UV Light

"There is nothing new under the sun but there are lots of old things we don't know."
-Ambrose Bierce, The Devil's Dictionary US author & satirist (1842 - 1914)

"A man should never be ashamed to own he has been wrong, which is but saying, that he is wiser today than he was yesterday."
-Alexander PopeEnglish poet & satirist (1688 - 1744)

Today I spent some time discussing different medications that was in a shelf of a medicine cabinet in the ER. I held up a box of tetanus vaccine. I asked the ER doctor what were the indications for the vaccine and how long does the immunity last once the vaccine is administered. He knew when and how to use it but then he said that the vaccine only gives you 6 months of immunity against tetanus. I corrected him and I told him that it is actually good for 10 years. His reply was, "No, this vaccine is from China, it only lasts 6 months." We both laughed. He was still wrong.

I held up a bottle of Atropine and I asked him for what conditions does he use it. He said that he would use it to control severe nausea and gastrointestinal upset. I walked over to a Advanced Cardiac Life Support poster that we put up last week and I showed him where in the algorithm that it should be used. It did not strick me until tonight that Atropine could probably be very effective in controlling gastrointestinal over-activity because it works on the parasympathetic nervous system which effects gastrointestinal motility. We probably do not use it in the states for that reason because it is potentially very toxic. So he was not entirely wrong he is just behind the times I guess you could say.

Similarly, there were numerous vials of Aminophyline which was commonly used for asthma in the 1970s but is not commonly used anymore in the states because it has a lot of toxic side effects and it has to be monitored closely. Incidentaly, I have yet to see any asthma inhalers. I think that it may be a cost issue.

I held up a vial of Calcium Gluconate and I asked the same question. He said something about its use with diabetes. I told him that since they do not have a lab where they are able to calculate a patients calcium level then he probably should not be giving it to anyone.

I held up a vial of Vitamin K and I asked when does he use this. He answered that it would be used on someone that has a bleeding problem. In the states, Vit K would be used to reverse someone that is taking too much Coumadin. I have yet to meet anyone on Coumadin in Afghanistan and unless we are dealing with a Vit K deficiency, which is pretty rare, it probably does not have much use in an ER. He also had vials of Vitamin B6. In the states we use this only when we prescribe a common tuberculosis medicine called INH. I wonder if Vitamin K and B6 are needed because nutritional deficiencies are common in Afganistan.

We then went through about 5 different blood pressure medications. One of them was Digitalis. This is another medication that needs to be monitored by a lab and I know that they do not have that capability.

I went upstairs and I learned that they were going to have their first surgical case in the OR. I was very excited for them. I have been told that they have the nicest operating room in all of Afghanistan. Here is a picture.

I walked into one of the ORs and the surgeon was very hesitant to have me go in the room. He explained that the UV light was on. When I first learnt that they used UV light to sterilize their operating rooms I sort of smiled to myself thinking that they were misguided. Tonight I was a little curious to see if I was correct because it was not the first time that they have proven me wrong. I actually found that there was a lot of literature on the use of UV light for germicidal irradiation. It has been in use for over 100 years. In 1903 the Nobel Prize for Medicine was awarded to Niels Finsen for his use of UV against tuberculosis. Here is a link to an article.

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Here is another article that I found on the first operation under UV light.

"January 15, 1936 a Duke surgical team led by J. Deryl Hart, MD, performed the first operation under ultraviolet (UV) lights.

The early days of Duke Hospital saw rash of postoperative infections, some fatal, in patients with large, “clean” surgical wounds. Duke surgeons investigated this puzzling problem. Tests showed the cause of the infections to be staphylococcus aureus. They focused their investigation on how the bacteria got into the operating rooms, as all personnel followed prevailing aseptic procedures for themselves and the patient, as well as sterilization of all equipment used in operations. They found that surgical staff brought the bacteria into the operating room on body hair, particularly in the nose. The most careful scrubbing didn’t eliminate all the bacteria on a person’s body.

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To combat the problem, Hart’s team turned to ultraviolet lights. They determined the exact power needed in UV lights to kill the bacteria in the operating field with the least risk for operating room personnel. Surgical staff, because they frequently worked under UV lights, had to wear protective clothing with visors to shield their eyes. The patients were safe as they were in the operating room only once.

Results were seen immediately. Patients experienced less post-operative pain, and, most important, infections fell from 33 percent to 3.8 percent, with no fatalities. Other hospitals following Hart’s lead experienced the same results. The cost for this improvement was minimal: UV lights sold for less than $10 each from retail outlets.

This research garnered national attention for the new Duke Hospital."

I got to thinking a little bit more, and I was reminded that a year ago, before we moved into our new home, we hired someone to get rid of the tobacco smoke smell from inside the home and they used UV ozone. So here I was thinking that they were doing something that was futile and I did not even bother to research its validity or even realize that I used the same method to rid my home of tobacco smell a year ago. Talk about pie to my face. I am still going to emphasise the use of bleach and other common methods to reduce germs in the OR, but they can continue on with their UV light. Here is the light. It hurts my eyes just looking at the picture.

The VCR program did their weekly sorting tonight. A few of you might recognize some of the boxes.

Some kid is going to look very stylish with these snake skin boots.

Muslims will be celebrating another Eid soon. It is officially called Eid ul-Adha and it lasts four days, a day longer then the Eid that took place after Ramadan, hence the name, "The Greater Eid."

I included a small summary from Wikepedia if you would like to learn more about it. Here is a link to the entire article.

"Men, women, and children are expected to dress in their finest clothing to perform Eid prayer (Salatu'l-`id) in any mosque. Muslims who can afford to do so sacrifice their best domestic animals (usually sheep, but also camels, cows, and goats) as a symbol of Ibrahim's (Abraham's) sacrifice. The sacrificed animals, called "udhiya Arabic: أضحية" also known as "qurbani", have to meet certain age and quality standards or else the animal is considered an unacceptable sacrifice. Generally, these must be at least 4 years old, and weigh 26 st. At the time of sacrifice, Allah's name is recited along with the offering statement and a supplication as Muhammad said. According to the Quran a large portion of the meat has to be given towards the poor and hungry people so they can all join in the feast which is held on Eid-ul-Adha. The remainder is cooked for the family celebration meal in which relatives and friends are invited to share. The regular charitable practices of the Muslim community are demonstrated during Eid ul-Adha by the concerted effort to see that no impoverished Muslim is left without sacrificial food during these days. Eid ul-Adha is a concrete affirmation of what the Muslim community ethic means in practice. People in these days are expected to visit their relations, starting with their parents, then their families and friends."

Thanks for reading.