I had just visited with a patient in contact isolation for clostridium difficile diarrhea. This is a bug that is spread easily between hospitalized patients, so I appropriately put on a plastic gown and rubber gloves before examining the patient. I was supposed to have washed my hands before exiting the room, but I think I forgot this time.
I opened the door of the patient’s room to exit, then closed it behind me. Right then a nurse standing nearby, in a more than subtly condescending tone, said, “Doctor, would you like to clean your hands?” as she motioned toward the sanitizer mounted on the wall nearby.
Appropriately chastened, yet still a little irritated at her tone, I replied rather deceptively, “Hmmm, are we supposed to use the sanitizer even if we wash our hands in the room?” (I knew full well that this would be redundant, but the phrasing of my question implied I’d already washed.)
“Yes. This patient is in contact isolation.”
Now, there are plenty of rules and protocols at the hospital, perhaps even too many. It seems that nurses often excel at following the rules down to the smallest jot and tiddle. But in this case, her newly-imposed rule of double hand sanitization seemed excessive. And right then, I remembered a sign on the door. Turning toward it and pointing, I said, “I guess I’m confused by this sign.”
On this makeshift printed sign were the instructions, “Do not use sanitizer. Hand washing only.” Of course, the intent of the sign is that sanitizer is not sufficient; one should wash with soap and water after seeing these patients. But I felt that it was more important at this instant to teach this nurse a small lesson about following the existing rules without adding her own, and so I relished the act of pointing out the literal and explicit instructions of the sign! Do not use sanitizer!
As she stood there slightly baffled, I smiled and reached for the hand sanitizer as I said, “But I use this stuff all the time! It’s great!”