247 Americans Die Every Day from Doctors not Washing Their Hands
A Conversation With Dr. Peter J. Pronovost
[URL="http://www.nytimes.com/2010/03/09/science/09conv.html?hpw"]Doctor Leads Quest for Safer Ways to Care for Patients[/URL]
Q. WASH YOUR HANDS? DON’T DOCTORS AUTOMATICALLY DO THAT?
A. National estimates are that we wash our hands 30 to 40 percent of the time. Hospitals working on improving their safety records are up to 70 percent. Still, that means that 30 percent of the time, people are not doing it.
At Hopkins, we tested the checklist idea in the surgical intensive care unit. It helped, though you still needed to do more to lower the infection rate. You needed to make sure that supplies — disinfectant, drapery, catheters — were near and handy. We observed that these items were stored in eight different places within the hospital, and that was why, in emergencies, people often skipped steps. So we gathered all the necessary materials and placed them together on an accessible cart. We assigned someone to be in charge of the cart and to always make sure it was stocked. We also instituted independent safeguards to make certain that the checklist was followed.
We said: “Doctors, we know you’re busy and sometimes forget to wash your hands. So nurses, you are to make sure the doctors do it. And if they don’t, you are empowered to stop takeoff on a procedure.”
Q. HOW DID THAT FLY?
A. You would have thought I started World War III! The nurses said it wasn’t their job to monitor doctors; the doctors said no nurse was going to stop takeoff. I said: “Doctors, we know we’re not perfect, and we can forget important safety measures. And nurses, how could you permit a doctor to start if they haven’t washed their hands?” I told the nurses they could page me day or night, and I’d support them. Well, in four years’ time, we’ve gotten infection rates down to almost zero in the I.C.U.
We then took this to 100 intensive care units at 70 hospitals in Michigan. We measured their infection rates, implemented the checklist, worked to get a more cooperative culture so that nurses could speak up. And again, we got it down to a near zero. We’ve been encouraging hospitals around the country to set up similar checklist systems.
Q. WHAT EXACTLY WAS WRONG HERE?
A. As at many hospitals, we had dysfunctional teamwork because of an exceedingly hierarchal culture. When confrontations occurred, the problem was rarely framed in terms of what was best for the patient. It was: “I’m right. I’m more senior than you. Don’t tell me what to do.”
Doctor-Caused Disease
HOSPITAL INFECTIONS
In the 1840's Dr. Ignaz Semmelweis directed a teaching hospital in Vienna, where 75% of the women giving birth were dying of puerperal fever. He observed that doctors went from dissecting cadavers to delivering babies without washing their hands. Dr. Semmelweis made the "radical" policy change of requiring doctors to wash their hands before delivery a baby. An amazing thing happened - the mortality rate drop fifteen-fold. Unfortunately, his arrogant colleagues couldn't see the connection, so they dismissed him and ostracized him. The rejection ultimately drove Semmelweis to death in an insane asylum - another great moment in the history of iatrogenic disease.
But doctors are enlightened nowadays about sanitation, aren't they? A 1981 study of washing habits in intensive care units found that only 28% of the doctors washed between patients in a teaching hospital and only 14% washed in the private hospital! Dr. Mendelsohn noted:
. . . the sanitary practices of the medical personnel are often abominable and the hospital itself is probably the most germ-laden facility in town.
Your chances of getting an infection in the hospital are one in 20 with 15,000 people dying annually from hospital-acquired infections.
Doctor and Patient
Why Don’t Doctors Wash Their Hands More?
By PAULINE W. CHEN, M.D.
Published: September 17, 2009
Over the last 30 years, despite countless efforts at change, poor hand hygiene has continued to contribute to the high rates of infections acquired in hospitals, clinics and other health care settings. According to the World Health Organization, these infections affect as many as 1.7 million patients in the United States each year, racking up an annual cost of $6.5 billion and contributing to more than 90,000 deaths annually.
"Harry Truman once said, 'There are 14 or 15 million Americans who have the resources to have representatives in Washington to protect their interests, and that the interests of the great mass of the other people - the 150 or 160 million - is the responsibility of the president of the United States, and I propose to fulfill it.'"
President John F. Kennedy
