Michael Heller, MDLast December we examined the magical thinking that has led to a hand-washing campaign as a weapon against influenza (even though the bug is not transmitted like that) and a mandate to use transport condoms on endovaginal probes apparently on the theory that the atmosphere of the planet would contaminate the probe and those bugs would crawl through the latex covering during the ultrasound exam thereby exposing that previously sterile environment, the human vagina, to contagion.

The current missive will consider the oft-repeated warnings to medical personnel and restaurant workers- hell,  to just about everybody- to wash their hands after utilizing the rest room. A recent consult with an ED nurse (Ref 1) confirmed that these warning are prominently displayed in women’s rest rooms as well and apparently make no distinction between the two most common activities performed there (technically known as “Number One” and ”Number Two”.)  In fact the ubiquity of this caveat in our society led to the ultimate endorsement-a Seinfeld Episode on the topic- which strongly implied that failure to wash the hands after taking a leak posed a grave threat to life as we Manhattanites we know it and condemned the non-washer to the derision of his/her fellow man/women.

Here’s the problem. The dirtiest (ie most bacteria per cubic millimeter) places on the human body are the ventral surface of the hand. The penis ( I have no data on the female nether regions) is one of the cleanest. And it gets worse. The dirtiest (same definition) part of the restroom is the door knob (or handle). So, it makes no sense at all to admonish patients, employees and health care providers to wash hands after peeing and before leaving the rest room. In fact, it would make much more sense to encourage washing of the penis after urinating now that the male member has been contaminated by the germ-laden hands. Whether Cidex or autoclaving the organ in question would provide even greater protection is currently the subject of a randomized trial (recruitment is taking longer than expected. Ref 2)

So, what to do?  I’d suggest the following as a rational approach:

1) take the endovaginal probe cover with you to the bathroom.

2) wash hands first as you may have touched a doorknob on the way in

3) encase the hand with the probe cover.

4) urinate as per usual

5) exit the bathroom with the hand still encased with the probe cover or utilize the “backside-push” technique if the door opens outward.

6) put the probe cover back on the probe to keep the Infectious Disease folks happy.

References:

1. Shulman A.  Personal communication 01/10/2010. Beth Israel ED, NY
2. Heller M, Bukata W, et al. A Randomized controlled trial of steam heat versus gluteraldehyde for disinfection of Mister Wiggly. Publication pending  01/2020