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Rapid Responses: Rapid Responses published:
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Wedding rings and hand washing
- J Shankar (4 February 1999)
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The clinical value of a wrist watch
- James Henderson, Sarah E McCracken (3 December 2007)
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Sweep second hand -Yes: Wrist watch -No
- Sam Richmond (5 December 2007)
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Fob watches for doctors
- Trish Groves (19 December 2007)
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Watch this space...
- MIchael A Moses (4 January 2008)
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Hand Washing
- dr sudarshan kumari (4 January 2008)
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J Shankar
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EDITOR - I read with interest the select commitee on science and technology's seventh report regarding hand washing as the single most important measure in infection control 1 and the letter by Hartley et al 2. I have seen many of my surgeon colleagues and nurses wash up for surgery with their wedding rings on. The skin under the ring can never be meticulously cleaned and is a potential source of infection. I am not aware of any guidelines on the removal of wedding rings prior to scrubbing for aseptic procedures. J Shankar Specialist Registrar Department of Ophthalmology East Glamorgan General Hospital Church Village Mid Glamorgan CF38 1AB 1 House of Lords Commitee on Science and Technology. Seventh report. London: Stationery Office, 1998. 2 Hartley J C, Mackay A D, Scott G M: Wrist watches must be removed before wasing hands. BMJ 1999;318:328. (30 Jan) |
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James Henderson, SpR Plastic Surgery Norfolk and Norwich University Hospital NHS Trust, Norwich, NR4 7UY, Sarah E McCracken
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Trusts are about to implement a “bare below the elbows” dress code policy for doctors. This includes the banishing of wristwatches from “clinical areas”1. There is no evidence that wristwatches are carriers of infection. It has been suggested, but not shown, that watches may impair handwashing2. Little account has been made of the clinical benefits of a wristwatch. The majority of beds and examination couches in hospitals do not currently allow sight of a clock. Twenty appropriately trained healthcare staff were assessed at their ability to carry out basic clinical observations without the use of a second hand, to assess the dependence placed on wristwatches. Nine senior medical students, six junior doctors, one consultant and four trained nurses were asked to evaluate heart rate (pulse) and respiratory rate on the Laerdal Sim Man® simulated patient. Each participant was assessed at regular pulse rates of 83, 36 and 168 beats per minute and respiratory rates of 14, 30 and 4 breaths per minute. Participants were given as much time as they wanted to make their estimate. Every participant took longer than one minute to make each estimate. All participants would have failed an undergraduate objective structured clinical examination (OSCE) station, and only one participant gave values for each reading that would not have been potentially dangerous in a clinical setting. Estimates for a pulse rate of 83 ranged from 60 to 120, and estimates for a respiratory rate of 14 ranged from 10 to 28, showing that it was often not possible for health care professionals even to distinguish normal from abnormal without the use of a second hand. This study highlights the necessity for doctors to have sight of a second hand when assessing patients, especially in emergency situations where a clock might not be present. A pilot study by the lead author of removing his own wristwatch had to be abandoned after one day because of consistent lateness. Fob watches have been found to be impractical for some clinical procedures3. If trusts wish to persist with the banning of wristwatches, they will be obliged to provide each bedspace with its own clock with a second hand. The same department of health guidelines commend the wearing of soft soled shoes to avoid “disturbing patients’ rest”1. The sound of a thousand clocks ticking might be rather more than a little disturbing. Yours sincerely James Henderson MA MB BChir MRCSEd MD FHEA Sarah McCracken MA BM BCh MRCP 1) Jacob, G, Dept of health guidelines (2007) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078433 2) Hartley JC, Mackay AD, Scott GM. (1999) Wrist watches must be removed before washing hands. BMJ 318:328. 3) Nevill M, Ikeda M. (2006) Watch out for infection control. British Journal of Infection Control 7(1) 12. Competing interests: JH likes to wear a wrist watch. |
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Sam Richmond, Consultant Neonatologist Sunderland Royal Hospital, SR4 7TP
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James Henderson and Sarah McCracken have produced an excellent argument for the use of a watch with a sweep second hand in medicine. However, there is no need for this watch to be worn on the wrist. In the past all nurses wore a small watch on a short length of chain pinned to their clothing. If this solution is rejected then try a fob-watch, with or without a waistcoat. Competing interests: None declared |
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Trish Groves, Deputy editor, BMJ BMJ
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James Henderson says that fob watches have been found to be impractical for some clinical procedures. There might be another reason for doctors to stick to wrist watches. I bought a fob watch when I passed finals and wore it on my white coat throughout my house jobs, finding it invaluable. But I lost count of the number of disparaging and not always jokey remarks I got from fellow doctors along the lines of "what's that? Think you're a nurse, or something?". I'd like to think times have changed, but somehow I doubt it. Competing interests: None declared |
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MIchael A Moses, SpR Plastic Surgery Norfolk and Norwich University Hospital, NR$ 7UY
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Dear Sir, I read with interest the results of Dr McCracken’s and Mr Henderson’s study. The need for medical staff involved in patient care to be able to count seconds is well recognized. Many published dress codes for hospital staff and students (both medical and nursing) including that for Stanford University Medical Center1 include the wearing of a watch with second hand as a compulsory requirement. If the wearing of wristwatches by clinical staff is to be banned for infection control reasons then it should be made clear that this is politically motivated since, as far as I am aware, there is no evidence linking the wearing of wristwatches with the transmission of a pathogenic organism to a patient from a healthcare worker. A fob watch is not an alternative. Since it must be cradled in one’s hand in order to be of any use, it will rapidly become a repository for infectious organisms with which the wearer has been in contact. As the authors suggest, a clock above each patient is the only way to ensure that a doctor has line of sight to a second hand in a critical situation. Indeed this is the case in the cardiac resuscitation area in the new emergency department at Columbia Presbyterian Medical Center in New York, the design of which I influenced whilst on my elective. In this case the potential noise of multiple ticking second hands was overcome by the use of digital timers above each bed. Yours etc, Mr Mike Moses, MRCSEd SpR, East of England Deanery 1.http://www.stanfordhospital.com/clinicsmedservices/medicalservices/rehabilitation/interns/dresscodeguidelines Competing interests: None declared |
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dr sudarshan kumari, neonatologist sunderlal jain hospital, ashok vihar delhi 110052, India
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This article about hand washing and removing wrist watches seems practical. However, while it is mandatory to remove watch before proceedures like lumbar puncture, iv lines or umbilical cannulation etc, it may not be always feasible at other times, like CPR, aspiration of mouth secretions which may be done in emergency situations. I have been using wrist watch with washable steel strap before entering the nursery , and have not encontered any problems. On the other hand, what needs to be abandoned is use of rings in nicu (i have seen many neonatologists puting on more than 4 rings in both hands). Rolling up of sleeves up to elbows in nursery, and tied up hairs-as loose hairs interfere with proceedures in nursery and not to use bangles in neonatal units should be rigorously practised (In India BANGLES are often used by FEMALE nursing aids as a symbol of being married ). Also long nails of personal looking after babies are not uncommon. Can we not have a dress code for nicu staff;
I feel we should look beyong wrist watches for prevention of infection in neonatal units, in addition to routine aseptic procedures Competing interests: None declared |
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