Handwashing

So today, I thought I'd vent a little about one of my biggest pet peeves- the LACK of handwashing that I observe all the time. This is not strictly pertaining to the healthcare community, but I'll focus mostly on them, and add a few words for everyone else.

As we all know (or hopefully know), handwashing is one of the BEST ways to prevent spreading infections from one person to the other. Some history "The first progress in combating infection was made by the Hungarian doctor Semmelweiss who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweiss, despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths" So, everyone should know that by washing hands between EVERY patient, we can decrease infection rates throughout our patient populations. Hospitals are now trying to track data, educate employees, have signs, etc all of which should help improve handwashing rates- but it seems that we're still not anywhere near 100% compliance. Everytime we walk into a patient room, the FIRST thing that should be done, while saying "hello!" should be handwashing. As a medical student, we must do standardized patient exams (fake clinical encounters with real actors/actresses which are then graded) and as part of the evaluation, you get one check mark for washing your hands before touching the patient. I also have a habit of washing my hands when I exit the room- the way I see it, I've performed a physical exam on the patient, probably have some type of bacteria, virus, fungi, whatever, on my hands, and should take it off right away. Even if my next stop is to the nurses station, I want my hands clean- I definitely don't want to get sick by carrying microbes with me everywhere I go.

Of course, handwashing takes about 30-45 seconds or so. One can also opt for the antimicrobial gels, lotions, creams, etc that also work quickly without having to waste time at a sink, followed by drying hands and wasting paper towels. Of course, those antimicrobial agents are expensive for the hospital when you consider how much would be required if everyone just used those rather than handwashing- but what is the extra expense when you compare it to the cost of ONE line infection that requires the patient to stay and extra 5-7 days, PLUS antibiotics? I'm sure the benefits outweigh the risk in this case.

To further elaborate, I have seen all "fishes of the food chain" not adhere to handwashing rules. That goes for medical students, nursing students, PAs, PTs, nurses, residents, attendings, and chiefs. I am pointing no fingers at any one person, we are all guilty (and I am by no means a saint- I'm sure I've forgotten sometimes as well). The important thing is that we must try to make changes and improve our compliance. Some things that I've seen and/or read about that seem to help are: The VA system has an anti-microbial foam at the entrance to each room- just one dab and you're good to go. Sure- these are somewhat costly, but again, doesn't it seem that the cost would still be less than the cost of increased hospitalization time? I've also seen signs posted around the floors- maybe there needs to be more signs, maybe even signs in the patients rooms, on the doors, chart racks, wherever people would be more likely to see them. I've even read that some hospitals who allow staff to issue "tickets" to people who are caught not washing their hands- these "tickets" must then be signed by their supervisor which would surely not be a good thing.

I don't know which way is the best way, but different measures need to be taken to improve this issue. Surely, there are other ideas floating around somewhere.

As I mentioned before, this does not only apply to healthcare workers. I also see people walking in and out of the bathroom (men's bathroom in my case) who will use the facility, and then walk out without washing their hands. In our microbiology class, I had the pleasure of plating some of that "stuff" from the handles in the bathroom, and let me tell you- it's NOT pretty. I even go the extra mile and have the paper towel ready to go, so that after I wash my hands, I will turn off the faucet WITH the paper towel, and also use the paper towel to open the door. Sure, maybe that's excessive since once I get outside, I touch things again, but hey- better than nothing. People eat at restaurants, leave the establishment without ever washing their hands. Same goes for handling babies, or pets. It's something small to remember, but can make a HUGE impact.

I'll close with this link that has some good information on handwashing and infection rates. Also, it links to some real data that backs up the statements made. Let's all try to improve infection rates one handwash at a time.