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Digital Issues

Surgery's Darkest Secret

A jarring essay published anonymously in the Annals of Internal Medicine pulls back the curtain on the dark side of surgical care that has gone ignored by too many for too long. It describes a conversation between a medical school proctor and student, who both share experiences from their clinical past that will make you shudder at the behavior that's allowed to take place in many ORs.

The student tells of the regret he felt at laughing along with an attending physician who remarked that the female patient he was prepping for a vaginal hysterectomy was enjoying the scrubbing of her labia and inner thighs. The proctor responded with his own uncomfortable recalling of the time he witnessed a physician perform an internal bimanual uterine massage to save the life of a woman who suffered uncontrollable bleeding during childbirth. When the life-saving physician proceeded to sing "La Cucaracha" while dancing with his hand still inside the woman, the essay's author joined in, until an anesthesiologist in the room shouted at them to stop.

It's a difficult essay to read, and that's the point. "Although we wish it were otherwise, most physicians at some point find themselves in the midst of situations where a colleague acts in a manner that is disrespectful to a patient," write the physician editors of Annals of Internal Medicine in an accompanying editorial. "It is our hope that the essay will gnaw on the consciences of readers who may recall an instance of their own repugnant behavior."

They say the essay is an opportunity for healthcare providers to see what inexcusable behavior looks like and to make those guilty of previous offences think twice before demeaning patients again. "If the essay squelches such behavior even once, then it was well worth publishing," write the editors, who say all healthcare professionals need the strength to reprimand their colleagues when necessary.

"We owe it to ourselves, to our profession, and especially to our patients," they add.

Daniel Cook

Our Surface Disinfection Knowledge Isn't Deep Enough

While there have been numerous studies focused on surface disinfection in healthcare settings, the collective body of knowledge on the subject is significantly lacking, suggests a systematic overview carried out by researchers at the University of Pennsylvania, and published in a recent edition of Annals of Internal Medicine.

Evaluating 80 studies published between 1998 and 2014, researchers found that few actually qualitatively compared cleaning methods or monitored the cleanliness of hard surfaces to determine which worked best. Additionally, few focused on hospital-acquired-infection rates. Instead, they typically assessed specific cleaning agents by comparing before-and-after levels of contamination on various surfaces.

Historical studies serve as a good starting point, says Craig A. Umscheid, MD, MSCE, the study's lead author. But, the study concludes, future research should address these key questions: What surfaces, including high-touch objects, should be cleaned and disinfected? How should surfaces be cleaned and disinfected, and what is the comparative effectiveness of different methods? How should cleaning and disinfecting be monitored and measured, and what would be appropriate benchmarks for cleanliness and reduced risk for pathogen transmission? How should interventions be implemented, including in-depth study of facilitators and barriers to real-world implementation?

Jim Burger

Spine Closure Improvement Could Fight Infections

A novel wound closure technique for spine procedures may virtually eliminate surgical site infections among patients undergoing scoliosis surgery.

Surgeons at the New York University Langone Medical Center have developed a multilayered flap closure method that they say reduces complications in scoliosis patients. Compared to the bulk skin closure method traditionally used, this new technique involves using flaps of muscle and fascia to eliminate "dead space" pockets around the surgical site, where infections tend to develop.

The surgeons have used the technique since 2009, and the hospital recently evaluated its effect on post-op complications. In the retrospective study, researchers looked at the cases of 76 patients, aged 8 to 25 years, who underwent posterior spinal fusion surgery. While 19% of 42 patients who received a conventional closure suffered post-op complications, there were no infections or complications reported among the 34 who'd received the new closure method.

"There was a time when complex scoliosis cases, including revision surgery, had infection rates approaching double digits," says study co-author Thomas Errico, MD, spine surgery chief at NYU Langone. "We have now lowered infection rates to under 1 percent."

Kendal Gapinski

InstaPoll: The Uber Economy ... In the OR?

Rather than buying your facility a new C-arm, why not just use the one at your sister facility across town? That's the concept behind a new company that aims to make equipment available across a health system's facilities in order to drive higher utilization rates and cut down on the capital equipment spending at each hospital or surgery center. Using the same principles that drive such consumer "sharing economy" companies as Uber and AirBnb, the company's cloud-based platform would let you see all of the available equipment in a health system and schedule time with necessary items for an upcoming procedure. Could this possibly work? Tell us in this week's InstaPoll.

Most (41%) of the 620 respondents to last week's poll say they'd like to retire between the ages of 60 and 65. The results:

At what age would you like to retire?

  • 50 to 55 8%
  • 55 to 60 19%
  • 60 to 65 41%
  • 65 to 70 25%
  • 70-plus 7%

Dan O'Connor

News & Notes

  • OR Excellence opportunities extended There's still time to take advantage of OR Excellence's early-bird pricing and contest offers. We've extended the deadline to Monday, September 7. Secure your spot for the uniquely interactive educational sessions (and networking opportunities), lock in savings ($100 off the registration fee and discounted rooms at the Marriott San Antonio Rivercenter), and enter for a chance at a host of prizes (including dinners, upgrades and 4 nights in the Vice Presidential Suite). For more information, visit the OR Excellence website.
  • OxyContin approved for pediatric use The FDA's approval of OxyContin for patients as young as 11 years is "not intended to expand or otherwise change the pattern of use of extended-release opioids in pediatric patients," says the agency, but to support the off-label prescribing that it says was already occurring with pediatric-focused, and not adult-focused, safety and efficacy data. OxyContin manufacturer Purdue Pharma worked up the data at the FDA's request.
  • Why handoffs require face time Checklists and computerized charts are extremely useful, but the opportunity to ask and answer questions face-to-face during handoffs does a lot more to ensure patient safety and prevent medical errors, according to 2 studies published by BMJ Quality and Safety. Researchers at the Richard L. Roudebush Veterans Affairs Medical Center and Regenstrief Institute in Indianapolis, Ind., note that spontaneous communication during provider changeovers can clear up ambiguous, inaccurate or limited information.