Question: Victor Krenz is assisting Dr. Connors with the fifth cataract surgery for the day. The patient is Kathy Wall, a diabetic patient, whose condition has been stable enough for her to undergo a surgical procedure. Victor has performed a six-minute surgical scrub on his hands before each of the five procedures. Dr. Connors indicates that he is in a hurry to get back to his office for a heavy afternoon schedule of patients. After both Dr. Connors and Victor are scrubbed, gowned, and ready to begin the operation, Victor feels a slight prick on the tip of his gloved finger as he moves the sterile syringe and needle on the tray. Dr. Connors, who does not notice the accidental needlestick to Victor’s glove, states again that he is in a hurry to finish this procedure. Victor knows that it will delay the surgery if he has to change gloves. He also knows that his hands have had a surgical scrub five times that morning and that they are clean.

Can Victor justify not changing into new gloves?

What could happen to Ms. Wall as a result of Victor’s needlestick?

How should Victor handle this situation?

José Menendez is an elderly patient of Dr. Juárez, a board-certified urologist. José has a history of recurrent UTIs dating back more than 10 years. When he becomes symptomatic, he has been instructed to call Dr. Juárez’s office and schedule a urinalysis. Dr. Juárez’s receptionist has just received a call from Mr. Menendez. He says he knows he is supposed to come in for a urine test but that he just wants a prescription phoned into his pharmacy instead. The receptionist asks Emilia, Dr. Juárez’s medical assistant, to take the call from Mr. Menendez.

Emilia listens as Mr. Menendez recounts that he is experiencing dysuria—painful, burning urination. She asks him to come in for a urinalysis, explaining that, as per standing orders, a clean-catch midstream specimen needs to be collected. Mr. Menendez repeats to Emilia that he does not want to come in to the office. “Why can’t you call in a prescription for Bactrim? That is what I took last time, and it helped.”

What is your response?

Should the responsibility for this call have fallen on Emilia, or should the receptionist have either handled the call herself or passed it on to Dr. Juárez?

What, if anything, could or should Emilia say to Mr. Menendez to persuade him to come in for the urinalysis?

Might the cost of the procedure be a factor in the reason why Mr. Menendez does not want to have a urinalysis, and, if so, what, if anything, can Emilia do or say about the cost?

Is it appropriate in this case, given the patient’s extensive history, to indeed call in a prescription for Bactrim?

If not, how should Emilia handle Mr. Menendez’s request for his prescription?

If so, what procedure should Emilia follow to arrange for a prescription?

How should this telephone call be charted?

What, if anything, should Dr. Juárez be told about the conversation with Mr. Menendez?

Answer: The surgical team needs to wear sterilized gloves to prevent transmission of infections…….