For hospitals, dirty hands still a danger

Infections: Although the importance of washing was discovered more than 100 years ago, busy health care workers often forget to scrub.

Medicine & Science

December 08, 2003|By David Kohn | David Kohn,SUN STAFF

For poor, pregnant women in early 19th-century Vienna, having a baby was often lethal. Those who couldn't afford a midwife went to the Vienna General Hospital, where they had an excellent chance of coming down with an ailment known as childbed fever.

The mysterious sickness killed as many as a quarter of the women in the obstetrics ward with a painful internal infection and caused epidemics in hospitals throughout Europe and the United States.

As an obstetrician at the Vienna hospital, Ignac Semmelweis saw first-hand the horror of the disease. And in 1847, at the age of 28, he hit upon the revolutionary idea that dirty hands were somehow transmitting "putrid cadaver particles" from the dead and sick to the pregnant women.

"People never thought to wash their hands, except just to get the obvious dirt off," said Dr. Sherwin B. Nuland, author of a new book on Semmelweis and his discovery.

Although his theory was not widely accepted at the time, Semmelweis is now recognized as a seminal figure in the development of medicine, honored in history books and statuary.

But a century and a half after his discovery, contaminated hands remain a major problem in hospitals and elsewhere - likely contributors to thousands, perhaps millions, of deaths each year.

Epidemiologist Val Curtis, for example, estimates that hand washing in the developing world would prevent the deaths of more than 2 million children a year.

"Hands are what the bugs ride on," said Curtis, a professor at the London School of Hygiene and Tropical Medicine, Britain's national public health school. Among those bugs is the influenza virus, which seems to be more potent than usual this year, according to the U.S. Centers for Disease Control and Prevention.

Hospitals also continue to struggle with unhygienic hands. Dozens of studies have shown that doctors and nurses wash their hands about half as often as they should. "Health care workers have not done as good a job as we would like," said Dr. Michele Pearson, who studies hospital infections for the CDC.

Dirty digits likely contribute to some of the 2 million infections acquired every year during hospital stays. Almost 90,000 of these patients die, according to the CDC.

There are several reasons for the lack of hospital hand washing. A 2001 study of nurses found that workload largely determined the amount of washing: The busier the nurses were, the less they washed their hands.

"If you're pressed for time, what are you not going to do? Wash your hands," said the study's lead author, Carol O'Boyle, a professor at the University of Minnesota School of Nursing. "Ironically, the busier they are, the more they probably need to wash their hands - and the less they do."

The sheer number of required washings can overwhelm even the most scrupulous caregiver. One study found that nurses and doctors in an intensive care unit should wash their hands an average of 45 times an hour.

"Essentially these people would be spending more than half their time washing their hands," said Dr. Trish Perl, an infectious disease specialist at Johns Hopkins Hospital.

To make hand washing easier, the CDC last year recommended that hospitals begin using alcohol-based sanitary gels, which get rid of bacteria and viruses without soap or water. Experts say these gels have the potential to revolutionize hospital hand washing, and O'Boyle calls them "one of them the biggest breakthroughs we've had in this area."

Used widely in European hospitals for 20 years, gels work as well as soap and water but don't require a sink. Many doctors and nurses apply them while walking to and from patients, Pearson says. One study showed that using the gels could reduce hand washing time by eight hours a week.

The gel push seems to be having an effect: A CDC survey found that 95 percent of hospitals had adopted the gel recommendations. Perl, who oversaw a 1997 program to install gel dispensers throughout Hopkins hospital, said the approach seems to have decreased hospital-acquired infections.

But by itself, the move to gel won't ensure hand washing perfection. Modern doctors and nurses must grapple with a problem that Semmelweis didn't have to face. Perl notes that compared with modern technological innovations, hand washing can seem boring and winds up neglected. "It's very mundane," she said. "It's not the sexy new gadget."

While the notion that hand washing removes dangerous microscopic organisms now seems self-evident, the mid-19th century was a profoundly different time.

Doctors at Vienna General Hospital often went directly from dissecting bodies to full pelvic examinations of women in labor. With the advantage of modern medical hindsight, it's not surprising that this practice would lead to widespread bacterial infection. But to physicians of the time, the resulting epidemics were a terrible mystery.

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