Wednesday, November 01, 2006

Clean Hands


The disk on the left shows bacteria colonies that grew from my hand before it was washed with a disinfectant. The disk on the right shows the number of colonies that grew from my hand after it was cleaned with the waterless, alcohol-based antiseptic that is in dispensers outside every patient room in our hospital.

It has been well documented that many infections in hospitals occur because of bacteria transferred from one patient to another when nurses or doctors do not wash their hands between seeing patients.

The New England Journal of Medicine published an article on this topic in July, 2006, entitled "System Failure Versus Personal Accountability -- The Case for Clean Hands," by Doctor Donald Goldmann at the Institute for Healthcare Improvement. His conclusion: "Each caregiver has the duty to perform hand hygiene -- pefectly and every time." "Yet, compliance with hand hygiene remains poor in most institutions -- often in the range of 40 to 50 percent."

It is inconceivable to those of us who are not doctors or nurses that caregivers would not follow simple standards for hand hygiene. We wonder why it does not occur. The article provides good background information on this topic.

Our clinical chiefs and senior adminstrators know that our hospital needs to have high performance in this arena, and we are strengthening our encouragement for this behavior through both positive reinforcement and penalties. As an example, our Chief of Medicine recently wrote the following to his staff:

Appropriate patient care requires that immediately prior to and following each patient encounter anyone having contact with the patient will cleanse the hands thoroughly, using either hand washing or the alcohol-based hand cleansers that are available everywhere in our environment. Anything less than perfect compliance with this standard (except in the case of a patient emergency requiring immediate intervention) represents substandard care which we will not tolerate.

To make this more clear: Everyone (including students, trainees, and faculty who may not expect to touch the patient when they approach) who enters a patient room or an exam room must clean their hands immediately before and immediately after the encounter. In addition, we are all responsible for ensuring that everyone on the healthcare team -- from attending physicians to environmental services personnel --practices scrupulous hand hygiene. Our task is to lead by example through good practice, to notify other healthcare workers if they forget to perform hand hygiene, and to respond respectfully when others do the same.

Please help us to ensure the finest care for our patients by adhering to and insisting upon proper hand hygiene.

Again, we lay people might wonder why it is necessary to provide such advice and reminders to people who have been trained in medical school; but since it is apparently necessary, my colleagues at BIDMC and other hospitals will continue to do so.

10 comments:

Nick said...

This may sound completely crazy, BUT, in 1997 we became a Planetree Hospital. We have therapy dogs, fresh flowers everywhere, 24 hour visiting, decorative fountains, and I'm sure we don't wash our hands anymore than your staff, but our infection rate dropped to 1% and has stayed there for nearly 9 years. Oh, yeah, and it's not because we don't have complicated cases. Plus we get plenty of patients from the nursing homes with infections too. Pitt, Penn State and Georgia Tech are trying to figure us out . . . I think, by creating a healing environment, white blood cells get a chance to WORK, but, soon we can quantify this and will keep you posted.

Anonymous said...

A not related question but I don't know how to post separately! How does a major hospital evaluate its doctors? Thanks -- would love to hear your approach.

Paul said...

I'll answer that in another posting. A really good question!

Bwana said...

Does this mean that BID's new slogan will be "You are in good hands" or "You are in clean hands" or "Our hands are clean?"

Seriously, this is an important point. Don Goldmann is a world-class doctor and well known for his expertise in infectious diseases and epidemiology.

Many years ago, I got to know him and he was talking about washing hands -- he told me that it is important to wash one's hands for at least 15 seconds in order to let the soap do its work. We also talked about the use of so-called anti-bacterial soap which may complicate problems in this area.

The advent of alcohol-based cleansers has probably made a difference in that it is easier to "wash up" quickly.

In everyday life, washing hands frequently, and especially before meals is a good way to prevent colds and other infections.

Recently, I read an article about how touching elbows - instead of shaking hands - was going to be the new norm to avoid transfer of germs from one person to another, a not inconsiderable issue when we consider bird flu, etc.

So, I'm hoping that BID's new slogan will actually be "COME RUB ELBOWS WITH US!!!"

Cheerz...Bwana

mdwannabe said...

The hospital where I work now is so much better about handwashing than where I use to work. I do not really want to mention the names of either!

The place now is great in that the alcohol handwash is everywhere in everywhere place, inside and outside of rooms. You can turn and not run into one. I really thing that this helps push their use as it's so convenient.

The solution used at this facility is the foam kind. I think its great also because its almost fun to play with, you'll sometimes catch people spraying it around, which playfully encourages its use. Its also great because kids will like to put it on their hands too!

Anonymous said...

I am very interested in the answer about How does a major hospital evaluate its doctors? and also I would like to know how do a major hospital selects a primary Doctors. I have change mine at least 2-3 times this year.

LS

DundeeMedStudent said...

You also have to take into account visitors. When I was working as an auxiliary nurse, I was forever telling visitors to wash their hands before and after seeing patients. The worst visitors where the ones who had relatives with an infection, they NEVER washed their hands. I was also recently told that around half the population (in Britain at least) carry MRSA on their skin, so patients can actually infect themselves in some cases, by touching things they shouldn't have.

It's not all the healthcare workers fault.

Paul said...

Good point.

And greetings from across the pond . . .

Anonymous said...

As a healthcare worker who is required by my job and dictated by my conscience to use this antimicrobial rubs to prevent infection, my concern is the longterm effects of the chemicals in these antimicrobial on healthcare workers. These are absorbed in the body and in time, could possibly accumulate in the system. Has there been studies on this issue, if not maybe our institution could initiate one to determine its safety on the people who use them often.

thanks

Roy Bercaw said...

CBS News March 22, 2009
Health Care Workers Battle Super Bugs

http://www.cbsnews.com/stories/2009/03/22/eveningnews/main4883235.shtml?tag=topStories;secondStory

or

http://tinyurl.com/dg9vs5