Wash them hands

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In a world of technological know-how, the best-laid plans of the smartest mice and men can be incapacitated by the inertia of human culture. Frequent handwashing is simple and critical to infection control, and a reluctance to adopt the habit in hospitals is defeating the dogged efforts to contain the rise of superbugs that carry deadly consequences for some patients.

A recent Winnipeg Regional Health Authority project that audited the hand-washing diligence of health workers in hospitals found that few sites hit the goal of 70 per cent compliance. The WRHA's nursing homes showed relatively well, with staff there washing their hands 82 per cent of the times deemed appropriate. Hospitals across the city, however, did poorly against the target and, in some specific units, did very, very badly -- Seven Oaks General stood out for its rate at 24 per cent and Victoria General at 46 per cent overall. In specific wards and facilities, groups of doctors, nurses and those employed to move patients around the hospitals failed abysmally at the task.

Over the years, since germs that are resistant to important antibiotics started hitting the radar of the infection-control industry, health professionals have stepped up efforts to reduce the chances of transmission. That has involved intense courses of heavy cleaning of equipment and furniture in facilities, and education campaigns for staff and the public who can spread troublesome viruses and bacteria to patients. But the bugs keep multiplying, sometimes infecting dozens of patients within a ward and making staff sick, too. The effect of Clostridium difficile, which erupts in violent bouts of vomiting and diarrhea, can be deadly for those whose health is compromised.

It seems a no-brainer that health professionals in the business of making people better would be the vanguard in a battle waged against agents of disease. And yet, rising rates of sickness from bugs contracted within hospitals indicate doctors, nurses, and health centre aides are not doing their part to control infection.

This phenomenon is not the result of lack of consideration. Handwashing is time-consuming, inconvenient and can render skin chapped and painful within a few days. But chemical sterilization in cleaning, high-heat treatment on equipment, and covering the cough are feeble weapons in the face of professional resistance to time-tested handwashing. As a carrier of disease, hands and personal equipment such as stethoscopes -- things that get around, so to speak -- are formidable adversaries. Alcohol-based gels designed to kill germs can work, but not as well as serious handwashing.

The WRHA found some encouraging fronts in its audit. Sites where education campaigns were underway showed workers were more likely to be scrubbing their palms. And further, staff within The Health Sciences Centre's newborn ICU -- those caring for the smallest and the sickest who cling precariously to life -- complied with handwashing practices 98 per cent of the time.

The finding is heartening. It indicates that professionals who are part of a fight for life are diligent in one of the most basic tasks in protecting those who can't fend for themselves. That ethic must spread. More work should be done to find practical fixes to barriers to compliance. Patients, further, must be encouraged actively to speak up for themselves, through signs and pamphlets that promote self-advocacy.

The ethos bred in the environment of an ICU for newborns should be tapped to spread the message throughout the wards, units and commons of the hospitals that need to become places where people are constantly asking themselves if they've washed their hands before they touch another.

Republished from the Winnipeg Free Press print edition July 2, 2012 A1