisms present in the healthcare professional’s saliva, nasal discharge and facial hair, and to protect the healthcare professional from being infected by microorganisms present in puss, blood, other body fluids, secretions (e.g. saliva) or excretions (e.g. feces) by the patient.

Medical professionals should wear a mask and eye protection or a visor (face shield) to protect mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to cause splashes or sprays of blood, body fluids, secretions or excretions. Masks should be worn at all times in restricted areas of the Operating Room – where sterile supplies are opened and at scrub sinks. Masks with face shields or masks and protective eyewear are required whenever splash, spray or droplets of blood or other potentially infectious materials may be generated.

Apron

Some surgical procedures may become really ‘messy’ – thus the surgeon needs to protect him/herself by wearing a waterproof apron. Surgical procedures where a lot of bleeding of spill of bodily fluids like amniotic fluid e.g. during a Caesarian section are examples where an apron is needed.

Surgical gowns

Surgical gowns are considered one of the most important protective items during surgical procedures. Sterile surgical gowns play an essential role in maintaining aseptic conditions by blocking the transfer of harmful microorganisms and chemicals to and from the patient, and reducing the transfer of bacteria from the skin of the surgical staff to the air in the operating room.

Wearing surgical gowns and other medical apparel (e.g. surgical masks, gloves, etc.) is of utmost importance as there will always be microorganisms present on or in the human skin, even after conducting strict hygienic and surgical scrubbing procedures.  The purpose of surgical gowns and other protective clothing is not only to keep bacteria from entering surgical wounds, but to also protect the surgical staff from bodily fluids, secretions or excretions like blood, urine, saline, or chemicals used and during surgical procedures.

 Bonus Information:

CDC Guidelines for hygienic hand-washing

IMPORTANT NOTE: Ensure that you have that most current CDC guidelines by visiting their  website regularly:

https://www.cdc.gov/handwashing/

*Hand-washing: Clean Hands Save Lives

Keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick and spreading germs to others. Many diseases and conditions are spread by not washing hands with soap and clean, running water. If clean, running water is not accessible, as is common in many parts of the world, use soap and available water. If soap and water are unavailable, use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands.

Wash Your Hands: The Right Way – See Project 00 A (above)

When should you wash your hands?

• Before, during, and after preparing food
• Before eating food
• Before and after caring for someone who is sick
• Before and after treating a cut or wound
• After using the toilet
• After changing diapers or cleaning up a child who has used the toilet
• After blowing your nose, coughing, or sneezing
• After touching an animal or animal waste
• After touching garbage

What is the right way to wash your hands?

• Wet your hands with clean, running water (warm or cold) and apply soap.
• Rub your hands together to make a lather and scrub them well; be sure to scrub the backs of your hands, between your fingers, and under your nails.
• Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
• Rinse your hands well under running water.
• Dry your hands using a clean towel or air dry them.

What if I don’t have soap and clean, running water?

Washing hands with soap and water is the best way to reduce the number of germs on them. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs.

Important Note: Hand sanitizers are not effective when hands are visibly dirty.

How do you use hand sanitizers?

• Apply the product to the palm of one hand.
• Rub your hands together.
• Rub the product over all surfaces of your hands and fingers until your hands are dry.

Cover Your Cough

Stop the spread of germs that can make you and others sick!

Influenza (flu) and other serious respiratory illnesses like respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by cough, sneezing, or unclean hands.

To help stop the spread of germs:

• **Cover your mouth and nose with a tissue when you cough or sneeze.
• Put your used tissue in the waste basket.
• If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.
• You may be asked to put on a facemask to protect others.
• Wash your hands often with soap and warm water for 20 seconds.
• If soap and water are not available, use an alcohol-based hand rub.

**More and more medical professionals recommend that one gets into a habit of coughing/sneezing into one’s armpit (axilla) or the inside of your elbow (in culture where greeting by handshaking hands is the acceptable thing to do).

[Download Module Two in PDF Format]

Looking forward to Module 3?

In Module 3 we will look at:

• The airways
• Anesthesia and anesthetics
• Video-clips of the voice-box
• And more!

Prepare by reviewing the Respiratory System in the Apprentice Doctor CD-ROM in your Apprentice Doctor Kit!

Trust you enjoyed this Apprentice Doctor Module. Your feedback will be appreciated!

Best wishes for your success!

Your Apprentice Doctor Mentor and Guide