Kerri Morrone, author of the diabetes blog Six Until Me, has written an entertaining and educational piece for this week’s grand rounds. The articles are presented in the theme of a visit to the grocery store “Stop & Blog”. The tour begins at the produce section where one can find a great selection of fish, pomegranate, and organic lettuce. Here is where Kerri includes the most recent article from On The Wards:

Brrr. It’s always freezing in the produce section. There should be a mandatory uniform for this arctic section, much like the new UK policy guidelines for healthcare uniforms, says On The Wards.

It is always refreshing to see how medical bloggers apply their creativity to the weekly grand rounds. There is more to us than just books and stethoscopes. Kudos to Kerri for a job well done!

The Department of Health in the UK published today new guidelines for hospital dress codes and laundering. The guidelines represent a compilation of expert opinion, scientific theory, and empiric research.

Among other recommendations, it is expected that health care personnel wear short-sleeved shirts and blouses. The sleeve cuffs presumably present a viable source for transmission of microorganisms. Interestingly, the report also recommends that white coats not be worn. I have several colleagues who would willingly give up the extra layer of fabric in a heartbeat. Oh wait, they already do. I, on the other hand, would prefer to wear the coat for personal protection and as a reservoir for my million-and-one accessories (e.g., stethoscope, pens, penlight, paperwork, PDA). The report suggests that “(w)here staff have direct patient contact, then suitable protection - for example, plastic aprons - should be worn.”

If the sleeve cuff is the principal reason for abandoning the white coat, then why not go for a short-sleeve coat? They are already standard issue in several countries. I realize this may become a fashion nightmare, but the compromise permits the pro-coats and anti-coats to live in harmony. Moreover, I can easily imagine disposable gowns mounting health care costs, particularly given the large number of caregivers and high frequency of entries into each patient’s room on any given day.

Another interesting–and probably nit-picky–recommendation is that health care workers wear soft-soled shoes, because they “reduce noise which can disturb patients’ rest”. Although the recommendation sounds good and benevolent in principle, I question its relevance in practice. Take a moment on a relatively quiet call night and listen intently to the sound from hard-soled Dansko® clogs. Unless the wearer is running to a code, the sounds these clogs emit are largely trivial. Moreover, compared to the competing sources of sound in a noisy hospital, heel clicks are practically insignificant.

Not to appear completely critical of the report, one recommendation I can fully support is the ban on ties. According to the report, it is “poor practice to wear neck-ties (other than bow-ties) in any care activity which involves patient contact”. The ties supposedly “perform no beneficial function … and have been shown to be colonized by pathogens”. Despite the professional appearance, I feel that ties are more a nuisance than a benefit. I doubt any hospital will suffer in public relations due to an absence of ties.

The report admits that there is no definitive evidence that uniforms pose a significant infection risk. It also falls short of calling all physicians to wear pajamas, er, scrubs. It emphasizes that professional dress is still important for the professionalism it communicates and the confidence it cultivates. There are other related recommendations, such as the use of clear name tags to identify the provider’s role. Naturally, tattoos and excessive jewelry are discouraged.

I will not delve into the report’s discussion of laundering, but here are a few tidbits: 1) 10-minute washes at 60 ^oC supposedly kills most microorganisms (10% of C. difficile spores may remain); and 2) MRSA can be removed at 30 ^oC with detergent.

The recommendations are scheduled to take effect in January 2008. Despite my seemingly critical review of the report, I largely support the changes. I think it is a valiant effort at further addressing infection control and implementing policies to hopefully stave off a MRSA catastrophe.

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The Efficient MD hosts this week’s Grand Rounds with an interesting theme: innovations and new technologies in health care. The submission from On The Wards was the most recent article about mobile phone use in hospitals. The topic is not entirely new, but it presents a few findings that increase our understanding of the possible risks of Internet-capable smartphones around medical equipment.

Similar to the controversy about whether cellular phones can cause brain cancer, there is brewing debate about whether these phones also affect medical devices. In two earlier articles discussing research findings from the Tan Tock Seng Hospital (Singapore) and Mayo Clinic (Rochester, Minnesota), I reported that mobile phone use was not detrimental to medical equipment. Similar studies have prompted the reversal of cell phone bans in many hospitals throughout the United States.

Just as we have become comfortable chatting on the phone while walking from patient room to the cafeteria, a new Dutch study presents a caveat to the earlier reports. While it is true that newer generation mobile phones may generate less electromagnetic interference (EMI) due to better shielding and signal downregulation, there is limited information characterizing the risks of using Internet-capable phones around medical devices.

To explore this question, researchers from the University of Amsterdam utilized wireless signal generators to mimic data transmission on modern mobile phones. The generators were placed in proximity of medical devices commonly found in the ICU, such as telemetry monitors, mechanical ventilators, and infusion pumps. The group detected 48 incidents in 26 devices (43%). Sixteen (33%) were classified as hazardous, 20 (42%) as significant, and 12 (25%) as light. The median distance of effect was 3 cm (range: 0.1 to 500 cm). Some hazardous effects included ventilator shutdown, restart, and setting adjustment. A syringe pump also stopped without an accompanying alarm. These were not trivial events.

One limitation of the study is that the group used signal generators at maximum power to assess the potential risk of cell phone use. Since mobile phones frequently regulate its power output based on the carrier network’s signal strength, we would expect lower EMI in real-world conditions. On the other hand, since the group’s aim was to characterize possible worst-case scenarios, this criticism is moot. Besides, deep inside the behemoth of a hospital, signal strength is usually weaker and EMI inversely stronger.

In brief, although newer generation Internet-capable smartphones present new challenges of electromagnetic interference, a one-meter buffer between phone and medical device still seems reasonable. Now to publish this article via my CrackBlackberry before I get too close to Mr. Johnson’s ventilator.

• Source
• van Lieshout EJ, van der Veer SN, Hensbroek R, Korevaar JC, et al. Interference by new-generation mobile phones on critical care medical equipment. Critical Care 2007;11:R98.

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5min Life Videopedia may appear like another of the million YouTube clones on the Internet. It, however, distinguishes itself from its competitors by focusing on brief instructional videos. The site builds on two premises: 1) “everybody is an expert in something and has something to teach others”; and 2) “any solution can be visually explained in no more than 5 minutes.” As a result, we have a great online video resource where users can provide or find answers to practical questions in a few short minutes.

The site has a Health category, which features informative health-related videos geared for the general public. The category addresses a breadth of topics, ranging from cardiology and dermatology to nutrition and first-aid. Some video clips demonstrate adult CPR, teach massage techniques, and discuss diverse medical issues (e.g., testicular pain, Golfer’s elbow, seizures in children, dealing with colic). There is also a section dedicated to performing self-exams, such as the testicular and breast exams.

Having launched only a few months ago, 5min is relatively new, yet its video catalog is quite impressive. As of today, the user affiliated with DrMDK.com, a pediatrics website, is the largest overall contributor to 5min (329 uploads) and its Health category (209 uploads). Most of the videos simply consist of pediatricians briefly speaking about a topic before a camera, which makes the thought of creating such videos less daunting. Teaching physicians, who are accustomed to engaging in lengthy discourse in their fields of interest, should have no problem.