Friday, April 13, 2007

I want to be proud, but I am not

I had hoped never to have to say such a thing. BIDMC is a wonderful hospital, full of warm, well-intentioned, and competent people who achieve excellent clinical results and even the occasional miracle. But I saw numbers recently that make me cringe. So it is time to let you know -- and to let my staff know -- that enough is enough.

I am talking about hand hygiene. I have raised this topic before and have referred to the national problem. Medical staff can't seem to remember that germs can be carried from one room to another, and one patient to another. OK, they know this, and they believe it. But they can't seem to toss off bad habits and adopt ingrained behavior to make sure they practice proper hand hygiene.

I like to think that things have improved from the 1840s:

Ignaz Philipp Simmelweis, while working as a doctor in Vienna from 1844 to 1850, determined that ... childbed fever was being spread in maternity hospitals by dirty hands. He proved that a chlorine hand wash reduced deaths from 18.27 percent to 1.27 percent. His superiors scorned his findings and eventually he lost his position. In the city of Pest, he repeated the hand washing measures, reducing mortality due to childbed fever to an average of 0.85 percent while elsewhere the death rate was 10-15 percent. Despite acceptance of his work by the young medical students and by the government of Hungary, and being published in medical journals of the time, his work was disdained by the academic authorities of the time.

But, maybe they have not improved. How else to explain the lack of compliance with well established principles of hand hygiene.?

So why am I upset? After months of intensive effort and various education and other campaigns, our compliance with hand hygiene has risen from 52% on our medical-surgical floors to 57%. Sure, it is great to see it rising, but does this result provide confidence to anyone out there that the message has sunk in? And, some floors remain at or below 40%. The results are better in the ICUs, rising from an average of 60% to 71%. But, in the words of our Quality and Safety staff, "opportunities remain for performance improvement and sustainability of improvement."

The results on one particularly noncompliant floor have prompted one of our Chiefs to write to his physicians:

THIS IS ABSOLUTELY INTOLERABLE!
It is bad patient care.
It increases our post op infection rate.
We should be setting the example for the students and nurses.
I have asked [the nurse manager] to have the nursing staff call attention to any physician, resident, staff, PA, med student, fellow, etc) on the ... service who does not wash his or her hands. This is meant to remind you. If I hear of anyone reprimanding a nurse for such a reminder, you will hear from me and it won't be a friendly call. I have no problem with you reminding the nursing staff if you see a lapse as well. Together we must achieve 100% compliance. There is no reason not to.


There is no reason not to. Dear BIDMC, please make me proud.

36 comments:

Maxine said...

wow, I just read a magazine article about safe surgeries, etc. One of the things to do was question each medical person as to what they thought was going to be done to you. I was patting myself on the back because the last time I had surgery at BIDMC I was annoyed at how many times THEY asked ME what was going to happen that day. Another thing mentioned in the article was making sure you told all medical staff to wash their hands before they came close to you. The magazine even suggested wearing a sign that says that. I thought that was a bit much, but maybe not. Perhaps if patients and staff try to remember, someone will

Martin O'Brien said...

This reminded me of a somewhat similar occurence at MGH back in 2002-2003.

I was undergoing chemo, and had a Hickman central line at the time, and kept getting line infections. During one of my frequent admissions to the hospital, they suspected a VRSA infection, and put me in a secluded room in isolation. Every doctor and nurse made sure to don gloves, gown and mask before entering the room, yet I was allowed to walk the corridors without any protective garb!

Shouldn't they have been concerned about me spreading something?!

Anonymous said...

Can part of the reluctance be from not wanting your hands to be chapped, dry, and bleeding? How do health care workers dealing with what must be like having your hands in dishwater and winter wind, all day long? If you see a number of patients in an hour, how many minutes an hour are you washing them in harsh chemicals? I am in total agreement with your concern, but what are health care workers supposed to do to keep their hands supple, comfortable, and usable?

Paul Levy said...

The cleaner we use does not chap or irritate your hands.

john said...

As a volunteer in another hospital, this plus covert reuse of gloves and gowns drive me nuts - how about a tech solution, so doors won't open until the handwasher has been activated?

John

Anonymous said...

This, unfortunately, is not a new issue in medicine, and is as widespread as it is old. Hospitals have tried everything under the sun to improve and nothing seems to work. I know to the layman, it defies logic or even sanity.

Paul, I believe you have an opportunity to break new ground here by brainstorming with your staff, and experimenting to maybe, actually, find something that works! There is nothing like having the CEO champion such an effort. Exhortations and education seem totally fruitless, or at best ephemeral. Dumping the responsibility on the nurses both degrades working relationships and lets the nurses off the hook. (Studies show all health care staff are involved to varying degrees). How about something along the lines of "mystery shoppers" (e.g. people specially assigned to observe and report offenders), or an "honor code"-like system where anyone observing non-hand-washing is obligated to report it by their employment contract? Or publish names of offenders in your blog each week - whatever! I'm sure you all could come up with even better ideas. A teaching hospital is an excellent place to entrench good habits.

Apollo said...

Anon 5:11 - At our teaching hospital in New Orleans, there are often hand lotion dispensers near the antimicrobial dispensers and sinks. However, I doubt that chapped skin is the main problem. I suspect that convenience and forgetfulness contribute more to a failure to wash hands frequently enough. If I remember correctly, a comment in Paul's previous posts on paper towel dispensers expressed some of the frustration of putting on sterile gloves with semi-dry hands (because the paper towels were too weak).

Though only a medical student, I hope I may suggest another issue that may contribute to poor adherence to hand hygiene: there may be a degree of cognitive dissonance between the notions that health care providers enter into each patient's life with so much potential to do good and the dangers that they bring with them in the form of infections on their skin (or clothing). When you enter the patient's room with a heart of gold (or at least a determination to help your patient), it's sometimes hard to remember that there is a very high probability that you are also posing an immediate, serious risk to the patient's health. MRSA infections don't produce symptoms in healthy individuals (i.e. the health care providers), perhaps making it seem like less of a threat in the subconscious of the health care provider as compared to something like HIV (i.e. you would be much harder pressed to find an HIV-positive doctor or nurse who isn't taking the proper precautions to prevent spreading HIV to patients). Of course, this same MRSA bacterium can wreak havoc in patients who are already sick and immunocompromised. I'm not surprised that Paul reports better adherence to hand hygiene in the ICUs: the health care providers there are very aware of the precarious health statuses of their patients and the danger of infections. Elswehere in the hospital, though, the risk may not be as visibly apparent.

I hope greater improvement comes soon, Paul! I would recommend getting some physicians in your hospital to champion the cause: as narrow-minded as it might seem, there's no one I (and my fellow med students, and our older colleagues) respect and listen to more than a good, well-spoken physician. Similarly, older physicians who may not be compliant enough at this time may be more willing to listen to a physician colleague/friend than anyone else telling them to wash their hands.

Anonymous said...

I am more than happy to remember to wash my hands after every patient encounter (which is obviously before the next patient counter) by being conscious of the fact that this patient---through no fault of his own, of course---is bed-bound, using a bedpan or commode, and has no opportunity to wash HIS hands which, of course, are then touching everything else in the room that I am going to touch. Ew.

Anonymous said...

1) Medicine is traditionally full of overachievers.
2) This is a problem with individuals--many individuals, but not including patient or system-related variables.
3) Very few get to Harvard by being dumb or not playing by the rules.

Given these three premises, can individual handwashing rates be part of individual evaluations? 52% or 57% are still failing grades where I go to school. Can the irate chairman not stop at affirming and deputizing the nursing staff, but go further to say that your handwashing rate goes in your rotation grade or annual employee review?

This is such a simple thing that I have to conclude that some people simply don't consider it very important. It's not beyond their capability. Assuming everyone is striving to achieve the most intelligent, advanced, and compassionate care in the world...for God's sake, you can wash your hands!

Jon said...

Paul,

As soon as I read your post about methodology to improve hand washing in the hospital I was reminded of a NYTimes Magazine article I read a while ago. It listed a number of strategies, both positive and negative, to improve hand washing rates. The final solution is innovative and rather entertaining. Its a quick read, though it does require a (free) log-in:
http://www.nytimes.com/2006/09/24/magazine/24wwln_freak.html?pagewanted=1&ei=5070&en=dc0c282be45a2d65&ex=1176696000

{if the link does not work, it is called "Selling Soap" and is from the 9/24/2006 issue of the NYTimes Magazine)

-Jon

PS I can't wait to try the non-irritating BIDMC cleaner. No more dishwasher-hands for me!

Anonymous said...

As a first year medical student, I have been fortunate enough to have exposure to many floors of BIDMC. Compared with the hospital across the street, BIDMC seems to have less hand washing dispensers and less posters reminding others to wash their hands. At every floor their is a large poster of Paul Farmer with text reminding others to clean their hands, and more importantly, dispensers for hand washing fluid are easily found nearby. Why not have hand washing dispensers in places other than outside patient rooms--next to elevator buttons, doorways, long hallways, and everywhere else physicians are in the hospital? Not only will this be adding an extra opportunity to wash hands, but more visible dispensers would communicate to patients that BIDMC will not accept this poor behavior.

Referring to previous posts, I agree that hand washing should be added in medical student evaluations. Teaching future healthcare professionals early is definitely part of the future solution.

Anonymous said...

To Apollo;
Your comment about having a physician do the "intervention" is a good one. When I was a medical student, I had no clue even who the CEO was! However, the CEO puts into place the policies and mechanisms by which the policies are enforced. Having he/she champion the effort with the administrative (e.g., quality assurance/infection control, etc.) staff and medical leadership, sends the unmistakable message that this issue is not going to go away.
I think it is clear that mere conversations, threats and memos from the department chiefs do not work (by no means is this unique to BIDMC.)A system approach is needed.

Anonymous said...

Paul,

You are wrong! The hand cleaner is irritating and chapping to some staff's hands. You may only use it once in a while and so, chapping is not a problem. Please work a 12 hour shift on my floor. Take care of 6-8 patients during that time frame. Now work 36 to 48 to 60 hours a week going in and out of patient rooms, both your own patients and your colleagues patients rooms and NOW tell me if your hands are chapped.

I am also sick and tired of this being on nurses' backs. Yes, you know what rolls down hill and once again it is the nurses responsibility.

Many many many caregivers go in and out of patients rooms. I have seen physicians who would not even think of going into the OR to perform surgery without a prolonged surgical hand scrub go in and out of patient rooms without a single thought to using Cal-stat.

I have seen phlebotomists, case managers, xray techs, physical therapists, aids, nurses, doctors etc go in and out of patient rooms without cleaning their hands, and yes, I do remind them. It's a good thing I have thick skin as I watch daggers from their eyes. What I have never seen is THEIR manager come to my floor and "police" their own staffs behavior. I have never once seen the chief of surgery or the chief of medicine on my floor during rounds to remind their staff. But yet, I have come to work at 6am to remind rounding physicians, I have stayed till 9pm to remind the evening shift and I have been there at 2am to remind the night shift, on Sat and Sunday after working a 60 hour week, I have been there to remind the weekend staff.

I ask, where are YOU and the CHIEFS????

Please help, not berate!

Paul Levy said...

I don't recall berating you -- nor was anyone suggesting it is the nurses' responsibility to solve the doctors' problem. It is each person's responsibility. And, the note I quoted was from a chief to his doctors.

Thank you for standing up for this and letting people know when they are not complying. But, if you are arriving early and leaving late just for this purpose -- which is what you have implied -- please don't. Eventually people have to take responsibility for their own actions -- and I would rather you be at home or doing something else.

Alexis said...

When my sister-in-law had a kidney transplant almost two months ago, and she remained absolutely adamant (as were we all) during that time that no one except the dialysis nurses could touch her dialysis central line, because we knew them and could trust them to follow strict cleanliness standards. Her surgeon, fortunately, completely backed her on this, to the irritation of more than one attending and many residents/interns.

I find that I have to carry my own hand sanitizer with me when I see patients, not because it's unavailable, but because I'm allergic to the scent of Purell, which seems ot have a monopoly on hand sanitation in our hospital. And yes, during my time there, I'm often applying lotion, washing it off, and re-applying, and so on, so I carry that with me too. A good strong hand lotion before bed seems to save me from chapping and wear, just as carrying my own (unscented) hand sanitizer prevents me from having red watery eyes when I see patients.

I think it's about forming a habit. I figure if I get into the habit of having clean hands as a medical student, then when I'm working the more stressful shifts, my fallback condition will be the habit of hygiene. If somehow, you could get all your staff to over-do the hand sanitizing for several weeks, they'd probably develop the habit, too, and your numbers would shoot up. Perhaps a competition would help? I know it sounds a bit juvenile, but in my time in corporate America, I saw that competitions with real rewards did actually work (with a few exceptions), and I doubt that a hospital is all that different.

ileana said...

Paul,

How do you measure this? Is it self-reporting, do you have someone counting them on a camera? I kept wondering about this.

Thanks for raising this. I guess I will ask next time I suspect my healthcare providers did not wash hands.

I think you need to make up a team song and sing it at the beginning of each shift. It would be funny if it weren't true.

Anonymous said...

I agree with the previous comment -- I work in another Boston area hospital, and while I am not involved in patient care, I do receive the global emails about hand washing and Cal-stat use. Our hospital has had competitions/challenges and I think it's been a fun and productive campaign. Heath care providers are so busy and while they SHOULD remember to do things as simple as sanitize their hands... it really doesn't surprise me that it gets forgotten! As a marketing person, I think the crafting of a fun, easy, and effective "message" to your employees is the key to success!

Anonymous said...

Wow. I don't get it. You couldn't make it easier. I recently spent a LOT of time in your hospital with a sick spouse. There's Purell dispenser everywhere you turn. I mean EVERYWHERE. Granted, I'm a little OCD, but I found it easy as pie to wash up on my way in and out of the room. Every time. And to their credit, I did see most of at least my husband's nurses doing it too. Doctors, not so much.

Laura said...

From the perspective of a germ-freak patient...My recent visit to BIDMC:

While in the waiting room, there were many small tables with magazines. Each table had a bottle of hand sanitizer, so I saw at least 4 bottles in my immediate proximity. I commend that there was even a bottle right next to the television controls! However, during my 45 minute wait, many people used the magazines, but not once did I see a patient use the hand sanitizer.

During my consult: My doctor cleaned his hands using the hand sanitizer posted on the wall next to the exam room. He then proceeded to greet me and shake my hand. He then went over to the computer, pulled out my imaging results. He then did a physical examination on my person. Afterwards, I asked a question which required him to use the computer again. At the end of the consult, he then shook my hand, walked out the door, and closed the door. During that time, he definitely could have transferred germs from me to the computer, the door handle, and every other item in the exam room that he touched--and vice versa. I of course sanitized my hands immediately upon leaving the room. However, I understand that most patients are not the germ-freak that I am.

Is it enough to just have medical providers clean their hands between patients? What about enforcing hand cleansing among patients? Especially for outpatient visits where the majority of people are physically able to move about--perhaps implement a policy where the staff member who leads the patient to the exam room politely asks the patient to use the hand sanitizer before allowing them to enter. That way, patients won't contaminate doctors from a mere handshake which then won't contaminate the items in the exam room that he touches. Also, maybe get rid of magazines and just turn on the t.v. instead? Or maybe I'm just paranoid...

Paul Levy said...

Ileana,

We measure this by how many bottles of hand cleanser are used and correlate that with the number of patients on the floor. We had previously, by direct observation, constructed a statistically valid mathematical model to enable this correlation on a going-forward basis.

Paul Levy said...

Anon 5:04 and others,

Thanks for the marketing ideas. We have done some of those, but we'll take a look at more.

Frankly, we have reviewed the literature and practices of as many places as possible, but it is possible we missed some good ideas.

BTW, all the places we talk to report the same compliance problem we see.

Anonymous said...

Paul;
This may be a bit off-subject, but I'd be interested in occasional posts regarding financial issues that you deal with. I read several other blogs which claim that financial incentives for health care providers are "all wrong" and all the problems of the industry could be fixed if only the incentives were set properly. Others have various claims for and solutions to the problem of the uninsured, etc., etc. Leading up to a national election, of course, health care is a hot issue. What is your perspective on these types of issues from the seat of a CEO of a large teaching hospital? My question is deliberately kind of vague and general since I'm not sure exactly what I'm asking for, but I know you can take this ball and run with it. Thanks.

Paul Levy said...

Will do. In the meanimte, check out Charlie Baker's blog on this topic.

Elliott said...

I assume the correlation between handwashing and central line infections is zero, but just curious if anyone ran the numbers to be sure.

Paul Levy said...

For sure. NO ONE installs or touches a central line without clean hands.

Amy said...

I work on a busy med-surg floor at BIDMC as an RN, and I can speak from experience about using the CalStat. In response to the comment that it chaps skin on the hands, this only happens to me in the winter time when everything is dryer. And I noticed that I think the formula changed to add a moisturizer to the CalStat solution. What usually ends up happening to me is I CalStat a few times, and then just wash my hands at the sink because I don't like the feel of using the solution too much on my hands, so the sinks are always an option.

My nurse manager was, from the very beginning, all about the CalStat containers we used on our floor. At first our numbers were really low, and she couldn't believe it was accurate. After doing some investigating, the problem was that the CalStat containers weren't getting collected, counted, and disposed of properly. So, she resorted to picking through trash to find empty containers. My manager developed a solution and now I believe our numbers are slowly going up. I'm wondering if this is a problem on other floors as well??

Anonymous said...

What about equipment? Blood pressure cuffs, pulse oximetry and other such items are used patient after patient. The hospital certainly cannot afford to toss them out after each use.

Lyss said...

That is gross! Glad I didn't pick up any diseases on my visit to your ER last September.

I've never had a doc not wash hands or use antibacterial gel right in front of me.

I am so grossed out by this. (And I'm hardly a germphobe.)

Victoria said...

A Mother’s Letter to a Hospital CEO

(by Victoria Nahum, whose son Josh died in October 2006 from a hospital acquired infection)(not in Boston)

My son died in your hospital 7 days ago. He died from a bacterial infection he caught there as a result of his medical care while being treated for something else. It created so much pressure around his brain that it caused part of it to be pushed into his spinal column, leaving him a helpless ventilator-dependent quadriplegic and ending his short but unforgettable life among us all.

In the week since his death, the days I live have small worth to me. I am numb now. I bring my husband coffee in the morning but he doesn’t smile or speak; he doesn’t even look at me. He sits, hands in lap, shoulders rounded, wearing a mask of pain that I have never seen before; it is
not a face I recognize when he is wearing it. I wish it would go away.

His voice is low and quiet and I am uncomfortable with its somber tone. We speak infrequently lately
because it feels like no good words remain for us. Our son is dead. What good thing can be spoken
now?

Gentle words that others have for us fall inadequately upon deaf ears. Angry words I rehearse in my head won’t help anything at all; spoken aloud they would change nothing for the better, they just sound mean, even to me. Explanations I seek out and find, full of swaggering, inflated medical terms come far, far, so ridiculously far - too late.

Here, now my husband and I sit. We have too many questions and they are all useless. “Why?” is the most impossible one of them all. How I wish he would just stop asking me that. I have no proper answer to comfort him. I am momentarily lost.

So what then? And is it really, “What then?” or should it rather be, “How then?” How then might we prevent this from happening again to anyone, ever? I wonder.

When our son was ill, I watched your nurses come in and out of his room by the hour and rather
than just noticing random women with a regular job to do, I instead saw what angels looked like,
masquerading in scrubs with name tags and stethoscopes to complete the disguise, caring for him generously and genuinely with real humanity integrated into their sense and deed of significant
duty. I heard endearing compassion in their voices and saw true concern in their eyes that made me
want to be like them somehow. Their gestures were warm and their care was competent. To them, my son was their own personal mission. They cared for him well; I would tell anyone – I believe they did their best. I know so.

• I got to know your nurses. They are devastated by our son’s death … So that it doesn’t
happen again, I want you to empower them to save their patients with appropriate
procedures and whatever rock-solid rules that they see fit to execute in the name of safer, better healthcare so they and you, may forego the sadness and futility you all must feel when a patient dies on your shared watch.

• I spoke at length with your doctors who treated my son. I felt their frustration when their
prescribed treatment did not work. I heard the disappointment in their voices when they spoke of how they did not succeed with their plan for his recovery; the failure they felt was noticeable. It hurt them to lose a patient … So it doesn’t happen again, I want you to help your doctors to achieve good, quality care with expected medical outcomes they can be proud of, even if it costs you another $10 per patient or surgical procedure for a preventive measure or device you didn’t want to pay for. In the end, the ounce of prevention costs so little in comparison to the loss of another life.

• I’ve listened to your administrators who seem ashamed and afraid and go blah, blah, blah,
shrinking back at the issue of the death of my son. Shamelessly, instead of offering right
words of authenticity and community, I hear cheap words of faked rationalization globbed in
paralyzing fear. You do your hospital no good thing to allow them to act in this manner … So
it doesn’t happen again, I want you to teach them to sincerely speak kind, genuine words that suggest shared knowledge of loss. Let them acknowledge fragility; perhaps even responsibility. Do not allow them to suggest that the status quo at your hospital is sufficient when our son is dead from his care. Empower your people to offer hope for a better future of proactive participation with a board of directors willing to improve care on every floor, in every room, for every patient. Demonstrate your honor and regret in appropriate amounts. Leave a significant mark in your community and make a deep imprint of high reputation and of real character that all great men and women do, as you take responsibility for deeds done under your own roof. It’s called
stepping up to the plate.

• I’ve been a patient as well as the caregiver, advocate and family member. I’ve felt both
trusting and helpless; I’ve been a participant and a bystander. I’ve had times when I had full
knowledge of an issue and have been ignorant in my lacking of medical understanding … So
it doesn’t happen again, I want you to show me and my family how we can contribute as important members of our own personal medical team so that we all, together with your staff, can effect our own best good, expected outcome. If you are unable to show us how to do that, then identify, invest in and empower those who can and do it as
part of your chosen service to the practice of medicine. Respect that I can be a capable, thinking, proactive partner in my own medical care instead of an unsavvy outsider who never went to medical school. Healthcare needs teamwork to work. We need to know how to “Prepare for Care” and we look to you for direction in doing that.
Dear CEO, I hope you read this letter, this PLEA FROM A MOTHER aloud. Tell your board that I do
not want anything for the loss of our dear son but a dramatic and effective plan for change that will
make a difference for others who trust healthcare in general and your hospital specifically. We look
to you to partner with us as patients and caregivers so that we may all be safe and well, both now, and in the future.

Sincerely,
Victoria Nahum
SAFE CARE CAMPAIGN, INC.
http://www.safecarecampaign.org
770-819-8787 (office)
678-472-9972 (mobile)
vnahum@safecarecampaign.org

daedalus2u said...

I heard of a motivational technique that was successful. Periodically, someone would go through and take hand cultures, essentially palm prints on growth media. Let them develop for a few days, and it becomes a very vivid demonstration of what insufficient hand sanitizing. Photographs could be posted, with or without identification.

daedalus2u said...

I saw your blog on canines. I am working with commensal autotrophic ammonia oxidizing bacteria, and have found that they substantially suppress heterotrophic bacteria in vivo. I think via oxidation of quorum sensing compounds.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15353593&query_hl=1&itool=pubmed_docsum

I have found that many eukaryotes have a substantial biofilm of these bacteria (clams, lobster, mussels, turtle, earthworm) and that a human (me) can sustain a biofilm of these bacteria long term (years) and there is substantial suppression of heterotrophic bacteria (I could send you the report).

This might be a good treatment for the dogs, to reduce potential transport of heterotophic bacteria. The largest density of sweat glands is on the paws, I think to suppress heterotrophic bacteria there.

This might be suitable for scalp treatment on humans to suppress bacteria. The autotrophic bacteria I am using are killed by a few percent isopropyl alcohol, so use on hands would be problematic.

Anonymous said...

In response to Anonymous and several others, facilities are now required in many countries and urged in others, to create skin care programs. These programs must provide the Health care Workers with skin cream/lotions which are safe to use with gloves, and help to condition the skin. There are also some great waterless antimicrobial products on the market now that contain effective emollients, and that studies have proven are less damaging to the skin compared to soap and water.
Hospitals should be working to prevent skin irriation before it starts, and have a an assessment tool in place with Occupational health to assist those with dermatitis or other conditions.
Many studies have shown hand hygiene compliance rates to increase with the addition of skin care programs.
This is major element of many successful programs launched in Europe...and now several being tested in Canada.
Hands are the most important tools of Health care Workers...they must be treated accordingly.

Anonymous said...

Could it be that many people have now adopted the belief in adaptation and survival of the fittest?
They may believe the more you try to erradicate, the stronger it becomes and the harder it is to be rid of. For instance, if your child gets chicken pocks is he/she protected from shingles as an adult? Let the child get sick, it will strengthen their immune system? Don't some germs that make you ill, get tougher as they are exposed to germicides, anti-biotics, disinfectants, etc. for sustained periods of time?
(M.R.S.A.)
I have encountered hospital workers whom have expressed they believe we are over doing it with the "germ/bacteria killers" and thus paving the way for "superbugs". Is this plausible?

jamocha said...

Hello!
As a neophyte to the infection control field, I enjoy reading this blog. I have a lot of questions that require careful thought and discussion, but first I would like to share my maiden voyage experience of launching a hand hygiene campaign. After a bit of research, it seemed that the most effective approach to improving hand hygiene compliance was to empower the patient to ask the HCW to wash his or her hands before patient contact, even MD's!! We had a bunch of "It's OK to Ask" brochures and poster printed up. As a courtesy to the MD's we gave them a "heads-up" on what was to come 2 weeks before the campaign launch. We parked outside of the MD's lounge to distribute brochures and pocket-sized bottles of alcohol hand rub. All seemed to be going well UNTIL---a group of surgeons REBELLED!! One MD flatly refused to support the notion of patients asking, and came to our office later to rip up his brochure into 1000 pieces and toss it at us!! WOW! Though a bit abusive and quite dramatic, this little tirade did more to launch our hand hygiene campaign than anything else we could have done! EVERYONE was talking about it!!! And it has actually changed our compliance. We have improved from a dismal 52% to 78%, with MDs leading the way at 90-100% compliance. MDs were the worst group before the campaign at 37%. Wooohoo!
Just a thought from the frontlines of hand hygiene!

Paul Levy said...

A great story. Thanks!

Dean said...

This evening I was discharged from
Erlanger Hospital in Chattanooga, Tennessee. I observed that there was a dispenser of Cal-Stat outside every patient room and inside the rooms. It was also available in rooms where I had scans and X-rays. I saw frequent use of Cal-Stat when staff entered my room and when they left. I asked a nurse about Cal-Stat and she said she liked it because it didn't irritate her hands. The "It's Okay to Ask" posters were up also. There were two in my room.

Dean