Doctors and nurses urged to give up handwashing

[cargal]

http://www.cnn.com/2002/HEALTH/10/28/hand.washing.ap/index.html

Doctors urged to give up hand washing

Monday, October 28, 2002 Posted: 11:27 AM EST (1627 GMT)

CHICAGO (AP) -- The government has issued guidelines urging doctors and nurses to abandon the ritual of washing their hands with soap and water between patients and instead rub on fast-drying alcohol gels to kill more germs.

The goal? Reduce the hospital spread of viruses and bacteria that infect an estimated 2 million people in the United States each year and kill about 90,000.

Many hospitals, anticipating the new guidelines from the Centers for Disease Control and Prevention, have already made the change, and studies show this can cut their infection rates in half.

Soap and water have been the standard for generations. But washing up properly between each patient can take a full minute and is often skipped to save time, especially in busy intensive care units where the risk of spreading germs is greatest.

While the alcohol-based gels and solutions kill more microbes, the main advantage is they are easier to use. With vials clipped to their uniforms, nurses can quickly swish their hands while on the move without stopping at a sink. The CDC estimates this saves an hour in an eight-hour intensive care shift.

"We've learned that using alcohol-based products improves adherence to hand hygiene," said Dr. Julie Gerberding, the CDC's director. "We will end up with more people doing the right thing and cleaning their hands."

She released the guidelines in Chicago at a meeting of the Infectious Disease Society of America.

The solutions are intended only to kill germs, not remove visible dirt. So hospital workers are still expected to wash up if they get messy hands. Also, surgeons have the choice of using the gels or sticking with antimicrobial soap.

Many brands of the solutions are available in grocery stores. They vary in how they look, feel and smell. But all contain 60 percent to 90 percent ethanol or isopropanol, and they are considered equally effective at killing germs.

The new guidelines apply only to hospitals and clinics, where there are many particularly nasty microbes, along with sick people who are susceptible to catching them.

At home, where such dangerous bugs are far less common, experts say ordinary soap and water are probably all people routinely need. But the alcohol gels can make sense in situations where water is not be easily available, such as at picnics, in portable toilets or on airplanes.

Hospital workers are instructed to clean up between each patient, before they put on gloves, after they take them off, when inserting catheters or when doing anything else that involves contact with body fluids.

Besides giving individual containers of gel to their staff, hospitals put dispensers at patients' bedsides, in clinics and wherever sick people are seen.

The alcohol dries in seconds without a towel and is so easy to use that "it is almost indefensible now not to clean your hands. People can't say they are too busy anymore," said Dr. David Gilbert of Providence Portland Medical Center in Portland, Oregon, president of the Infectious Disease Society.

Using the gels involves squirting a dime-size dollop on one palm, then rubbing the hands together, covering all the surfaces, until the hands are dry.

Typically, people carry between 10,000 and 10 million bacteria on each hand. The medical profession has long known this is one way disease is transmitted. Dr. Ignaz Semmelweis pioneered the field in Austria in 1846, when he speculated that doctors spread "cadaverous particles" when they delivered babies after doing autopsies. He insisted that students clean their hands with chlorine.

Introduction of the alcohol gels "is the biggest revolution in hand hygiene since Semmelweis," said Elaine Larson, associate dean for research at Columbia School of Nursing. "We used to say 'hand washing.' Now it's hand hygiene."

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Copyright 2002 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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[Roland]

if any substance is capable of killing ALL pathogens (I think there are a few endospore forming bacilli that can even survive Iodine). With soap and water it is not necessary to KILL everything since effectiveness is achieved largely by WASHING THE PATHOGENS AWAY. This is to say nothing of more exotic agents such as prions which are resistent to almost everything EXCEPT being washed away. Give me soap and water any day.

[Roland]

if any substance is capable of killing ALL pathogens (I think there are a few endospore forming bacilli that can even survive Iodine). With soap and water it is not necessary to KILL everything since effectiveness is achieved largely by WASHING THE PATHOGENS AWAY. This is to say nothing of more exotic agents such as prions which are resistent to almost everything EXCEPT being washed away. Give me soap and water any day.

[susanmary]

The antiseptic gels are outside every patient's room as well as stragetically placed in strategic points in the unit, outside med room, etc. I believe it is Purell. Very sticky and leaves residue. Slightly drying, but I use it. Prefer to wash my hands, and do so constantly.

[susanmary]

The antiseptic gels are outside every patient's room as well as stragetically placed in strategic points in the unit, outside med room, etc. I believe it is Purell. Very sticky and leaves residue. Slightly drying, but I use it. Prefer to wash my hands, and do so constantly.

[Roland]

for resistence to antimicrobial substances (unlike soap and water where the bugs are washed away). Thus, lets say that on average someone has a billion germs on their hands when they use the gel and it kills 99% of them. I would wager that over time if you cultured the 1% which survived (or 1/10th of one percent as the case may be and assuming you COULD do a culture something quite unlikely since less than 1/10th of 1% of all bacteria CAN be cultured) that you would find similarities in those organisms. I think these gels are fine as a SUPPLEMENT to hand washing, but not as a replacement. Give it a few years and you'll probably read how certain infections are being propigated via this practice.

[Roland]

for resistence to antimicrobial substances (unlike soap and water where the bugs are washed away). Thus, lets say that on average someone has a billion germs on their hands when they use the gel and it kills 99% of them. I would wager that over time if you cultured the 1% which survived (or 1/10th of one percent as the case may be and assuming you COULD do a culture something quite unlikely since less than 1/10th of 1% of all bacteria CAN be cultured) that you would find similarities in those organisms. I think these gels are fine as a SUPPLEMENT to hand washing, but not as a replacement. Give it a few years and you'll probably read how certain infections are being propigated via this practice.

[sbic56, BSN, RN]

Change is hard sometimes, but these gels are a definite improvement. Realistically, nurses do not wash between every patient, but they can use the gel . We have a dispenser placed outside each room on the wall. I think it's great. I still wash alot, but find my hands are less dry with these gels...ours has a moisterizer of some sort in it, too.

[sbic56, BSN, RN]

Change is hard sometimes, but these gels are a definite improvement. Realistically, nurses do not wash between every patient, but they can use the gel . We have a dispenser placed outside each room on the wall. I think it's great. I still wash alot, but find my hands are less dry with these gels...ours has a moisterizer of some sort in it, too.

[rncountry]

Anyone who is telling you that you can go 12 hours and not actively wash your hands has not read the guidelines. They recommend that you still wash you hands between every 5th patient contact. The actual recommendations are only three pages out of 44 and don't take much time to read, though I would encourage anyone to read the whole document so that misunderstandings like the above are not perpetuated.

[rncountry]

Anyone who is telling you that you can go 12 hours and not actively wash your hands has not read the guidelines. They recommend that you still wash you hands between every 5th patient contact. The actual recommendations are only three pages out of 44 and don't take much time to read, though I would encourage anyone to read the whole document so that misunderstandings like the above are not perpetuated.