Handwash
The Sunday Star Times makes the rather obvious connection between the spread of the Superbug ESBL and the lax hand-washing practices of staff, particularly doctors. I will be the first to admit that we doctors are a slack bunch in general when it comes to hand-washing.
““There are many excuses healthcare workers come up with for skipping hand hygiene,” says Roberts [SALLY ROBERTS is clinical head of microbiology at Auckland City Hospital]. They’re busy. Constant hand-washing irritates the skin. Some workers think changing gloves will be adequate (it isn’t, because microbes can penetrate the micro-holes). Or they simply don’t accept they have a role in transmitting infection.”
It is my observation that the latter two reasons Roberts gives are uncommon. Most people wash their hands after using gloves, if only to reduce their likelihood of developing latex allergy or to remove the powder. And I’ve never met a single nurse or doctor who thinks that lack of hand-washing does not lead to transmission of infection. So it is the first two reasons are the predominant ones for poor hand-washing regimes. Which is why there is a simple solution.
Alcohol hand rubs.
They are quick and easy to use and most contain emollients that keep the skin from cracking with multiple use. While not quite as good as a proper hand wash, they are far, far better than nothing at all. And many, if not most, hospitals now have this hand rub. However, staff are not used to it, so don’t use it. It should be reasonably simply to encourage staff to use the hand rub. You still need to wash your hands occasionally (the manufacturers say after 20 uses which translates to about once an hour for ICU staff and 3-4 times a day for GPs – much more manageable)
Interestingly, I have observed that it is the younger staff who do not wash their hands. I recall hand-washing regimes being drilled into me by fearsome senior nurses. I suspect these disciplines are not emphasized, perhaps not even taught, at medical school nowadays. Comments on this from current new graduates would be welcome.
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Nov 3 09 3:49 am
As an old fearsome, retired senior , OR nurse, may I opine that most young, new graduates wouldn't know a sterile or clinically clean field if they wombled across one and fell into a pit of guano and frigging sheep crutchings. You would pity the poor wee soul who approached me or mine to do some procedure without handwashing, or whatever was required. GRRRR …
Nov 3 09 6:09 am
One of the most dangerous (from an infection point of view) procedures is putting in a central venous line. There is good science to show that infections can be dramatically reduced if it is donewith full surgical drapes. Anyone out there with hospital experience: What proportion of central lines are put in with full drapes?
The place where antibiotic resistant bacteria really proliferate is the intensive care unit: lots of invasive procedures, very vulnerable patients, most on antibiotics. The infection control advice which everyone is taught is for staff to decontaminate their hands before and after every patient contact. If you count up the number of patient contacts a nurse has in an intensive care unit in an hour, and multiply that by the number of seconds it needs to do an effective handwash (the type that the old trout would do), you get to many more seconds than there are in an hour. The nurse would also have raw hands in less than a day (and be off on ACC?). If a full traditional hand wash is demanded, it just won't happen. The alcohol gel may in theory be less effective, but it is a lot easier to comply with, so in practice much more effective.
Nov 3 09 10:46 am
PIC lines are usually done with full drapes/gowns/gloves. Most long lines are put in as per normal IV technique. Subclavians and external jugular lines are usually done as emergencies and the technique is very variable.