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To slow an epidemic, focus on handwashing

Adapted from MdLinx

Improving the rates of hand-washing at airports could significantly reduce the spread of many infectious diseases such as the Flu and other viruses including the corona virus.

The study, which is based on epidemiological modeling and simulations, the team estimates that on average, only about 20% of people in airports have clean hands ( washed with soap and water, for at least 15 seconds, within the last hour), which leaves the other 80% are potentially contaminated. Improving that to 60% can slow global disease spread by almost 70%! The CDC and the WHO both indicate that hand hygiene is the most efficient and cost-effective way to control disease propagation. For any given disease outbreak, the authors said, identifying the closest 10 airports with the highest impact and focusing hand-washing education at them would be the most effective way of limiting the disease spread.

There is more to say about hands than hand surgery…

Here is the full reference: Hand‐Hygiene Mitigation Strategies Against Global Disease Spreading through the Air Transportation Network

Avocado Hand

Avocado, the green-skinned, egg-shaped fruit, is getting more popular than ever. With it, there are increasing reports in media and medical news about avocado related  hand injuries .

 

Accidental knife injuries happen to fingers of the hand holding the avocado while peeling it. Such injuries has increased to the point that is they have been named ‘ Avocado hand’.

The hard shell covering a soft fruit allows the knife to slip through the flesh of the avocado and aim straight to ones fingers.  The best way to safely cut the avocado is not to hold it in your hand, but on a plate and aim the sharp edge of the knife away from your fingers. This can lead to serious injuries such as cut tendons, nerves, and blood vessels.

Ir Med J. The Avocado Hand. 2017 Dec 18;110(10):658.

Washing Your Hands

Adapted from BBC

Washing your hands- straightforward, or is it?

There’s plenty of evidence that washing one’s hands can reduce the spread of disease, only 5% of people wash their hands ‘properly’ ‘all the time’.

10% of 3000 people were witnessed leaving public toilets without washing their hands, and of those who did,33% didn’t use soap. While it is well established that we need to wash our hands properly, there are plenty of myths about what is proper.

Does the water need to be hot to get your hands clean?

In a survey of 500 adults, 69% believed that the temperature of the water has an impact on the effectiveness of hand-washing. Researchers found that water temperature made no statistically significant difference when other factors are controlled. Temperature still affects washing, though, because excessively cold or hot water lets people spend less time washing their hands than comfortable water temperature.

Is anti-bacterial hand wash better than soap?

A 2007 and a 2015 review both concluded that anti-bacterial hand washes  did not reduce the number of bacteria remaining on people’s hands after washing any more than soap did, nor was it any better than soap. Triclosan, a main ingredient on most antibacterial hand soaps, May increase anti-bacterial resistance and that and has been banned in the US and in the European Union.

Do you need to dry your hands afterwards?

Letting new hands air-dry is fine as long as he did not contaminated hands before they try out. Durkan’s transfer to your hands more easily if they’re wet.

Hand dryer or hand towel?

There’s a lot of debate surrounding this one. Most of us don’t want for as long as 45 minutes needed for the hands to dry using hand dry. New were hand dryers take 10 seconds hand and our equivalent to paper towels.

Making toilets nicer also makes a difference. One study observe 3,000 people in the US, found that if the toilets were clean and well-kept, people were more likely to stop and wash their hands properly. When the sinks were dirty, they just wanted to get out of there.

Whichever way you choose to wash and dry your hands, do it for longer than you think.

Athletic Hand Injury

Adapted in part from the Hospital for Special Surgery PlayBook

Sports related injuries can be the result of a single trauma or due to repetitive overuse. Certain sports such as boxing, basketball, and volleyball have greater risk of injury to the  bones, ligaments and muscles of the hand and wrist.

One common injury is a boxer’s fracture, which is a fracture of one of the metacarpal bones: it happens when your punch lands wrong.

Basketball and volleyball players frequently get ‘jammed’ fingers. This happens with a forceful encounter with the ball. There may be visible misalignment of the finger. A jammed finger can be anything from an innocent sprain to a bad fracture-dislocation requiring urgent surgery. 

Looks can be deceiving and these injuries should never be underestimated.It is easy but costly to dismiss a serious injury. If pain and swelling do not go away in reasonable time, you should seek medical attention including proper x-rays.

Appropriately sized, and well applied hand wraps and/or gloves protect the hands from such injuries, and proper training is essential to prevent such injuries. Some of these injuries come with an easy fix while others require surgery and dedicated hand therapy.

While still recovering, you may still work on staying in shape and game ready by running, working on lower body and strengthening your core.Your treating physician, together with your therapist, will set the schedule and time frame towards full use and will let you know when it is safe to start exercising your injured hand.If you do too much too soon and push through pain, you may be delaying your recovery or reversing the outcome of your treatment.

No More Powdered Gloves

Adapted from Medscape

For several years, there has been a push to ban using powder in medical gloves. The US Food and Drug Administration (FDA) recently unveiled a proposal to ban powdered surgeons’ gloves and the absorbable powder lubricating them, as well as powdered gloves for patient examinations. Both synthetic gloves and those manufactured from natural rubber latex are covered.

Professional groups such as the American College of Surgeons, the American Academy of Allergy, Asthma and Immunology, and the American Nurses Association had already taken stands against powdered gloves. Government agencies such as the Centers for Disease Control and Prevention joined the chorus, as did the healthcare systems of Germany and the United Kingdom, as well as several healthcare organizations, such as Cleveland Clinic and Johns Hopkins, have either restricted or forbidden the use of these gloves.

Surgical gloves were first used in 1889, and soon, all sorts of lubricants were used to make them easier to don. Several studies has indicated respiratory complications.

 

 

Titanium Rings

Adapted from NPR

Emergency room staff frequently have to remove rings and wedding bands of the fingers of patients when fingers swell up for any of several reasons. Finger swelling traps rings, which in return restrict blood flow, and cause even more swelling and pain. It not taken off in time, more severe blood flow restriction may lead to the loss of the finger- not fun.

Ordinarily, this wouldn’t be much of a problem. But… this was before Titanium rings became fashionable. Titanium rings are growing in popularity because they’re very strong, light, hypoallergenic and less expensive gold or platinum rings. But that strength makes them more difficult to remove, even with ring cutters. Sometimes bolt cutters have to be used as seen in this picture.

 

 

 

Driving Safely Following Injury or Surgery

Adapted from NYTimes.com.

Driving is one of the many functions that we perform with little effort yet has a huge impact on our safety. It you think about it, though, you will notice  the many joints and muscles you must engage before you even start the car: fingers, wrist, elbow, shoulder, neck, head, ankle, knee, and hip.

Following injury or surgery, a natural question surfaces: When is it safe to resume driving?

The short answer is: There are no widely accepted timeline.

For patients who must wear casts, slings, neck collars or fracture boots, and for patients recovering from a sprain, fracture, or surgery,  the ability to steer, glance at mirrors and brake safely can be seriously impaired.

Immobilization of either arm in a splint or sling significantly impairs driving ability. Patients should not drive if the wrist, elbow, or shoulder are immobilized, be it  a cast, splint, sling, or an immobilizer.

Patients should not drive if they are in enough pain to impair their ability to steer or respond to sudden events while driving. Patients should also not be driving if they require narcotics for pain control as narcotics affect the patient’s ability to make proper and timely decisions, as well as execute them quickly.

A lot of studies focus on the ability to drive following lower extremity injury or surgery. They focus on how long it takes to make an emergency stop. Braking function returns to normal four weeks after right knee arthroscopy, nine weeks after surgery for an ankle fracture, and six weeks after the patient can walk unencumbered after a fracture of a major lower-body bone.

When the patient feels ready to resume driving, it’s best that to practice in a parking lot or low traffic area and determine how much comfortable he/she is to drive around other people. It is also a good advice to do resume driving in good weather and during daytime until the patient is comfortable handling emergent situations.

Unfortunately, many patients dismiss the advice and return to driving earlier than what is considered safe.

Decide to Drive

Did you know:

  • 421000 motor vehicle crash injuries were related to distracted driving in 2011?
  • Eating is related to three-fold increase in risk of crashing a vehicle?
  • Risk of crashing increases 700% when a teen driver reaches a phone?
  • Texting increased risk of crashing a motor vehicle by 2300%?

Fragility Fractures

Fragility Fractures

A Fragility Fracture is any fracture that follows a low impact injury, typically, a fall from a standing height or less.

In healthy people, such falls should not cause any bone fractures. If this happens, irrespective caused the fall, one should wonder what made the bones fragile. The first fracture is a warning sign, and a very important one! One broken bone  is plenty, and all effort should me made to prevent a future, and potentially more serious, fracture.

The most common cause of fragility fractures is osteoporosis.  An earlier stage is called osteopenia. About 52 million Americans have osteoporosis or osteopenia. Of those, two million break a bone each year. This number is expected to double by 2040.

  • Osteoporosis has no signs or symptoms until a fracture occurs.
  • One half of all women and up to one quarter of all men will suffer a fragility fracture in their lifetime.
  • If you have had a previous fragility fracture, you are twice as likely to suffer a fracture in the future.
  • Over 2 million fragility fractures occur each year – more than heart attacks, stokes, and breast cancer combined. This number is on the rise and expected to double by 2040.
  • While a wrist fracture may not have the most severe impact on life, a spine fracture, or a hip fracture, may end the patient up in a nursing home for life. There is also 25% increased risk for mortality following a hip fracture.

For more information about fragility fractures, prevention, and treatment, please check the main fragility fracture webpage.

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