Keeping it Clean

from the Surgical Infection Society’s annual meeting in Las Vegas 

It’s hard to avoid hearing about hand washing at infectious disease meetings, and this was no exception. 

image courtesy Flickr user Kleiner Kolibri

First came the observation from a senior surgeon that he finds many of his colleagues not washing their hands as regularly and conscientiously as they should, seemingly lulled by an inappropriate reliance on alcohol gels. 

“Surgeons take a gob of alcohol-based hand scrub, put it on their hands and come into the operating room,” said Dr. Kamal  M.F. Itani, chief of surgery at the VA  Boston Healthcare System in West Roxbury, Mass. “They forget that the recommendation is to wash their hands and clean under their nails and then apply the alcohol agent. We need to rededicate ourselves to the proper use of these products.” 

His observation on how surgeons and other health care workers often behave, and his emphasis that plain old soap and water trumps alcohol gel, strikingly echoed a similar message from another infectious diseases expert that I blogged about here 1 year ago. 

The second message about hand washing by medical personnel came from an analysis of a hand-hygiene program run at Boston University Medical Center.  The program came into being because hand washing among health-care personnel is notoriously poor, especially among physicians, said surgeon Dr. Dorothy W. Bird. 

 At the start of 2007, a hospital task force began a 2.5 year campaign to promote hand hygiene, including staff education and reminders and monitoring of compliance by measuring the amount of soap the staff used. By early 2009, the task force declared mission accomplished, with hand-washing volume exceeding the target rate and infection rates in the surgical intensive care unit significantly down. But the new analysis looked at what happened next, and it wasn’t good. With the program stopped, the reminders missing, and no one keeping tabs on the hand-washing rate, the surgical staff quickly reverted to its old ways and within a matter of months infection rates jumped back up significantly above the nadir reached at the end of the discontinued program. 

The clear message: Hospital staff need ongoing reminders and monitoring to ensure their hands get washed.  And the Boston University surgeons are restarting the education and monitoring program. 

—Mitchel Zoler (on Twitter @mitchelzoler)

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Filed under Health Policy, Hospital and Critical Care Medicine, IMNG, Infectious Diseases, Internal Medicine

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