HEALTHCARE
July 23, 2011

Unsung Medical Heroes: A Roll of Tape and a Cotton Swab

Two very-low tech solutions to common medical problems show how easy it can be to reduce costs and improve care.

We hear a lot about medical advances that involve scans and other high-tech equipment. Recently, it's been found that a simple roll of tape and a cotton swab can help solve two of today's vexing medical problems. In much the same way Ignaz Semmelweis discovered in the 1840s that women giving birth were considerably less likely to develop life-threatening infections if doctors would wash their hands before delivering the child.

Usually, red tape adds layers of complication to a simple process. Here, it makes a complicated process simpler.

It took over 20 years for hand-washing to become accepted medical practice. Hopefully, it won't take 20 years for the cotton swab and red tape solutions to be put to the test.

Normally, health care workers must put on protective equipment including gowns and gloves to even enter the rooms of patients in isolation or who are highly infectious. This is time consuming, creates barriers to communication and is also expensive. Afterwards, they have to remove and discard protective clothing before dealing with other patients or co-workers.

Yet many communications with infectious patients are very brief.

Doctors at Trinity Medical Center in Iowa found that a roll of red duct tape helped solve some of the problems of communicating with these highly infectious patients. A three-foot square "Red Box" in these patients' rooms made life a lot easier for both doctors and patients.

As long as health care workers stayed in the Red Box, brief communications with patients did not risk transmitting the patient's infection. And the red tape also served as a visual warning to health care workers that they were entering an infectious zone. This is normally only indicated by a sign outside the patient's room.

When surveyed, 67% of health care workers said that the Red Box lessened barriers when communicating with patients. And 79% reported that the Red Box saved time and helped them better assess and communicate with patients. Usually, red tape adds layers of complication to a simple process. Here, it makes a complicated process simpler.

Infection of surgical wounds is also a common hospital problem. There are estimated to be over half a million surgical infections occurring annually in the U.S. It's especially troubling in surgery of the intestine or bowel because these are bacteria-rich regions of the body that are highly prone to infection. And there's currently no effective way to lower the number of these infections.

A California surgeon published a study in April that showed that infections from appendectomies could be cut more than six-fold by using a simple cotton swab.

Patients whose wounds were probed also had shorter hospital stays (five days vs. seven) and reported less pain. Their wounds also appeared to heal better cosmetically, as judged by eye.

Shirin Towfigh, MD, FACS, is an attending surgeon in the Division of General Surgery and the Center for Minimally Invasive Surgery at Cedars-Sinai Medical Center in Los Angeles. She was taught as a surgical resident to probe surgical wounds daily with a sterile cotton swab. She once thought that this painless procedure was standard medical practice, but soon found out that it isn't. Over the years, it seemed to be effective at cutting the number of post-surgical infections. So she designed a study to test this out.

The study was of 76 patients who had undergone surgery for perforated appendicitis. All had their surgical wound loosely closed with staples every two centimeters. Half had their wound probed with a sterile cotton-tipped applicator between the staples daily until the wound had closed and was impenetrable. The other half did not have their wound probed. All patients received intravenous antibiotics.

The infection rate was 3% in patients who had their wounds probed and 19% in the patients who didn't. Patients whose wounds were probed also had shorter hospital stays (five days vs. seven) and reported less pain. Their wounds also appeared to heal better cosmetically, as judged by eye.

Dr. Towfigh does not know why the probing reduces infections. She suspects that the probing allows contaminated fluid within the tissues to drain better.

How many more studies similar to the red tape and cotton swab studies are passing under the medical radar right now?

An article on the cotton swab study appears in the April 2011 issue of Archives of Surgery.

The study on the Red Box was presented June 29, 2011 at the 38th Annual Educational Conference and International Meeting of the Association for Professionals in Infection Control and Epidemiology (APIC). The conference was held in Baltimore.

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