When we all scratch our heads and wonder why the medical establishment
has added the thimerosal containing flu vaccine to the infant / toddler
schedule amongst the concerns of congress and many doctors with the
safety of the current vaccine schedule we can look to history for the
I read about this doctor in Bob Barefoot's Book "Death by Diet." I then
researched and found two pages on him in the encyclopedia Britannica.
Check out the above link. One thing my encyclopedia states is that after
he encouraged hand washing in Vienna the mortality rate fell from 18.27
to 1.27 percent for those women having babies delivered in the hospital.
In March 1848 and August of 1848 the mortality rate was zero while hand
washing was taking place. These doctors and their students would go from
conducting autopsies on people who died from a disease directly to
operating on and delivering babies. No hand washing at all.
So what was Vienna's response? They fired Semmelweis, he went to a
different hospital in Pest and began saving lives there. Vienna went
back to NOT washing and then mortality went back up to 10 to 15 percent.
Things did not change for literally decades.
*** Reluctance to change ***
That is what continued to kill woman having babies delivered in the
hospitals by the doctors. The midwife wing did not have the severity of
the problem nor did those who were delivering at home.
History has many answers. So, when you leave the hospital or doctors
office with your autistic child. Just think of Dr. Semmelweis, and the
lives he saved by standing up for common sense and cause and effect
medicine. The DAN protocol has been written by the Dr. Semmelweis' of
our day. They hold some measure of relief for your suffering children.
Buy the protocol and read, and don't stop. Your child is where your
responsibility is at.
However, one last fact to remember. Dr. Semmelweis is said to have gone
insane as a result of his inability to understand why peoples "pride" and
"reluctance to change" took precedence over the health of their patients.
So be careful, don't expect things to change overnight. A generation
will have to die off prior to common sense ever taking hold again. If it
AMA endorses hand hygiene
principles for back-to-school season
If you were to ask a public health worker, “What are the
ten most deadly weapons?” the answer wouldn’t be “guns” or “drugs” or
“knives.” It would be “hands.”
More specifically, our ten fingers – those seemingly
innocuous digits that, when they’re not grasping doorknobs or handling money
or flushing the toilet, are busy spreading everyday bugs like E. coli or
Shigella or simply the common cold. Hands can prove to be particularly
perilous during the back-to-school season, when students flood back into
classrooms, carrying with them a summer’s worth of bad hand washing habits.”
Not so fast, says Will Sawyer, MD, a solo practice family
physician in Cincinnati and an AMA member for 16 years. First you have to
Henry the Hand. In an effort to battle the unhygienic habits of
Americans, Henry travels across the nation, spreading the word about proper
hand washing and reinforcing hand-healthy behaviors in children and adults.
Much of the population does not fully understand the
tremendous impact that regular, thorough hand washing can have on disease
rates, especially in the back-to-school and hospital environments. “We known
this for multiple decades, prior to the antibiotic era,” Dr. Sawyer said.
“Hands are the number one vector of transmission of communicable disease.”
Dr. Sawyer said a spike is seen every year in the
incidence of illness several weeks after school starts in the fall. When
students are sick, they miss school; when students miss school, the
cumulative effects ripple throughout the community. “Absenteeism is a big
issue, to not only schools from a funding perspective, but in terms of
learning capacity,” he said. “A healthy student is a better learner.”
Additional costs are felt by parents who must miss work in order to stay
home and care for their child.
In light of this, Dr. Sawyer saw an opportunity to
implement a significant yet easy-to-understand behavioral change among
students. The concept is more than just hand washing; it’s hand awareness.
Henry the Hand teaches four basic principles of hand awareness, endorsed by
the American Medical Association.
First, and most obvious: “Wash your hands when they are dirty and
Second: “Do not cough into your hands.”
Third: “Do not sneeze into your hands.”
Fourth:" Above all, do not put your fingers into your eyes, nose
This last principal, Dr. Sawyer says, is the most
important in terms of disease prevention. Placing one’s fingers into the
mucus membranes of the eyes, nose, or mouth can easily lead to self-innoculation
with bacteria such as strep (common in preschool, middle school and high
school students) as well as viruses such as the common cold, pink eye and
various flu-like viruses, Dr. Sawyer said.
To promote Henry the Hand’s mission in this
back-to-school season, Dr. Sawyer has created an Adopt-a-School program. The
program allows all physicians and health care workers to “adopt” a local
school to help teach Henry’s four principles for good hand hygiene, hence
improving the health of the student population. In Cincinnati, several
doctors have already brought Henry to school with them. The program has also
been implemented in Rochester, Minn., Chicago and Kalamazoo, Mich. “All the
doctor has to do is make the connection with the school,” Dr. Sawyer said,
“so an interested teacher, parent or nurse can implement the program.”
Physicians who participate in the Adopt-a-School program will receive
helpful materials from Dr. Sawyer, such as a classroom hand washing schedule
“We want to spread the word, not the germs,” Dr. Sawyer urged. “This
program will decrease absenteeism from schools and maintain healthy
learners. We need to make it a natural, innate behavior. It needs to be
consistently demonstrated to children, because children learn from what we
do, not what we say. Kids are observant, so they’re more likely to say ‘Gee,
that person didn’t wash their hands in the bathroom.’”
An added bonus: as these doctors teach proper hand
hygiene, the concept seeps into their subconscious and translates into their
own practice. While Dr. Sawyer is not advocating repetitive hand washing
that borders on the compulsive, he does believe that Henry the Hand’s
Adopt-a-School program has the potential to improve student’s health in a
very real way. “The point is not to raise everyone’s level of paranoia or
fear; it’s to increase awareness about how very simple it is to decrease
CDC's advice to doctors: Clean your hands
New guidelines emphasize the role of hand hygiene in reducing the spread of
Editorial. Nov. 25, 2002. Additional information
Each year, about 2 million American patients develop infections while
hospitalized. An estimated 90,000 of them die as a result. Additionally,
infections are a complication of care in numerous other settings, including
long-term-care facilities and clinics. The problem revealed by these
statistics is not new. But reducing its cost, in terms of human suffering as
well as actual health care dollars, is literally within reach. Physicians
and other health care professionals could make significant inroads by
increasing their vigilance in a key area: hand hygiene. And that's why the
Centers for Disease Control and Prevention last month issued new guidelines
on this very topic.
The agency's directive, which is in sync with current American Medical
Association policy, is very clear: Clean 'em up."Clean hands are the single
most important factor in preventing the spread of dangerous germs and
antibiotic resistance in health care settings," said CDC director Julie
Gerberding, MD, MPH. The American Medical Association has long advanced the
importance of hand hygiene in minimizing the spread of infection, both
within the practice of medicine and among members of the general population.
Now, the CDC guidelines move into new territory by advising the use of
alcohol-based hand rubs by health care professionals in addition to
traditional hand washing with soap and water. First off, recent studies
indicate that these hand rubs reduce the number of bacteria on hands more
effectively than does soap and water. These products should not be confused
with anti-microbial soaps, gels and lotions that have proliferated the
consumer market. While the AMA has raised red flags about these anti-microbials
and their possible role in antibiotic resistance, alcohol rubs do not pose
the same risk.
The CDC offers other practical reasons for its guidance.
Data show that health care personnel may find alcohol-based hand rubs more
convenient than traditional hand washing. One study concluded that, during
the course of an eight-hour shift, an intensive-care unit nurse could save
about an hour by using an alcohol-based hand rub.
The reality is that health care personnel are always on the go, running from
room to room, patient to patient. This sometimes makes hand washing with
soap and water difficult. But these hand rubs are more accessible -- a tube
can be carried in the pocket of a doctor's white coat or clipped on to
scrubs. The CDC also emphasizes some important how-tos. First, when using an
alcohol-based hand rub, apply it to the palm of one hand and rub hands
together, covering all surfaces of hands and fingers, until hands are dry.
And these rubs do not preclude other infection-control basics. When hands
are visibly soiled, wash with soap and water. Additionally, the use of
gloves does not eliminate the need for hand hygiene or vice versa.
According to agency data, gloves reduce contamination by 70% to 80%,
preventing cross-contamination and protecting patients and health care
personnel from infection. But hand rubs should be used before and after each
patient, just as gloves should be changed before and after each patient.
The CDC's new recommendations are an important reminder for physicians --
and just one aspect of the continued struggle against the spread of these
pernicious germs. AMA policy encourages doctors to talk to patients, young
and old, to remind them to wash hands when they are dirty and prior to
eating, to avoid coughing or sneezing into hands and to keep fingers away
from the eyes, nose or mouth.
Dec. 8-14 is National Hand Washing Awareness Week. This will provide a
perfect opportunity for physicians to drive home these hand-awareness
principles -- in the hospital, in their practices, in communicating with
patients and in their own lives.
|The History of Hand
|Oliver Wendell Holmes
investigated the circumstances around puerperal (or childbed) fever
and concluded that puerperal fever was transmitted from patient to
patient by doctors and nurses on their hands and clothing (Holmes,
||Ignaz Semmelweis was the
first clinician to reduce mortality by introducing a handwashing
policy (Semmelweis, 1847)
||Didier Pittet and
colleagues conducted one of the more recent major studies to show
how a sustained improvement in compliance with hand hygiene can
coincide with a reduction in hospital-acquired infection (Pittet et
In 1847 Dr Ignaz Semmelweis was an
assistant in the maternity wards of a Vienna Hospital. He observed that
puerperal fever in the delivery room staffed by medical students was up
to three times higher than in a second delivery room staffed by
midwives. He recognised that the students might be transferring the
disease from their dissections to their hands and ordered that students
must wash their hands after dissection and before patient examination.
The mortality rate dropped from over 20% to 3%. (Semmelweis, 1847)
Despite these results, Semmelweis's colleagues treated his findings with
hostility and he eventually resigned his position. It was not until
after his death that others such as Louis Pasteur and Oliver Wendell
Holmes recognised the importance of his work.
Handwashing has been
described as "the simplest of infection prevention practices, yet the
most neglected" (Gruendemann & Mangum, 2001). The reasons for low
compliance can be complex and relate to both the healthcare workers
themselves and their immediate environment.
However, all infection cannot be prevented even if the methods are
excellent. There is an irreducible minimum which it is impossible to
avoid but is difficult to define (Ayliffe, 1986).
The acquisition of a hospital acquired infection (HAI) increases the
costs of care by almost three times due to the increased length of stay
in hospital, drug therapy, tests and specialist care. It has been
estimated that a single HAI is associated with a cost of around £3,000.
If only 10% of HAIs were prevented in England, a saving of £300,000
would be made (Plowman et al, 2000).
The Study on the Efficacy of Nosocomial Infection Control (SENIC) showed
that an active surveillance and control programme with a physician and
an infection control nurse could reduce infection rates by 32% (Ayliffe
et al, 2001), which considering the above costs indicates a significant
So Why Don't We Disinfect Our Hands?
Several reasons have
been cited for low compliance. These are listed below (Pittet et al,
handwashing supplies |
|Being too busy
about it |
table shows the results of a study that looked at compliance rates of
various healthcare workers with hand hygiene procedures:
FIVE : Handwashing Compliance
||Health Care Assistant
(Adapted from Gallagher, 1999)
|Effective handwashing, done at
appropriate times, reduces cross-transmission of micro-organisms from
one person to another or from one place to another|
|The skin is made up of two layers: the
epidermis and the dermis, the latter lying on a layer of fat (the
|The stratum corneum layer of the skin
is capable of harbouring the micro-organisms that should be removed
during hand disinfection|
|There are two types of micro-organisms
which make up the skin flora - resident (or colonising) flora and
transient (or contaminating) flora. Resident flora are deeply seated
within the skin and can only be removed by antiseptic agents.
Transient flora can be removed by mechanical action, i.e. with soap
|The aim of routine hand disinfection is
to remove transient micro-organisms acquired on the hands before they
can be transferred|
|The aim of surgical hand disinfection
is to substantially reduce resident micro-organsims and remove
transient micro-organisms |
|There are a range of agents available
for hand disinfection and the choice of the agent relates to what
activity the healthcare worker intends to perform. |
|The reasons for low compliance can be
complex and relate to both the healthcare workers themselves and their
"UNICEF Warns on Water in Southern Iraq"
Associated Press (www.ap.org) (04/29/03)
UNICEF's Marc Vergara has warned of an impending water crisis in southern
Iraq that could potentially lead to cholera, dysentery and diarrhea
outbreaks in the region, especially among children. Vergara is urging that
funds be given immediately, in order to provide the chlorine gas needed to
purify water from local sources and to avoid further disease among Iraqi
Cleanliness 'cuts superbug rates'
Rates of the MRSA superbug have been slashed through an intensive hospital
cleanliness programme. University College London Hospital says it has
cut MRSA rates by introducing
universal cleanliness standards. Experts say superbug rates could be cut
dramatically if the technique was introduced across the NHS.
It has been estimated the MRSA (methicillin-resistant Staphylococcus aureus)
is killing up to 5,000 people a year in England. MRSA bugs have built up
resistance to antibiotics commonly used in hospitals. Many hospital-acquired
infections are caused by staff using non-sterile techniques for procedures
including intravenous injections, say infection-control staff at UCLH. But
nurses at the hospital have devised a way to create an aseptic (sterile)
environment which reduces the amount of disease-causing micro organisms to a
minimum which has cut the number of infections among its most vulnerable
The haematology unit at University College Hospital in London has developed
the Aseptic Non Touch Technique (ANTT), which involves a programme of
hand-washing and sterilising techniques to protect patients from
contamination. Picture guidelines showing how to carry out the technique are
displayed in all clinical areas. It is being introduced across the trust,
with more than 2,000 nurses being trained to use it. Stephen Rowley, a
senior nurse in haematology, who developed the technique, said: "Improved
standards of cleaning and hygiene are important in controlling infections
"However, our research shows that one of the most effective ways of
containing acquired infection is through the application of a standardised
aseptic technique for clinical procedures. "I believe if this technique was
adopted across the NHS there would be a dramatic reduction in patients
infections and deaths from MRSA and other acquired infections. Geoff Scott,
a medical microbiologist at UCLH, said the specialist cancer unit at the
hospital should have the highest rates of MRSA because its patients were
most susceptible, but due to ANTT it had the lowest. "ANTT has changed
aseptic practice from being adhoc and highly variable to being completely
standardised. "It has improved hand washing effectiveness and ensures that
hand washing is done at the right times."
Med Complications May Cost $9B Per Year
By LINDSEY TANNER
AP Medical Writer
October 8, 2003, 10:13 AM EDT
CHICAGO -- Postoperative infections, surgical wounds accidentally opening
and other often-preventable complications lead to more than 32,000 U.S.
hospital deaths and more than $9 billion in extra costs annually, a report
suggests. Researchers from the U.S. government's Agency for Healthcare
Research analyzed data on 18 complications sometimes caused by medical
errors. They found that such complications contribute to 2.4 million extra
days in the hospital each year.
The findings greatly underestimate the problem, since many other
complications happen that are not listed in hospital administrative data,
the researchers said. The study follows a 1999 Institute of Medicine report
that said medical mistakes kill anywhere from 44,000 to 98,000 hospitalized
Americans a year. That report focused national attention on the problem and
led to numerous recommendations for improving safety. The new report, based
on data from 994 hospitals nationwide in 2000, provides a more detailed look
at specific complications and the costs associated with each one.
Many of the 18 complications, including medical objects left inside patients
after surgery, are preventable medical errors. Some, like bleeding after
surgery, might not always be avoidable, said Dr. Chunliu Zhan of the U.S.
Agency for Healthcare Research and Quality. Zhan did the research with Dr.
Marlene Miller, now at Johns Hopkins Children's Center. The study was
published in Wednesday's Journal of the American Medical Association. "Given
their staggering magnitude, these estimates are clearly sobering," Drs. Saul
Weingart and Lisa Iezzoni of Harvard's Beth Israel Deaconess Medical Center
said in an accompanying editorial.
The most serious complication was post-surgery sepsis -- bloodstream
infections -- which occurred in 2,592 patients. Sepsis resulted in 11 extra
days of hospitalization and $57,727 in extra costs per patient, plus a 22
percent higher risk of death. Improved medical practices, including an
emphasis on better hand-washing, might help reduce the rates, Zhan said.
Surgical wound openings were the second most serious complication, resulting
in nine extra days of hospitalization, $40,323 in extra costs and a nearly
10 percent higher death rate. Zhan said the figures do not capture all
complication-related costs. For example, one common injury -- trauma during
vaginal childbirth without use of forceps or other instruments -- resulted
in virtually no extra hospitalization costs or deaths but probably led to
other complications in mothers or their infants, the researchers said. There
were 51,223 such injuries studied.
Zhan said his study does not answer whether progress has been made since the
1999 Institute of Medicine report. His agency is among many working on
reducing medical errors and complications. Among other things, the
agency recently developed a fact sheet listing steps patients can take to
get safer treatment, including questioning doctors about what to expect from
surgery and asking about which hospital would be best for their particular
NOW WASH YOUR HANDS: Our children may do it, but our
Possibly the greatest breakthrough in hospital care was the novel idea
that doctors should wash their hands after seeing a patient. It was an
observation first made in the 1850s, and there was a sudden and dramatic
improvement in patient recovery.
Patients will not be delighted to hear that it remains a rare event. The
vast majority of doctors still do not wash up, but instead spread germs
to the next patient on their rounds. In an attempt to encourage doctors
to visit the little boys' room, the Mayo Clinic is recommending a super
alcohol-based hand rub as a great way to keep down those nasty germs.
But if the average doc shirks away from good old soap and water, it's
unlikely he's going to run for the new hand wash.
(Source: Mayo Clinic Proceedings, 2004; 79: 109-16).
Study: Doctors' ties may be health threat
Neckwear can harbor disease-carrying bugs
By Roni Rabin
Newsday Staff Writer
May 24, 2004, 3:39 PM EDT
New research suggests doctors should dress down, and not just on
Fridays. A small study of neckties worn by doctors at a Queens hospital
found almost half the 42 ties tested harbored microorganisms that can
cause illness. By comparison, only one of ten ties worn by security
guards tested positive for a disease-carrying microorganism. The study is
being presented Monday at the American Society for Microbiology meeting
in New Orleans. Steven Nurkin, one of the authors, says the
findings aren't entirely new:
Earlier studies have found bacteria on everything from doctors'
stethoscopes to pagers and pens. But there's a critical difference, said
Nurkin, who graduates from medical school in two weeks: Neckties need to
be dry cleaned.
"Most people don't do that every time they wear a tie," he said. "You
come home and throw the tie on your tie rack and a week or so later, you
wear it again. It's rarely clean." Nurkin, a native of Brooklyn studying
medicine in Israel, said he got the idea for the research while doing a
surgery elective at the New York Hospital-Queens. He noticed the doctors'
neckties because in Israel, physicians rarely wear ties.
"I watched the doctors come over for a physical exam or procedure and saw
the neckties would swing in front of the patient's face, or patients
would cough on them," he said. Occasionally a doctor would wash his
hands -- and then adjust his tie, Nurkin said. "I thought: maybe that's a
point of interest." Nurkin emphasized the ties tested did not harbor any
multi-drug resistant bacteria, but said, "The potential is there."
Of the 42 physician neckties sampled, 20 contained one or more
microorganisms known to cause disease, including 12 that carried
Staphylococcus aureus, five a gram negative bacteria, one that carried
aspergillus and two ties that carried multiple pathogens. Staph bacteria,
which often live harmlessly on the skin, can cause serious wound
infections; Aspergillus, a mold, is an opportunistic infection that
threatens vulnerable patients. Gram negative bacteria refers to a type of
staining in the lab.
Of the 10 security guards' ties, only one grew Staphylococcus aureus.
Some 5 to 10 percent of all hospital patients acquire an infection in the
hospital, which translates into over 2 million infections, 90,000 deaths
and over $4.5 billion in annual costs, the study notes.
While being well-dressed is encouraged by hospital administrators and may
add to "an aura of professionalism" and inspire patient confidence, the
authors note, "As the clinician moves from patient to patient, the tie
may serve to carry microorganisms from patient to patient as well."
Physicians may also unwittingly carry microbes from the hospital into the
community. "This study brings into question whether wearing a necktie is
in the best interest of our patients," the authors conclude.
Nurkin, 27, graduates in two weeks from medical school at the American-Technion
Program of the Bruce Rappaport Faculty of Medicine in Haifa, Israel.
Incidence of diarrhea by more than 50% after handwashing program in
Pakistan 02 Jun 2004
An intensive program of handwashing education and promotion in Pakistan
decreased the incidence of diarrhea by more than 50 percent among
children, according to a study in the June 2 issue of The Journal of the
American Medical Association (JAMA), a theme issue on Global Health.
Stephen P. Luby, M.D., of the Centers for Disease Control and Prevention,
Atlanta, presented the findings of the study today at a JAMA media
briefing at the National Press Club in Washington, D.C.
Nearly 2 million children worldwide die annually from diarrheal disease,
according to background information in the article. Previous studies have
estimated that handwashing promotion interventions could prevent 1
million child deaths per year.
Washing hands with soap prevents diarrhea, but children at the highest
risk of death from diarrhea are younger than 1 year, too young to wash
their own hands. Previous studies could not adequately assess the impact
of household handwashing on diarrhea in infants. Dr. Luby and colleagues
evaluated whether promotion of handwashing with soap among adult and
children household members decreased diarrhea among children at the
highest risk of death from diarrhea. The study was conducted among 36
low-income neighborhoods in urban squatter settlements in Karachi,
Pakistan. Eligible households located in the study area had at least 2
children younger than 15 years, at least 1 of whom was younger than 5
As part of the intervention, field workers visited participating
households at least weekly from April 2002 to April 2003 in 25
neighborhoods to provide education to all household members old enough to
understand about proper handwashing with soap after defecation and before
preparing food, eating, and feeding a child.
They used slide shows, videotapes, and pamphlets to illustrate health
problems resulting from contaminated hands. Within intervention
neighborhoods, 300 households (1,523 children) received
a regular supply of antibacterial soap and 300 households (1,640
children) received plain soap.
A total of 11 neighborhoods (306 households and 1,528 children) were
randomized to the control group, which did not receive handwashing
education or soap. The researchers found that children younger than 15
years living in households that received handwashing education and plain
soap had a 53 percent lower incidence of diarrhea compared with children
living in households that did not receive such education or soap.
"Infants living in households that received handwashing promotion and
plain soap had 39 percent fewer days with diarrhea vs. infants living in
control neighborhoods. Severely malnourished children younger than 5
years living in households that received handwashing promotion and plain
soap had 42 percent fewer days with diarrhea vs. severely malnourished
children in the control group," the authors write.
The authors found similar reductions in diarrhea in households using both
plain and antibacterial soap. The authors report, "We found no
significant difference in diarrheal disease among persons living in
households receiving antibacterial soap compared with plain soap. This is
not surprising because triclocarban [in the antibacterial soap] is a
bacteriostatic agent that inhibits the growth of
some gram-positive bacteria but is not effective against gram-negative
bacteria, viruses, or parasites that cause infectious diarrhea."
The authors note that the act of handwashing with soap physically removes
pathogens that may cause diarrhea from hands that might otherwise
transmit these pathogens to vulnerable infants. "Although visiting
households weekly to provide free soap and encourage handwashing
was effective in reducing diarrhea, this approach is prohibitively
expensive for widespread implementation. The next essential step is to
develop effective approaches to promote handwashing that cost less and
can be used to reach millions of at-risk households.
Studies evaluating the durability of behavioral change from handwashing
promotion are also important to assess cost-effectiveness. In the
interim, existing public health programs should experiment with
integrating handwashing promotion into their current activities," the
(JAMA. 2004;291:2547-2554. Available post-embargo at JAMA.com).
Editor's Note: This study was mainly supported by Procter and Gamble
Company, including salary support for Dr. Luby. Procter and Gamble also
supplied the soap for the study. The Centers for Disease Control and
Prevention contributed the personnel time of co-authors Drs. Painter and
Hoekstra, and administrative support for the study.
Contact: Llewlyn Grant
JAMA and Archives Journals Website
Your life is in hospital workers' (clean) hands
Washing hands can save patients' lives, but hospital workers still don't
do it enough
By Peter DeMarco, Globe Correspondent | July 13, 2004
Hand-washing is perhaps the easiest, lowest-technology way to prevent the
spread of germs, but even the highest-tech hospitals can't seem to get
their doctors and nurses to do it enough.
Nearly two years ago, the US Centers for Disease Control and Prevention
told every hospital in the country that their doctors, nurses and other
health-care workers needed to do a better job of washing their hands to
cut down on patient infections. Several Boston hospitals took the advice
launched all-out campaigns to encourage more hand-washing, plastering
intensive care units with educational posters, throwing pizza parties for
units that improved their hand-washing rates and posting observers to
count the number of times workers missed opportunities to wash up.
But Brigham and Women's Hospital, which has one of the most successful
hand-hygiene programs around, still only reached 80 percent compliance in
some intensive care units -- and then only while it was offering free
movie passes to the units that kept their rates high.
''Without that incentive, [the rates] have sort of come back down," said
Dr. Deborah Yokoe, supervisor of Brigham and Women's infection control
unit. ''The question we're really facing now is: How do we get over this
hump?" Hospital workers have known since the mid- to late-19th century
that it's important for them to wash their hands. In 1847, Dr. Ignac
Semmelweis was pushed out of a Viennese hospital for demanding that
workers wash hands, but his then-radical notion -- that hand-washing
would reduce the number of mothers dying after childbirth -- caught on a
few decades later.
The CDC's 2002 voluntary hand-washing guidelines, including how and when
workers should wash their hands, followed a study by infection control
experts at the University of Geneva Hospitals that found a 50 percent
drop-off in patient infections after modest increases in hand-washing by
staff members. According to infection experts and federal statistics, as
many as 5 percent to 10 percent of US patients contract an infection
while in the hospital, resulting in about 2 million infections per year
-- leading to 90,000 deaths -- at a cost of $4.5 billion.
But getting doctors and nurses to become obsessive hand washers is
For most, it's a question of competing priorities. Quick-drying hand gels
that kill bacteria without need of soap and water are now standard fare
in 95 percent of US hospitals. But still, at 30 seconds per hand wash,
busy hospital workers who constantly jump from patient to patient could
minutes per hour washing their hands, leaving them less time to do other
important tasks, like examining patients and double-checking drug doses.
''It's not just that you're busy: you're busy doing things that are all
important for the patient," said Dr. Atul Gawande, a general surgeon at
the Brigham, and a writer who has expounded on the importance of
hand-washing. ''Of all the things you have to do, hand-washing will slip
down on that list." Sterilization has long been the norm in operating
rooms, but that thinking doesn't necessarily carry over to other areas of
the hospital, where seemingly innocuous tasks such as picking up a
patient's chart, touching your tie, or typing on a computer keyboard can
easily spread germs.
Susan Marino, an infection control practitioner at the Brigham who spends
hours each month counting the number of times hospital workers wash their
hands, said workers can be lulled into thinking that latex gloves offer
enough protection. But if they inadvertently touch dirtied gloves as
they're taking them off, all the germs end up on their bare hands, and
they need to wash again, she said. Standing in an ICU unit one recent
afternoon with her clipboard in hand, Marino observed as a half-dozen
workers failed to wash their hands either before they put on gloves or
after they peeled them off.
''Surgeons would consider it absolutely unacceptable if fellow surgeons
didn't do a thorough scrubbing," said Dr. David Hooper, chief of
infection control at Massachusetts General Hospital, whose hospitalwide
compliance rates are above 60 percent, up from 40 percent a few years
ago. ''You've got to get a critical mass where it becomes
self-reinforcing; where it becomes professionally unacceptable not to
Another problem infection control experts face as they roll out
hand-washing initiatives is that no one knows for sure just how many
infections better hand hygiene will eliminate. The Swiss study showed
that boosting the compliance rate from 48 percent to 66 percent
hospitalwide cut patient infection rates in half over a four-year period.
But better hand hygiene won't stop all infections: Intravenous lines,
surgical sites, catheters and ventilator tubes will always be
susceptible, and germs are also spread by visitors and the patients
themselves, not just hospital workers.
Dr. John Boyce of the Hospital of Saint Raphael in New Haven, who
coauthored the CDC's hand-washing guidelines, said most hospitals
probably would see a significant reduction in infections if they could
maintain an 80 percent or 85 percent compliance rate. Realizing that
change takes time, infection control experts have been careful about
pushing workers too hard to improve their washing rates, choosing to
entice them with prizes and praise rather than penalizing them for
failing to wash. ''Penalizing just doesn't work," Yokoe said. ''It makes
people more defensive and it makes them less likely to change their
behavior. We absolutely do not want to become the infection control
The other battle hospitals are up against is one they just may never win
--human nature. Gawande, who put forth a call for better hand hygiene in
an article in the New England Journal of Medicine this winter, said even
he, at times, simply forgets to wash. ''I'm in the midst of writing this
article [on hand-washing]. I'm being as scrupulous as I can be, and I
still blew it. Or a patient reaches out to shake your hand, and you may
find it strange to say, 'Oh, I've got to wash my hands first."' Still,
infection control experts at a handful of area hospitals say they have
been able to increase their compliance from roughly 40 percent to 70
percent with outreach efforts. To keep it going up, Yokoe said she
intends to meet with staff members from one of her hospital's intensive
care units today for a hand-washing brainstorming session.
At Beth Israel Deaconess Medical Center, infection control director Dr.
Sharon Wright said she hopes that ICU doctors and nurses will begin to
take ownership of their hand-washing compliance, and begin
self-monitoring their units some time this month. And if they need a few
extra sets of eyes, Wright said, patients can speak up, too. ''Initially
it was a rare patient who was aware of [hand washing], but now they may
bring a bottle of hand gel on the T. They can buy them in drug stores.
''It wouldn't be unusual anymore for a patient to ask a doctor, 'I didn't
see you wash your hands.' "
© 2004 The New York Times Company
Hand washing dramatically cuts illness in kids
Use of soap could halve deaths from preventable disease, researchers say
Updated: 7:09 p.m. ET July 14, 2005
LONDON - Washing hands with soap can halve the number of young children
suffering from pneumonia, the leading killer of youngsters under 5 years old
worldwide. It can also greatly reduce cases of diarrhea and the skin
infection impetigo, scientists said on Friday.
Although it may seem simple and logical, researchers from the Centers for
Disease Control and Prevention have shown improved hygiene could save many
lives, particularly in poor countries.
“One of the things that this research shows it that there are even more
health benefits to the simple act of hand washing than we have previously
appreciated,” said Dr. Stephen Luby, the lead researcher and an
epidemiologist at the CDC. “Therefore efforts to promote it become that much
more important,” he added in an interview.
More than 27,000 deaths a day
More than 27,000 children under the age of five, mostly in developing
countries, die every day from preventable causes. Pneumonia and other
respiratory infections kill an estimated 2 million children each year.
Almost three-quarters of those who die are less than a year old. Hand
washing with soap is particularly important in poor countries because there
are so many more pathogens in the environment. Children also do not have the
same level of nutrition and access to healthcare as in richer nations so
they are much more vulnerable.
“Removing the pathogens from a low-income household has a greater health
benefit than it would in London or Atlanta,” Luby added. He and colleagues
compared the impact of routinely washing with soap in 900 households in
squatter settlements in Karachi, Pakistan over a year. About 600 households
received supplies of regular or antibacterial soap while 300, which acted as
a control group received, received school supplies.
The homes were visited weekly to encourage better hygiene.
Cases of pneumonia and diarrhea were cut by 50 percent in families given
soap compared to the control group. There was also a 34 percent drop in
impetigo. There was no difference in households given the two types of soap.
The research, which was funded by Procter & Gamble Co., is published in The
Lancet medical journal. Luby said washing hands is particularly important
before preparing food and eating, after using the toilet and after cleaning
an infant to reduce the amount of pathogens.
“The time has come to shout from the roof tops that hand-hygiene promotion
should be a worldwide priority for public health and health care,” Didier
Pittet, of Switzerland’s Hopitaux Universitaires de Geneve, said in a
Copyright 2005 Reuters Limited. All rights reserved. Republication or
redistribution of Reuters content is expressly prohibited without the prior
written consent of Reuters.
© 2005 MSNBC.com
MRSA: Now wash your hands
It's been said that the greatest medical breakthrough was to get doctors
to wash their hands, an observation that was made around 140 years ago.
Sadly it's still something they too rarely do, judging by the latest
figures that show a rise of the deadly infection MRSA in UK hospitals.
Cases have risen by nearly 4 per cent in the last year, which continues a
pattern seen over the last decade.
In a wonderful piece of government-speak, Prof Pat Troop of the Health
Protection Agency explains that the continual increase is due to advances
in modern medicine that "are now able to keep patients alive for
longer". So presumably we have to bring in nasty infections to kill them
(Source: Department of Health website).
Common Antibacterial Agent Causes Health,
Environmental Effects and Antibiotic Resistance
(Beyond Pesticides, December 13, 2004) An antibacterial
chemical, commonly found in antibacterial soaps, deodorants, toothpastes,
cosmetics, fabrics and plastics, has been repeatedly shown to cause
health and environmental effects, while compounding antibiotic
resistance, according to an article and literature review released by
Beyond Pesticides in the latest issue of Pesticides and You. The
article, “The Ubiquitous Triclosan: A common antibacterial agent
exposed,” explains how this toxic chemical shows up in common consumer
products, including antibacterial soaps, deodorants, toothpastes,
cosmetics, fabrics and plastics, and provides a thorough review of what
is known about the chemical and how it escapes full regulatory review.
The major findings of the article and literature review include the
|Triclosan is found in hundreds of common everyday products,
including nearly half of all commercial soaps. It is used so frequently
that triclosan has made its way into the human body—a Swedish study
found triclosan in human breast milk in three out of five women. |
|Numerous studies have found that triclosan promotes the emergence
of bacteria that are resistant to antibiotics. There is good evidence
that with the continued widespread use of triclosan, antibiotic
resistance will become increasingly problematic. |
|Dioxin, a highly carcinogenic, endocrine disrupting compound, may
be formed during the manufacturing process of triclosan, and thus is a
likely contaminant. More alarmingly, researchers found that when
sunlight is shined on triclosan in water and on fabric, a portion of
triclosan is transformed into dioxin. Because of its ubiquitous nature,
the conversion to dioxin is of major concern. |
|Triclosan is one of the most frequently detected compounds in
rivers, streams, and other bodies of water, often in high
concentrations. Triclosan is highly toxic to a number of different
types of algae. Since algae are the primary producers in many aquatic
ecosystems, high levels of triclosan may have destructive effects on
aquatic ecosystems. |
full text of the article is available on Beyond Pesticides’ website.
Other articles in this issue of Pesticides and You include “Montana’s War
on Weeds: Dow Chemical influences Forest Service shift to its
herbicides,” and “Lesson of the West Nile Virus Response: After five
years, what have we learned?” To subscribe, contact
Beyond Pesticides. For past
issues, visit the
Pesticides and You Archives.
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