Thursday 19 July 2018

Nosocomial nose? The noes have it!

Joy! Sometimes the headlines write themselves. Regular readers will know that I lurk-a-lot at Metafilter a site which allows a community of interested and interesting people to post once a day about what is floating their boat. Not everything there floats mine, but there is enough overlap that I check in most days in my restless search for Blob-copy. A MeFi post about I recognized your foul stench [It's a Star Wars ref] just cries to be clicked.

I've been interested academically in the evolution of olfactory receptors and am curious about the refusal of my students to use theirs. Pretty much anything that smells in the lab (or the previous inhabitants of a lecture theatre) will have them elaborately fanning their faces and throwing open windows. Young people don't like silage or slurry [or even know the difference]; they don't like Escherichia coli; Bacillus subtilis; Streptomyces or Pseudomonas aeruginosa - none of them or old bones. Limburger? No thanks! In my human physiology course I tell the students that, before they had pee-sticks, doctors used to diagnose diabetes by dipping their finger in a urine sample and tasting it - sweet indicates a problem, because are kidneys are really good at recovering circulating glucose. EEeeuuww, the students shriek. They must be terrible cooks if they are so unwilling to taste, taste, taste.

The MeFi post is more or less about a commercial product called Liquid Ass which 'smells like butt-crack' and has a ready market among fart frat boys even at $13/bottle. Ho ho "I sprayed a small stream of it in my buddy's office and it ruined his entire day!" etc. But there is a minority demand for the product among those who are training nurses, first-responders and battlefield triage medics. Best get the disgust [prev] under control in class before you have to deal with it at the coal-face. As so often on MeFi, the comments are often as rich as the original post. I now know far more than I need  about fisting, for example. And a list from Slarty Bartfast of various hospital smells that knock Liquid Ass into the ha'penny place: yeasty body odour; bloody stool; necrosis and gangrene. And others that are less unpleasant: electrocautery [bloboprev]; amniotic fluid, strep throat

But, given my previous short list of the smell of different species of bacteria; and my ongoing interest in the well-known potentially deadly nosocomial [hospital-acquired] pathogen Clostridium difficile, I was delighted to find the comment by ericales "I've found C. diff to have a very recognizable odor." Yes, yes, but what is that smell? I googled and found lots of nurses certain that they were 100% precise and 100% accurate and no need for the path lab in detecting a C.diff infection by the whiff: moldy like stale bread...tinged with a little skunk; outhouse during 3 months of 110+ degree temperature days; rotten chicken meat smell, (like when you smell that chicken and go..."no way..can't make this tonight!) mixed with baby diaper sweet smell, mixed with old blood smell [which in turn smells like I have nickels in my mouth]; road kill on a 100 degree day mixed with silent but deadly flatus.

But it just ain't true, because when you put normal nurses, even the confident ones, in a proper scientifically controlled double-blind experiment, it turns out that they are piss-poor in matching the smell to real C.diff samples. But you might have know that already from the lack of agreement about what C.diff actually smells like.

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