Dr. Stacie Bering: Regular, good hand hygiene is critical

It’s hard to believe, in this age of spectacular medical advances, but a little over 150 years ago the medical establishment didn’t know about germs. Doctors believed illness was caused by an imbalance of the four “humors,” fluids that influenced health.

Enter Dr. Ignaz Semmelweiss, an Austrian physician, assistant at the First Obstetrical Clinic of the Vienna General hospital. The First Obstetrical Clinic had a problem. Eighteen percent of the women who gave birth there died of childbed fever, a condition thought to be unpreventable. But there was another clinic at the hospital, aptly called the Second Obstetrical Clinic, where the death rate was only 2 percent. What was the difference?

The First Clinic was staffed by medical students, the Second Clinic by midwives. The midwives worked only in their clinic, while the medical students worked in many different departments, including the autopsy lab.

A colleague of Semmelweiss died after cutting his finger with a knife he used while performing an autopsy on a woman who had died of childbed fever. The colleague’s autopsy showed the same signs as the woman who had died. So, putting two and two together, Semmelweiss proposed that there was some sort of contamination that he and his medical students were passing along from the autopsy suite to the labor suite.

These gentlemen did not wear gloves. Not while doing autopsies and not while examining women in labor. They washed their hands with soap and water after they left the autopsy suite, but not in between examining the laboring women.

Semmelweiss devised an antiseptic solution containing chlorine and instructed his students to wash their hands after leaving the autopsy suite and before examining each patient. The rate of childbed fever plummeted. Nonetheless, some of his colleagues balked, complaining that the new ritual took too much time, and what was this contamination, anyway?

We’ve got the germ theory pretty well figured out now. And it’s clear that hand washing, or hand hygiene, as it’s come to be known in health-care circles, can play an enormous role in the prevention of infection.

But maybe we forget the lesson sometimes. According to the federal Centers for Disease Control, health-care acquired infections (HAI) account for 2 million infections and 90,000 deaths annually and cost our health-care system more than $4.5 million. HAI are infections that patients get in the course of treatment for some other ailment or that health-care workers get in the course of performing their duties.

In hospitals, HAI’s have resulted in germs that are resistant to multiple antibiotics, making them difficult to treat. Controlling these infections is a major focus of patient safety programs. Meetings are held. Systems are designed.

But sometimes the simplest intervention can make a huge impact. Here’s where hand hygiene comes in. Soap and water is the old standby. But washing your hands before and after seeing each patient, especially for a nurse or aide in a hospital, can be hard on the hands and time consuming. (Remember Semmelweiss’ colleagues who objected to using his antiseptic solution.)

Fortunately, studies show that alcohol-based waterless hand gels, the kind found on market shelves, work as well as old-fashioned soap and water. The hospital I work at has dispensers by the door of every patient’s room, ready for a convenient squirt before and after a patient visit.

To be effective at lowering the rate of HAI’s, all health-care workers, nurses and aides and respiratory therapists and doctors and even visitors need to remember to use that gel. Unlike so much in medicine these days, this is a simple intervention, one requiring no paperwork at all, and it’s cheap.

This should remind us all that hand hygiene isn’t just for hospitals and doctors’ offices. We spread disease among ourselves by forgetting to wash up after using the bathroom, after changing a baby’s diaper, before making dinner. Whether it’s soap and water or a squirt of waterless gel, remembering to practice good hand hygiene makes good sense.

Dr. Stacie Bering is a Spokane physician. Contact her with general questions and topics for future columns by mail at Dr. Stacie Bering, Features Department, The Spokesman-Review, P.O. Box 2160, Spokane WA 99210 or by e-mail at doctorstacie@mac.com. She cannot answer personal medical questions in her column.