Saturday, April 28, 2007

Weird, glowing substances

There's an episode of Scrubs1 that shows the incidental passing of an infectious agent from medical personnel to patients and visitors and back to medical personnel. The infectious agent is represented by a green, glowing substance that illuminates the hand or mouth or nose as it is transferred by touch from person to person. Of course, Scrubs is a television program played for laughs.

If infectious diseases were actually weird, glowing substances, it might be easier to prevent their inadvertent transmission. We would all see exactly what we’re dealing with. OK, I’m back to one of my favorite subjects2 – hand washing, one of the most important things we can do to prevent harm to our patients.

Getting medical professionals to wash their hands was a struggle 150 years ago. Before the germ theory of medicine was understood, a Hungarian physician by the name of Ignaz Philipp Semmelweis speculated that the unwashed hands of physicians and medical students contributed to the significant infection rates of maternity patients. Puerperal fever (childbed fever) was common in mid-19th-century hospitals and mortality rates ranged from 10% to 35%.

Dr. Semmelweis observed that the mortality of patients who were cared for by physicians and students was up to three times higher than that of patients cared for in midwife wards. When a friend of his died after cutting his finger in a post mortem, Dr. Semmelweis speculated that the source of the disease that killed his colleague was the same as that killing maternity patients. He insisted that medical personnel wash their hands in a chlorine solution before each maternal examination. The result? The death rates of women in Dr. Semmelweis’ hospital dropped from 12% to 1%.3

You would think that Dr. Semmelweis’ dramatic results of the early 1850’s would have prompted widespread hand washing throughout Europe, but hand washing was resisted by the medical establishment. This was in part because Dr. Semmelweis did an inconsistent job of explaining and promoting the practice of hand washing. But it was also because the medical people of that day had a hard time acknowledging their hands were “dirty” and because it would be a decade before Louis Pasteur definitively demonstrated germ theory (and even then, the theory was not immediately accepted).

Today – many generations and many medical advances later – we understand the importance of hand washing. So why is national compliance with hand washing protocols so poor in hospitals across the country?

Last year hand washing compliance at CGH averaged 94.5%. That is excellent, compared with the 50-60% compliance rates reported for hospitals generally.4 But what does it say about the 5.5% of CGH people who do not comply?5 What additional risk does a failure to follow hand washing policy pose for patients, for visitors, for fellow workers – or for our families when we greet them after work?

That is why next Wednesday, May 2, is Hand Hygiene Day at CGH.

At the start of each shift on May 2, members of senior management and I will join Sue Chamberlain, Director of the Infection Control Program, in distributing free hand sanitizers to each employee (and to anyone else!) who enters CGH. It’s a way to promote the importance of hand washing for everyone – no exceptions!

Special thanks to the manufacturer of Purell® for providing CGH with the free supply of product for Hand Hygiene Day.

Because of Drs. Semmelweis, Pasteur, and the other pioneers of medicine, we know how to prevent the spread of infection. Thanks to hand sanitizers, it is easier than ever to do so.

Let’s use Hand Hygiene Day to reach 100% compliance – and stay there.

[1] Scrubs is a half-hour comedy on NBC-TV that focuses on the surreal experiences of a medical resident surrounded by bizarre characters.

[2] I have written before about the importance of hand washing and infection control: “All fish swim in the same water,” March 5, 2005; “Why the obsession about hand washing?” March 19, 2005; “A culture of safety,” July 3, 2005; “Not Halloween masks,” October 29, 2005; “Lowest infection rate in Syracuse,” June 24, 2006; and “A tipping point,” March 18, 2006. I have re-posed excerpts from these letters on the CGH website: Click on “CGH Family Letter” and look for “Excerpts – Letters about Infection Control.”

[3] The sources for this information are: Emerging Infectious Diseases, Vol. 7, No. 2, Mar–Apr 2001, published by the Centers for Disease Control ( and (

[4] On April 13, 2007, Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, MA, disclosed in his blog that “[a]fter months of intensive effort…our compliance with hand hygiene has risen from 52% on medical-surgical floors to 57%....And some floors remain at or below 40%...The results of one particularly noncompliant floor have prompted one of our Chiefs to write to his physicians: THIS IS ABSOLUTELY INTOLERABLE! It is bad patient care…” (original emphasis) To see Mr. Levy’s blog entry, go to:

[5] CGH hand washing compliance is tracked monthly by staff who make unannounced observations.

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