Disease Prevention

Read the following article and reply with one thing you have learned from reading it.


Mom was right: wash your hands
By Stephen Smith, Globe Staff, 10/1/2002
SAN DIEGO - The disembodied voices were more plaintive than demanding.
Please, they said, return to the hospital room and clean your hands.
For 15 months at one of the nation's most prestigious hospitals, Johns Hopkins in Baltimore, motion sensors and computers electronically peered over the shoulders of health-care workers who failed to perform the most basic of all infection-control methods.
It is a measure of just how seriously disease specialists view an epidemic of neglect sweeping US hospitals - the failure by doctors, nurses, and other health-care workers to remove bacteria from their hands.
At a summit of infectious disease specialists this week, the Interscience Conference on Antimicrobial Agents and Chemotherapy, new federal standards are being introduced that will fundamentally alter how hands are cleaned in the nation's hospitals, clinics, and doctor offices.
Out: soap and water. In: alcohol-based hand rubs.
The stakes are enormous. It is estimated that at least 2 million patients acquire infections each year while in US hospitals, resulting in 90,000 deaths.
''No matter how much we tell people to wash their hands with soap and water, they won't,'' said Elaine Larson, a Columbia University nursing professor imbued with a missionary's zeal when it comes to hand hygiene. ''This new policy represents a major change in tradition, in practice. Can you imagine telling surgeons they can't scrub anymore?''
Instead, surgeons who perform the most delicate of operations as well as workers responsible for more routine tasks are being urged to take a dollop of hand rub from dispensers becoming ubiquitous at hospitals such as Massachusetts General and Brigham and Women's.
The reasons for the shift in hand-cleaning gestalt are essentially two-fold. First, alcohol-based foams and gels actually disinfect. Old-fashioned soap and water is best for removing debris that gets on hands rather than killing dangerous bacteria. Second, the soap-and-water drill had become timely and cumbersome in a health-care environment that expects medical professionals to perform more tasks more quickly. Studies show that, at best, only 48 percent of medical workers follow hand hygiene guidelines. And some reports find compliance as low as 12 percent.
That's why the easy-to-use hand rubs have emerged as the hand cleaner of choice. The US Centers for Disease Control and Prevention will issue an advisory this fall telling health-care administrators that they need to switch to the rubs, which contain about 60 percent alcohol and come as foams, gels, and rinses.
The use of the alcohol-based rubs actually appears to be slowing the bacteria that have colonized the nation's hospitals in recent decades, while also reducing costs.
The infection control department at the Veterans Affairs Medical Center in Washington wanted to know if using the hand rubs could reverse the march of two of the most pernicious bacterial bugs, methicillin-resistant Staphylococcus aureus, or MRSA, and vancomycin-resistant enterococcus, or VRE. So, for the first two years that the hand rubs were introduced, researchers tracked the incidence of hospital-acquired infections.
The results: Cases of MRSA decreased 21 percent, while episodes of VRE infection plummeted 43 percent. That happened even as in-patient admissions to the hospital remained steady while outpatient visits actually increased by 20 percent.
It's costing the hospital $2,400 a year to provide the hand rub. The cost of a single case of hospital-acquired infection - and most specialists believe this figure is conservative - has been estimated at $2,200. Administrators at the VA Hospital believe using the hand rub prevented more than 30 cases of bacterial infection.
''The only change that we made that would have accounted for the change in infection is the implementation of the alcohol-based, hand-rub system,'' said Maureen E. Schultz, an infection control nurse at the hospital.
The findings of the Washington researchers mirrored the seven-year experience of infection specialists in Switzerland. At the University of Geneva Hospitals, posters were plastered throughout the hospital encouraging health-care workers to protect themselves and their patients by using the hand rubs.
The need for education became apparent after a study of the Geneva hospital workers - including physicians - showed only 27.5 percent possessed good knowledge of how to prevent transmission of bacterial infections from one patient to another.
The campaign to improve compliance with hand hygiene rules, including the price of the rinse, amounted to $2.30 per patient last year.
At Johns Hopkins Hospital, administrators decided subtlety was not the better part of persuasion. So, using a grant from the National Institutes of Health, they installed an electronic monitoring system in the nine-room, 14-bed surgical intermediate care unit to track whether health-care workers were cleaning their hands.
The system detected movement in and out of patient rooms as well as hand-cleaning practices. If doctors and nurses didn't clean their hands, a message sounded as they left the room. There were six varied commands - three masculine voices, three feminine.
''We did that so that the messages wouldn't just fade into the background,'' said Dr. Pamela Lipsett, director of the surgical intensive care unit.
The messages worked. Hand cleaning increased about 40 percent. And hospital-acquired infections plummeted 50 percent, said Sandra Swoboda, a nurse in the unit. The system was deactivated at the end of the experiment last October, but hospital administrators are considering rearming it.
''In our unit,'' Swoboda said, ''big brother watching certainly was a benefit.''
Stephen Smith can be reached at stsmith@globe.com.
This story ran on page C1 of the Boston Globe on 10/1/2002.
© Copyright 2002 Globe Newspaper Company.

READ THIS!

Read an article on a current health issue: disease, health care etc.