Wednesday, 29 February 2012

The Italian way

I was in Italy recently on a scholarship observing minimally invasive heart valve surgery. Observing practice in other units both at home and abroad is always very educational and should be encouraged. I spent quite a bit of time in the operating room and one thing (amongst many) that struck me was the Italian attitude to cross infection. Once you got beyond the changing room, everyone had to have a orthopedic type full hat on with a mask. If you did not, you were quickly and courteously reminded to cover yourself up. In theatre, every drop of blood that was spilt, whether on the floor or on a surgical instrument was immediately cleaned.
Now I am sure that there are those over here who would argue that this is overkill and that there is no evidence for such a strict regimen. There may not be evidence FOR the practice (because probably the study has not been done yet) but there is no evidence AGAINST the practice. Intuitively one would expect such a practice to  diminish the incidence of wound infections. The SSI (modern speak for wound infection) rate  in this unit is indeed very low. Now I"m not a mouth piece for top down directives but the same applies to the 'bare below the elbows' policy. There may not be evidence in favour of it but it probably helps - especially if there is a problem with cross infection.
I am old enough to remember Italian type regimen in the operting theatre in the UK. Things were also pretty strict on the wards and nurse in charge was really in charge and enforced such practices. But time moves on, and attitudes change. It reminds me one of the themes of Pope Benedict's speech at the palace of Westminster when he visited these shores. In reference to moral values he said 'If the moral principles underpinning the democratic process are themselves determined by nothing more solid than social consensus, then the fragility of the process becomes all too evident' - the same applies to our recent attitudes to the control of cross infection - the result - dimishing effectiveness of antibiotics, spending of millions on employing people to persuade staff to do what they should have never stopped doing and more top down directives and targets. 
We are I think, winning the battle, again, against cross infection  - but at what cost in health dollars and lives and until when ? 
The Tuscan food, wine and hospitality were also pretty memorable!