Hi all,

I am trying to decide on a surgeon and I found one that seems very competent, has good reviews, and is in my price range. The problem is he has a video up of him doing a surgery and his nose is not covered by his mask. No one in the operating room has their nose covered actually. Should this be a deal breaker? Or is it not that big of a deal? I checked several other videos and most surgeons have both mouth and nose covered even if wearing eye glasses. I did see one or two where someone other than the surgeon didn't have their nose covered.

In addition - I think I saw the first one (nose not covered) open a package of something - maybe a bandage - while wearing his gloves. Would that be an issue? I doubt the package would be sterilized on the outside like instruments are so....? What do you all think?

Oh right - I forgot her name. Thank for for your good wishes.

This conversation is killing me! I just can't not chime in a little more.

The mask is a long time gold standard in the US, and kind of a "no-brainer". I think the reasons have been outlined why in this thread. For a little more background: Back in the day, florence Nightingale was actually revolutionary, and her studies and data collection birthed hand-washing that remains the number one barrier against infection, and was the precursor to infection control. Today, In the operating room, AORN and APIC have identified best practice that includes wearing of masks. Hospitals and clinics have to meet standards for infection control, and routinely have to pass surveys where they are observed in action. In most hospitals, its the Joint Commission who surveys, and their survey standards are based on CMS requirements and other governing bodies known best practices. If ANYONE entered the OR once the room is prepped for surgery without a mask, you'd get a huge ding - and maybe not pass that survey (I am not an expert on OR standards so I can't say if that would be enough to shut you down, but it might be) I don't know who regulates Mexican ORs.

For me, the bottom line is that even if you think there is not enough evidence to say you must wear a mask, I do think there NO evidence to say wearing one would hurt. Given the fact that it's a universally expected standard of care in the United States makes me think it's a good idea.

Hi Michigan chick. Thank you for your input. I just want to point out that they are all wearing masks. It is the nose covering issue that is the problem. Did you mean nose in your above post or just mask in general? For me - not having the nose covered is pretty much the same as not wearing a mask though.

Thank you for explaining about the standards. I added a question on my google comparison chart I made asking if they follow ASMBS guidelines. I will add the other standards you mention.

Interestingly, I did see one or two studies that showed wearing a mask (at all) could lead to a slightly higher but not significantly higher infection rate because the mask edges would scrape off bacteria laden facial skin cells which would float down into the incision. The overwhelming advice I have found in various protocols, however, is that tying the mask correctly is a must and that means over nose and mouth.

You are welcome to chime in as much as you want.

Edited June 7, 201412 yr by Travelmego

Hi. Travel. Sorry for the delayed reply.

I would have some concern re: overall in-office, in-OR procedures. if someone is lax about something as basic as surgical masks, what else do they cut corners on?

If this place is your only option, then definitely... kindly tell the doctor and the team that you insist on them wearing masks for your procedure, and to do so from skin-to-skin (i.e., from when they take you in the room and first cut you, to when your skin is closed). Granted, with you asleep, you won't know; but patients everywhere have to speak up for what they want these days. Guess that includes wanting a surgeon to wear surgical masks.

Good luck.

@@Dr-Patient - sorry, I thought I had replied to your post. Do you think it would be enough if the surgeon agrees that everyone has a mask over mouth and nose or would this be too much a major indicator of other sloppy practices

Aha, I see the debate lives on!

@@zmdh39 Because in the USA doctors can easily get sued and that tends to encourage them to follow stringent criteria. This has widely been seen as a plus in improving sanitary conditions. The down side is it drives up costs. Mexico doesn't seem to have the same set up where doctors can be easily sued. I don't know how their licensing and revocation works.

In the case of the USA, perhaps putting government controlled rules might make implementing new sterile procedures slow down to the minimum required by the government. The government would cover the hospitals and physicians tushes that way rather than the legal and insurance system do it. What does Mexico do?

I am really not following your point about why do people comment? I am not going to wait till after I go to Mexico to have an opinion on Mexican sterile techniques. <3

Edited June 10, 201412 yr by Travelmego

@@Travelmego I did mean mask on the nose, but really, in my opinion, not putting it over the nose is just about like not wearing one at all.

Travelmego- masks are in issue for you? How about gloves?? My nurses rarely wore gloves!! Taking my IV plug in and out, emptying my drain...no gloves. And their gloves, when worn, did not fit.

I am still planning on writing about my experience but I have an infection in my right wrist where my IV was placed and I can't even turn my car key, let alone type. I am in here using swipe with my phone.

Travelmego- masks are in issue for you? How about gloves?? My nurses rarely wore gloves!! Taking my IV plug in and out, emptying my drain...no gloves. And their gloves, when worn, did not fit.

I am still planning on writing about my experience but I have an infection in my right wrist where my IV was placed and I can't even turn my car key, let alone type. I am in here using swipe with my phone.

Oh dear! I'm sorry to hear that this has happened to you, dear Sassy.

Sassy, oh my. You just got home didn't you? Please be sure to go to the doctor about your hand right away.

Sassy, oh my. You just got home didn't you? Please be sure to go to the doctor about your hand right away.

I went to the ER when I had a very high fever the night I got home.

Get phone numbers before you leave Mexico and have plans for what you will do when you get back to the US.

Ok, I am imagining proper technique in my head for putting in an IV. Mind you, I don't know squat but......

Ok, Should the nurse put on gloves, then open the sterile pack not touching anything else, and then insert the needle?

Or should the nurse open the package, then drop the needle onto a sterile cloth without touching it, and then put on gloves and then insert it in you before touching anything else?

I know the inside of the sterile pack is sterile but I don't think the outsides are right? So how do they keep it sterile?

Rocky - as much as I would love to go to an internationally certified hospital, the doctors I have seen at Angeles are out of my budget. And no, I don't have the time to save up the extra. I am on a tight schedule. So, for me - it has been a matter of comparing doctors in the 4,500 range. I feel comfortable (so far!) with the one I found. However, we must all practice due diligence and ask, ask, ask about sterile technique.

Question is - what do we ask? If you all can help me figure out what to ask,

I will add it to my google doc chart. I am going to make a final checklist master template so people can ask these questions while researching themselves.

Edited June 13, 201412 yr by Travelmego

I am not implying my infection wouldn't have happened in the US, not for one second!! I'm not saying lack of gloves caused my infection.

Just saying if lack of masks scare you, my nurses didn't wear gloves, quite a bit.

She wore them doing the initial set up of my IV but not when plugging it to take a shower or when emptying my drain.

Times when she came in contact with my bodily fluids. So it is the nurses who were putting themselves at risk.

Good god, if she isn't concerned about her own self coming into contact with bodily fluids.........

If I were working in a hospital I think I would just wear a hazmat suit the entire time.

@@Rocky1 Yea I think he is a good choice. Seems to be so far. I spoke with a lady who is an OR scrub nurse in the usa and had just had surgery with him. She said his sterile technique was perfect.

Edited June 14, 201412 yr by Travelmego

Ok, I am imagining proper technique in my head for putting in an IV. Mind you, I don't know squat but......

Ok, Should the nurse put on gloves, then open the sterile pack not touching anything else, and then insert the needle?

Or should the nurse open the package, then drop the needle onto a sterile cloth without touching it, and then put on gloves and then insert it in you before touching anything else?

I know the inside of the sterile pack is sterile but I don't think the outsides are right? So how do they keep it sterile?

LOL, none of the above. Some procedures are clean, some are sterile, which dictates the process.

Here's the thing. I think it's imperative that you are the master of your own health care and that you make informed choices. You should expect your healthcare practitioners to provide safe care and you should have some basic expectations (like did you SEE them wash their hands before and after the touch you). But since you are not a medical professional, you are never going to be able to evaluate everything they do. You need to make sure they are accredited by some regulating body to show that they meet standards of practice. Research the best you can, and go with someone you trust. The trust is key here, because even if they have passed a survey, there is no guarantee they will not deviate during your procedure. You need to trust that they will adhere to the standards when no one is watching.