COVID-19 update with Dr. Benjamin Marcum

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Myth 9:  If I have to go out for essential activities, I am powerless to protect myself.

I was a third year medical student in Norfolk, Virginia, on my very first day of surgery rotation.  I was in the OR for the first time, scrubbing in for the first time, assisting with the opening of a person for the first time for the sake of alleviating an affliction that only could be solved through surgery.  Already suffering from information overload, a bit intimidated by the rushing, quietly efficient staff and the beeps and the smells of the OR, I had dutifully scrubbed beside the surgeon for the requisite minutes, cleaning out from under my fingernails and scrubbing each finger, hand, arm individually, learning to clean from fingertips to elbow.  I was now in the the OR preparing to gown up for the first time, my hands and arms to the elbows dripping from the thorough scrubbing 30 seconds before.  I was handed a blue disposable surgical towel by a battle hardened masked and gowned scrub nurse I had never met and gruffly told to dry my hands from fingertips up to elbows with one side of the towel and then the other hand to elbow with the other side of the towel.  Awkwardly, painstakingly, I did my best to follow her brusque instructions without upsetting the natural flow of an adrenaline charged OR preparing for operation.  No sooner had I applied the towel to my left fingertips than was it ripped from my hands by a now furious scrub nurse.  “You touched your towel to your belly!” she hollered.  “Take another one and DON’T TOUCH ANYTHING WITH IT EXCEPT YOUR HANDS!”  This was my introduction to sterile technique; that rigid, deeply ingrained protocol that medical personnel follow for the sole purpose of preventing the most serious of complications from surgical procedures: post operative infection.  To this day I believe I did not touch the towel to my body and contaminate it.  Perhaps I did.  Nevertheless, twelve years later, that lesson is burned in my memory and serves as a reminder of how seriously devastating poor sterile technique can be.  I think perhaps that scrub nurse really enjoyed teaching that lesson to nervous, hesitant third year medical students and I’m positive I wasn’t the first or the last recipient of her intense tutelage.  And bless her for doing so because I think about her and that lesson every single time I practice sterile technique. She has probably saved several lives. 

I am well versed in sterile technique and especially in the OR, it is easy for me to remember not to touch my face or any potentially contaminated surface.  Protocols in the OR help keep medical staff from contacting those surfaces and spreading pathogens to the surgical field.  Avoiding spreading bacteria in the OR is second nature to me, But I find that outside the OR, even I have a difficult time remembering not to touch my face or to wash after touching a potentially contaminated surface.  Certainly with practice over the last 2 weeks it’s easier and in the clinic I’m 100% when it comes to washing between potential exposures.  But if I’m in a grocery store (which I have not been in a couple of weeks), what do I do?

The CDC has developed new recommendations regarding keeping yourself protected if you must go in public.  You can find all the recommendations they have made about prevention from getting sick here.  https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/index.html

But I want to spend some time talking about using masks and gloves in public.  Using a mask, even as the CDC suggests, a cloth mask, is mainly helpful to prevent you from touching your face when you are in public.  The sensation of the mask on your face is a constant reminder not to put your hands there, and even further, a reminder to pay attention to where your hands are at all times.  In the OR, I never place my hands on a surface outside of the surgical field.  I always, 100% of the time, am aware of where my hands are and if I accidentally touch my face mask or a light or some other potentially contaminated surface, I stop operating immediately and change gloves.  This is because a gloved hand that touches a contaminated surface is not a safe hand.  The same is true if you are at the grocery store and you choose to wear gloves.  It is absolutely fine to wear gloves if you want when you are in public, but touching your face with a gloved hand after touching public surfaces is just as dangerous as touching your face with an ungloved hand.  For that matter, if you touch a public surface and your skin is contaminated with the virus and then you pick up your phone, the phone is now contaminated and can spread the virus to your face when you answer a call.  The virus is not going to enter your body through the skin on your hands.  It has to contact a mucosal surface like your eyes, mouth or the inside of your nose.  If you choose to wear gloves, discard them in the trash and wash your hands before getting in the car.  Driving with the same gloves you have worn in public will still spread virus to the steering wheel and door handle and gearshift and those virus particles may be waiting for you the next day when you get back in the car to grab your sunglasses that you forgot.  

Wearing gloves is fine but please don’t let it give you a false sense of security.  If you can manage it, not wearing gloves and just using a 60% alcohol gel after touching any potentially contaminated surface is probably just about as safe as you can be.  The addition of a cloth mask will also serve as a reminder not to touch the main entry points of the virus.  I wish avoiding contaminated surfaces in public were as easy as in the OR where we can create sterile fields but alas, the virus could be laying in wait anywhere.  We must believe that every surface is contaminated and treat them as such.  If we do we are likely to avoid infection.  

While there are techniques you can practice and master to avoid infection if you go out in public, obviously if you are not in the store, you can’t be exposed to the virus.  This is why every possible authoritative or regulatory agency is constantly encouraging individuals only to go out if absolutely necessary.  And only one person should go to the store.  Obviously if you are a single parent and have no one to watch your child I understand but if you can have a healthy family member watch them, even better.  Curbside is your friend.  Plan ahead because curbside appointments are understandably booked several days out.  Also, the Erath County Commissioners and several other local groups are willing to go get your groceries or run errands for free.  Many businesses will deliver contact free.  Before you go to a public space, ask yourself, is this really necessary for the well-being of my family?  Is this outing worth spreading the virus? 
The lesson I learned in that Norfolk, VA OR over a decade ago was that every surface is contaminated with microbial pathogens.  Every contaminated surface in an OR is a threat to the health of my surgical patient.  In the case of a deadly virus that is spread through respiratory droplets, every public surface now poses the same threat.  If we are in public, we must know where our hands are at all times.  We must only touch surfaces that absolutely must be touched to accomplish the task at hand.  Once we do, hands should be washed as soon as possible.  If you are wearing gloves, you have to assume they are contaminated and may spread the virus to whatever you touch (phone, groceries, doors, shopping cart) until they are changed.  Thanks for reading and thanks for thinking about how to protect yourself and your family by limiting the spread of this virus when you are out and about.

Keep enduring.
BAM

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