How can nurses forget to scrub hands???

Sheri257 · Dec 16, 2003

Interesting read. Thanks a lot.

sashibeak · Dec 16, 2003

Great article!

Thanx!

SmilingBluEyes · Dec 16, 2003

I do a 5 minute scrub the minute I enter my OB floor and wash between patients, always. Its as much to protect ME as them, after all.

I don't know HOW they can forget, really. It's disgusting to me not to.

NurseHardee · Dec 29, 2003

Well the article was not online when I tried to access it. But let me kinda answer the question.... How could nurses forget to scrub hands?

I always try to scrub my hands while doing my notes, eating a sandwich, sitting on the toilet on my 5 minute lunch break with skates on, and all at the same time. That way despite the hospital speedup, I am able to always meticulously scrub my hands. You too can do that double load of work and keep your hands spotlessly non-contaminated! Catheters can help keep hands clean, too.

Nurse Hardee... and speedy, too..........

Vsummer1 · Dec 29, 2003

FOR THOSE OF YOU WHO CAN'T USE THE LINK:

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.

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By David Kohn

Sun Staff

Originally published December 8, 2003

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.

Over the years, respected doctors proposed numerous theories: victims were literally scared to death by the prospect of entering the hospital, or they were attacked by impure vapors from wounded men on a lower floor, or their wombs had been shocked by cold air, which blocked the free flow of fluids.

None of these ideas made sense to Semmelweis, who became obsessed with finding a cure. "Think about what it must have been like to come to work early in the morning and there would be young women, 16 or 17, some of them," said author Nuland, a professor of surgery at Yale University Medical School.

"And a minimum of one out of six of them were dying - sometimes one out of four was dying. Can you imagine what that was like for a young doctor? That had a profound affect on him."

Starting in 1845, Semmelweis delved into childbed fever, dissecting the bodies of dozens of victims and poring over records from previous epidemics.

His eureka moment occurred in March 1847, when his mentor died after being stuck in the finger by a knife during an autopsy. After reviewing the autopsy report, Semmelweis realized that this death closely resembled those caused by childbed fever. The key, he saw, was the mode of transmission.

Years later, he described his insight: "The transmitting source of those cadaver particles was to be found in the hands of the students and attending physicians."

This realization had a dark corollary: Semmelweis had inadvertently infected many women. "God only knows the number of patients who have gone to their graves prematurely by my fault," he wrote.

Soon after this discovery, he instituted a strict regimen of hand washing, all but eliminating childbed fever from Vienna General Hospital. The illness is now very rare, and can be treated with antibiotics.

In a bitter twist, his breakthrough was not accepted by the medical establishment. Some biographers have painted Semmelweis as a tragic hero, undercut by powerful doctors unwilling to accept his radical views.

But in his book, The Doctors' Plague: Germs, Childbed Fever and the Strange Story of Ignac Semmelweis, Nuland describes his subject as an insecure, disagreeable crank who lacked the charm and drive necessary to convince others of the truth.

Over the years, Semmelweis became increasingly irrational and incoherent. He died in a mental institution in 1865. In his book, Nuland argues that Semmelweis probably suffered from early-onset Alzheimer's disease.

In any case, hand washing did not become widespread for two decades. Glasgow surgeon Joseph Lister, who had never heard of Semmelweis, rediscovered the idea in 1867. Calm and methodical, Lister eventually succeeded in spreading his theory across Europe.

Nuland - who is fascinated by self-destructive personalities - judges his subject's failure harshly. "I blame Semmelweis for the death of hundreds of thousands of women who didn't have to die, because after 1847 this should have caught on very rapidly," he said. "I put the responsibility squarely in his lap."

allnurses Guide · Dec 29, 2003

I find that sometimes I do forget to wash my hands as I rush from room to room. But never in OB however I rarely have more than one patient there.

We have gel dispensers on the wall next to the doors of the patient rooms and they have helped us if we turn to leave without washing, we see the gel and use that.

Nobody's perfect. Most of the time I wash . . . .but I know I've forgotten.

steph

Long Term Care Columnist / Guide · Dec 29, 2003

It's fairly easy for me to remember to wash, because I detest the icky feeling my hands get from wearing gloves, and all I want to do when I take them off is to de-funk. We also have the alcohol gel stuff, which works well when I'm in a hurry. My main area of neglect in this department is washing long enough and with warm enough water.......much of the time, it's a quick rub with soap and a cold-water rinse, and I know that's not adequate. But warm water soon chaps my hands, and I HATE lotion, so I end up using cold water about half the time.

Sarah Kat · Dec 29, 2003

There was a report on the local news the other day stating that nurses were better about washing than docs. I can't recall where the data came from.