Hand washing


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  answer.


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 ever does.

Robert Meyer


Your hands,
your health

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 get past 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 before eating.”

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 or mouth.”

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 disease.”

CDC's advice to doctors: Clean your hands
New guidelines emphasize the role of hand hygiene in reducing the spread of infection.


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 Hygiene

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, 1843)
1847 Ignaz Semmelweis was the first clinician to reduce mortality by introducing a handwashing policy (Semmelweis, 1847)
2000 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 al, 2000)

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 impact.

So Why Don't We Disinfect Our Hands?
Several reasons have been cited for low compliance. These are listed below (Pittet et al, 2000):
bulletSkin irritation
bulletInaccessible handwashing supplies
bulletWearing gloves
bulletBeing too busy
bulletNot thinking about it

The following table shows the results of a study that looked at compliance rates of various healthcare workers with hand hygiene procedures:

  TABLE FIVE : Handwashing Compliance
      Compliance %   Non-compliance %
  Doctor 33 % 67 %
  Nurse 36 % 64 %
  Health Care Assistant 43 % 57 %
  Student nurse 0 % 100 %
  Coffee volunteer 100 % 0 %

(Adapted from Gallagher, 1999)

bulletEffective handwashing, done at appropriate times, reduces cross-transmission of micro-organisms from one person to another or from one place to another
bulletThe skin is made up of two layers: the epidermis and the dermis, the latter lying on a layer of fat (the subcutaneous layer)
bulletThe stratum corneum layer of the skin is capable of harbouring the micro-organisms that should be removed during hand disinfection
bulletThere 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 and water.
bulletThe aim of routine hand disinfection is to remove transient micro-organisms acquired on the hands before they can be transferred
bulletThe aim of surgical hand disinfection is to substantially reduce resident micro-organsims and remove transient micro-organisms
bulletThere 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.
bulletThe reasons for low compliance can be complex and relate to both the healthcare workers themselves and their immediate environment.

"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 children.


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 patients.

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 like MRSA.

"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

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 condition.


NOW WASH YOUR HANDS: Our children may do it, but our doctors won't

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 years.

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 authors conclude.

(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 and
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 proving difficult.

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 spend 10
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 wash."

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 police."

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 commentary.

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

URL: http://www.msnbc.msn.com/id/8570593/


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 off instead.

(Source: Department of Health website).


Daily News
Updated on December 13, 2004

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 following:

bulletTriclosan 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.
bulletNumerous 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.
bulletDioxin, 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.
bulletTriclosan 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.

The 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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