Teaching Doctors to Clean like Preschoolers

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My first surgical rotation as a medical student was OB/Gyn and I still remember my first day like it was yesterday. We were all so eager to deliver a baby we could barely contain ourselves when we stepped onto the labor and delivery floor with the intern who was responsible for orienting us. “Ok, let’s go scrub into this C-section,” he said nonchalantly while stepping on the sink foot pedal. Seeing three blank medical student stares, he froze and said, “wait, no one taught you to scrub in?” We spent the next fifteen minutes practicing sterile scrubbing, gowning, and gloving techniques. Everything from how to clean under your fingernails to opening the OR door without contaminating yourself, or others. We ended up missing the C-section, but there were so many others after that where we would attend sterile and ready.

A few times I witnessed operating room scrub nurses call out fellow students who may have contaminated themselves. Improper technique, an unconscious nose rub, or the graze of a hand on an off-limits surface could all get you flagged and thrown out of the OR. With the high stakes of a vulnerable patient on the operating table, no one begrudged the ritualistic cleaning of the OR or the rules surrounding it.

Throughout medical school sterile technique was reviewed on multiple rotations and in many scenarios: operating rooms, bedside procedures, outpatient diagnostic tests, biopsies, and emergency room procedures. However, I do not remember being taught how to take off my protective equipment without contaminating myself more than once or twice. Overall, the focus was always more on protecting the patient than protecting myself. In many situations, such as the operating room, the gowns and gloves were there to primarily protect the patient from germs. In other cases though, this gear is meant to protect me from contamination, and subsequently other patients who come in contact with me and my clothes after that contamination.

During the Ebola scare earlier this year, our hospital practiced the donning and doffing of personal protective equipment. While we all initially thought that this dress rehearsal was superfluous because we knew the steps already, we learned through our practicing how sloppy our techniques could be if not done carefully and we appreciated the refresher.

A recent JAMA study looked at how often hospital workers contaminated themselves when removing gloves and gowns and found that contamination occurred 46% of the time. I found the methodology interesting in that they used a fluorescent lotion similar to the Glo-Germs I used to teach my son’s preschool class about washing their hands. This study made me interested in whether or not we could use these Glo-Germs to teach hospital workers not only about taking off our protective gear, but putting it on and washing our hands between patients. Similar to practicing for big moments, like Ebola prevention, we should also practice the little moments that we perform multiple times each day. After watching a classroom of preschoolers practice washing their hands after Glo-Germs, I unscientifically believe they were better than 46% and I am hopeful that a group of medical professionals could learn to do better.

 

[The opinions expressed above are my own and do not necessarily reflect those of my employer, The Children’s Hospital of Philadelphia.]

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