Wednesday, November 01, 2006
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.
Posted by Paul Levy at 11/01/2006 03:16:00 PM