April 23, 2014
Poor Handwashing in Hospitals?

Poor Handwashing in Hospitals?

by John Swartzberg, M.D.  |  

It’s frustrating that we’re still talking about the need to get more health care workers to consistently wash their hands when treating patients. Infections acquired in hospitals, nursing homes and other medical facilities sicken more than a million Americans every year and kill about 100,000 of them, according to Centers for Disease Control and Prevention (CDC) estimates, and cost billions of dollars to treat. Especially worrisome is the fact that increasingly these infections are resistant to antibiotics.

Many of these infections could be prevented by simple handwashing. But despite campaigns by hospitals and health care organizations, studies have found that hospital workers don’t follow handwashing rules half the time, on average. Ignaz Semmelweis must be rolling in his grave.

The drive for cleanliness in modern medicine can partly be credited to Semmelweis, a Hungarian doctor who went to Vienna in the 1840s to practice obstetrics, a deadly branch of medicine in those days. Women giving birth at Vienna’s General Hospital often died of “childbed fever,” a form of blood poisoning.

Semmelweis knew nothing about microbes (this was before scientists knew about germs) but he had a hunch. Doctors and medical students came to the obstetrical clinic from the autopsy room without washing up. In another part of the hospital where births were attended by midwives, the death rate was dramatically lower. When Semmelweis insisted that these doctors and students wash their hands in a strong chlorine solution before they touched a patient, the fatality rate immediately dropped.

So what happened? Most doctors still would not wash their hands, and Semmelweis was widely regarded as a lunatic. He finally lost his sanity and died in a mental ward, possibly from blood poisoning.

Hospitals still harbor far too many microorganisms that sicken patients—in spite of our understanding of how infections spread, our arsenal of antiseptics, masks, and rubber gloves and the determination of medical professionals to clean up their act.

And much of this remains a matter of poor hand hygiene. While in recent years some hospitals have taken steps that have greatly improved hand hygiene and reduced infection rates, overall we’ve made too little progress.

As part of a variety of nationwide efforts, the CDC as well as some hospitals and medical groups, are encouraging patients (and family members) to be assertive and ask health care providers if they have washed their hands or used alcohol-based gel. That’s a good idea in theory, but it can be intimidating for patients, who may fear they’ll seem rude and will antagonize the doctor or nurse. And many patients are too sick to ask. The responsibility has to be on health-care workers and hospitals.