Viewpoint FROM THE CHIEF MEDICAL EDITOR

Keeping it Clean?

Larry E. Patterson, M.D.

Going back to my residency days, our hospital operating room suites had an infection-control measure that I found odd. When you passed from the non-sterile area into the sterile corridor, you were required to wear special foot covers. While these protective "booties" were not sterile, they were clean and they reduced the load of bad outside agents that entered the sterile area. That might have made sense, however, patients were retrieved from all over the hospital on stretchers. These stretchers often passed by highly contagious patients. The wheels of these stretchers — picking up who knows what on their journey through the hospital — came right down the sterile corridor and directly into the operating rooms. No booties were considered for the wheels. No one could answer this inconsistency.

At some point, the rules on shoe covers seemed to relax a lot, perhaps when people realized that there's no practical way to keep a floor sterile. I don't know if the rules actually changed, but I've seen clog-type shoes come into vogue over the last decade or so. (I still wear the booties, but mostly to keep misdirected BSS off my feet!) Years ago, the hospitals started removing that sticky flypaper floor covering that marked the sterile corridor entrance after a paper was published that showed it had no effect.

Washing My Hands of It

This leads me to my latest confusion in asepsis: hand washing. When I attend church, I may shake hands with 20 or 30 people before and after the service. If I go to a political rally, maybe 50 hands. And at Brad Shingleton's President's Reception at ASCRS in Chicago, I must have shaken a hundred hands, mostly doctors. At no time did I, or apparently anyone on the receiving end, feel the need to immediately excuse ourselves to go wash our hands.

But I'm told I should thoroughly wash my hands after each and every patient encounter in the office. Yes, it makes sense that many contagious diseases are indeed transmitted by hand-to-hand contact. If I finish examining a patient who had conjunctivitis, you bet I head straight for the sink. In fact, I wash my hands before I even pick up my pen or touch the chart, because I don't want to take any chances. But in my general ophthalmology practice, most patients have no more evidence of any communicable disease than any of the doctors whose hands I shook at the reception. And I'll bet the skin around the average eye is a lot cleaner than our hands anyway.

Are we saying that our patients are somehow different than everyone else we meet outside the office? Or should we get a new greeting besides shaking hands? Do you wash your hands after meeting sales reps in your office? Don't get upset — I'm not suggesting we stop washing our hands at the office. But can someone out there smarter than me, and there are a lot of you, explain this inconsistency?