How about a switch operated door with integral sanitizer dispenser?
Unfortunately, chemistry doesn’t work that way. We can discover compounds, learn what they do and how they behave, then put them to use, but we have a hell of a time trying to get molecules to do what we want them to do. If we could do what you suggest, we could probably also cure the common cold and/or cancer…!
Were such a powder to exist, though, you run the risk of irritation/infection on a patient by having the powder enter a wound (or even their lungs, eyes, etc).
Repeatedly exposing workers to ultraviolet light on a regular basis like this would lead to a lawsuit…and probably an increase in cancer statistics.
I have a friend who is a nurse in a hematology/transplant ward. She herself is also immunocompromised due to having had cancer as a teenager, and she gets sick very often. She is the responsible nurse for the floor’s handwashing practices, and it’s her job to observe staff and ensure that they adhere to the four-point handwashing rules: wash as you go into the room, before and after contact with the patient, and as you leave.
Nurses still don’t do it, not even in such a ward, because it often results in them putting sanitizer on their hands about once every 4 minutes or somesuch (yes, they studied it). This isn’t all that safe for the nurses; their hands get dry, their skin cracks, resulting in an increased risk of infection to them. A lot of sanitizers contain isopropyl alcohol, which in sufficient (high) concentration is a known skin irritant, and is a suspected female reproductive system toxin with known effects on the kidneys, liver and CNS. So does ethanol, also a common base for hand sanitizers. Same with n-propanol. Anti-bacterial products are also associated with resistant strains of bacteria and hospital-based outbreaks.
Hand washing regulations must balance the health and disease vector risks to the patient with the risks of the antibacterial/sanitizer to the healthcare professional. I certainly don’t have the answer to the problem; clearly handwashing is a necessary part of preventing the spread of infections in hospitals, but there’s often more to it than just telling the staff to “wash, already!”
They might want you to stay longer if you were paying with cash, and they knew you were going to actually pay. To the best of my knowledge, most insurance companies pay using DRG (Diagnosis Related Groups). If your chart is icd coded for a simple appendectomy; they’re going to pay the rate for a simple appendectomy. In other words, the hospital makes money by kicking you to the curb as soon as they can; resulting in less staffing and other costs.
I scrubbed in and out when my dad was in the SICU at Rochester General. When it was required I also gowned up and used a mask.
I think your second point is the most valid one: introducing such a powder would be introducing risk.
Point 1 is apples and oranges:
Creating a molecule to address a very simple set of criteria (bind to something after a reasonable time, be nontoxic, glow or turn purple) should be relatively easy to do, while the common cold and cancer are different problems altogether, with thousands of complicating issues, as well as the lack of one “common cold” and one “cancer”
Modern techniques such as high throughput screening and combinatorial chemistry should make it relatively easy to find candidate molecules that do most of what they need, and then chemists can tweak things until they get the tint they like. And for the timing, just coat it in something that breaks down slowly with skin oils.
The real problem: once the stuff is identified, who is going to pay for all of the drug safety studies and clinical trials and other expensive parts of the drug pipeline for this substance to be approved…
And Point 3: I wasn’t thinking of shining a tanning lamp on them! Why not just a very subtle blacklight like they use at Six Flags to see your hand stamp?
Of course visitors should be encouraged to perform proper hand hygiene - but if they don’t, they won’t necessarily know why or care why some alarm keeps going off every time they go in and out of a room. This will turn the alarm into some irritating background noise that everyone ignores (except for the poor patient stuck by the door who has to live with the noise.)
This will irritate the staff in different ways - having to explain the alarm to people all the time, explain proper hand hygiene and having to tell irate patients and family members that, no, the staff member can’t keep the alarm off for good.
If the hospital that I did my Internal Medicine rotation had this system, I would have set the alarm off all the time (well, unless I used the hand sanitizer JUST because of the alarm). I was very religious about using the hand sanitizer as I entered a room, but unless I touched the patient, something belonging to the patient, or any surface, I didn’t wash my hands when I left the room.
Since I’m doing pharmacy, most of the time I went into a patients room was to ask them a question, or council them on medications we were discharging them on. Which means, most of the time I walked into a patients room, and had my hands clasped behind my back the entire time I was in there, or taking notes on my note pad. I seldom actually touched anything.
Though, I took my share of infectious disease classes, and if I did touch something, I washed my hands. I didn’t want to catch anything myself!
I work in a teaching hospital. The nurses usually nail the student nurses but nobody (as far as I’ve seen) says anything to the student MDs.
[Housekeeping cannot say anything re: infection control to student nurses - ‘it’s none of your business’. But when infection ‘gets out’ it’s usually housekeeping’s fault, eh? 'Cause the PROFESSIONAL STAFF wouldn’t … ] When I observed this little drama, between an older RN and a housekeeper, I about threw a fit.
Also: when a patient is on isolation (harboring something communicable) and all people entering the room should glove, gown and maybe mask up - someone needs to be alert to enforce the importance of this on the patient’s visitors.
Anyone who works in health care could go on and on, but carelessness abounds, from the high-end educated people to the low-end, lesser educated people.
A few years ago, a nurse from Infection Control went around the hospital spraying some substance on peoples’ hands, then asking them to wash up. She then used a UV light to check the results. To everyone’s amazement, guess which department’s employees had the cleanest hands after the handwashing?
Housekeeping! It was a nine days wonder:)
an seanchai
As a biomedical technician, I just want to thank you for being pretty much the only person to ever think of the biomedical staff. 
And yes, it would be another thing to break, and since no one thinks ahead of time, the first time it DID break maintenance and biomed would argue over who gets to (has to) fix it.
It’s also worth noting that clinical alarms already go unnoticed/ignored by a large percentage of staff. They learn how to tune out all but the worst alarms, like apnea or asystole. I can’t tell you how often I walk around in the hospital and hear pumps giving the “infusion complete” alarm, monitors giving arrhythmia alarms, etc… and no one is doing a thing.
It’s not like the alarm has to be a generic klaxon. It can just be a recording that says “Unsanitary entry detected in room X. Hospital policy requires that you use the hand sanitizer located inside the door.” And then turns off. Iit’s not like you need to keep running the alarm until it’s reset. One buzz and a stern voice telling you to do something is enough. Hell, the patients will probably self-police it most places. If I were conscious in a hospital room and a hospital employee came in and set off the alarm, you think I’d just sit idly by if he hit the button and sent a pile of sanitizer to the floor?
You could have a little flashing light next to the hand sanitizer for people who are really clueless.
I’ve typed this all out and I’m sure it’s TL;DR for most people, and a bit of a hijack to boot. I don’t think it needs its own thread, but if the mods feel it does, please feel free to split it off or whatever.
Are you a chemist, minor7flat5? Although I’m a few years removed from working in pharmaceutical labs, and a few more years removed from my biochemistry degree, I still consider myself to be a chemist and none of what you described seems easy to me. I’d love to be proven wrong, though.
*bind something after a reasonable time - Since the skin enzymes are a givenn and not changeable in their behaviour, this would suggest pellets or a coating of some sort which would dissolve/sublimate/degrade in time to release your Molecule X. What would cause it to react within a certain amount of time? What random surface in a room can be guaranteed to have the properties that would allow this to happen? How do you control for spillage of water, blood, urine, or other substances which might accelerate or prevent this substance from binding after X time? If/when the coating does degrade, what does it turn into? Is that toxic? Is it goopy? Is it hard to clean up? By what mechanism does the molecule then bind to surface enzymes or enter the cell in order to function?
*be non-toxic - believe me, molecules which can interact/bind with specific enzymes/human cell substances which are also non-toxic or have only desired effects are the holy grail of drug design and pharmaceutical companies (and new age kooks). They are also unlikely to exist, since by their nature they are required to interfere with human biochemistry (that is, bind to enzymes), which inevitably will have some impact on the rest of human biochemistry. The impact might be good - like Gleevec pretty much cures Chronic Myelogenous Leukemia, but there are still adverse side effects to this. Or it might be bad, like thalidomide inactivates cereblon, leading to limb malformations.
*glow or turn purple - assuming that purple isn’t a requirement, and just any colour will do, you need a molecule that has a strong chromophore that can either be detected by UV or visible light. Such molecules are often those that complex with metals, most of which are toxic to humans, or molecules that have resonance; alternating double and single bonds, or aromatic compounds, many of which are also toxic. Many of these exist, and many do change colour based on conditions (e.g. acidic or basic environment). A well-known example is phenolphthalein. It is carcinogenic.
None of this addresses the need to bind to a human enzyme; which enzyme? If you want people to touch surfaces and have their hands turn purple, then this molecule would have to bind to the skin cells pretty permanently - what is the long-term effect of stopping that enzyme from doing its job? Enzymes have a purpose, and fucking with them has consequences. And once the non-handwashing culprit has been identified, how do you remove your molecule from the enzyme? What substance will flush out/preferentially bind the enzyme -and will it be released so that the enzyme can go back to work. Assuming your molecule is released, how is it metabolized? What are the effects on the kidneys, liver, heart or other organs?
There’s a heck of a lot of chemistry and biochemistry here - and likely much that I haven’t thought about, and none of it is simple.
As for the cold or cancer - we understand the mechanism of action of the common cold virus, and we understand how many (not all) cancers develop, or at least are in the process of discovering that. Finding a molecule to stop it though…that’s a whole other story, because of all that I mentioned and more. If we could simply design a molecule to bind to enzyme ABC123 and have no other impact on the body, trust me, we would, and many, many diseases would be cured. It isn’t that easy, though, which is why we have many more drug candidates than cures, and even the " cures" and treatments we have cause problems of their own.
High throughput screening and combinatorial chemistry can identify candidates in a class of molecules that have already been discovered/made/had derivatives made of, but us poor chemists don’t get to tell the molecules what to do. We make something, expose it to some cells, and wait for it to tell us if it’s a cure or a terrible death. Would that it were as you say; the world would be a better place.
Because blacklight is UV light, although the lowest frequency part, with a funky visible component added to make it look trippy. High exposure, however has been linked to skin cancers, aging skin and is damaging to vitamin A. At Six Flags they check for a second or two. In your scenario, a healthcare professional would be doing such several times a day in order for the handwashing rules to be effective. That becomes a major health risk after a 40 year career. Like most things, “it’s the dose that makes the poison”.
What if some of your hypothetical healthcare providers would rather use good old soap and water? How would you keep your system from alarming when they wash at the sink instead of using the sanitizer?
Nothing to add except I wish more people got on board with handwashing.
But now, an anecdote!
On the other hand( so to speak) last year the facility where I worked had “handwashing audits”. We failed. Scores in the 20 percent range, some even lower.
We were shocked that we scored so abysmally low. We clean a lot of poop and we are pretty good with gloves and handwashing. (We didn’t have a lot of hand sanitzer pumps around you don’t keep alcohol around in a psych hospital) Sure we weren’t perfect, but…total failures?
Turns out the auditors were marking us down because we would leave the patient rooms, discard gloves in the hallway garbage (no cans in the rooms) and go to the bathroom sinks rather than use…the sinks in the patient rooms. Except our patient rooms don’t have sinks. :smack:
They gave us each a personal use bottle of sanitizer and also allowed hand washing in the bathroom sinks. We passed this time at around 84% compliance.
Wow! I didn’t expect such fervor.
(In response to your question, I have been working in big pharma for the past twenty years, admittedly not as a chemist, though with more than a layman’s knowledge of scientific processes in the drug pipeline)
And I don’t disagree with your logic: for example, in work with folks in Drug Safety, I was amazed at the nature of metabolites in the body and how much diligence was placed on tagging and identifying every last scrap of stuff that turns up in a body after a drug is introduced—stuff that can be toxic even if the drug wasn’t. There are so many reasons why a good drug candidate can fail all along the pipeline.
Given unlimited resources (e.g. typical $800million and 14y to make a new drug), I’m confident such a magic powder could be developed.
Anyway, you are thinking too deeply about this: It was just a throwaway idea. I feel your most important point was that this “magic powder” would be a contaminant that really has no business being brought into hospital rooms.
And the blacklight bit? That’s just for spot checks, once a week or once a month. It’s not like this special stuff would be used in every room daily.
Does anyone know the process that the beds, handrails, telephones, remote controls, bedside table, etc go through to prevent the transmission of disease, in-between patients? What is done with the assorted items, and who does it? Always wondered about that.
I think the idea is that not every patient room will have a sink. It’s a bit of a foreign concept for me as I have never personally worked in or visited a site that didn’t have sinks in patient rooms. Clinic, ER, long term care… all of them have sinks in patient care areas. Good for me; I hate hand sanitizer.
I think disrupting the patients, not to mention being a nuisance to the staff who do wash properly, in an effort to force people into following protocol is… well, it’s not a good idea, especially in certain circumstances (e.g., long term care patient on comfort cares surrounded by grieving family).
I think that spot checking and relatively severe (because “It’s just hand washing! It’s not like I hurt anybody!”*) punishment for noncompliance is the only thing that will fix it. It only takes 20 seconds. They all know why they should wash their hands and that germs can spread quite quickly if they don’t. They don’t care. They’re lazy.
*Yes, I actually heard this, during a meeting following a little outbreak of VRE in one particular wing of my facility. Some of the dumbest people I know are health care providers.
Wow, sorry for all the “I thinks”. I had a really stupid argument earlier with a wannabe psych who stomped his feet and cried because I disagreed with his position that people who state their thoughts and feelings without first saying “I think…” are controlling and trying to pass their opinions off as fact.
He’s a douchebag and I am never talking to him again.
this reminds me of that auto curse ticket in that old futuristic stallone movie. an electronic hall monitor railing against doctors? no way it is happening unless it is made subtle.
A hospital in the system I used to work for is getting closer to this idea.
They have sensors in the rooms in various locations and each nurse wears a sensor all shift as well. (All movable equipment has a mounted sensor as well.) Every movement is tracked 24/7 by a program, live and recorded.
So, not only can you tell that Sally Jensen, R.N. came into room N315 at 4:36pm and took the jet vent out, you can see how long she was in there and if she approached the sensors by the sinks or the sanitizer dispenser.
Now, this doesn’t make her use the sanitizer or wash her hands but when the patient in a room she visits tells the head shift nurse that Sally Jensen, R.N. did not clean her hands, they can go back and look at the log and see that the patient is correct.
At least, that’s the plan.
(Sensors are also used for safety as the nurse’s location is always transmitted so in a crisis situation, she simply sets off her communication alarm and the tracking shows exactly where she is located in the building.)
No, doctors are not made to wear the sensors if they don’t want. Can’t be making doctors upset.