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Michael Peck
May 4, 2010, 1:09:46 PM5/4/10
to ABA Prevention Committee
Subject:
Date: Tue, 4 May 2010 16:53:07 +0800
From: andre...@surgery.cuhk.edu.hk
To: sd.m...@wxs.nl; Tom.P...@wales.nhs.uk; rba...@gmail.com; jmo...@wfubmc.edu
CC: mpe...@hotmail.com; wibe...@hotmail.com; aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; mo...@who.int; cinnam...@gmail.com
David, as an Edinburgh man EUSOL must be dear to your heart but this relates to the nursing research back in the early 1990's done under the supervision of David Leaper when he was a Senior Lecturer in Bristol and they discovered, not surprisingly that Eusol kills cells in culture. The nurses took this on board and decided it was bad for wounds and it got completely out of control even having a lawyer writing in the Nursing Mirror opining that any nurse asked to clean/dress a wound with Eusol by a doctor should refuse and contact her Union rep....letters in the BMJ etc etc wonderful stuff.
But yes, the ISBI has to keep up with the times and love it or hate it Facebook is one way. Another way is to form a Yahoo discussion group - but yes David whilst you are in charge get something set up...very happy to help and even co-ordinate the Asia Pacific sector!!
Take care and best wishes,
Andrew
By the way could you forward this to Keith Judkin as his AOL server does not like Chinese servers.
Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,
Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.
email: andre...@surgery.cuhk.edu.hk
tel: (852).2632.2639
fax: (852).2632.4675
From: David Mackie [mailto:sd.m...@wxs.nl]
Sent: Tuesday, May 04, 2010 4:37 PM
To: Tom Potokar (ABM ULHB - Burns & Plastics); BURD, Andrew; Rajeev Ahuja; Joseph Molnar
Cc: Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Subject: RE: Urgent...on elbows!
Dear Andrew,
I agree with Tom.
I think the elbow test is a red herring: either the water was too hot, whichever way the nurse tested or failed to test the water, in which case the nurse would appear to be negligent, or there was some other cause of the injuries, as Ken Dunn suggested.
This email discussion has been most interesting. How can the ISBI best create an effective Q and A forum to help members in this way? Any ideas?
(website? blog? facebook? - I know nothing about these things.) Email is effective, because the messages drop into the inbox, but there is a wider membership out there who have not been reached this time, nurses in particular!
Kind regards to all
David Mackie
(p.s. we still use EUSOL from time to time, but I do not recall any incident relating to it.)
-----Oorspronkelijk bericht-----
Van: Tom Potokar (ABM ULHB - Burns & Plastics) [mailto:Tom.P...@wales.nhs.uk]
Verzonden: dinsdag 4 mei 2010 10:08
Aan: BURD, Andrew; Rajeev Ahuja; Joseph Molnar
CC: Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Onderwerp: RE: Urgent...on elbows!Hi Andrew,A couple of comments..you mention that the water was 45 degrees. If you put your hand into 45 degress you would immediately remove it as it is certainly extremely uncomfortable (different from if you are in bath at 40 degrees and slowly increase the temp.) I am therefore suprised that the nurse was able to bathe the baby in this temp and also very suprised that there was no (apparent) screaming from the child. The elbow dipping business seems like nonsense to me and reflects more the sort of practice that Hattie Jaques would have done in a carry on film than any baring on evidence or reality.ReghardsTomMr Tom Potokar FRCS(Ed); FRCS(Plast); DA(UK); DTM&HConsultant Plastic SurgeonSenior Clinical TutorDirector InterburnsWelsh Centre for Burns & Plastic SurgeryCanolfan Llosgiadau a Llawfeddygaeth Blastig CymruEmail: Tom.P...@wales.nhs.ukTel:0044 (0)1792 702222 ext 4574 (Secretary)
From: BURD, Andrew [andre...@surgery.cuhk.edu.hk]
Sent: 30 April 2010 02:38
To: Rajeev Ahuja; Joseph Molnar
Cc: Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom Potokar (ABM ULHB - Burns & Plastics); Tom Potokar (ABM ULHB - Burns & Plastics); Tom Potokar (ABM ULHB - Burns & Plastics); Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Subject: RE: Urgent...on elbows!Cymraeg;-Many thanks for all the comments so far.It has been ascertained that the temperature of the water was most probably in the region of 45 degrees Celsius (113 degrees Fahrenheit for our American friends). The baby is three months old and did not cry during bathing.Was in the water for two to three minutes.When the nurse was drying the baby she noticed some blistering of the skin of the lower limbs. Subsequently extended to 14% BSA and the baby was transferred to a PICU in the south of HK. I have not been able to see either the baby or the photographs but apparently baby is fine and not needing surgery.Headlines in today's paper: "Scalded baby's nurse admits making an error" and the error? She did not use her elbow to test the water temperature! Apparently all the nursing schools in HK tell the nurses to test the water with the elbow. Parents want compensation and the nurse to be sacked.Something so simple and it is to do with Burns Prevention. The mixer tap would deliver water at 48 degrees centigrade so that is too high a temperature. Thermometers are not perfect. I have asked my Face book friends this question and yes there seem to be two diverging schools of thought....the thinkers and the doers! The former use hands, thermometers, wrists and anything but the scragg end of the chickens neck (the human elbow) and those that follow grandmothers advice..well they do dip the scragg end of the chickens neck in the water!Does anyone remember the Eusol debate?So how can one sensitively educate the nurse educators?!For all doctors replying to this can you take a straw poll of your nursing colleagues to see how they respond to the question "How do you test the temperature of the water before bathing a three month old baby in a bath?".Best wishes to all.AndrewProfessor Andrew Burd. MB ChB MD FRCSEd FHKAM
Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,
Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.
email: andre...@surgery.cuhk.edu.hk
tel: (852).2632.2639
fax: (852).2632.4675
From: Rajeev Ahuja [mailto:rba...@gmail.com]
Sent: Friday, April 30, 2010 8:59 AM
To: Joseph Molnar
Cc: BURD, Andrew; Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Subject: Re: Urgent...on elbows!This seems like the most sensible and scientific reasoning to me by far.Rajeev AhujaOn Fri, Apr 30, 2010 at 6:24 AM, Joseph Molnar <jmo...@wfubmc.edu> wrote:
Joe,
We did a mathematical model of a contact burn a few years ago based on the work of Moritz and Henriques (American Journal of Pathology, 1940's, 3 articles).
Raphael, Florin Despa and I looked at specific macromolecules and how they denature as a function of temperature. The bottom line is that in the US, there are plumbing standards to keep water from exiting the tap of less than 120 deg F. This is nicely summarized in the following website (its an expert witness website but seems accurate):
http://www.hgexperts.com/article.asp?id=5135
Seems like this is a lack of plumbing standards and not which part of the body can sense temperature the best, (an unreliable metric - that's why we have thermometers).
Best,
do
Dennis P. Orgill, M.D., Ph.D.
Professor of Surgery
Assistant Program Director
Combined Plastic Surgery Residency
Harvard Medical School
Associate Chief, Plastic Surgery
Brigham and Women's Hospital
75 Francis St.
Boston, MA 02115
▼ 617-732-5456
▼ 617-732-6397
dor...@partners.org
From: BURD, Andrew [mailto:andre...@surgery.cuhk.edu.hk]
Sent: Thursday, April 29, 2010 6:43 AMCc: ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Joseph Molnar; Charles Mock; Rajeev Ahuja; cinnam...@gmail.com
To: Michael Peck; Wilma de Benavides
Subject: Urgent...on elbows!Dear Michael and fellow member of the prevention committee...breaking news in Hong Kong. A baby has been accidentally scalded whilst in a public hospital and the investigation panel deemed that because she had not tested the temperature of the water with her elbow she was negligent and will be disciplined. The parents are clambering for her to be sacked. The nurse is understandably going through hell.I am trying to find any evidence to support or refute the "elbow test" as a matter of urgency. There are those who are claiming it is a world wide practice to test the temperature of the water with the elbow. My preliminary research indicates that it has as much justification as many urban myths and the only justification I can find is the comment that the hands are used to water and therefore not so sensitive to the temperature whilst the elbow is not so used to water and so is more sensitive to the temperature. This explains why grandma used to say test the temperature of milk on the wrist and the temperature of water by the elbow..but is grandma's explanation justification for sacking nurse?!It strikes me that this is a load of nonsense but what are the facts!Please let me know your thoughts on this asap as we have to nip this in the bud one way or the other.best wishes,AndrewFor what it is worth I have raised four children and given countless baths but never used my elbow!! Oh and it was not my hospital and have no personal involvement but I do care about the child and the parents but also about the nurse.Professor Andrew Burd. MB ChB MD FRCSEd FHKAMChief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,
Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.
email: andre...@surgery.cuhk.edu.hk
tel: (852).2632.2639
fax: (852).2632.4675
--
Dr. Rajeev B. Ahuja
Secretary, ISBI
Secretary General, IPRAS-Asia Pacific Section
Chair, IPRAS 2009
Head, Department of Burns & Plastic Surgery,
Lok Nayak Hospital & assoc. Maulana Azad Medical College,
New Delhi -110002
Phone: 011-23231871
Fax: 011-23222756
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