Friday, August 17, 2007
How often do you wash your hands? Are you fanatical and wash them more frequently than you need to? Do you only wash them when you really have to? Or do you wash them as often as necessary, but not obsessively?
When I was a student nurse, we learned the proper techniques for hand washing and, of course, the whole bit about how often and when to wash. It’s amazing though, how many people don’t wash their hands properly or often enough.
I have been reading about the debate as to whether people should be using the so-called antibacterial hand washes. I use them and I do encourage my kids to use them in certain situations. For example, my son was working in a store where he would work the cash. We all know that money can be very dirty, so I think that the use of a hand sanitizer when working at a cash is a good idea. When out shopping and handling lots of things and then eating in a fast food cart, I think that’s another great use for a hand sanitizer. But they shouldn’t replace hand washing, in my opinion.
A lot of the actual cleaning is in the movement and action of washing, the running of water and the friction caused by rubbing your hands together. From what I’ve seen, people who use hand sanitizers tend to just rub their hands together and not do the hand washing movement that is needed.
A good hand washing technique is simple, but it can’t be rushed:
- Make your hands wet with warm running water.
- Using soap, rub your hands together, making sure that your fingers rub into the areas between the fingers of the opposite hand. This should take at least 10 to 15 seconds, minimum.
Wash the top of your hands, not just the inside (palms) and don’t forget the thumbs. Apparently, they are often forgotten. Also, remember to clean under your nails and to let the water run under as well.
- Rinse your hands well and then dry with a clean towel.
If you are using a hand sanitizer, you can use the same motions of rubbing your hands together, in between your fingers and remembering the tops of your hands and your thumbs.
We all know that hand washing is important to stay healthy and to prevent the spread of infection, but do we all know how important it is? It’s been documented in the medical literature that the spread of illness drops drastically when proper hand washing is observed. From an anecdotal point of view, when I was just graduating from nursing, I worked in post-partum and nursery. The rules were incredibly strict about hand washing when you were in the newborn nursery. Pretty well every time you turned around, you had to wash your hands. The entire time I was there, I didn’t catch one cold, one virus, one illness. Nothing. It was the healthiest time ever in my life. My hands were raw and red, but I was healthy. :-)
News for Today:
Whiplash may produce delayed jaw pain
Umbilical cord clamping should be delayed, says expert
Are too many people diagnosed as 'depressed?'
Antibacterial agent not so 'anti' after all: study
Osteoarthritis drug Prexige under review by Health Canada
Review backs antidepressant effects of omega-3s
Study: Abortion pills don't bring risks
SARS more dangerous for some, study finds
Thursday, August 16, 2007
Grief is a funny thing. We all react differently to the death of a loved family member or pet. Although I had worked in medicine in acute care, we often didn’t have time to think about how people reacted to a death but when I worked in palliative care, it was part of the job.
I’ve long been interested in death and how different cultures think about it and treat it. Back in college, I recall taking a humanities course called Death and Dying, so my interest went back pretty far. But it’s not really something people like to talk about so it’s hard sometimes to be interested in a topic that’s taboo for many.
Our family has experienced several deaths in the past four years or so. My husband’s father passed away after a three-week illness, our golden retriever died of cancer, my brother took his life, our last two guinea pigs left us and then, on Monday, my heart dog – Oscar – died. I know that the death of a guinea pig isn’t on the same level as the death of a brother, but it’s a loss. To me, it’s another soul that has left this earth and it’s a soul that my children loved, so their pain at losing an animal hurts my heart.
The house is a lot quieter these days. I listen for Oscar’s tags, the click-click of his nails on the floor, the thud as he jumps down off my son’s bed. I remember when Rox died (our golden), I often saw him out of the corner of my eye. I haven’t had that with Oscar yet. I often felt comforted by those imaged visions of Rox so I wonder why I’m not experiencing it with Oscar. Maybe it’s too soon. Or maybe it won’t happen.
Oscar was a funny dog – he loved flowers. One time when he got loose, I caught him because he had stopped to smell some flowers. Silly dog. So, now there is a big bouquet of beautiful flowers in the window sill where he’d go and show the neighbourhood how scary and frightening he looked. Silly dog. I miss him.
News for Today:
High-risk women not undertaking prevention for breast cancer: study
Ambulatory oxygen rarely a benefit in COPD patients without resting hypoxemia
FDA Warns Adults About Medicine for Kids
Few obese adults get treatment plan from docs
Mild Heart Attacks Are More Likely to Kill Diabetic Patients
Wednesday, August 15, 2007
I was reading an article on errors in hospitals and it reminded me of how easy it is to make mistakes. It is very easy.
Doctors and nurses are quite overwhelmed a lot of the time. The patients in the hospital now are sicker than patients 20 years ago; I know that sounds odd, but it’s true. Many of the patients we had 20 years ago are now being treated on an out-patient basis or their stays in hospital are much shorter than they might have been back then. Patients are living longer with more serious illnesses and treatments and therapies are getting more complicated.
Of course, a mistake can never be excused – mistakes shouldn’t happen. The problem is, when you’re dealing with humans, they are going to happen. In most professions, an error is found and corrected, most people are none the wiser. But if a healthcare professional errs, it’s a life we’re talking about.
The general public can help protect themselves in some ways too. When I was working in the hospital, it always amazed me how people would trustingly take a cup full of pills and just pop them down without any comment. I wanted them to look at their pills, to learn what they were taking, what the pills looked like, what their names were, and what they did. When a patient questioned why they were getting a blue pill instead of the usual orange one, I didn’t just tell them to take it, I’d either answer the question (dosage change, drug company change, etc), or I’d take the pill and say, “hold on, I’ll double check for you.” I wanted the patients to know what they were taking. I know that not all nurses do that; I know of some nurses who would just brush it off, but I like to hope that they’re in the very small minority.
Pharmacists can make errors too. We had that happen when my oldest son was a baby. He was given 10 times the dose of antibiotics he should have received. It’s only because of my nursing training and the knowledge that I knew it was wrong, so we went back to the pharmacy and had it corrected. But, considering the dose he was given, he could have been killed. Thank God I was able to pick up on it.
The worst part of that situation was that the pharmacist never acknowledged or apologized for the error. Another pharmacist on duty gave us the right dosage, but despite going up the chain, to the very top, I never got an apology. That’s all I wanted.
So, you as the general public, what can you do? When your doctor gives you a prescription, ask what the paper says, have the medical-ese translated for you. Clarify with the doctor how many times a day, what dosage, what medication, and for how long. That way, if there is a problem with the prescription at the pharmacy level, you know what you were told. When you pick up your prescription, check the label to make sure it matches what you were told at the doctor’s. If it doesn’t, ask for an explanation. It could be a perfectly reasonable explanation or it could be an error. And then it’s your turn. Make sure you take the medication as directed and only as directed. And, *finish* the prescription, even if you feel absolutely wonderful after only a few days.
Here are some tips for reading prescriptions:
QD means every day.
BID means twice a day.
TID means three times a day.
QID means four times a day.
Now, QID does not mean, normally, that it has to be every six hours, just four fairly evenly spread out times in the day. In the hospital, would often be 6 a.m., noon, 6 pm and bed time. But, double check with the pharmacist to be sure.
Q1H means every hour
Q2H means every 2 hours
Q3H means every 3 hours, and so on.
QHS means at bed time
Mistakes shouldn’t happen, but we know that they do. So, we all need to do our part to prevent them or catch them when they do happen.
Tuesday, August 14, 2007
Sorry folks, just the news today. Yesterday's entry may explain why.
News for today:
Study, meta-analysis examine factors associated with death from heatstroke
Even a little pot-belly increases heart risk: study
Promising DNA Vaccine For Multiple Sclerosis
Antioxidant pills don't prevent heart disease
Study raises issues on cluster headache drug
Fluctuating eye pressure associated with visual field deterioration in glaucoma patients
Inducing labor for convenience gets a second look
Training helps Alzheimer's caregivers
Posted by Marijke Vroomen-Durning at 7:13 AM
Monday, August 13, 2007
My beloved greyhound, Oscar, has passed away. He died this morning at 10:10 after an extremely short fight with cancer. He would have been 5 years old next week, on the 23rd.
Lyme disease is getting a lot of coverage these days. Although we hear of people becoming infected in the United States, it’s happening in Canada too, although in not as nearly has high numbers. According to an article published in the Globe and Mail on August 10, “Of the 310 reported cases of Lyme disease contracted by Canadians between 1995 and 2004, more than half occurred outside of Canada, either in the United States or Europe.”
Why do we have to worry about Lyme disease? The number of infected people is growing. In 1993, there were 8257 reported cases in the United States of human Lyme disease, in 2005, there were 23,305 reported cases. The Centers of Disease Control provides this map to show which areas in the United States have a higher risk of Lyme disease.
In Canada, the presence of Lyme disease carrying ticks has spread from one area in the province of Ontario to other parts of Ontario, Quebec, Manitoba, Nova Scotia and British Columbia.
Another reason to worry is many people who are infected don’t know it, and aren’t getting the proper treatment at the earliest possible time. This can lead to complications as the disease progresses.
The only way to get Lyme disease is to be bitten by an infected tick – so the best treatment is prevention. If you’re going into a heavily wooded area or into long grass in an area known for high risk of Lyme disease, you can reduce your risk of being bitten by following a few simple rules:
- Light-coloured clothing makes it easier to spot ticks that may be hitching a ride with you.
- High rubber boots can help protect your feet and legs.
- Long sleeves and long pants will keep skin from being exposed.
- Tucking your pant legs into your socks can prevent ticks from going up your leg, but be careful that your sock fabric doesn’t stretch too much and provide openings between the stitches that can allow ticks in.
- Use insect repellent with DEET or permethrin.
If you find a tick on you when you come inside, don’t grab it and pull it off. Ticks must be removed carefully. These instructions were taken from the American College of Physicians’ website:
Early removal of an attached tick is extremely important because it takes more than 24 hours for a tick to transmit the bacteria. To remove a tick, use fine-tipped tweezers.
Grasp the tick as close as possible to the skin and slowly pull it straight out. The mouth parts may stay attached, but do not be alarmed as these will not cause Lyme disease. After removal, apply antiseptic or alcohol to the bite area. Do not apply mineral oil, Vaseline, heat, or other agents to remove the tick. These practices do not remove ticks and may actually increase your chance of infection by causing the tick to excrete bacteria.
If you remove a tick as soon as you find it, it is very likely that the tick did not transmit the bacteria Borrelia burgdorferi to you because it was not attached long enough for transmission to occur. Your doctor may suggest watching the bite and waiting to see if any symptoms occur instead of beginning treatment immediately. If you begin to develop symptoms or a rash at the site of a tick bite, contact your doctor right away.
It’s entirely possible to be bitten, and infected, without knowing it until symptoms become obvious. Rather than write them all out, the American College of Physicians do a great job of describing the symptoms and the three stages that appear. If you do have Lyme disease, it’s important that you be started on antibiotics as soon as possible. If Lyme disease isn’t treated, it could lead to joint swelling, neurological problems, loss of memory, difficulty concentrating, difficulty sleeping, even abnormal heart beats.
So, as they used to say on Hill Street Blues (anyone out there remember that show?): Be careful out there.
News for Today:
Cheaper, shorter cardiac rehab just as good as longer programs: study
Risk of common vaginal infection linked to preterm birth appears higher for blacks
Hole-in-the-heart self repair kit