More Evidence That Hand Washing Really Works

A few months back, we wrote about one hospital’s very creative effort to get its medical staff to do a better job of washing their hands. Because so many people die in hospitals each year from bacterial infections they acquire while being treated for something else, the Institute of Medicine had sounded a loud alarm, urging all hospitals to do something about the problem.

One of the easiest ways to get a potentially fatal infection is if you have a central-line catheter put in; as many as 28,000 patients die each year from infections caused by the insertion of a central-line catheter.

The current New England Journal of Medicine reports on a study conducted in Michigan hospitals to see if increased vigilance on hand hygiene would cut down on the incidence of catheter infections.

And it worked, big-time. “The results are pretty breathtaking,” Dr. Peter Pronovost, a Johns Hopkins researcher and the lead author of the study told the Baltimore Sun. “The numbers of infections went down quickly and they stayed down.”


Jemaleddin

And yet, where I see this headed is a new class of malpractice lawsuit: The Dirty-Handed Doctor.

sjshar1510

(PS: Please dont mind, that I'm writing a little "off" the topic at the moment)

Absolute Wow!!!

Though I am an idiot who took 2 months for registering as a user on this blog.

I'm overwhelmed that I'll be expressing something here that will be read by my favorite Authors!

Please don't mind if I stretch my praises about Mr Dubner or Dr Levitt.

You guys are "absolutely amazing"; though I know you would be tired to hearing this:)

Regards,
Sanjeev

crquack

My experience agrees with this and the previous post: Doctors are bad at washing hands. However, I would like to know who, if anyone, looked at the hand-washing habits of nurses. In my experience they are just as bad if not worse. Their effect on patient care particularly in the ICU is vastly more important than the effect of the doctor. The doctor may only touch the patient twice a day, the nurse will do so many more times.

Just because they had a nursing team "spying" on the doctors does not mean their own profession is above scrutiny.

Finally, I would hope there were at least some physicians embarassed to accept a $10 voucher for washing their hands...

JoeKeeley

I hate to ask, but what is a "central-line catheter"? I know what a catheter is, and I shutter at the thought of what "cental-line" is, but I am unsure.

If it's what I think, I don't know what is worse: The number of fatal infections or the number of those catheters!

Happy New Year, Joe

carltoncl

@JoeKeeley: http://en.wikipedia.org/wiki/Central_venous_catheter

TartanBill

Semmelweis, Pasteur, and Lister are names from the history books, 19'th century. I am reminded of the difference between we humans and the rats upon which we perform experiments in behavioral psychology; the rats learn, the humans rationalize.

Alger

Nearly 160 years after Semmelweis, and apparently doctor's *still* don't get it. What's up with that?

mrupert

It never ceases to amaze me just how many people DO NO wash their hands in the men's room here at work. It kinda makes you feel like a germ-o-phobe whenever grabbing for a door handle, but I do find myself washing my hands pretty frequently, especially at work.
--ftm

REsource

I happen to live in a city on the Mexico-USA border which make this a true melting pot of cultures, people, and germs. There is so much cross-border movement that strange and rare germs head up here from South America, Central America, and, because of a long porous border, all other places.

Our son was treated (2 operations and months on antibiotic stews) for atypical micobacteria. These are micobacterias which are "Atypical" because they do not respond to antibiotics (hence the surgury). The bacterii have mutated because of the lack of professional medical oversight in administering antibiotics in certain world regions.

I, for example, can walk from our city center to Mexico, purchase any non-narcotic drug (at a big discount) and come home and self-administer. If an uninformed person did the same, they are highly likely to stop taking the antibiotic when symtoms disappear. Big problem!

My response? I avoid dining out. When I do, I would never touch, for example, a salt shaker with my bare hand. I live with Purell in my pocket, in my car, on my desk.

The so-called Bird Flu is a real potential threat, but mutations of atypical bacterii could be just as bad. One good thing is that bacteria tend to be greater in physical size than viruses, and are therefore somewhat less mobile.

The work at Johns Hopkins is commendable, easy to implement, and should be duplicated at every public health setting worldwide, as well as every public place (schools, institutions).

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prftex

What occurs to me most powerfully about this is that Americans- and perhaps all Westerners- still treat their medical caretakers with God-like reverence and consequent blind trust, probably due to a combination of childhood imprinting and cultural totems. One need only think of the many worthless louts we knew in college who became physicians, however, to realize that their self-awareness, conscientiousness, and sense of responsibility probably falls along a bell curve like the rest of the populations'. The unmanageable part of this scenario is of course tracing the offending microbe back to a particular dirty-handed offender. If that were possible a whole different set of principles would apply, but this is more like bathroom-wall graffiti- happily anonymous for the offender.

A $10 voucher for hand washing, therefore, while perhaps embarrassing for a Physician with a God complex, is proof that people with an understanding of economics have a better chance of solving the world's chronic problems than any others-

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PatHMV

I remember when my grandmother was in the hospital, basically comatose, for a couple of months. I regularly observed one particular nurse touch and adjust various tubes going into her body, and she never washed her hands, either before or after working on her.

We never complained, for fear that she would retaliate against grandmother if she got in trouble. Her attitude was such that we felt this was a realistic possibility.

She was in the hospital at that time in part because of a drug-resistant infection she picked up during a surgical procedure at another hospital. Fortunately, she survived and had several more good years before passing.

Frankly, I think any medical professional who doesn't wash his or her hands before touching a patient should be horse-whipped.

Crosbie

Ditch the wedding rings, watches, and religious attachments too while you're at it.

Better to demonstrate the love for one's neighbour before the love for one's god.

keithbchurch

This is a big problem in the UK - anecdoctal evidence suggests cleaning standards have fallen in recent years - there are bound to be studies on this in the US based journals (ie Lancet).

Doctors are often singled out for blame...there is a theory that dirty ties are a problem.

See:

http://news.bbc.co.uk/1/hi/health/4735038.stm

keithbchurch

Doh. I meant *UK* based journals.

ray

Having survived post operative staph and e-coli infections, then a reaction to the antibiotic, after by-pass surgery I am glad that someone is bringing this to light.

zoemccabe

To answer the question of what is a central line catheter...it is a large bore catheter inserted into a larger vessel like the subclavian, carotid or femoral vein. They remain in place for 4-7 days depending on location. Obviously the femoral (groin ) area gets infected more quickly.

Drymiotes

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ed

PatHMV's experience with her grandmother got my attention. My mother died when she went into a hospital with one problem and picked up another in the hospital--a staph infection.

It was a particularly awful death, too: The people who were treating her--badly--inserted a feeding tube down her throat that prevented her from talking the last 6-8 weeks of her (unnecessarily shortened) life. They also operated on her to fix the staph infection they had induced and left drainage (etc.) tubes in her that were so uncomfortable that they felt obliged to wrap her hands in padded gloves and tie them to the bed for the last 6-8 weeks of her life.

So now she couldn't talk or write, couldn't even scratch an itch or hold my father's hand, and was in agony from an infection she hadn't had when she entered the hospital.

Which brings me to PatHMV's conclusion that any health worker who doesn't wash his/her hands should be horse-whipped. Pat, you are more forgiving than I am.

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AussiePete

While I sympathise with REsource's experience, I quail at the type of person who won't touch a salt cellar on a restaurant table.
Seriously,adults with non-compromised immune systems do not need to "protect" themselves with this sort of O/C behaviour.
Your pathology may have had a real life inception, but a avoiding eating in restaurants or shaking hands isn't preventing a disease. It's a symptom of one.

Pinky

how to get more article about handwashing???