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Infant Bioethics Committee

A preterm baby had had necrotising enterocolitis and his entireintestine was necrotic. At 2 weeks of age, he no longer needed theventilator, and a laparotomy confirmed that he had no functionalbowel. Should the parents be asked if they would like the baby tohave a central intravenous line sited, for total parenteral nutrition?At the Albert Einstein College of Medicine this question wasresolved by the Infant Bioethics Committee,l which was unanimousin the opinion that the parents should be offered the placement of aline. Some committee members believed that it would be better forthe baby to die sooner rather than as a result of complications of anintravenous line. The parents decided on a central line for their

baby. Despite many complications of the line, the infant lived for 17months, but his mental development was poor and he was able to dolittle more than recognise his parents. He was perceived, by hisparents, as experiencing pleasure, and the parents enjoyed caring forhim.From the parents’ point of view, the committee made the right

decision, but whether or not the treatment was in the best interestsof the infant is unknown. Would the course of events have been anydifferent if the ethics committee had not been involved?

1. Fleischman AR. Parental responsibilities and infant bioethics committee. HastingsCenter Rep 1990; 20: no 2.

Dirty dishcloths

Nothing instils confidence in one’s dinner party guests more than adisplay of sparkling worktops and gleaming utensils. A well-keptkitchen may indeed be a fair indication of culinary delights to come,but according to Scott and Bloomfield1 there are hidden healthhazards lurking among the pots and pans. These workers

investigated the survival and transfer of microbial contamination viacloths, hands, utensils, and laminated surfaces. They found that theextent of survival of microorganisms (laboratory and wild-typestrains of Escherichia coli, Klebsiella aerogenes, Pseudomonasaeruginosa, Salmonella spp, and Staphylococcus aureus) dependedon whether cloths and surfaces were clean or soiled--soiled cloths,not surprisingly, allowing better survival. Drying led to a

substantial reduction in recoverable organisms from clean surfacesbut was less effective for soiled surfaces and cloths-even cleancloths. That more organisms were recovered from cloths at a giventime than from surfaces was probably largely because of the slowerdrying rate of the cloths. Additionally, they found that largenumbers of organisms were transferred from contaminated

surfaces, utensils, or cloths to fingers, or from contaminated clothsto surfaces. Their findings emphasise the importance both of goodhand hygiene and of adequate decontamination procedures forcloths, laminated surfaces, utensils, and other food contact surfacesduring the handling and preparation of food. Scott and Bloomfieldthen go on to investigate the most effective decontaminationprocedures They found that chemical disinfection of cloths withhypochlorite and phenolic disinfectants led to substantialreductions in contamination, although this may be unreliable forheavily contaminated cloths. Detergent washing alone was not goodenough to decontaminate cloths, and leaving cloths at room

temperature after washing led to regrowth of survivors. Foreffective and consistent decontamination of cloths, washing shouldbe followed by drying at 80°C for two hours.2 The best advice? Usedisposable cloths.

1. Scott E, Bloomfield SF. The survival and transfer of microbial contamination viacloths, hands and utensils. J Appl Bacteriol 1990; 68: 271-78.

2. Scott E, Bloomfield SF. Investigations of the effectiveness of detergent washing,drying and chemical disinfection on contamination of cleaning cloths. J ApplBacteriol 1990; 68: 279-83.

Lancet telephone numberOn May 6 the prefixes for telephone numbers in the London areawill acquire an extra digit. To contact The Lancet, callers fromoutside central London should dial 071-436 4981.

In England Now

Your review of the book Myocardial Medley (March 10, p 597)reminds me of a consultant radiologist with whom I once worked.He was fascinated by unusual syndromes, and one of his ambitionswas to detect and report upon the one which involves bronchiectasisand dextrocardia.The day came when we sent him a patient for a bronchogram

(which I undertook). When the radiograph came to be read, thelung lesions were easily seen and the heart shadow was clearlyoutlined. Unfortunately, my colleague had been working with astudent radiographer who had a habit of mixing up her left and rightside markings. Without thinking he reversed the plate. Some timelater, we pointed out his error and suggested it might be a case ofKartagener’s syndrome. They say his wrath was wonderful tobehold.

* * *

This city, so far north that it is beyond the range of the Met Officeradar, is said by its inhabitants to have nine months of winter andthree months of cold weather. My office, for reasons no doubt validto workhouse architects, juts out from the main hospital building sothat it is exposed on three sides. The windows are draughty and theradiators are placed directly beneath them to give the impression ofwarmth without the reality. Which explains why I requestedadditional heating when I took over the office some years ago.Although persistent, I failed. However, a couple of years agorenovations to the building required that I move out of my office to asmaller room so that my room could be used by a speech therapist, agirl whose charms and better communication skills resulted in herhaving a portable electric radiator within a week.When I returned some months later, the portable radiator

remained, apparently forgotten by management. But during thewinter most Monday mornings find me seeking my radiator. This Ido under the pretence of showing the new group of medical studentsaround the hospital, which must leave them puzzled at the strangeplaces I apparently feel it important for them to know.The reason I must do this is that during the course of most

weekends my radiator is removed: if the radiator was my own

property I might use the word stolen, but since it belongs to thehealth authority I am content with the word removed. On oneoccasion a patient had been admitted with hypothermia and myradiator was apparently the only portable source of heat available.Often the junior medical staff take it to heat their own rooms.Sometimes a ward heating system has failed and my radiator hascome to the rescue. Occasionally one or other of my consultantcolleagues has felt his need was greater than mine--most

embarrassing as I have to make excuses to visit each of their officesin turn, and having located it decide whether to accuse the occupantor stay quiet and remove it later.

However, I have found that having a cold office has someadvantages. Many an interview with relatives who were expected tobe "difficult" has started with a long sympathetic discussion abouthow the NHS treats doctors, and the resulting empathy has madethe rest of the interview much more friendly than expected.

International Diary17th congress of the Collegium Internationale Neuro-

Psychopharmacologicum is to be held in Kyoto, Japan, on Sept 10-15:17th CINP Congress, c/o Simul International Inc., Kowa Building No 9,1-8-10 Kasaka, Minato-ku, Tokyo, Japan.

International conference entitled Multidisciplinary Aspects ofTerminal Care will be held in Glasgow on Sept 11-13: Prince and Princessof Wales Hospice, 73 Carlton Place, Glasgow G5 9TD, UK.

12th congress of the European Society of Cardiology is to be held inStockholm, Sweden, on Sept 16-20: Secretariat of Fellowship of the ESC, 22rue Juste Olivier, PO Box 299, CH-1260 Nyon, Switzerland (22-62 13 77).