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"Bare below the elbow" is a government rule for combatting MRSA, even though there's no evidence to support it. Dr David Nicholl heads to Cuba in a search for the truth.

Hospital acquired infections are a major issue, and the government is in a frenzy over the issue, and rightly so for anything that affects patient care. I, as a busy clinician do take this issue very seriously by washing hands after every patient contact.

However one of the dafter aspects of government policy is that all healthcare staff should be 'bare below the elbow' even though there is not a shred of scientific evidence that this has anything to do with hospital acquired infections such as MRSA.

Even the Department of Health’s own guidance states "there is no conclusive evidence that uniforms (or other work clothes) pose a significant hazard in terms of spreading infection" but "it seems that the public believe there is a risk".

This ‘bare below the elbow policy’ got me thinking. Could I think of any hospital in the World that had instituted a ‘bare below the elbow’ policy that was likely to have a very low rate of such infections? One old friend just kept popping up in my mind.

It occurred to me, and maybe this is because I watched Michael Moore's "Sicko" recently that although the clinicians in Guantanamo have been accused of many things (by me and others) I suspect that their rate of hospital acquired infections amongst detainees is probably extremely low, not least because:

  1. They have a very poor turnover of bed occupancy- ie if you are kept in the same bed/cell for 5 years+ the rate of MRSA etc will be tiny.
  2. They have essentially no visitors apart from the occasional lawyer (if they are lucky enough to even have access to a lawyer).
  3. They have ERF (extreme reaction force) teams who can use a water cannon to deep-clean cells and keep the odd recalcitrant prisoner nice and clean. This will clearly minimize any infection risk.

I would be somewhat sceptical that the UK public would be too keen on a Guantanamo style NHS to limit the number of hospital acquired infections, but just in case they are, I enclose a photo...the one on the left is considered a danger to society, the one in the right is a politically correct 'bare below the elbow' clinician in (orange) surgical scrubs.

MRSA Terrorist

But I like to think of myself as an evidence based clinician, and Guantanamo has been much criticized as being, well, lacking in evidence. So I put my question regarding hospital acquired infections in Guantanamo to the one person in the UK who might know, Clive Stafford-Smith, lawyer to some of the detainees including British resident Binyam Mohammed.

After all, unknown to Clive, the future of the NHS could lie in his (hopefully clean) hands.

Clive told me “No idea what the truth is on Gitmo and we're not likely to get anything accurate. All I can say is that the latest with Binyam Mohamed is that their response to his smearing his cell (and himself) in faeces for 6 weeks has been simply to turn his water off in his cell -- this is all a matter of disobedience, not mental health. Perhaps the NHS could do that.”

Nonetheless if the Department of Health really thinks there is hard evidence that ‘bare below the elbows’ will halt limit infections like MRSA, maybe we could send some managers to Guantanamo to find out.

Now dear readers, you may think I am being a little frivolous, maybe I am. However I have a very serious point and that is this. If we are going to spend a lot of money on limiting hospital acquired infections are we not better off rolling up our sleeves and basing it on hard science and not soft sound bites?

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