Wednesday, February 27, 2019

Doctor, would you mind washing your hands?

Last year was the bicentennial of the birth of Ignaz Semmelweis (1818-1865), a Hungarian obstetrician who saved the lives of thousands of mothers. In the 1800s, "childbed fever" was rampant in maternity hospitals throughout Europe, and about 10% of new mothers died of this poorly understood condition. There were many theories, some quite outlandish, about the cause. In 1846 Semmelweis became the chief of obstetrics at a Vienna hospital. He was able to connect the facts that the rate of childbed fever was much less in a neighboring hospital where midwives did the deliveries than at the hospital where doctors did the deliveries and that the doctors (but not the midwives) attended autopsies before doing their rounds. He figured out that something was carried on the hands of the doctors from the autopsy room, though this was before anyone knew about bacteria and he called the culprit “decomposing animal material.” He began insisting that the doctors at his hospital wash their hands with a chlorine solution after leaving the autopsy room and before examining mothers in labor. The rates of fever and death dramatically dropped after he began this practice. It was a long time before his theory and practice was widely adopted, and only after his untimely early death was his work given the recognition it deserved.
Why is this history lesson relevant to us? In 2019, with all our understanding about infections and how they are spread, about 7% of hospital patients develop an infection while in the hospital, so-called nosocomial infections. In the intensive care unit, this may reach as high as 50%! Most of these infections are still carried on the hands of doctors and nurses from one patient to another. Study after study has shown that less than half of doctors carefully wash their hands between examining patients despite multiple interventions designed to increase this behavior. The introduction of alcohol-based water-less hand washing antiseptic solutions has made the process faster and easier, but even so only a minority routinely use this between seeing every patient. I was able to find at least twenty studies of methods that were used to try to get more health care workers to follow this simple life-saving practice. Most showed at least some improvement, but still rarely achieved compliance much above 50%.
Infections caught in the hospital tend to be nasty ones: MRSA (resistant staph infections), other bacteria that are resistant to most antibiotics, C-diff causing horrible colitis, etc.
So, take matters into your own hands! If you are a patient in the hospital, when a nurse or doctor comes to see you, be obnoxious. I would suggest something on the lines of “Dr. X/Ms. Y, I am really paranoid about getting an infection. Can I ask you to wash your hands before you examine me?” Better to be thought a difficult patient than a sick one.

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