When data sing?

Albert Einstein had quoted that “Wisdom is not a product of schooling but of the lifelong attempt to acquire it” AND I say, it is only possible when data are translated to information, which when used or practised then they generate knowledge and when knowledge is practised or applied regularly then the WISDOM prevails. Instead of theoretical jargons, I have put a straightforward example that I have encountered and tackled during my surgical practices more than 17 years back.

Data (Input) to Information (Output) – Problem identification to verification

Most of the cases of all surgical units were experiencing post-surgical wound infection. Everyone was aware of this problem, but no one had identified the exact causes of the outbreak of wound infection. After a couple of days of intensive literature review and observation, I suspected that the cause of these infections was due to some flaws on the preoperative preparation of patients.  Usually, nurses prepare patients with preoperative fasting, sedation and shaving of the surgical sites a day before. I suspected the shaving of a surgical site a day before the surgery could be a primary reason for these infections. Even though they followed the best practices for preoperative procedures, the shaving always causes invisible minor injuries in skins. These invisible injuries were a favourable environment for any microbes to grow overnight and which was further aggravated by dire situation of hospital wards in terms of their cleanliness and lack of practice of patients to take a shower a day before surgery.

I brought my interpretation of the cause of the wound infection to our unit chief and mentioned that I would like to change the procedures of preparation of surgical cases. After receiving a green signal from the chief, I immediately put some minor changes in pre-operative preparation of surgical patients in our unit. Usually, each medical officer had to stay overnight in the hospital a day before the unit’s routine surgery day. This was to ensure that all surgical cases were well prepared for the surgery the next day.

I stopped preoperative shaving of each patient a day before and requested to do shaving one to two hours before surgery in our unit. This decision served as a case-control study between units too. The results were amazing, with nearly nil wound infection in the unit. Very few post-surgical wound infections were observed in the unit compared to others. I didn’t conduct any statistical analysis or hypothesis testing.

These data and information identified the followings: i) WHAT is the issue and factors for wound infection, ii) WHO are affected or responsible for, iii) WHEN it happened and iv) WHERE was the problem.

Knowledge (outcome) to Wisdom (impact) – Practiced changed and instituted

The results before and after changing the shaving practices and comparing with the other units were so convincing. Therefore, the entire surgical department convinced with my hypothesis and decided to change the practice of preoperative shaving of the surgical site to one to two hours before surgery. This led to a dramatic decrease in wound infections in the entire department. This practice prevented forming a favourable environment for bacterial growth. In addition, pre-operative cleaning with iodine solution before surgery in a surgical site also complemented creating an unfavourable environment for bacterial growth. Therefore, reducing the complications and hospital stay.

Knowledge developed (HOW): Stopping to shave a day before and shaving only 2 hours before the surgery

Wisdom Prevailed (WHY): To reduce the surgical wound infection and reduce the hospital stay and the cost of patient and hospital staff.

If data and information are like a look back to the past, knowledge and wisdom are related to what we do at present and what we want to attain in the future. This example demonstrated how the data, information and knowledge help to understand the context.

Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA

Disclaimer: Views are my personal, examples are from my experience and don’t represent the view where I work.