Always Wash Your Hands

In medicine, they teach you to become germophobes and be aware of handwashing techniques. Its for a good reason too. Not only will you be preventing the spread of certain diseases and bacteria/viruses, but most importantly, you'll be protecting yourself against being exposed to things that you shouldn't be. The simplest way they teach to to do that is by washing your hands. Before you see a patient. After you see a patient. Before procedures. After procedures. After you blow your nose. After you watch a patient cough into their hand and then proceed to shake your hand. After touching questionable doorknobs in clinics. The list goes on and on.

In the real world, every clinic I have worked at has had antibacterial hand gel sanitizer dispensers outside of every patient room. So before entering, I'd gel it up, and after I'd leave, I'd gel it up again. It became a habit.  I'd only wash my hands in the room with the patient after examining diabetic feet (ewwwwww, its one of the reasons I'm not going into adult medicine), examining someone sweaty (eww again), or doing a procedure of some sort. Anyways, I use hand sanitizers all the freakin time. Even when I'm not in clinic or at the hospital, I'll feel better after I've cleaned my hands.

Sometimes, I'm acutely aware of which part of my hands have touched something "dirty" that now has to be sanitized. I think that hyperacuity comes with being trained in working with the sterile technique, where everything blue (or green depending on the hospital) can't be touched by anything unsterile. I learned to watch myself and all parts of myself to prevent contaminating any sterile field. Plus, I got yelled at by the scrub techs a couple of times while I was on surgery. All of those things together made me hyperaware of what I've touched and what needs to be washed.

In the exam environment, usually with the med school's OSCEs (Objective Structured Clinical Examinations) and even the USMLE Step 2 CS (Clinical Skills), washing your hands is usually the last thing on your mind, but its the easiest way to gain points (or lose points depending on which way you look at it). I know for a fact during my 3.5 years of med school when we had OSCEs, I'd always have to consciously remember to walk into the SP's room and wash my hands at the sink first. (SPs are standardized patients, basically actors hired by the school to memorize a script and only answer to what we students ask.) It made introductions really awkward, but it was the only way that evaluators could see that yes, we actually wash our hands before every patient we see. The CS exam is the OSCE of all OSCEs, and it counts as one of our board exams that we absolutely have to pass to be licensed. There are 11 patient encounters for 20 minutes each (I think?) and then 10 minutes between each encounter to either answer questions or write a clinic note. That was a really high pressure exam, and it moved very very quickly. Even as a germophobe and all the hand cleaning habits I formed, I forgot to wash my hands before THREE patient encounters. Oh. My. Gosh. I nearly panicked once I realized what I forgot and I prayed that I wouldn't fail just because of that. Thankfully, I remembered to wash my hands inside each room for each encounter after that, and thankfully I managed to pass! :)

I realized later why I kept forgetting........ I hadn't taken an OSCE in over 9 months, and there were no hand sanitizer dispensers outside the rooms, and that's where my habit bit me in the butt. These exams are really not representative of what we do normally, but they need a standardized exam to put us all somewhere on some vague scale. All that matters is that I passed.

Until the next one then.

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