Friday, September 18, 2009

Handwashing - It's Not Just for the OR

Yesterday, Pauline Chen, M.D. posted a terrific blog post about the importance of handwashing by medical professionals. In her piece "Why Don't Doctors Wash Their Hands More?" Dr. Chen outlines the important lesson she learned as a medical student...

"Within seconds the circulating nurse, the anesthesiologist and an operating room technician had hustled me over to a corner of the room. Standing in a semi-circle around me, they clucked their reprimands: You’ve got to be careful! Remember the sterile field! Just step away if you’re contaminated! Didn’t you pay attention? And, perhaps most humiliating: You medical students never learn!

If I hadn’t known it before, I knew it then. Hand hygiene and sterile technique are so successfully maintained in operating rooms not because of the reminders that hang over scrub sinks, but because it is part of the culture and identity of those who work there. No self-respecting surgeon, nurse, anesthesiologist or technician would ever dream of breaching those sterile protocols in the surgical suites. Or of allowing any deviation from the aseptic norms to simply pass."

But she continues to say that such dedication to handwashing does not continue outside of the operating room and wonders "Why Don't Doctors Wash Their Hands More?"

Click here to read the piece.

A team of INQRI researchers has found that handwashing is key to reducing infections. This team, at Johns Hopkins University, has conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. There are some 80,000 catheter-induced bloodstream infections each year, causing up to 28,000 deaths. This study has shown that substantial reductions in infections can be widely achieved, particularly when nurses lead the infection control efforts. Their study builds on the well-known work of Dr. Peter Pronovost, creator of the line-insertion “checklist.” What makes the INQRI-funded work unique is that nurses drive the program in ICUs and they have achieved better results than have previous studies. Some of the components of the program include back-to-basics reminders such as having everyone who touches a central line wash their hands with soap and water; or ensuring that patients be fully covered by a sterile drape (except for a small hole where the line is inserted); or removing unnecessary lines from patients that can spawn infections. ICUs that have embraced this nurse-driven protocol have in many cases completely eliminated bloodstream infections among their patients for several months at a time.

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