Speaking of places where the use of cell phones is inappropriate, despite this news article which paints their use in an emergency as a good thing:
BUENOS AIRES (Reuters) – The light from the cell phone screens allowed surgeons to complete an emergency appendix operation during a blackout in a city in central Argentina, reports said on Saturday.
Leonardo Molina, 29, was on the operating table on July 21, when the power went out in the Policlinico Juan D. Peron, the main hospital in Villa Mercedes, a small city in San Luis province.
“The generator, which should have been working correctly, didn’t work,” a hospital spokesman, whose name was not given, told TN television news station.
“The surgeons and anesthetists were in the dark… A family member got some cell phones together from people in the hallway and took them in to provide light,” he said.
However, I’m wondering how they sterilized the things before bringing into the clean environment of the operating room. Cell phones weren’t designed to be sterile. Did they put them in bags?
The evidence that personal cell phones in a hospital environment are dangerous is somewhat better than the evidence that they’re useful:
Cell phones belonging to hospital staff were found to be tainted with bacteria — including the drug-resistant MRSA superbug — and may be a source of hospital-acquired infections, according to study released Friday.
Researchers from the Ondokuz Mayis University in Turkey led by Fatma Ulger tested the phones and dominant hands of 200 doctors and nurses working in hospital operating rooms and intensive care units.
I don’t think much of the use of cell phones in an operating room under any circumstances whatever.
I am not a fan of medical tourism and this finding should certainly make anyone think twice. I wonder about how frequently cell phones are used by hospital staff in the United States.
The pretext given for banning their use by patients in hospitals in the United States, interference with medical equipment, is controversial. This survey found the danger to be greatly overblown. This article in Science Daily suggests the same thing. There are also plenty of anecdotal reports of interference.
However, cell phones as a vehicle for transmitting pathogens is a completely different issue and mainly one for hospital staff. It’s difficult to obtain hard statistics but there’s no lack of anecdotal reports of widespread personal use of cell phones by staff in operating rooms. I’ve heard of instances of surgeons taking personal cell phone calls in the middle of operations.
I’m pretty certain that it’s technically possible to determine cell phone usage in hospitals. I suspect the results would be interesting.
They ought to also culture the docs’ pens, PDA’s and the computer keyboards for comparison (the last having been done in other studies somewhere). I suspect they will find the same bacteria everywhere. The emphasis should be on handcleaning. Even more so it should be on stopping antibiotic abuse. Hate to say it, but that will probably take some government intervention. Catering to the patient as consumer makes it difficult to cut back.
As far as electrical interference, I have never been able to get my cell phone, or anyone else’s cell phone to interfere with any of our monitors or devices. I have the biomed guys try to accomplish it with me also. No go. The AICD reps use their cell phones in the EPS lab when we are implanting. People with AICDs and pacemakers use them all the time also. If you watch as you walk around hospitals, you see people using them all the time anyway. Absent definitive studies, people are going ahead and using them. Most of my ICU and OR experience is oriented towards cardiac, vascular and pulmonary care, so there may be other areas where the equipment is sensitive, but I have never seen or heard of any evidence from colleagues. (We use equipment in sterile bags pretty often just so you know. When a CT surgeon wants to look for plaque on the aorta before cannulating, we put the ultrasound probe in a big long plastic (sterile) bag. Retinal surgeons commonly use sterile plastic baggies to cover their hands so they can adjust their lights. TBH, they probably did not cover them. The lights in an OR are not sterile and not covered.)
Steve
Thanks, Steve.
What baffles me is just how much stuff in hospitals was never designed to be sterile.
And antibiotic abuse is a hot button issue with me. The development of new antibiotics is slowing rather than speeding up. Apparently, we’ve already picked the low-hanging fruit. Unless we’re very careful we’ll return to the pre-antibiotic days which is why I think that reducing over-the-counter availability of antibiotics and right-sizing their use in agriculture should be major foreign policy issues. Not that we don’t have over-use in agriculture here, too.
WTF? Is this a joke?
No, it’s not a joke, Drew. Do you think it’s not going on?
The way this post happened is that in my earlier post about air-traffic controllers and personal phone calls I was about to write “I don’t think that air-traffic controllers should use their cell phones for personal calls while working any more than I think that a surgeon should in an operating room”. I decided it might be prudent to research whether there was an issue and was surprised to find that it’s actually a pretty hot topic. The Academy of Surgeons has a policy on it and everything (I assume they’re against it).
But apparently the use of personal cellphones by hospital staff is a pretty common practice.
I don’t care if its cell phones, flowers, golf balls or ham sandwiches, they have no place in the operating room. None. And if this is real, its malpractice.
Do all you know that infection is one of the biggest risks/issues in surgical procedures? That’s why the OR is so damned cold.
I’m suspicious.
It’s controversial but it’s possible that iatrogenic (physician-caused) and nosocomial (hospital-caused) death are the most common causes of death in the United States.
Again, cell phones are not likely to be any worse than pens and pagers, which every doc needs. TBH, lots of docs use their cell phone instead of a pager. You guys appear to not quite understand operating rooms and sterility. Not everything in an OR is sterile. The floor, ceilings, walls, OR table, the anesthesia machine and monitors are all dirty. Fortunately, bugs don’t just jump across. Items which are coming in direct contact are sterile. Items which might be touched by a scrub nurse or surgeon during the procedure are sterile. The rest is just kept relatively clean.
What is your data source for physicians causing so many deaths? Below I have linked to the CDC;s table for causes of death. We do knock off some here and there in the course of treating heart disease and cancer, but I certainly dont see us causing most of these. Docs should get some credit for unnecessary infections, but some should also go to our morbidly obese patients. Fat does not perfuse well, hence more prone to infections. Also, we do longer, more complex procedures on older sicker patients than in the past (I keep our OR data), so there is more exposure.
Attention to detail can help. We have found that infections from central line placement, lines put into major blood vessels like the internal jugular vein, can be dropped almost to zero if we take the time and spend a little extra money to prevent them. Medicare is leading the way on this right now.
Steve
http://danger.mongabay.com/causes_of_death.htm
Steve
Steve and Dave –
I’m not sure I’m fully following you. Is the implication that current OR practice is such that non-sterile practices (eg cell phone usage) are widely prevalent? This is odd, even bizarre.
Because my father was a doctor I have been a first hand OR witness to 10-15 surgical procedures. (Bypasses, cancer tumor removal, subdural hematoma, appendix etc…..a bunch of stuff) That experience is dated. Many years ago. But the OR was like being in God’s presence. No bullshit allowed, and very, very professional.
War Stories: Unfortunately, I’ve been under the knife twice in the past couple years for cervical fusions. As anyone who has been under the knife knows, at the moment of truth you get wheeled into the OR basically buck naked….(bright lights and COLD! A nurse with a catheter in hand. Oh, boy!)…….you are asked to move from the gurney to the operating table…….its all moving very fast…..and then someone puts a mask over your face and says “please breath”…………………………………and you are instantaneously gone.
The next thing you know is the recovery room nurse leaning over your face and asking “how are you doing?”. (Not so good, Dammit!!) She squeezes the opium drip. You are now better.
So you really don’t know what goes on during the procedure.
But I digress.
Really. OR people behaving badly?
Drew-I think you just misunderstand what constitutes sterile practice and what causes infections. One of the lowest infection rates recorded was obtained, as told to me by my infectious disease guy, in a tent hospital in Africa. What really matters in sterility is what touches the patient. Carrying a cell phone in your pocket or on your belt is not a risk as far as we can tell. There are bacteria in our clothes, on our shoes. While we could operate naked after taking a Betadine shower, and if we do I have my nurses picked out already (evil grin), we do not. What you want is for people caring for patients to wash before and after touching the patient.
In every cardiac OR I have worked in, people chat and joke like any other OR. Most surgery has its dull, routine parts. When it is time to be very serious, we are very serious. Same thing in trauma surgery and neuro. What is moving very fast for you, is routine for me. OTOH, chances are if I tried to do your job, it would seem too fast. I remember the first time I went up in a jet when I was in the Air Force. Seemed overwhelming, but the pilot was laughing. I actually encourage my students to learn to lighten up a bit. When people are too tense, they make mistakes and/or do not communicate well.
BTW, GL with the fusions. C-spine injuries are a professional hazard, so we have some sympathy.
Steve
My view is that physicians are over-worked. That’s when mistakes happen.
As to sources on iatrogenic morbidity and mortality, they’re not hard to find. Here’s one example. Another is here: JAMA, 2000: 284:483- 485. There are plenty of sources on SSRI-induced suicides.
And then there’s tardive dyskinesia, iatrogenic Parkinson’s.
In all honesty I think you put your finger on one source of the problem in a previous comment: the patient as customer. These are among the reasons I don’t believe in direct-to-consumer advertising of prescription medicine.