The following article is written by Helen M. French, RN, BSN, retired operating room nurse and author of Frenchie's Hospital Survival Tips.
There is an old poem by Robert Fulghum from 1990 which is titled, "All I Really Need to Know I Learned in Kindergarten." It is a cute poem and it is worth taking the time to read it. I hope all readers take note of his words on "basic sanitation, flushing and washing your hands before you eat" and extrapolating the items into sophisticated "adult terms" to heart.
After 33 years of working in the operating room, the last 20 of which were in a level I trauma facility, I have realized long ago that rules and regulations are only made for those who have not learned a thing in their lifetime nor have they followed guidelines even when mandated. As a result, just as in elementary school, the majority gets punished for the violations of a few. Sadly, perhaps these who violate the rules constantly just never went to kindergarten or, perhaps, these violators are just arrogant and don't care.
Whatever the rule-breakers reasons are for not following rules, their actions or non- actions in regard to healthcare are literally injuring and killing hospitalized and non-hospitalized patients throughout the entire United States. The data on all events now indicates and adds up to the carnage of millions of patient victims. I ask, do we have to place all the victims' bodies on a pile in every community so they can be visualized in order to incite mobs to block the streets that lead to the offending facilities? When the public finally realizes what does occur in many facilities, public backlash will occur.
I have been collecting healthcare/OR information for my entire career. The data I have accumulated the last 10 years validates my belief that hospital policies and guidelines are just not being adhered to by many staffers no matter what anyone says. Even CMS knows this since in recent years it has stated it will not reimburse hospitals for patient procedures on which an infection developed. A "Never Event" list of more than 28 issues is now just being enforced. One of the "events" (infections) can now be traced down to a staffer's individual DNA. Infections are on top of the list for those involved in surveys of hospitals and ambulatory surgical centers. A litigious society, surveys and all the too-kits in the world will not stop the primary causes of infection. Since best practices based on ambiguous data come and go as fast as the wind, only practical and common sense will prevail at the end of the day.
Although there are many cost management concerns in all healthcare facilities which encompass staffing, inventory, turnover time between procedures and the like, the most cost-avoidant and most deadly issue for patients and even the staff is the lack of basic knowledge and awareness about simple handwashing and bathroom equipment issues. This lack of awareness — or the lack of compliance — could also come around full circle to the staffers in regard to their own health and possibly the health of their loved ones and even the public whom they might infect even in a local grocery store (note many recent articles pertaining to infected scrubs and even doctors' ties ). Somewhere on the chord of a circle is our most important product — our patients. It is our patients whom we are entrusted to protect. It is our patients whom we cannot allow to be affected or infected by someone else's bathroom contagion.
Healthcare facilities can train staffers at orientation and every six months during in-services. Healthcare facilities can mandate guidelines and policies. They can put into place sophisticated and costly systems such as RFIDs, ID monitoring, etc., which then produce more problems and more vigilante FTEs since higher tech products have their own variables which can only be solved by experts. There is always a learning curve for all staffers, but as the old saying goes, anything made by man is not 100 percent reliable. In my 33 years in the OR, I have never seen technology per se push the costs down for the hospital's benefit or for the patient. Real quality and excellent service does not add costs to any system. Real quality and excellent service are always patient friendly and cost avoidant.
A bathroom-related FYI to always be aware of pertaining to operative procedures of all types is that if there is "spillage" from a patient's gastrointestinal/genitourinary system, it is considered a class #3 contaminated case and it has to be noted as such, per regulations, on the operative chart by the OR circulating nurse. If the spillage from a patient's GI/GU system is infected, such as in a ruptured appendix or infected gallbladder case, then it is considered a class #4 dirty case. The important issue to understand is that when a staffer uses the facilities' bathroom during the day, they are literally contaminating the bathroom with class #3 or with class #4 agents. If their bathroom habits are lacking, and if their surgical consciousness is lacking, or if they hesitate to correct or report their cohorts poor bathroom habits or poor "sterile" surgical practices, then it is no wonder that our patients are sustaining infections at an alarming rate.
Although, there are other issues related to HAIs such as proper disinfection and sterilization of endoscopic equipment and surgical instruments, proper handwashing by staffers is critical to ensuring all patients do not become infected with any HAIs. Staffers are human. They cough, they sneeze, they shake peoples' hands, they touch computer keyboards and they obtain and send specimens and the like. However, it is the bathrooms which are fraught with germs. It is the bathroom environment which is a dangerous fomite.
Six things to know
Here are just six more critical FYI bathroom tips for illustration in order to help common sense and common solutions to prevail. Each hospital has its own issues and variables due to the type of equipment used, but the principles of infection/transmission of bacteria, virus and prions are all the same. However, one cannot ever balance cost in the favor of costs or political correctness. Managers must always balance the costs in favor of patient safety. A bathroom toilet in healthcare facilities can illustrate how simple and how cheap just one healthcare solution can be if one follows certain basic protocols.
#1 FYI: If there is no lid on a toilet, the surrounding area of about six feet in circumference will be covered with class #3 or class #4 toilet water. The area, or the stalls, the stall door, the stall handles, the floor of the stall, the toilet paper roll, etc., will be contaminated to some degree. Note: At home, people might be brushing their teeth with toothbrushes that are covered with their toilet water if one did not put the lid down before flushing.
#2 FYI: If there are no auto sensor devices in place in the bathroom for dispensing soap or turning on the flow of water, then one will most likely see staffers manually pump the soap dispenser (with dirty hands) and manually turn on and off the water handles (with dirty hands, which will remain dirty if they do not use a paper towel to turn off the water handle once their hands are washed).
#3 FYI: If there is only auto sensor equipment in a bathroom, and no paper towels, I ask, "How will a staffer open up a dirty door handle without re-infecting themselves?" Note: A trash can needs to be at the exit door if one does supply paper towels, but then there is the debate about the environmental effect of using paper towels.
#4 FYI: If one conducts research, take note of the recent articles stating that "blow hand dryers" in a bathroom spread germs to the surrounding area. The newer blow dryers have a containing wall. Note: On the issue of blow hand dryers is the lack of timely replacement of the filter, which is a problem linked to swine-flu transmission.
#5 FYI: If staffers do not wash their hands for a specific amount of time nor use friction properly to remove any visible debris from their hands or wash in and among their fingers, and then rinse fully, all will be for naught (water, soap, friction and time are key factors). If there is no water or soap available, as could be in emergency conditions, the removal of any visible debris is still necessary for any waterless hand soaps to be effective against bacteri, and viruses. Note: Prions are another issue for another day.
#6 FYI: In the OR arena, the old fashioned way of scrubbing (i.e., a 10-minute scrub initially and after that a five-minute scrub using cold water and/or warm water, with several options of hand soap) has given way to foams and gels. Initially, the costs of maintaining the sink equipment, the cost of water, the cost of the hand soaps (staffer's allergies had to be considered) and the cost of heating the water were suddenly touted as passé. At this point, I will not get into any debate about surgical waterless hand scrubs, but considering the old fashioned handwashing principles regarding method, time, friction and rinse, no one will ever convince me that the old fashioned handwash technique is still not the safest for staffers and for our patients since many staffers do not clean under their nails with a file before surgical cases nor really rub the waterless agents fully and deliberately over and between their fingers, nor over their hands nor up to their elbow. Importantly, no one really knows the long-term health ramifications of waterless soaps as used day in and day out in the surgical/invasive arena.
However, it is these same staffers who frequent the facilities' bathroom during their eight, 10, 12 or more hour shifts. It is these same staffers who might have a hole in their surgical glove and not be aware of it. It is these same staffers who sometimes will not acknowledge they do have a hole in their glove so they don't get "written up" or so the surgeon does not get upset after he or she finds outs that a patient's sterile procedure per se was compromised. In my opinion, a round of antibiotics an hour before surgery (per regulations) will probably not eradicate a patient's nosocomial infection. To add to that picture is the articles which state over and over that there is very little communication post-surgically with the surgical suites QI staffers. To add one more issue to that picture is the question, "When an orthopedic implant site is found to be infected and the site has to be debrided and the implants removed or more implanted, is the infection really documented in state/national data?" All the ortho space helmets in the world will not reduce patients' infections on orthopedic cases. Only day-to-day compliance to everyday simple healthcare facilities policies will reduce patient infections in all specialties. More importantly, only proper handwashing techniques between cases, when staffers always rush out to use the bathroom, will prevent patient infections on the next case if there is glove failure in the form of a tear in a glove from a suture needle puncture or from a sharp instrument, etc.
Conclusion
In conclusion, but not the end, the national data is in on infections. The national data has found our healthcare system wanting and now the regulations are astronomical. I believe we must go back to many types of "old fashioned" practices. I believe we must quit being so politically correct. I feel that few are really researching/resolving their own issues and that fewer yet are regulating themselves. When any healthcare manager needs to buy a book or needs to attend conferences/meeting on how to interpret healthcare regulations, then I must state that, "It is a sad time in our nursing and medical history for our patients because it is they who suffer the consequences of our poor practices or inaction." I say, "Quit hiding data!" I say, "Open up the files hidden in risk managers' offices so the real issues can be solved and please wash your hands properly after going to the bathroom."
I don't like reading the "Click It or Ticket" signs in Virginia because I feel most citizens follow the rules, but perhaps we should paraphrase the verbiage on small bright colored laminated signs on every hospital or surgical clinic bathroom wall in the United States to read: "Wash or Say Farewell." For our patients' sake, it is time to get tough.
Learn more about Ms. French's E-book Frenchie's Hospital Survival Tips by clicking here.
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