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To measure directly the rate of contamination, during routine patient examination, of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci (VRE).
A large, academic, tertiary-care hospital.
Between January 1997 and December 1998, 49 patients colonized or infected with VRE were entered in the study.
After routine examination, the examiner's glove fingertips, gown (the umbilical region and the cuffs), and stethoscope diaphragm were pressed onto Columbia colistin-nalidixic acid (CNA) agar plates with 5% sheep blood plus vancomycin 6 ug/mL. The stethoscope diaphragm was sampled again after cleaning with a 70% isopropanol wipe.
VRE were isolated from at least 1 examiner site (gloves, gowns, or stethoscope) in 33 (67%) of 49 cases. Gloves were contaminated in 63%, gowns in 37%, and stethoscopes in 31%. All three items were positive for VRE in 24%. One case each had stethoscope and gown contamination without glove contamination. Only 1 (2%) of 49 stethoscopes was positive after wiping with an alcohol swab. Contamination at any site was more likely when the patient had a colostomy or ileostomy. Patients identified by rectal-swab culture alone were as likely to contaminate their examiners as were those identified by clinical specimens.
Our study revealed a high rate of examiner contamination with VRE. The similar risk of contamination identified by surveillance and clinical cases reinforces concerns that patients not known to be colonized with VRE could serve as sources for dissemination. Wiping with alcohol is effective in decontaminating stethoscopes.
It is usual to observe that there is nothing republican in Algernon Sidney's Discourses concerning government that Milton did not better express; nothing institutional that Harrington did not better imagine; no theoretical or polemic point that Locke did not better conceive and argue. Granted such a dearth of originality in Sidney's case, there yet remains an achievement peculiar to his writings which perhaps Locke alone comes anywhere near approaching. This achievement has to do with ethopoeia or self-representation, an ineradicable dimension of all political activity, yet somehow hidden from our discussions of political philosophy. Sidney and Locke (and Hobbes a bit more slyly) recognize that political ideas most obviously do not operate in a vacuum, but must make their way through a maze of human habit and history, sentiment and experience, which comprise the very stuff of political practice. That is to say, for any idea of government to be understood and embraced, it must be found personable, sociable – congenial to the beliefs and aspirations, apt and timely to the needs, of the community to which it is addressed. Such civility is properly exercised by the author, whose formulations convey something more than an intellectual position, because the way in which a political argument is conducted not only implicates the character of the person making it but the nature of the society to which we are enjoined.
It is sometimes possible to catch philosophy “doing rhetoric” - which is to say seducing us with mere play of words - where it professes not to, thereby compromising its own claims to truth. Doing rhetoric means orchestrating a subtle slippage of meanings where philosophy has imposed distinctions, surreptitiously evading if not subverting philosophical categories and constraints, and asserting one sort of order but pursuing another. Hobbes offers a particularly tempting target for such criticism, inasmuch as he makes his science linguistic and formal rather than experimental and material. That is to say, he makes science a matter of how we use words. But there is also a considerable, indeed ancient history to this pastime of partitioning off philosophy from rhetoric, perhaps inaugurated by Plato, who depicts Socrates as opposing his sort of speech to the speech of the great Sophists Gorgias and Protagoras, as well as to such virtuoso orators as Lysias.