Achieving Perfect Hand Washing: an Audit Cycle with Surgical Internees.

The aim of this study is to achieve 100% compliance in surgical hand antisepsis along with identification of areas of worst compliance and efficacies of various interventions best suited to deal with them. This audit was performed over 6 days in a tertiary care hospital in Calcutta, India, with 42 surgical internees. Compliance to ideal hand washing technique was recorded after each attempt with the first attempt as baseline. Video demonstration, personal demonstration by a consultant, and individual instruction were used as subsequent interventions to achieve 100% compliance. The baseline level of compliance was found to be 33.59%. A total of 6 attempts was required to achieve 100% compliance, with the increase in compliance being statistically significant (p = 0.0294). Personal instruction was found to be the most effective intervention. Hand washing technique was the criterion that needed the most number of attempts (n = 6) to rectify. This study found video-based instruction and individual guidance effective teaching tools for surgical hand disinfection and gave novel data regarding the reasons responsible for poor compliance to proper hand washing in a general surgical setting. This study demonstrated the efficiency of audit cycles in the improvement of surgical hand washing and can be the preferred mode of intervention in future studies aimed at achieving ideal hand antisepsis.

A Field Fire Ulcer.

Basal cell carcinoma (BCC) is the most common skin cancer, mostly affecting areas of the skin exposed to UV radiation. Though metastasis is rare, the tumour may be locally invasive with a high recurrence rate. Pathophysiology involves neoplastic transformation of the pluripotent cells of the epidermis and follicular epithelium. 'Field fire BCC' is an uncommon type of BCC, showing concomitant crusting, ulceration and scarring which spreads peripherally with a central area of regression.