3rd Opinion: Doctor, did you wash your hands?

I have long been seeking the key to this enigma, because with this key may come the solution. What am I missing?

By GABI BARBASH, MD MPH
Sourasky Medical Center (photo credit: courtesy)
Sourasky Medical Center
(photo credit: courtesy)
It is 3 in the morning. I am sitting in the darkened patient’s room here on the 10th floor in Mount Sinai Hospital, New York. The patient, who is now asleep after a long day, is a local friend and I am here to accompany him in the strange and intimidating world of big hospital medicine.
Meanwhile, I am looking around and trying to absorb new ideas and lessons from this mecca of medical care. My friend is asleep and I am jet-lagged, dozing in front of the hospital computer screensaver that continuously displays, from left to right, a red-on-blue message: “Hand Hygiene Saves Life.” This set me thinking...
We try to educate patients to have realistic expectations when they seek healthcare, and to understand that medical interventions, however helpful, come with risks. One of the more prominent and frightening risks is hospital infections.
Those contagions, also known as “nosocomial infections” or “hospital-acquired infections,” are a global problem of epic proportions. In the United States, the Centers for Disease Control and Prevention estimate that roughly 1.7 million hospital-associated infections cause or contribute to 99,000 deaths each year.
In Israel, there are about 40,000 hospital-acquired infections (with positive cultures) each year, and these are estimated to cause 4,000 to 5,000 deaths annually.
Hospital-acquired infections occur because a hospital’s environment is teeming with dozens of types of bacteria, many of which have achieved strong levels of resistance to antibiotics. In addition, hospitals host the perfect prey for these bacteria, patients with reduced resistance. However, no small part of the blame rests on us, the physicians and nurses and other staff members, since these hospital infections are transmitted significantly more often when hospital personnel fail to regularly practice proper hygiene.
Healthcare is an area where the public is led to believe that the more costly and more advanced the technology, the better. Hand-washing is an excellent example for shattering that myth. It is a simple, low-tech act which is the single most important measure for reducing the risks of transmitting skin microorganisms from one person to another and from one site to another on the same patient.
It has been proven in abundant studies that the risk of infection is significantly reduced with strict enforcement of hygienic practices.
There is absolutely no argument that washing hands between patient contacts and after contact with bodily fluids is an important component of infection control.
It is estimated that the spread of nosocomial infections is connected with hand contamination of healthcare workers in almost 40 percent of cases.

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The problem is a genuine challenge in most modern hospitals in the Western world, and this is why the WHO launched the 2005 GLOBAL Patient Safety Challenge that includes hand hygiene. We hospital administrators are doing our utmost to make this change in behavior as easy as possible by attaching the containers of antiseptic or alcohol-based gel in the most convenient locations and even on each patient’s bed when possible.
The harsh reality is that too many physicians and nurses in most hospitals, even in advanced leading medical centers, don’t bother to carry out this very simple practice. When we run inspections on staff adherence to hand-washing rules, we find significant differences in behavior between open and concealed inspections.
The proportion of staff members complying with hand washing rules sometimes drops by an astounding 50 percent or more when they believe they are not being observed.
Hospital administrations are investing in rounds of feverish meetings trying to figure out how to lower the rate of post-surgical infections. To me, as a hospital director, this is a mind-blowing enigma: Why is it so difficult to persuade physicians and nurses worldwide to take this simple but critical step despite their knowing and genuinely understanding how important it is to protect their patients from potentially lethal hospital-acquired infections?
Why is it that before they approach a patient’s bed they ignore the container of cleansing gel and knowingly put their patients at risk of contamination by resistant hospital-populated bacteria? Why are we forced to seek technological methods to electronically monitor personnel compliance, or weigh disciplinary enforcement of practices that are so obviously mandatory?
Both the Mount Sinai and Sourasky Tel Aviv Medical Centers are large tertiary hospitals serving diversified patient populations by using highly advanced (and very expensive) treatment modalities and highly advanced (and expensive) diagnostic technologies. Because of their reputations and proven excellence, neither center has any problem in recruiting top-quality nurses and physicians. Why is it then so difficult for us and many, many hospitals all over the world to convince our excellent, intelligent and otherwise highly motivated and accountable physicians and nurses not to behave so irresponsibly by avoiding the simple life-saving act of washing their hands before and after they have examined or treated their patients?
I have long been seeking the key to this enigma, because with this key may come the solution. What am I missing?
Meanwhile, I urge all patients in every hospital on the planet: Do not be embarrassed. Always ask your physician, “Did you wash your hands?” It may, at first, seem somewhat disrespectful, but what may appear to be a little chutzpah may wind up saving your life.
Dr. Gabi Barbash is the CEO of the Tel Aviv Sourasky Medical Center.