127 Hours: Great movie but disgraceful display of infection control

Following on from the likes of Shallow Grave, Trainspotting, 28 Days Later and Slumdog Millionaire; Danny Boyle is developing quite a reputation fordirecting films that take the audience out of their comfort zone. His latest epic, 127 Hours, is certainly no different.

Variously described as gruesome, gut-wrenching, stomach-churning, frightening, nauseating, bloody and horrific, the movie was based on Aron Ralston's autobiography, Between a Rock and a Hard Place. To give a brief synopsis. Aron goes off into the Utah wilderness to do some canyoneering and ends up with his arm trapped irremovably behind a boulder. After 127 hours of screaming and soul-searching, Aron realises help is not forthcoming so decides the only way to escape from his accidental captivity is to remove the very thing that is holding him there - his arm.

Now I could issue all the usual platitudes that are offered to exceptional movies like 127 Hours. Danny Boyle excelled himself yet again. James Franco gave an excellent performance as Aron. And the story, true in almost every detail, was horrifying. Horrifying to the point that I was dreading the final outcome and whether my stomach could actually cope.

But this is not meant to be a film review, there is another point to this blog. Throughout the film, I could only imagine the look on the face of our Clinical Governance Officer as she cried into her wine glass at the unconventional attitude to infection control unfolding before her.

As Aron prepared himself to carry out this little operation, was any consideration given to cleaning the skin? None whatsoever! All sorts of bacteria would have been there, especially given that Aron had spent the previous five days free from any form of basic hygiene. Surely even a simple antiseptic wipe could have been used to stop bacteria being transferred to the blood stream.

Another way to prevent bacteria getting into the wound would be to wear disposable gloves. I accept that putting gloves on both hands may have been unnecessary on this particular occasion, but he could have put a single glove on his operational hand. Of course this would only be after washing it thoroughly with soap and water and then again with alcohol gel, but none of these were done.

Not only was there a lack of cleanliness with Aron himself, the tool used to amputate his arm had been used to hack at the boulder for the previous 126 hours so would have been extremely filthy and a hotbed for all types of nasty bacteria. No sterilisation was carried out and the tool was completely inappropriate anyway. Amputation doesn't normally fall under the remit of first aiders so scalpels usually aren't carried; however something more suitable than a penknife should have been used.

As if the preparation and execution of the amputation wasn't bad enough, there was no effective clinical waste procedure. Blood dripped onto the ground and also onto Aron's clothing without being properly collected and cleaned up using correctly colour coded disposable mops and buckets, and there was no disposal of material using the correctly colour coded clinical waste bags. Finally, once finished, the arm was left for anyone to get cross contamination from.

It was not just blood that was allowed to flow freely into the environment, there were other bodily fluids too. Bodily fluids that seemed to make a good substitute for drinking water, but let's not even go there. If you ever have to administer paracetamol and there is no drinking water available, I would strongly advise against improvising the way Aron did.

And all that just relates to infection control, don't even get me started on the lack of observations taken - pulse, resps, blood pressure, pain score etc.So the moral of this story. The next time you think of going on a trek, just check your first aid kit and make sure you have all the right equipment. Perhaps also take a mobile phone and let people know where you are going and when you will be back.

Disclaimer: This is written completely tongue-in-cheek and not meant to be critical of Aron whatsoever. I can't imagine ever being in the position where the choice is to hack my arm off or die. I'm inclined to think that most people would not have the courage for the former, so just give up and accept the latter.